Skip to main content
SpringerLink
Log in

Cancer-Related Cognitive Impairment

  • Chapter
  • First Online:
Common Issues in Breast Cancer Survivors

  • 692 Accesses

Abstract

Cancer-related cognitive impairment, or “chemobrain,” is reported by up to 75% of breast cancer patients during treatment with 35% of survivors experiencing lasting effects. Cognitive deficits can be observed in any of the eight cognitive domains, and imaging supports organic brain injury via several proposed mechanisms including inflammation, hormonal and cytokine alterations, and direct neural damage. Screening is best accomplished by referral for neuropsychological testing, though components can be used by the oncology care team. Referral to a cognitive or occupational therapist is recommended to identify and treat the cognitive deficits, and comorbid conditions such as pain, fatigue, and sleep disturbance should be addressed. Small trials of brief exposure to CNS stimulants or anti-dementia medications report minimal benefit.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Harvey PD. Domains of cognition and their assessment. Dialogues Clin Neurosci. 2019;21:227–37.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Wefel JS, Schagen SB. Chemotherapy-related cognitive dysfunction. Curr Neurol Neurosci Rep. 2012;12:267–75.

    Article  CAS  PubMed  Google Scholar 

  3. Wieneke MH, Dienst ER. Neuropsychological assessment of cognitive functioning following chemotherapy for breast cancer. Psychooncology. 1995;4:61–6.

    Article  Google Scholar 

  4. Wefel JS, Lenzi R, Theriault RL, Davis RN, Meyers CA. The cognitive sequelae of standard-dose adjuvant chemotherapy in women with breast carcinoma: results of a prospective, randomized, longitudinal trial. Cancer. 2004;100:2292–9.

    Article  CAS  PubMed  Google Scholar 

  5. Patel SK, et al. Inflammatory biomarkers, comorbidity, and neurocognition in women with newly diagnosed breast cancer. JNCI J Natl Cancer Inst. 2015;107(8):djv131.

    Google Scholar 

  6. van der Willik KD, et al. Inflammation markers and cognitive performance in breast cancer survivors 20 years after completion of chemotherapy: a cohort study. Breast Cancer Res BCR. 2018;20(1):135.

    Google Scholar 

  7. Janelsins MC, Kesler SR, Ahles TA, Morrow GR. Prevalence, mechanisms, and management of cancer-related cognitive impairment. Int Rev Psychiatry Abingdon Engl. 2014;26:102–113.

    Google Scholar 

  8. Ahles TA, et al. Longitudinal assessment of cognitive changes associated with adjuvant treatment for breast cancer: impact of age and cognitive reserve. J Clin Oncol. 2010;28:4434–40.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Ahles TA, Saykin AJ. Candidate mechanisms for chemotherapy-induced cognitive changes. Nat Rev Cancer. 2007;7:192–201.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Ahles TA, et al. The relationship of APOE genotype to neuropsychological performance in long-term cancer survivors treated with standard dose chemotherapy. Psychooncology. 2003;12:612–9.

    Article  PubMed  Google Scholar 

  11. Vardy J, Wefel JS, Ahles T, Tannock IF, Schagen SB. Cancer and cancer-therapy related cognitive dysfunction: an international perspective from the Venice cognitive workshop. Ann Oncol. 2008;19:623–9.

    Article  CAS  PubMed  Google Scholar 

  12. Cheung YT, et al. Association of proinflammatory cytokines and chemotherapy-associated cognitive impairment in breast cancer patients: a multi-centered, prospective, cohort study. Ann Oncol. 2015;26:1446–51.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Lyon DE, et al. Relationship of systemic cytokine concentrations to cognitive function over two years in women with early stage breast cancer. J Neuroimmunol. 2016;301:74–82.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Wefel JS, Kesler SR, Noll KR, Schagen SB. Clinical characteristics, pathophysiology, and management of noncentral nervous system cancer-related cognitive impairment in adults. CA Cancer J Clin. 2015;65:123–38.

    Article  PubMed  Google Scholar 

  15. McDonald BC, Conroy SK, Ahles TA, West JD, Saykin AJ. Alterations in brain activation during working memory processing associated with breast cancer and treatment: a prospective functional magnetic resonance imaging study. J Clin Oncol. 2012;30:2500–8.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Pomykala KL, et al. The association between pro-inflammatory cytokines, regional cerebral metabolism, and cognitive complaints following adjuvant chemotherapy for breast cancer. Brain Imaging Behav. 2013;7:511–23.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Kesler S, et al. Reduced hippocampal volume and verbal memory performance associated with interleukin-6 and tumor necrosis factor-alpha levels in chemotherapy-treated breast cancer survivors. Brain Behav Immun. 2013;30:S109–16.

