Quesnel Catherine, Savard Josée, Ivers Hans
School of Psychology, Université Laval and Laval University Cancer Research Center, Quebec, QC, Canada.
Breast Cancer Res Treat. 2009 Jul;116(1):113-23. doi: 10.1007/s10549-008-0114-2. Epub 2008 Jul 16.
Published cross-sectional studies have revealed that chemotherapy for breast cancer is associated with significant cognitive impairments. However, because these studies included no baseline assessment, it is unknown whether the cognitive impairments were pre-existent to cancer treatment or truly secondary to chemotherapy. To resolve this issue, this prospective study aimed to compare the effects of chemotherapy to the effect of radiotherapy on cognitive functioning in women treated for non-metastatic breast cancer.
A total of 81 breast cancer patients, 41 receiving chemotherapy as part of their breast cancer treatment regimen and 40 receiving radiotherapy without chemotherapy were evaluated using an extensive battery of neuropsychological tests at baseline (ie, pre-chemotherapy or pre-radiotherapy), post-treatment (ie, post-chemotherapy or post-radiotherapy) and at a 3-month follow-up assessment.
A mixed model covariance analysis revealed that receiving any kind of breast cancer treatment, with chemotherapy or not, was associated with impaired capacities for recruiting information in verbal memory. Moreover, the results showed that verbal fluency was impaired after breast cancer treatment, but only in patients who received chemotherapy.
Overall, this study reveals subtle cognitive impairments associated with breast cancer treatment. Specifically, it suggests that chemotherapy has a specific negative effect on verbal fluency, that breast cancer treatment in general negatively affects verbal memory, but that other cognitive functions are well preserved. Future studies should, however, attempt to better control the practice effect that may have masked other subtle alterations and use more ecologically valid measures of cognitive functioning.
已发表的横断面研究表明，乳腺癌化疗与显著的认知障碍有关。然而，由于这些研究未进行基线评估，尚不清楚这些认知障碍是癌症治疗前就已存在，还是真正继发于化疗。为解决这一问题，本前瞻性研究旨在比较化疗与放疗对非转移性乳腺癌女性认知功能的影响。
共有81例乳腺癌患者，其中41例在乳腺癌治疗方案中接受化疗，40例接受放疗但未接受化疗，在基线（即化疗前或放疗前）、治疗后（即化疗后或放疗后）以及3个月随访评估时，使用一系列广泛的神经心理学测试进行评估。
混合模型协方差分析显示，接受任何一种乳腺癌治疗，无论是否接受化疗，都与言语记忆中信息提取能力受损有关。此外，结果表明乳腺癌治疗后言语流畅性受损，但仅在接受化疗的患者中出现。
总体而言，本研究揭示了与乳腺癌治疗相关的细微认知障碍。具体而言，表明化疗对言语流畅性有特定的负面影响，乳腺癌治疗总体上对言语记忆有负面影响，但其他认知功能保存良好。然而，未来的研究应尝试更好地控制可能掩盖其他细微变化的练习效应，并使用更具生态效度的认知功能测量方法。
