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Screening for Cognitive Impairment Associated with Chemotherapy for Breast Cancer

  • Clinical Trials (S Hurvitz, Section Editor)
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Abstract

At least 20 % of women treated with chemotherapy for breast cancer experience some form of cognitive decline. Recent recommendations call for clinicians to screen cognitive abilities. Screening of factors that can contribute to cognitive impairment is also currently recommended. We describe a battery of free, online, self-report surveys that would take approximately 30 min to complete in the context of an overall functional assessment of wellness. Key physical characteristics to be screened include fatigue and insomnia. Significant psychological characteristics include distress, depression, and anxiety. Fundamental social characteristics include basic needs, workplace issues, and interpersonal well-being. Systematic screening that could be completed in the clinic waiting room or during chemotherapy infusion is an important first step towards more holistic patient care that addresses cognitive side effects, just as physical side effects of treatment are routinely addressed.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. World Health Organization. Cancer: fact sheet 297. 2015. Retrieved from http://www.who.int/mediacentre/factsheets/fs297/en/

  2. American Cancer Society. Global cancer facts and figures, 2nd edition. 2008. Retrieved from http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-027766.pdf

  3. Siegel RL, Miller KD, Jemal A. Cancer statistics. CA Cancer J Clin. 2015;65:5–29. doi:10.3322/caac.21254.

    Article  PubMed  Google Scholar 

  4. Ahles TA, Saykin AJ. Breast cancer chemotherapy-related cognitive dysfunction. Clin Breast Cancer. 2002;3:S84–90.

    Article  CAS  PubMed  Google Scholar 

  5. Wieneke MH, Dienst ER. Neuropsychological assessment of cognitive functioning following chemotherapy for breast cancer. Psycho-Oncology. 1995;4:61–6. doi:10.1002/pon.2960040108.

    Article  Google Scholar 

  6. Castellon SA, Ganz PA, Bower JE, Petersen L, Abraham L, Greendale GA. Neurocognitive performance in breast cancer survivors exposed to adjuvant chemotherapy and tamoxifen. J Clin Exp Neuropsychol. 2004;26:955–69.

    Article  PubMed  Google Scholar 

  7. Collins B, Mackenzie J, Kyeremanteng C. Study of the cognitive effects of chemotherapy: considerations in selection of a control group. J Clin Exp Neuropsychol. 2013;35:435–44. doi:10.1080/13803395.2013.781995.

    Article  PubMed  Google Scholar 

  8. Myers JS. Chemotherapy-related cognitive impairment: the breast cancer experience. Oncol Nurs Forum. 2012;39:E31–40. doi:10.1188/12.

    Article  PubMed  Google Scholar 

  9. Ando-Tanabe N, Iwamitsu Y, Kuranami M, Okazaki S, Yasuda H, Nakatani Y, et al. Cognitive function in women with breast cancer receiving adjuvant chemotherapy and healthy controls. Breast Cancer. 2012;21:453–62. doi:10.1007/s12282-012-0405-7.

    Article  PubMed  Google Scholar 

  10. Andreano JM, Waisman J, Donley L, Cahill L. Effects of breast cancer treatment on the hormonal and cognitive consequences of acute stress. Psycho-Oncology. 2012;21:1091–8. doi:10.1002/pon.2006.

    Article  PubMed  Google Scholar 

  11. Berman MG, Askren MK, Jung M, Therrien B, Peltier S, Noll DC, et al. Pretreatment worry and neurocognitive responses in women with breast cancer. Health Psychol. 2014;33:222–31. doi:10.1037/a0033425.

    Article  PubMed  Google Scholar 

  12. Breckenridge LM, Bruns GL, Todd BL, Feuerstein M. Cognitive limitations associated with tamoxifen and aromatase inhibitors in employed breast cancer survivors. Psycho-Oncology. 2012;21:43–53. doi:10.1002/pon.1860.

    Article  PubMed  Google Scholar 

  13. Collins B, Mackenzie J, Stewart A, Bielajew C, Verma S. Cognitive effects of hormonal therapy in early stage breast cancer patients: a prospective study. Psycho-Oncology. 2009;18:811–21. doi:10.1002/pon.1453.

    Article  PubMed  Google Scholar 

  14. Hurria A, Somlo G, Ahles T. Renaming “chemobrain”. Cancer Investig. 2007;25:373–7. doi:10.1080/07357900701506672.

    Article  Google Scholar 

  15. Shilling V, Jenkins V, Fallowfield J, Howell T. The effects of hormone therapy on cognition in breast cancer. J Steroid Biochem Mol Biol. 2003;86:405–12. doi:10.1016/j.jsbmb.2003.07.001.