    Article  CAS  PubMed  Google Scholar 

  18. Phillips K-A, Bernhard J. Adjuvant breast cancer treatment and cognitive function: current knowledge and research directions. JNCI J Natl Cancer Inst. 2003;95:190–7.

    Article  CAS  PubMed  Google Scholar 

  19. Rocca WA, et al. Increased risk of cognitive impairment or dementia in women who underwent oophorectomy before menopause. Neurology. 2007;69:1074–83.

    Article  CAS  PubMed  Google Scholar 

  20. Rocca WA, Grossardt BR, Shuster LT. Oophorectomy, estrogen, and dementia: a 2014 update. Mol Cell Endocrinol. 2014;389:7–12.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Rocca WA, Grossardt BR, Maraganore DM. The long-term effects of oophorectomy on cognitive and motor aging are age dependent. Neurodegener Dis. 2008;5:257–60.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Rocca WA, et al. Increased risk of parkinsonism in women who underwent oophorectomy before menopause. Neurology. 2008;70:200–9.

    Article  CAS  PubMed  Google Scholar 

  23. Rocca WA, et al. Bilateral oophorectomy and accelerated aging: cause or effect? J Gerontol A Biol Sci Med Sci. 2017;72:1213–7.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Hogervorst E, Bandelow S. Sex steroids to maintain cognitive function in women after the menopause: a meta-analyses of treatment trials. Maturitas. 2010;66:56–71.

    Article  CAS  PubMed  Google Scholar 

  25. Resnick SM, et al. The Women’s Health Initiative Study of Cognitive Aging (WHISCA): a randomized clinical trial of the effects of hormone therapy on age-associated cognitive decline. Clin Trials. 2004;1:440–50.

    Article  PubMed  Google Scholar 

  26. Espeland MA, et al. Long term effects of conjugated equine estrogens therapies on domain-specific cognitive function: results from the Women’s Health Initiative Study of Cognitive Aging (WHISCA) extension. J Am Geriatr Soc. 2010;58:1263–71.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Espeland MA, et al. Relative effects of tamoxifen, raloxifene, and conjugated equine estrogens on cognition. J Women’s Health. 2010;19:371–9.

    Article  Google Scholar 

  28. Legault C, et al. Effects of tamoxifen and raloxifene on memory and other cognitive abilities: cognition in the study of tamoxifen and raloxifene. J Clin Oncol. 2009;27:5144–52.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Castellon SA, et al. Neurocognitive performance in breast cancer survivors exposed to adjuvant chemotherapy and tamoxifen. J Clin Exp Neuropsychol. 2004;26:955–69.

    Article  PubMed  Google Scholar 

  30. Palmer JL, Trotter T, Joy AA, Carlson LE. Cognitive effects of tamoxifen in pre-menopausal women with breast cancer compared to healthy controls. J Cancer Surviv. 2008;2:275–82.

    Article  PubMed  Google Scholar 

  31. Hermelink K, et al. Short-term effects of treatment-induced hormonal changes on cognitive function in breast cancer patients. Cancer. 2008;113:2431–9.

    Article  PubMed  Google Scholar 

  32. Ahles TA, Root JC, Ryan EL. Cancer- and cancer treatment–associated cognitive change: an update on the state of the science. J Clin Oncol. 2012;30:3675–86.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Hermelink K, et al. Cognitive function during neoadjuvant chemotherapy for breast cancer. Cancer. 2007;109:1905–13.

    Article  CAS  PubMed  Google Scholar 

  34. Tannock IF, Ahles TA, Ganz PA, van Dam FS. Cognitive impairment associated with chemotherapy for cancer: report of a workshop. J Clin Oncol. 2004;22:2233–9.

    Article  PubMed  Google Scholar 

  35. Anderson-Hanley C, Sherman ML, Riggs R, Agocha VB, Compas BE. Neuropsychological effects of treatments for adults with cancer: a meta-analysis and review of the literature. J Int Neuropsychol Soc. 2003;9:967–82.

