Skip to main content

Advertisement

SpringerLink
Log in

Low neuropsychologic performance among adult cancer survivors treated with chemotherapy

  • Published:
Current Neurology and Neuroscience Reports Aims and scope Submit manuscript

Abstract

Decline in neuropsychologic test performance following adjuvant chemotherapy for various types of cancer has gained much research attention over the past decade. From available data, about one fourth to one third of individuals undergoing systemic chemotherapy exhibit measurable decrements in performance of standard tests of cognitive function. Many cancer survivors report that cognitive problems interfere with function and compromise quality of life. However, these declines appear subtle and there are little available longitudinal data examining pre- to post-treatment cognitive change. Further, there is little available evidence identifying the causes of cognitive decline. This paper reviews current literature on low neuropsychologic performance following systemic chemotherapy and hypotheses on the causes of cognitive symptoms following chemotherapy. Future research directions, with emphasis on longitudinal research design as well as treatment implications, are discussed.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Olin JJ: Cognitive function after systemic therapy for breast cancer. Oncology 2001, 15:613–624. Comprehensive review of cognitive function following systemic chemotherapy among breast cancer survivors+.

    PubMed  CAS  Google Scholar 

  2. Ahles TA, Saykin A: Cognitive effects of standard-dose chemotherapy in patients with cancer. Cancer Invest 2001, 19:812–820. Comprehensive review of research on the neuropsychologic effects of systemic chemotherapy among adult cancer survivors.

    Article  PubMed  CAS  Google Scholar 

  3. Meyers CA: Neurocognitive dysfunction in cancer patients. Oncology 2000, 14:75–79.

    PubMed  CAS  Google Scholar 

  4. McCarthy NJ, Swain SM: Update on adjuvant chemotherapy for early breast cancer. Oncology 2000, 14:1267–1280.

    PubMed  CAS  Google Scholar 

  5. President’s Cancer Panel: Cancer Care Issues in the United States: Quality of Care, Quality of Life. Bethesda, Maryland, National Cancer Program, National Cancer Institute, 1999.

    Google Scholar 

  6. Ferrell BR, Hassey R, Dow K: Quality of life among long-term cancer survivors. Oncology 1997, 11:565–576.

    PubMed  CAS  Google Scholar 

  7. Ahles TA, Saykin AJ, Furstenberg CT, et al.: Neuropsychologic impact of standard-dose systemic chemotherapy in long-term survivors of breast cancer and lymphoma. J Clin Oncol 2002, 20:485–493. First study assessing neuropsychologic impact of chemotherapy in cancer survivors of 5 years or greater. Compared with control subjects matched on age, IQ, and time since treatment, individuals treated with chemotherapy demonstrated lower neuropsychologic performance than individuals treated with local therapy.

    Article  PubMed  CAS  Google Scholar 

  8. van Dam FS, Schagen M, Muller SB, et al.: Impairment of cognitive function in women receiving adjuvant treatment for high risk breast cancer: high dose versus standard dose chemotherapy. J Natl Cancer Inst 1998, 90:210–218.

    Article  PubMed  Google Scholar 

  9. Schagen SB, Hamberger HL, Muller MJ, et al.: Neurophysiological evaluation of late effects of adjuvant high-dose chemotherapy on cognitive function. J Neuro-Oncol 2001, 51:159–165. Another study assessing the neurocognitive effects of chemotherapy among cancer survivors as compared with matched control subjects (ie, cancer survivors treated with local therapies such as and surgery and radiation). Chemotherapy recipients had lower performance on standardized neuropsychologic tests.

    Article  CAS  Google Scholar 

  10. Walch SE, Ahles TA, Saykin AJ: Neuropsychological impact of cancer and cancer treatments in adults. In Psycho-Oncology. Edited by Holland J. New York: Oxford University Press; 1998.

    Google Scholar 

  11. Walch SE, Ahles TA, Saykin AJ: Cognitive sequelea of treatment in children. In Psycho-Oncology. Edited by Holland J. New York: Oxford University Press; 1998.

