A meta-analysis of cognitive impairment and decline associated with adjuvant chemotherapy in women with breast cancer

Miyuki Ono; James M Ogilvie; Jennifer S Wilson; Heather J Green; Suzanne K Chambers; Tamara Ownsworth; David H K Shum

doi:10.3389/fonc.2015.00059

A meta-analysis of cognitive impairment and decline associated with adjuvant chemotherapy in women with breast cancer

Front Oncol. 2015 Mar 10:5:59. doi: 10.3389/fonc.2015.00059. eCollection 2015.

Authors

Miyuki Ono¹, James M Ogilvie¹, Jennifer S Wilson¹, Heather J Green², Suzanne K Chambers¹, Tamara Ownsworth¹, David H K Shum³

Affiliations

¹ Griffith Health Institute Behavioural Basis of Health Program, School of Applied Psychology, Griffith University , Brisbane, QLD , Australia.
² Griffith Health Institute Behavioural Basis of Health Program, School of Applied Psychology, Griffith University , Gold Coast, QLD , Australia.
³ Griffith Health Institute Behavioural Basis of Health Program, School of Applied Psychology, Griffith University , Brisbane, QLD , Australia ; Griffith Health Institute Behavioural Basis of Health Program, School of Applied Psychology, Griffith University , Gold Coast, QLD , Australia.

Abstract

A meta-analysis was performed to quantify the magnitude and nature of the association between adjuvant chemotherapy and performance on a range of cognitive domains among breast cancer patients. A total of 27 studies (14 cross-sectional, 8 both cross-sectional and prospective, and 5 prospective) were included in the analyses, involving 1562 breast cancer patients who had undergone adjuvant chemotherapy and 2799 controls that included breast cancer patients who did not receive adjuvant chemotherapy. A total of 737 effect sizes (Cohen's d) were calculated for cross-sectional and prospective longitudinal studies separately and classified into eight cognitive domains. The mean effect sizes varied across cross-sectional and prospective longitudinal studies (ranging from -1.12 to 0.62 and -0.29 to 1.12, respectively). Each cognitive domain produced small effect sizes for cross-sectional and prospective longitudinal studies (ranging from -0.25 to 0.41). Results from cross-sectional studies indicated a significant association between adjuvant chemotherapy and cognitive impairment that held across studies with varied methodological approaches. For prospective studies, results generally indicated that cognitive functioning improved over time after receiving adjuvant chemotherapy. Greater cognitive impairment was reported in cross-sectional studies comparing chemotherapy groups with healthy control groups. Results suggested that cognitive impairment is present among breast cancer patients irrespective of a history of chemotherapy. Prospective longitudinal research is warranted to examine the degree and persisting nature of cognitive impairment present both before and after chemotherapy, with comparisons made to participants' cognitive function prior to diagnosis. Accurate understanding of the effects of chemotherapy is essential to enable informed decisions regarding treatment and to improve quality of life among breast cancer patients.

Keywords: adjuvant chemotherapy; breast cancer; cognitive functioning; meta-analysis; moderators.

Publication types

Review