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Cognitive Dysfunction Linked to Chemotherapy.

SAN ANTONIO -- Cancer chemotherapy appears to have adverse effects upon specific areas of cognitive function, according to two reports at a breast cancer symposium sponsored by the San Antonio Cancer Institute.

Dr. Nadine Tchen said preliminary results of her ongoing study suggest the affected areas are memory, language, and self-regulation and planning.

Many of the side effects of postoperative adjunctive chemotherapy for breast cancer are well established: myelosuppression, hair loss, nausea and vomiting, fatigue, and early menopause. However, three small published studies suggest chemotherapy is also associated with adverse cognitive effects, particularly in the domains of memory and language, according to Dr. Tchen of Princess Margaret Hospital, Toronto.

Determining just how significant a problem this is has become a priority with the emergence of effective alternatives to cancer chemotherapy that have less onerous side effects, such as goserelin.

To better define the cognitive effects of chemotherapy, Dr. Tchen has embarked on a matched cohort study whose goal is to enroll 100 breast cancer patients and an equal number of friends, relatives, or neighbors as controls.

To date, 34 breast cancer patients have undergone cognitive testing and standardized quality of life assessment toward the end of their course of chemotherapy. The plan is to repeat the testing 12 and 24 months later to gain insight into how long the cognitive deficits last.

Ten of 34 patients were classified as having moderate to severe cognitive impairment using the High Sensitivity Cognitive Screen, as were just 4 of 30 controls. In the area of language, eight cancer patients receiving adjuvant chemotherapy were classified as mildly impaired, five had moderate to severe impairment, and 21 were rated normal or borderline. In contrast, only 3 of 30 controls exhibited any degree of language impairment.

Similar trends were noted in the do mains of memory and self-regulation and planning. However, chemotherapy patients and controls didn't differ in the areas of attention and concentration, visual-motor capability, and spatial perception.

Quality of life assessment using the Functional Assessment of Cancer Therapy-General version (FACT-G) showed chemotherapy patients were worse off than controls in terms of the physical and functional subscales but scored unexpectedly better on the emotional subscale, perhaps because of successful coping with their life-threatening disease, Dr. Tchen said.

In a separate presentation, Dr. Charles L. Loprinzi predicted chemotherapy-induced neurocognitive dysfunction, or "chemo brain," as he calls it, is an issue "you're going to hear a lot more about in upcoming years as more attention focuses on the problem, and rightfully so."

"Chemo brain is an evolving phenomenon, the data are coming from a number of different sources, and I think it's a real thing," said Dr. Loprinzi, professor of medicine at Mayo Medical School and chairman of medical oncology at the Mayo Clinic, Rochester, Minn.

While chemo brain has only recently drawn systematic scientific scrutiny, on cologists have long observed anecdotally that adjuvant chemotherapy regimens for breast cancer seem to be associated with loss of short-term memory, slower reaction time and thought processing, and reduced ability to concentrate on tasks, he noted.

Two proposed etiologies are direct pharmacologic neurotoxicity or loss of estrogen's neurocognitive protective effect secondary to chemotherapy-induced ovarian ablation.
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Publication:OB GYN News
Date:Apr 1, 2001
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