Department of Gynecology and Obstetrics, Ludwig Maximilian University, Munich, Germany.
Psychooncology. 2010 Dec;19(12):1321-8. doi: 10.1002/pon.1695.
Complaints of cognitive dysfunction are frequent among cancer patients. Many studies have identified neuropsychological compromise associated with cancer and cancer therapy; however, the neuropsychological compromise was not related to self-reported cognitive dysfunction. In this prospective study, the authors examined if confounding factors masked an underlying association of self-perceived cognitive function with actual cognitive performance. Determinants of self-perceived cognitive dysfunction were investigated.
Self-perceived cognitive function and cognitive performance were assessed before treatment, at the end of treatment, and 1 year after baseline in 101 breast cancer patients randomized to standard versus intensified chemotherapy. Linear mixed-effects models were applied to test the relationships of performance on neuropsychological tests, patient characteristics, and treatment variables to self-reported cognitive function. Change of cognitive performance was tested as a predictor of change in self-reports.
Self-perceived cognitive function deteriorated during chemotherapy and had partially recovered 1 year after diagnosis. The personality trait negative affectivity, current depression, and chemotherapy regimen were consistently related to cognitive self-reports. No significant associations with performance in any of the 12 cognitive tests emerged. Change of cognitive performance was not reflected in self-reports of cognitive function.
Neuropsychological compromise and self-perceived cognitive dysfunction are independent phenomena in cancer patients. Generally, cancer-associated neuropsychological compromise is not noticed by affected patients, but negative affectivity and treatment burden induce pessimistic self-appraisals of cognitive functioning regardless of the presence of neuropsychological compromise. Clinicians should consider this when determining adequate therapy for patients who complain of 'chemobrain'.
癌症患者常抱怨认知功能障碍。许多研究已经确定了与癌症和癌症治疗相关的神经认知障碍；然而，神经认知障碍与自我报告的认知功能障碍无关。在这项前瞻性研究中，作者研究了混杂因素是否掩盖了自我感知的认知功能与实际认知表现之间的潜在关联。调查了自我感知认知障碍的决定因素。
101 名随机接受标准或强化化疗的乳腺癌患者在基线前、治疗结束时和 1 年后进行自我感知认知功能和认知表现评估。线性混合效应模型用于测试神经心理学测试的表现、患者特征和治疗变量与自我报告认知功能的关系。测试认知表现的变化是否可以预测自我报告的变化。
自我感知认知功能在化疗期间恶化，在诊断后 1 年部分恢复。人格特质负性情感、当前抑郁和化疗方案与认知自我报告一致相关。在 12 项认知测试中的任何一项中，均未出现与表现显著相关的结果。认知表现的变化并未反映在认知功能的自我报告中。
癌症患者的神经认知障碍和自我感知认知障碍是两个独立的现象。一般来说，癌症相关的神经认知障碍不会被受影响的患者注意到，但负性情感和治疗负担会导致对认知功能的悲观自我评价，而不论是否存在神经认知障碍。当确定对抱怨“化疗脑”的患者进行适当的治疗时，临床医生应考虑到这一点。