    Article  PubMed  Google Scholar 

  36. Jansen CE, Miaskowski C, Dodd M, Dowling G, Kramer J. A metaanalysis of studies of the effects of cancer chemotherapy on various domains of cognitive function. Cancer. 2005;104:2222–33.

    Article  PubMed  Google Scholar 

  37. Falleti MG, Sanfilippo A, Maruff P, Weih L, Phillips K-A. The nature and severity of cognitive impairment associated with adjuvant chemotherapy in women with breast cancer: a meta-analysis of the current literature. Brain Cogn. 2005;59:60–70.

    Article  PubMed  Google Scholar 

  38. Shilling V, Jenkins V, Morris R, Deutsch G, Bloomfield D. The effects of adjuvant chemotherapy on cognition in women with breast cancer—preliminary results of an observational longitudinal study. Breast. 2005;14:142–50.

    Article  CAS  PubMed  Google Scholar 

  39. Jansen CE, Cooper BA, Dodd MJ, Miaskowski CA. A prospective longitudinal study of chemotherapy-induced cognitive changes in breast cancer patients. Support Care Cancer. 2011;19:1647–56.

    Article  PubMed  Google Scholar 

  40. Wefel JS, Saleeba AK, Buzdar AU, Meyers CA. Acute and late onset cognitive dysfunction associated with chemotherapy in women with breast cancer. Cancer. 2010;116:3348–56.

    Article  PubMed  Google Scholar 

  41. Janelsins MC, et al. Cognitive complaints in survivors of breast cancer after chemotherapy compared with age-matched controls: an analysis from a nationwide, multicenter, prospective longitudinal study. J Clin Oncol. 2017;35:506–14.

    Article  PubMed  Google Scholar 

  42. Janelsins MC, et al. An update on cancer- and chemotherapy-related cognitive dysfunction: current status. Semin Oncol. 2011;38:431–8.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Koppelmans V, et al. Neuropsychological performance in survivors of breast cancer more than 20 years after adjuvant chemotherapy. J Clin Oncol. 2012;30:1080–6.

    Article  PubMed  Google Scholar 

  44. Schagen SB, Muller MJ, Boogerd W, Mellenbergh GJ, van Dam FSAM. Change in cognitive function after chemotherapy: a prospective longitudinal study in breast cancer patients. JNCI J Natl Cancer Inst. 2006;98:1742–5.

    Article  CAS  PubMed  Google Scholar 

  45. Gullett JM, et al. Relationship of fatigue with cognitive performance in women with early-stage breast cancer over 2 years. Psychooncology. 2019;28:997–1003.

    PubMed  PubMed Central  Google Scholar 

  46. Wefel JS, et al. ‘Chemobrain’ in breast carcinoma? Cancer. 2004;101:466–75.

    Article  PubMed  Google Scholar 

  47. Ahles TA, et al. Cognitive function in breast cancer patients prior to adjuvant treatment. Breast Cancer Res Treat. 2008;110:143–52.

    Article  CAS  PubMed  Google Scholar 

  48. Fan HGM, et al. Fatigue, menopausal symptoms, and cognitive function in women after adjuvant chemotherapy for breast cancer: 1- and 2-year follow-up of a prospective controlled study. J Clin Oncol. 2005;23:8025–32.

    Article  PubMed  Google Scholar 

  49. Denlinger CS, et al. Survivorship: cognitive function, version 1.2014. J Natl Compr Canc Netw. 2014;12:976–86.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Nemoto K. Understanding voxel-based morphometry. Brain Nerve Shinkei Kenkyu No Shinpo. 2017;69:505–11.

    PubMed  Google Scholar 

  51. McDonald BC, Conroy SK, Smith DJ, West JD, Saykin AJ. Frontal gray matter reduction after breast cancer chemotherapy and association with executive symptoms: a replication and extension study. Brain Behav Immun. 2013;30:S117–25.

    Article  PubMed  Google Scholar 

  52. McDonald BC, Conroy SK, Ahles TA, West JD, Saykin AJ. Gray matter reduction associated with systemic chemotherapy for breast cancer: a prospective MRI study. Breast Cancer Res Treat. 2010;123:819.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Li M, Caeyenberghs K. Longitudinal assessment of chemotherapy-induced changes in brain and cognitive functioning: a systematic review. Neurosci Biobehav Rev. 2018;92:304–17.

    Article  PubMed  Google Scholar 

  54. Andreotti C, et al. Reliable change in neuropsychological assessment of breast cancer survivors. Psychooncology. 2016;25:43–50.

