Catherine E. Jansen

A metaanalysis of studies of the effects of cancer chemotherapy on various domains of cognitive function

Little is known about the effects of chemotherapy on cognitive function. The purposes of this metaanalysis were to estimate the effect sizes for the effect of chemotherapy on each domain of cognitive function and to differentiate effect sizes by each method of comparison of effects (i.e., normative data, control group, or baseline data).

Preliminary results of a longitudinal study of changes in cognitive function in breast cancer patients undergoing chemotherapy with doxorubicin and cyclophosphamide

Objectives: Recent studies suggest that standard dose chemotherapy for breast cancer may cross the blood–brain barrier. However, the evidence for chemotherapy‐induced cognitive impairments in breast cancer patients is inconsistent. The purposes of this study in a sample of newly diagnosed patients with breast cancer were to (1) evaluate cognitive function prior to the administration of chemotherapy; (2) assess changes in cognitive function over time; and (3) evaluate potential relationships between cognitive function and anxiety, depression, fatigue, hemoglobin level, menopausal status, and perception of cognitive function.

Potential Mechanisms for Chemotherapy-Induced Impairments in Cognitive Function

PURPOSE/OBJECTIVES To review the domains of cognitive function and their corresponding neuroanatomic structures as well as present current evidence for neurotoxicity associated with specific chemotherapeutic agents and potential mechanisms for chemotherapy-induced cognitive impairments. DATA SOURCES Published research articles, review articles, and textbooks. DATA SYNTHESIS Chemotherapy does not appear to cross the blood-brain barrier when given in standard doses; however, many chemotherapy drugs have the potential to cause cognitive impairments through more than one mechanism. In addition, patient factors may be protective or place individuals at higher risk for cognitive impairments. CONCLUSIONS Although evidence of chemotherapy-induced impairments in cognitive function exists, no clinical studies have attempted to elucidate the mechanisms for chemotherapy-induced impairments in cognitive function. In addition, further studies are needed to determine predictive factors, potential biomarkers, and relevant assessment parameters. IMPLICATIONS FOR NURSING The ability to identify high-risk patients has important implications for practice in regard to informed consent, patient education about the effects of treatment, and preventive strategies.

A meta-analysis of the sensitivity of various neuropsychological tests used to detect chemotherapy-induced cognitive impairment in patients with breast cancer

PURPOSE/OBJECTIVES To identify which neuropsychological tests have been used to evaluate chemotherapy-induced impairment in various domains of cognitive function in patients with breast cancer and to determine the sensitivity of each of the tests through estimation of effect size. DATA SOURCES Original studies published from 1966-June 2006. DATA SYNTHESIS Although an array of neuropsychological tests are available to measure the various domains of cognitive function, information is lacking regarding the sensitivity and specificity of the tests to detect changes in cognitive function from chemotherapy. CONCLUSIONS This meta-analysis provides initial data on the sensitivity of some neuropsychological tests to determine chemotherapy-induced changes in cognitive function in patients with breast cancer. IMPLICATIONS FOR NURSING The identification of sensitive neuro-psychological tests is crucial to further understanding of chemotherapy-induced cognitive impairments.

Putting Evidence Into Practice: Evidence-Based Interventions for Cancer and Cancer Treatment-Related Cognitive Impairment

Cognitive impairment is a clinically complex symptom commonly experienced by cancer survivors. Although research in this area has grown, many questions remain regarding underlying mechanisms, trajectory, and specific interventions nurses can offer patients to prevent, treat, and manage cognitive impairment effectively. As part of the Oncology Nursing Society (ONS) Putting Evidence Into Practice (PEP) initiative, a comprehensive examination of the current literature was conducted to identify effective interventions for cognitive impairment in cancer survivors. The studies were categorized into nonpharmacologic interventions, including complementary and alternative therapies and cognitive training, and pharmacologic interventions, including psychostimulants and erythropoietin-stimulating agents. Using the ONS PEP Weight of Evidence Classification Schema, the levels of evidence for these interventions were consistent with the categories of effectiveness not established or not recommended for practice. Additional research is needed to identify effective preventive and treatment strategies for cognitive impairment in cancer survivors.

COPING STRATEGIES AND INTERVENTIONS FOR COGNITIVE CHANGES IN PATIENTS WITH CANCER

OBJECTIVES To provide a comprehensive summary of the coping strategies and evidence-based interventions used to address cognitive impairment following cancer and cancer treatment. DATA SOURCES Review and synthesis of empirical articles. CONCLUSION Survivors identified a structured environment and validation of their cognitive concerns as essential to adjustment. Although interventional research is still limited, non-pharmacological approaches such as cognitive training programs show the greatest promise. IMPLICATIONS FOR NURSING PRACTICE Oncology nurses must understand the available evidence and provide information and guidance to cancer survivors to address cognitive changes after cancer.

Predictors of the Trajectories of Self-Reported Attentional Fatigue in Women With Breast Cancer Undergoing Radiation Therapy

PURPOSE/OBJECTIVES To examine how attentional fatigue changed from the time of simulation to four months after the completion of radiation therapy and to investigate whether specific variables predicted initial levels and trajectories of attentional fatigue. DESIGN Descriptive, longitudinal study. SETTING Two radiation therapy departments. SAMPLE 73 women with breast cancer who received primary or adjuvant radiation therapy. METHODS Participants completed questionnaires prior to, during, and after radiation therapy. Descriptive statistics and hierarchical linear modeling were used for data analysis. MAIN RESEARCH VARIABLES Attentional fatigue; demographic, clinical, and symptom characteristics. FINDINGS Large amounts of interindividual variability were found in the trajectories of attentional fatigue. At baseline, higher levels of attentional fatigue were associated with younger age, not working, a higher number of comorbidities, and higher levels of trait anxiety. The trajectory of attentional fatigue improved over time for women with higher body mass index at baseline. CONCLUSIONS This study is the first to identify predictors of interindividual variability in attentional fatigue in women with breast cancer undergoing radiation therapy. The predictors should be considered in the design of future correlational and interventional studies. IMPLICATIONS FOR NURSING Nurses could use knowledge of the predictors to identify patients at risk for higher levels of attentional fatigue. In addition, nurses could use the information to educate patients about how attentional fatigue may change during and following radiation therapy for breast cancer.

Cognitive Changes Associated with Cancer and Cancer Therapy: Patient Assessment and Education

OBJECTIVES To provide a comprehensive review of assessment strategies used to determine cancer- and/or cancer treatment-related cognitive changes. DATA SOURCES Review and synthesis of review articles, databased resources. CONCLUSION Although several assessment strategies have been used to determine cancer- and/or cancer treatment-related cognitive changes, definitive standards have yet to be established. Further studies are needed to provide insight into practical and sensitive assessment tools to recognize cognitive changes that can be used in the clinical setting. IMPLICATIONS FOR NURSING PRACTICE The nurses awareness of cognitive concerns is essential for patient education and determination of when patients may need to be referred for more extensive evaluations.