    Article  CAS  PubMed  Google Scholar 

  16. Butow PN, Phillips F, Schweder J, White K, Underhill C, Goldstein D. Psychosocial well-being and supportive care needs of cancer patients living in urban and rural/regional areas: a systematic review. Support Care Cancer. 2012;20:1–22. doi:10.1007/s00520-011-1270-1.

    Article  PubMed  Google Scholar 

  17. Hendren S, Chin N, Fisher S, Winters P, Griggs J, Mohile S, et al. Patients’ barriers to receipt of cancer care, and factors associated with needing more assistance from a patient navigator. J Natl Med Assoc. 2011;103:701–10. doi:10.1016/S0027-9684(15)30409-0.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Wagner LI, Spiegel D, Pearman T. Using the science of psychosocial care to implement the new American College of Surgeons commission on cancer distress screening standard. J Natl Compr Cancer Netw. 2013;1:214–21. This focused review provides practical information on implementing screening standards into routine breast cancer treatment.

    Google Scholar 

  19. Boykoff N, Moieni M, Subramamian SK. Confronting chemobrain: an in-depth look at survivors’ reports of impact on work, social networks, and health care response. J Cancer Surviv. 2009;3:223–32. doi:10.1007/s11764-009-0098-x.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Bower JE. Behavioral symptoms in patients with breast cancer and survivors. J Clin Oncol. 2008;26:768–77. doi:10.1200/JCO.2007.14.3248.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Vichaya EG, Chiu GS, Krukowski K, Lacourt TE, Kavelaars A, Dantzer R, et al. Review article: mechanisms of chemotherapy-induced behavioral toxicities. Front Neurosci. 2015;9:131. doi:10.3389/fnins.2015.00131.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Abraham J, Haut MW, Moran MT, Filburn S, Lemiuex S, Kuwabara H. Adjuvant chemotherapy for breast cancer: effects on cerebral white matter seen in diffusion tensor imaging. Clin Breast Cancer. 2008;8:88–91. doi:10.3816/CBC.2008.n.007.

    Article  PubMed  Google Scholar 

  23. de Ruiter MB, Reneman L, Boogerd W, Veltman DJ, Caan M, Douaud G, et al. Late effects of high-dose adjuvant chemotherapy on white and gray matter in breast cancer survivors: converging results from multimodal magnetic resonance imaging. Hum Brain Mapp. 2012;33:2971–83. doi:10.1002/hbm.21422.

    Article  PubMed  Google Scholar 

  24. Deprez S, Amant F, Smeets A, Peeters R, Leemans A, Van Hecke W, et al. Longitudinal assessment of chemotherapy-induced structural changes in cerebral white matter and its correlation with impaired cognitive functioning. J Clin Oncol. 2012;30:274–81. doi:10.1200/JCO.2011.36.8571.

    Article  PubMed  Google Scholar 

  25. Silverman DH, Dy CJ, Castellon SA, Lai J, Pio BS, Abraham L, et al. Altered frontocortical, cerebellar, and basal ganglia activity in adjuvant-treated breast cancer survivors 5–10 years after chemotherapy. Breast Cancer Res Treat. 2007;103:303–11. doi:10.1007/s10549-006-9380-z.

    Article  CAS  PubMed  Google Scholar 

  26. Runowicz CD, Leach CR, Henry NL, Henry KS, Mackey HT, Cowens-Alvarado RL, et al. American Cancer Society/American Society of Clinical Oncology breast cancer survivorship care guideline. J Clin Oncol. 2016;34:611–35. doi:10.1200/JCO.2015.64.3809. This ASCO special article provides recommendations to assist primary care and other clinicians in the care of breast cancer survivors, including assessment and management of cognitive impairment and contributing factors of cognitive impairment.

    Article  CAS  PubMed  Google Scholar 

  27. American College of Surgeons Commission on Cancer (2016). Cancer program standards: ensuring patient-centered care manual, 2016 edition. Retrieved from https://www.facs.org/~/media/files/quality%20programs/cancer/coc/2016%20coc%20standards%20manual_interactive%20pdf.ashx. This manual describes CoC accreditation requirements including psychosocial distress screening and navigation.

  28. Brady MJ, Cella DF, Mo F, Bonomi AE, Tulsky DS, Lloyd SR, et al. Reliability and validity of the Functional Assessment of Cancer Therapy-Breast quality-of-life instrument. J Clin Oncol. 1997;15:974–86.