    Google Scholar 

  12. Sohlberg MM, Mateer CA: Cognitive Rehabilitation: An Integrative Neuropsychological Approach. New York: Guilford Press; 2001.

    Google Scholar 

  13. Silberfarb PM, Philber D, Levine PM: Psychosocial aspects of neoplastic disease: II. Affective and cognitive effects of chemotherapy in cancer patients. Am J Psychiatry 1980, 137:597–601.

    PubMed  CAS  Google Scholar 

  14. Silberfarb PM: Chemotherapy and cognitive deficits in cancer patients. Annu Rev Med 1983, 34:35–46.

    Article  PubMed  CAS  Google Scholar 

  15. Oxman TE, Silberfarb PM: Serial cognitive testing in cancer patients receiving chemotherapy. Am J Psychiatry 1980, 137:597–601.

    Google Scholar 

  16. Kassa S, Olnes BT, Mastekassa A: Neuopsychological evaluation of patients with inoperable non-small cell lung cancer treated with combination chemotherapy and radiotherapy. Actica Oncol 1988, 27:241–246.

    Google Scholar 

  17. Komaki R, Meyers CA, Shin DM, et al.: Evaluation of cognitive function in patients with limited small cell lung cancer prior to and shortly following prophylactic cranial irradiation. Int J Radiat Oncol Biol Phys 1995, 33:179–182.

    Article  PubMed  CAS  Google Scholar 

  18. Wieneke MH, Dienst ER: Neuropsychological assessment of cognitive functioning following chemotherapy for breast cancer. Psycho-Oncology 1995, 4:61–66.

    Article  Google Scholar 

  19. van Dam FS, Schagen SB, Muller MJ, et al.: Impairment of cognitive function in women receiving adjuvant treatment for high risk breast cancer: High dose versus standard dose chemotherapy. J Natl Cancer Inst 1998, 90:210–218.

    Article  PubMed  Google Scholar 

  20. Schagen SB, van Dam FS, Muller MJ, et al.: Cognitive deficits after postoperative adjuvant chemotherapy for breast carcinoma. Cancer 1999, 85:640–650.

    Article  PubMed  CAS  Google Scholar 

  21. Schagen SB, Hamburger HL, Muller MJ, et al.: Neuropsychological evaluation of late effects of adjuvant high-dose chemotherapy on cognitive function. J Neuro-Oncol 2001, 51:159–165.

    Article  CAS  Google Scholar 

  22. Tuxen MK, Werner-Hansen S: Neurotoxicity secondary to antineoplastic drugs. Cancer Treat Rev 1994, 20:191–214.

    Article  PubMed  CAS  Google Scholar 

  23. Troy L, McFarland K, Littman-Power S, et al.: Cisplatin-based therapy: a neurological and neuropsychological review. Psychooncology 2000, 9:29–39. Review of cytotoxic therapies and hypothesized mechanisms that may give rise to low neuropsychologic performance among cancer patients.

    Article  PubMed  CAS  Google Scholar 

  24. Wechsler Adult Intelligence Scale-Third Edition, Wechsler Memory Scale-Third Edition, Technical manual. San Antonio, TX: The Psychological Corporation; 1997.

  25. Lezak M: Neuropsychological assessment. New York: Oxford Press; 1995.

    Google Scholar 

  26. Mori E, Hirono N, Yamashita H, et al.: Premorbid brain size as a determinant of researve capacity against intellectual decline in Alzheimer’s disease. Am J Psychiatry 1997, 154:18–24.

    PubMed  CAS  Google Scholar 

  27. Stern RA, Silva SG, Chaisson N, Evans DL: Influence of cognitive reserve on neuropsychological functioning in asymptomatic human immunodeficiency virus-1 infection. Arch Neurol 1996, 53:148–153.

