Wefel Jeffrey S, Kesler Shelli R, Noll Kyle R, Schagen Sanne B
Associate Professor, Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
CA Cancer J Clin. 2015 Mar;65(2):123-38. doi: 10.3322/caac.21258. Epub 2014 Dec 5.
Answer questions and earn CME/CNE Over the past few decades, a body of research has emerged confirming what many adult patients with noncentral nervous system cancer have long reported-that cancer and its treatment are frequently associated with cancer-related cognitive impairment (CRCI). The severity of CRCI varies, and symptoms can emerge early or late in the disease course. Nonetheless, CRCI is typically mild to moderate in nature and primarily involves the domains of memory, attention, executive functioning, and processing speed. Animal models and novel neuroimaging techniques have begun to unravel the pathophysiologic mechanisms underlying CRCI, including the role of inflammatory cascades, direct neurotoxic effects, damage to progenitor cells, white matter abnormalities, and reduced functional connectivity, among others. Given the paucity of research on CRCI with other cancer populations, this review synthesizes the current literature with a deliberate focus on CRCI within the context of breast cancer. A hypothetical case-study approach is used to illustrate how CRCI often presents clinically and how current science can inform practice. While the literature regarding intervention for CRCI is nascent, behavioral and pharmacologic approaches are discussed.
回答问题并获得继续医学教育/护理继续教育学时 在过去几十年中，一系列研究证实了许多非中枢神经系统癌症成年患者长期以来的报告——癌症及其治疗常常与癌症相关认知障碍（CRCI）有关。CRCI的严重程度各不相同，症状可在病程早期或晚期出现。尽管如此，CRCI通常性质为轻度至中度，主要涉及记忆、注意力、执行功能和处理速度等领域。动物模型和新型神经成像技术已开始揭示CRCI潜在的病理生理机制，包括炎症级联反应的作用、直接神经毒性作用、祖细胞损伤、白质异常以及功能连接性降低等。鉴于针对其他癌症人群的CRCI研究较少，本综述综合了当前文献，并特意聚焦于乳腺癌背景下的CRCI。采用假设性案例研究方法来说明CRCI在临床上通常如何表现以及当前科学如何为实践提供信息。虽然关于CRCI干预的文献尚处于初期阶段，但也讨论了行为和药物治疗方法。
