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Executive functioning impairment in women treated with chemotherapy for breast cancer: a systematic review

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Abstract

Purpose

Women with breast cancer have reported adverse cognitive effects following chemotherapy. Evidence is mixed on whether executive functioning is particularly impaired in women treated with chemotherapy, in part due to the wide range of tasks used to measure executive processes. We performed a systematic review of the published literature to evaluate whether some subcomponents of executive functioning are more vulnerable to impairment than others among breast cancer survivors who had been treated with chemotherapy.

Methods

Studies published as of April 2017 were identified using three electronic databases (MEDLINE, PsycINFO, and Web of Science) and a manual search of relevant reference lists. The methodological quality of included studies was assessed using a checklist of predefined criteria.

Results

Of 1280 identified articles, a total of 41 were included for review. Study findings were categorized into three primary subdomains of executive functioning: inhibition, shifting, and updating. Although there was heterogeneity in the neuropsychological measures used to assess executive functioning, tests could be grouped into the subcomponents they assessed. Inhibition appears relatively spared from the effects of chemotherapy, whereas impairments in shifting and updating are more commonly found following chemotherapy.

Conclusions

Examination of subcomponents of executive functioning is recommended to better characterize the nature of executive dysfunction in women treated with chemotherapy. Future studies should include executive functioning tasks of varying complexity, use of multiple tasks to increase reliability, and alternative indices to capture performance, such as within-person variability.

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Acknowledgements

We thank Lior Krimus for his assistance with assessing the methodological quality of the studies. Support for this study was provided by the Canadian Breast Cancer Foundation and the Canadian Institutes of Health Research (CIHR) in partnership with Pfizer Canada. This work was undertaken as part of a dissertation project by CY, who was supported by a doctoral scholarship from the Canadian Institutes of Health Research.

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Authors and Affiliations

  1. Department of Psychology, York University, Toronto, ON, Canada

    Christie Yao & Jill B. Rich

  2. Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada

    Lori J. Bernstein

  3. Department of Psychiatry, University of Toronto, Toronto, ON, Canada

    Lori J. Bernstein

  4. Clinical Neuropsychology Service, St. Josephs Healthcare, 100 West 5th Street, Room G191, Hamilton, ON, L8N 3K7, Canada

    Christie Yao

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  1. Christie Yao
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Correspondence to Christie Yao.

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Yao, C., Bernstein, L.J. & Rich, J.B. Executive functioning impairment in women treated with chemotherapy for breast cancer: a systematic review. Breast Cancer Res Treat 166, 15–28 (2017). https://doi.org/10.1007/s10549-017-4376-4

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