    PubMed  CAS  Google Scholar 

  28. Yaffe K, Cauley J, Sands L, Browner W: Apolipoprotein E phenotype and cognitive decline in a prospective study of elderly community women. Arch Neurol 1997, 54:1110–1114.

    PubMed  CAS  Google Scholar 

  29. Tardiff BE, Newman MF, Saunders AM, et al.: Preliminary report of a genetic basis for cognitive decline after cardiac operations. Ann Thorac Surg 1997, 64:715–720.

    Article  PubMed  CAS  Google Scholar 

  30. Newman MF, Croughwell ND, Blumenthal JA, et al.: Predictors of cognitive decline after cardiac operation. Ann Thorac Surg 1995, 59:1326–1330.

    Article  PubMed  CAS  Google Scholar 

  31. Haan MN, Shemanski L, Jgust WJ, et al.: The role of APOE-E4 in modulating effects of other risk factors for cognitive decline in elderly persons. JAMA 1999, 282:40–46.

    Article  PubMed  CAS  Google Scholar 

  32. Sherwin BB: Cognitive assessment for postmenopausal women and general assessment of their mental health. Psychopharmacol Bull 1998, 34:323–326.

    PubMed  CAS  Google Scholar 

  33. Sherwin BB: Estrogen and cognitive function in women. Proc Soc Exp Biol Med 1998, 217:17–22.

    PubMed  CAS  Google Scholar 

  34. Ditkoff EC, Gary WG, Cristo M, Lobo RA: Estrogen improves psychological function in asymptomatic postmenopausal women. Obstet Gynecol 1991, 78:991–995.

    PubMed  CAS  Google Scholar 

  35. Barrett-Connor E, Kritz-Silverstein D: Estrogen replacement therapy and cognitive function in older women. JAMA 1993, 260:2637–2641.

    Article  Google Scholar 

  36. Sherwin BB, Phillips S: Estrogen and cognitive function in surgically menopausal women. Ann N Y Acad Sci 1990, 592:474–475.

    Article  Google Scholar 

  37. Winer EP, Hudis C, Burstein HJ, et al.: ASCO technology assessment: the use of aromatase inhibitors as adjuvant therapy for women with hormone receptor positive breast cancer: status report 2002. J Clin Oncol 2002, 20:3317–3327.

    Article  PubMed  CAS  Google Scholar 

  38. Arpels JC: The female brain hypoestrogenic continuum from the premenstrual syndrome to menopause. J Reproduct Med 1996, 41:633–639.

    CAS  Google Scholar 

  39. Yaffe K, Drueger K, Sarkar S, et al.: Cognitive function in postmenopausal women treated with raloxifene. N Engl J Med 2001, 344:1207–1213.

    Article  PubMed  CAS  Google Scholar 

  40. Saykin A, Ahles TA: Neurocognitive dysfunction in cancer patients. Oncology 2000, 14:81–85.

    Google Scholar 

  41. Saykin AJ, Ahles TA, Schoenfeld JD, et al.: Gray matter reduction on voxel-based morphemetry in chemotherapy -treated cancer survivors. J Int Neuropsychol Soc 2003, in press.

  42. Cicerone KD, Dahlberg C, Kalmar K, et al.: Evidence-based cognitive rehabilitation: recommendations for clinical practice. Arch Phys Med Rehab 2000, 81:1596–1615. Comprehensive review of the evidence base for efficacy of cognitive rehabilitation interventions.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Behavioral Medicine Section, Department of Psychiatry & Center for Psycho-Oncology Research, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, 03756, Lebanon, NH, USA

    Robert J. Ferguson PhD & Tim A. Ahles PhD

Authors
  1. Robert J. Ferguson PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tim A. Ahles PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ferguson, R.J., Ahles, T.A. Low neuropsychologic performance among adult cancer survivors treated with chemotherapy. Curr Neurol Neurosci Rep 3, 215–222 (2003). https://doi.org/10.1007/s11910-003-0081-2

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11910-003-0081-2

Keywords

Search

Navigation