    CAS  PubMed  Google Scholar 

  29. Wagner L, Sweet J, Butt Z, Lai J, Cella D. Measuring patient self-reported cognitive function: development of the Functional Assessment of Cancer Therapy–Cognitive Function instrument. J Support Oncol. 2009;7:W32–9.

    Google Scholar 

  30. Dumas JA, Makarewicz J, Schaubhut GJ, Devins R, Albert K, Dittus K, et al. Chemotherapy altered brain functional connectivity in women with breast cancer: a pilot study. Brain Imaging Behav. 2013;7:524–32. doi:10.1007/s11682-013-9244-1.

    Article  PubMed  Google Scholar 

  31. López Zunini RA, Scherling C, Wallis N, Collins B, MacKenzie J, Bielaiew C, et al. Differences in verbal memory retrieval in breast cancer chemotherapy patients compared to healthy controls: a prospective fMRI study. Brain Imaging Behav. 2013;7:460–77. doi:10.1007/s11682-012-9213-0.

    Article  PubMed  Google Scholar 

  32. Herrera C, Chambon C, Michel BF, Paban V, Alescio-Lautier B. Positive effects of computer-based cognitive training in adults with mild cognitive impairment. Neuropsychologia. 2012;50:1871–81. doi:10.1016/j.neuropsychologia.2012.04.012.

    Article  CAS  PubMed  Google Scholar 

  33. Conroy SK, McDonald BC, Ahles TA, West JD, Saykin AJ. Chemotherapy-induced amenorrhea: a prospective study of brain activation changes and neurocognitive correlates. Brain Imaging Behav. 2013;7:491–500. doi:10.1007/s11682-013-9240-5.

    Article  PubMed  Google Scholar 

  34. Downie FP, Mar Fan HG, Houédé-Tchen N, Yi Q, Tannock IF. Cognitive function, fatigue, and menopausal symptoms in breast cancer patients receiving adjuvant chemotherapy: evaluation with patient interview after formal assessment. Psychooncology. 2006;15:921–30. doi:10.1002/pon.1035.

    Article  PubMed  Google Scholar 

  35. Eberling JL, Wu C, Tong-Turnbeaugh R, Jagust WJ. Estrogen- and tamoxifen-associated effects on brain structure and function. Neuroimage. 2004;21:364–71. doi:10.1016/j.neuroimage.2003.08.037.

    Article  PubMed  Google Scholar 

  36. Evangelista AL, Santos EM. Cluster of symptoms in women with breast cancer treated with curative intent. Support Care Cancer. 2012;20:1499–506. doi:10.1007/s00520-011-1238-1.

    Article  PubMed  Google Scholar 

  37. Jenkins V, Shilling V, Fallowfield L, Howell A, Hutton S. Does hormone therapy for the treatment of breast cancer have a detrimental effect on memory and cognition? A pilot study. Psychooncology. 2004;1:61–66.0. doi:10.1002/pon.709.

    Article  Google Scholar 

  38. Lyon DE, Cohen R, Chen H, Kelly DL, Starkweather A, Ahn H et al. The relationship of cognitive performance to concurrent symptoms, cancer- and cancer-treatment-related variables in women with early-stage breast cancer: a 2-year longitudinal study. J Cancer Res Clin Oncol. 2016, 1-14. doi: 10.1007/s00432-016-2163-y

  39. Pinto AC, de Azambuja E. Improving quality of life after breast cancer: dealing with symptoms. Maturitas. 2011;70:343–8. doi:10.1016/j.maturitas.2011.09.008.

    Article  PubMed  Google Scholar 

  40. Pullens MJ, De Vries J, Van Warmerdam LJ, Van De Wal MA, Roukema JA. Chemotherapy and cognitive complaints in women with breast cancer. Psychooncology. 2013;22:1783–9. doi:10.1002/pon.3214.

    Article  PubMed  Google Scholar 

  41. Reid-Arndt SA, Yee A, Perry MC, Hsieh C. Cognitive and psychological factors associated with early posttreatment functional outcomes in breast cancer survivors. Psychosoc Oncol. 2009;27:415–34. doi:10.1080/07347330903183117.

    Article  Google Scholar 

  42. Jacobsen PB, Hann DM, Azzarello LM, Horton J, Balducci L, Lyman GH. Fatigue in women receiving adjuvant chemotherapy for breast cancer: characteristics, course, and correlates. J Pain Symp Manag. 1999;18:233–42.

    Article  CAS  Google Scholar 

  43. Mock V, Atkinson A, Barsevick A, Cella D, Cimprich B, Cleeland C, et al. NCCN Practice guidelines for cancer-related fatigue. Oncology. 2000;14:151–61.