    Article  PubMed  Google Scholar 

  55. Ryan EL, Miskovitz G, Sutton D, Ahles T. A tailored occupational therapy approach to cognitive rehabilitation of chemotherapy-related cognitive side effects in breast cancer survivors: two case studies of premenopausally affected women. Psicooncología Madr. 2011;8:315–42.

    Google Scholar 

  56. Selamat MH, Loh SY, Mackenzie L, Vardy J. Chemobrain experienced by breast cancer survivors: a meta-ethnography study investigating research and care implications. PLoS One San Franc. 2014;9:e108002.

    Article  CAS  Google Scholar 

  57. Ercoli LM, et al. Cognitive rehabilitation group intervention for breast cancer survivors: results of a randomized clinical trial. Psychooncology. 2015;24:1360–7.

    Article  CAS  PubMed  Google Scholar 

  58. Ferguson RJ, et al. Cognitive-behavioral management of chemotherapy-related cognitive change. Psychooncology. 2007;16:772–7.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Ferguson RJ, et al. Development of CBT for chemotherapy-related cognitive change: results of a waitlist control trial. Psychooncology. 2012;21:176–86.

    Article  PubMed  Google Scholar 

  60. The American Occupational Therapy Association [AOTA]. Occupational therapy practice framework: Domain and Process (3rd Edition). Am J Occup Ther. 2014;68:S1–S48.

    Google Scholar 

  61. Pergolotti M, Williams GR, Campbell C, Munoz LA, Muss HB. Occupational therapy for adults with cancer: why it matters. Oncologist. 2016;21:314–9.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Wolf TJ, et al. The feasibility of using metacognitive strategy training to improve cognitive performance and neural connectivity in women with chemotherapy-induced cognitive impairment. Oncology. 2016;91:143–52.

    Article  PubMed  Google Scholar 

  63. Green HJ, Tefay M, Mihuta ME. Feasibility of small group cognitive rehabilitation in a clinical cancer setting. Psychooncology. 2018;27:1341–3.

    Article  PubMed  Google Scholar 

  64. Vo JB, et al. Thinking well beyond diagnosis: a four-year evaluation of a cognitive changes education for breast cancer survivors. Nurs Res Rev. 2019;21–9.

    Google Scholar 

  65. Conklin HM, et al. Acute neurocognitive response to methylphenidate among survivors of childhood cancer: a randomized, double-blind, cross-over trial. J Pediatr Psychol. 2007;32:1127–39.

    Article  PubMed  Google Scholar 

  66. Mar Fan HG, et al. A randomised, placebo-controlled, double-blind trial of the effects of d-methylphenidate on fatigue and cognitive dysfunction in women undergoing adjuvant chemotherapy for breast cancer. Support Care Cancer. 2008;16:577–83.

    Article  PubMed  Google Scholar 

  67. Kohli S, et al. The effect of modafinil on cognitive function in breast cancer survivors. Cancer. 2009;115:2605–16.

    Article  CAS  PubMed  Google Scholar 

  68. Lawrence JA, et al. A study of donepezil in female breast cancer survivors with self-reported cognitive dysfunction 1 to 5 years following adjuvant chemotherapy. J Cancer Surviv. 2016;10:176–84.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Departments of Medicine and Pediatrics, Duke University Medical Center, Durham, NC, USA

    Austin Wesevich

  2. Physical Therapy and Occupational Therapy Department, Duke University Hospital, Durham, NC, USA

    Karen S. Johnson

  3. Department of Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, NC, USA

    Ivy Altomare

Authors
  1. Austin Wesevich
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Karen S. Johnson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ivy Altomare
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ivy Altomare .

Editor information

Editors and Affiliations

  1. Medical Oncology, Duke University School of Medicine/Duke Cancer Institute, Durham, NC, USA

    Gretchen G. Kimmick

  2. Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA

    Rebecca A. Shelby

  3. Duke University School of Medicine Duke Cancer Network, Durham, NC, USA

    Linda M. Sutton

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Wesevich, A., Johnson, K.S., Altomare, I. (2021). Cancer-Related Cognitive Impairment. In: Kimmick, G.G., Shelby, R.A., Sutton, L.M. (eds) Common Issues in Breast Cancer Survivors. Springer, Cham. https://doi.org/10.1007/978-3-030-75377-1_9

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-75377-1_9

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-75376-4

  • Online ISBN: 978-3-030-75377-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation