Kim Hee-Ju, Kim Jung Eun Esther, Jung Sun Ok, Lee Dasuel, Abraham Ivo
Author Affiliations: College of Nursing, The Catholic University of Korea (Dr HJ Kim and Ms Lee), Seoul, South Korea; Division of Nursing Science, College of Health Sciences, Ewha Womans University (Ms Jung), Seoul, South Korea; School of Nursing, San Francisco State University (Dr JE Kim), California; and Center for Health Outcomes and PharmacoEconomic Research and Arizona Cancer Center, University of Arizona (Dr Abraham), Tucson.
Cancer Nurs. 2023;46(3):E159-E168. doi: 10.1097/NCC.0000000000001079. Epub 2022 Mar 24.
Findings from longitudinal studies can provide more conclusive evidence as to the impact of chemotherapy on cognitive functioning.
This study aimed to ( a ) synthesize the evidence from longitudinal studies of the neuropsychological effects associated with chemotherapy in breast cancer patients, ( b ) identify associated factors, and ( c ) evaluate methodological issues.
Data were extracted from PubMed, EMBASE, CINAHL, PsycINFO, and the Cochrane Library. Inclusion criteria included the original study with the breast cancer sample, validated measure, and at least 1 baseline data point before and after chemotherapy began. Data accrued for sample characteristics, data-collection time points, statistical methods for longitudinal data analysis, outcome measures, and major findings (eg, longitudinal changes in cognitive function).
We selected 42 articles for this review. The sample sizes ranged from 20 to 610, and most recruited were younger than 70 years. We found a trend across studies-statistically significant objective cognitive function deteriorations in severity and prevalence after initiating chemotherapy compared with a control group or relative to their baseline observations. A subsample, as high as 65%, experienced marked declines in cognitive function after initiating chemotherapy. The memory domain was most affected. The consistently associated factors were education, IQ, and regimen. Major methodological concerns were the measurement-the wide range of neuropsychological tests and a test's unclear domains.
Chemotherapy affects objective cognitive function in some subsets. The highest-impact time point, mechanisms, and clinical significance of chemotherapy-associated cognitive impairment need additional evidence.
Clinicians must assess and manage cognitive impairment during and after chemotherapy.
纵向研究的结果可为化疗对认知功能的影响提供更确凿的证据。
本研究旨在（a）综合乳腺癌患者化疗相关神经心理学效应纵向研究的证据；（b）确定相关因素；（c）评估方法学问题。
从PubMed、EMBASE、CINAHL、PsycINFO和Cochrane图书馆中提取数据。纳入标准包括以乳腺癌样本为对象的原始研究、经过验证的测量方法，以及化疗开始前后至少1个基线数据点。收集样本特征、数据收集时间点、纵向数据分析的统计方法、结局指标和主要发现（如认知功能的纵向变化）的数据。
我们为本综述选择了42篇文章。样本量从20到610不等，大多数招募的患者年龄小于70岁。我们发现各研究呈现出一种趋势——与对照组相比或相对于其基线观察结果，化疗开始后客观认知功能在严重程度和患病率方面出现具有统计学意义的恶化。一个子样本，高达65%，在化疗开始后经历了认知功能的显著下降。记忆领域受影响最大。始终相关的因素是教育程度、智商和治疗方案。主要的方法学问题是测量——神经心理学测试范围广泛且测试领域不明确。
化疗在某些亚组中会影响客观认知功能。化疗相关认知障碍的最高影响时间点、机制和临床意义需要更多证据。
临床医生必须在化疗期间及化疗后评估和管理认知障碍。