    CAS  PubMed  Google Scholar 

  44. de Jong N, Courtens AM, Abu-Saad HH, Schouten HD. Fatigue in patients with breast cancer receiving adjuvant chemotherapy: a review of the literature. Cancer Nurs. 2002;25:283–97.

    Article  PubMed  Google Scholar 

  45. Sitzia J, Huggins L. Side effects of cyclophosphamide, methotrexate, and 5-fluorouracil (CMF) chemotherapy for breast cancer. Cancer Pract. 1998;6:13–21. doi:10.1046/j.1523-5394.1998.1998006013.x.

    Article  CAS  PubMed  Google Scholar 

  46. Jacobsen PB, Garland LL, Booth-Jones M, Donovan KA, Thors CL, Winters E, et al. Relationship of hemoglobin levels to fatigue and cognitive functioning among cancer patients receiving chemotherapy. J Pain Symptom Manag. 2004;28:7–18. doi:10.1016/j.jpainsymman.2003.11.002.

    Article  CAS  Google Scholar 

  47. National Heart Lung and Blood Institute. What causes anemia? 2012. Retrieved from http://www.nhlbi.nih.gov/health/health-topics/topics/anemia/causes

  48. Smith E, Lai JS, Cella D. Building a measure of fatigue: the Functional Assessment of Chronic Illness Therapy Fatigue Scale. PMR. 2010;2:359–63. doi:10.1016/j.pmrj.2010.04.017.

    Article  Google Scholar 

  49. Bastien CH, VallieÁres A, Morin CM. Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med. 2001;2:297–307. doi:10.1016/S1389-9457(00)00065-4.

    Article  PubMed  Google Scholar 

  50. Sateia MJ, Lang BJ. Sleep and cancer: recent developments. Curr Oncol Rep. 2008;10:309–18.

    Article  PubMed  Google Scholar 

  51. Airaksinen E, Larsson M, Lundberg I, Forsell Y. Cognitive functions in depressive disorders: evidence from a population-based study. Psychol Med. 2004;34(1):83–91.

    Article  CAS  PubMed  Google Scholar 

  52. Airaksinen E, Larsson M, Forsell Y. Neuropsychological functions in anxiety disorders in population-based samples: evidence of episodic memory dysfunction. J Psychiatr Res. 2005;39:207–14. doi:10.1016/j.jpsychires.2004.06.001.

    Article  PubMed  Google Scholar 

  53. Fann JR, Thomas-Rich AM, Katon WJ, Cowley D, Pepping M, McGregor BA, et al. Major depression after breast cancer: a review of epidemiology and treatment. Gen Hosp Psychiatry. 2008;30:112–26. doi:10.1016/j.genhosppsych.2007.10.008.

    Article  PubMed  Google Scholar 

  54. Mitchell AJ, Chan M, Bhatti H, Halton M, Grassi L, Johansen C, et al. Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: a meta-analysis of 94 interview-based studies. Lancet Oncol. 2011;12:160–74. doi:10.1016/S1470-2045(11)70002-X.

    Article  PubMed  Google Scholar 

  55. Lovibond SH, Lovibond PF. Manual for the depression anxiety stress scales. 2nd ed. Sydney: Psychology Foundation; 1995.

    Google Scholar 

  56. Bauer A. Cancer.net, Spotlight on: oncology social workers–Part I, a Q&A. 2014. Retrieved from http://www.cancer.net/blog/2014-04/spotlight-oncology-social-workers-%E2%80%93-part-i-qa

  57. Web Finance Inc. Work environment. 2014. Retrieved from http://www.businessdictionary.com/definition/work-environment.html

  58. Morean DF, O’Dwyer L, Cherney LR. Therapies for cognitive deficits associated with chemotherapy for breast cancer: a systematic review. Arch Phys Med Rehabil. 2015;96:1880–97.

    Article  PubMed  Google Scholar 

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Acknowledgments

The study was supported by an Advanced Rehabilitation Research Training Award: Interventions for Neurologic Communication Disorders (award no. 90AR5015-01-00) from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) and the Evergreen Invitational Women’s Health Grants Initiative. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Correspondence to Diane F. Morean.

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Diane F. Morean and Leora R. Cherney declare that they have nothing to declare.

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Morean, D.F., Cherney, L.R. Screening for Cognitive Impairment Associated with Chemotherapy for Breast Cancer. Curr Breast Cancer Rep 8, 151–157 (2016). https://doi.org/10.1007/s12609-016-0219-2

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