Systematic review of pharmacologic and non-pharmacologic interventions to manage cognitive alterations after chemotherapy for breast cancer

Chan, Raymond J., McCarthy, Alexandra L., Devenish, Jackie, Sullivan, Karen A., & Chan, Alexandre (2015) Systematic review of pharmacologic and non-pharmacologic interventions to manage cognitive alterations after chemotherapy for breast cancer. European Journal of Cancer, 51(4), pp. 437-450.

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Abstract

Purpose

Cognitive alterations are reported in breast cancer patients receiving chemotherapy. This has adverse effects on patients’ quality of life and function. This systematic review investigates the effectiveness of pharmacologic and non-pharmacologic interventions to manage cognitive alterations associated with breast cancer treatment.

Methods

Medline via EBSCOhost, CINAHL and Cochrane CENTRAL were searched for the period January 1999 to May 2014 for prospective randomized controlled trials related to the management of chemotherapy-associated cognitive alterations. Included studies investigated the management of chemotherapy-associated cognitive alterations and used subjective or objective measures in patients with breast cancer during or after chemotherapy. Two authors independently extracted data and assessed the risk of bias.

Results

Thirteen studies involving 1138 participants were included. Overall, the risk of bias for the 13 studies were either high (n=11) or unclear (n=2). Pharmacologic interventions included psychostimulants (n=4), epoetin alfa (n=1), and Ginkgo biloba (n=1). Non-pharmacologic interventions were cognitive training (n=5) and physical activity (n=2). Pharmacologic agents were ineffective except for self-reported cognitive function in an epoetin alfa study. Cognitive training interventions demonstrated benefits in self-reported cognitive function, memory, verbal function and language and orientation/attention. Physical activity interventions were effective in improving executive function and self-reported concentration.

Conclusion

Current evidence does not favor the pharmacologic management of cognitive alterations associated with breast cancer treatment. Cognitive training and physical activity interventions appear promising, but additional studies are required to establish their efficacy. Further research is needed to overcome methodological shortfalls such as heterogeneity in participant characteristics and non-standardized neuropsychological outcome measures.

Impact and interest:

10 citations in Scopus
10 citations in Web of Science®
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ID Code: 79677
Item Type: Journal Article
Refereed: Yes
Additional URLs:
Keywords: Breast cancer, Chemotherapy, Cognitive function, Cognitive training, Physical activity, Psychostimulants, Systematic review, Meta-analysis
DOI: 10.1016/j.ejca.2014.12.017
ISSN: 0959-8049
Subjects: Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > NURSING (111000) > Clinical Nursing - Secondary (Acute Care) (111003)
Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > ONCOLOGY AND CARCINOGENESIS (111200) > Oncology and Carcinogenesis not elsewhere classified (111299)
Australian and New Zealand Standard Research Classification > PSYCHOLOGY AND COGNITIVE SCIENCES (170000) > COGNITIVE SCIENCE (170200) > Cognitive Science not elsewhere classified (170299)
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Current > Schools > School of Nursing
Current > Schools > School of Public Health & Social Work
Copyright Owner: Copyright 2015 The Authors
Copyright Statement: This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Deposited On: 05 Jan 2015 04:57
Last Modified: 15 May 2015 02:24

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