Kim Hee-Ju, Jung Sun-Ok, Kim Esther, Abraham Ivo
College of Nursing, The Catholic University of Korea, Seoul, South Korea.
Division of Nursing Science, College of Health Sciences, Ewha Womans University, Seoul, South Korea.
Eur J Oncol Nurs. 2022 Apr;57:102099. doi: 10.1016/j.ejon.2022.102099. Epub 2022 Jan 29.
This meta-analysis with longitudinal prospective cohort studies aimed to (a) determine whether chemotherapy is associated with time-dependent subjective cognitive impairment outcomes in breast cancer patients, and (b) identify the time point with the highest impact of chemotherapy on subjective cognitive impairment.
Data were gathered from PubMed, EMBASE, CINAHL, PsycInfo, and the Cochrane Library. The mean differences of the subjective cognitive impairment level between the chemotherapy-treated patients and controls (patients not treated by chemotherapy and healthy subjects) were calculated using effect sizes (Hedges' g) by clinical time periods. The five clinical time periods were (a) baseline, (b) during chemotherapy, (c) within 1 month postchemotherapy, (d) within 1 year postchemotherapy, and (e) 1 year or longer postchemotherapy.
Longitudinal data from nine data sets from 13 studies were pooled and analyzed. At baseline, chemotherapy-treated patients showed slightly better subjective cognitive impairment compared to patients not treated by chemotherapy and did not differ from healthy controls. Yet, the chemotherapy-treated patients had significantly worse subjective cognitive impairment compared to both type of controls after initiating chemotherapy. The effect sizes for the group differences were larger for the group comparison with healthy controls than the nonchemotherapy control (-0.50 vs. -0.19). The largest effects were found within 1 month postchemotherapy (-0.85), suggesting the acute impact of chemotherapy.
Chemotherapy is associated with subjective cognitive impairment. The impact of chemotherapy appears to be an acute rather than a chronic side effect. Clinicians must consider including the assessment and management of subjective cognitive impairment in their routine practice.
这项纳入纵向前瞻性队列研究的荟萃分析旨在：（a）确定化疗是否与乳腺癌患者随时间变化的主观认知障碍结局相关，以及（b）确定化疗对主观认知障碍影响最大的时间点。
从PubMed、EMBASE、CINAHL、PsycInfo和Cochrane图书馆收集数据。使用效应量（Hedges' g）按临床时间段计算化疗患者与对照组（未接受化疗的患者和健康受试者）之间主观认知障碍水平的平均差异。五个临床时间段分别为：（a）基线期，（b）化疗期间，（c）化疗后1个月内，（d）化疗后1年内，以及（e）化疗后1年或更长时间。
汇总并分析了来自13项研究的9个数据集的纵向数据。在基线期，与未接受化疗的患者相比，接受化疗的患者主观认知障碍情况略好，且与健康对照组无差异。然而，开始化疗后，与两种对照组相比，接受化疗的患者主观认知障碍明显更严重。与健康对照组的组间比较的效应量大于与未化疗对照组的比较（-0.50对-0.19）。化疗后1个月内效应最大（-0.85），表明化疗的急性影响。
化疗与主观认知障碍相关。化疗的影响似乎是一种急性而非慢性副作用。临床医生在日常实践中必须考虑纳入主观认知障碍的评估和管理。
