Cognitive Dysfunction Following Adjuvant Chemotherapy for Breast Cancer: Two Case Studies
Purpose/Objectives: To describe the cognitive dysfunction experienced by two women after they received adjuvant chemotherapy for breast cancer and to discuss the potential role of changes in reproductive status and depression in the development of cognitive dysfunction.
Data Sources: Journal articles, research data, and clinical experience.
Data Synthesis: Following chemotherapy, 17%-50% of women with breast cancer experience cognitive dysfunction that may include decrements in memory, attention, and psychomotor efficiency. One mechanism that may contribute to cognitive dysfunction involves changes in reproductive status resulting from chemotherapy. Additionally, the presence of depression may confound the experience of cognitive dysfunction.
Conclusions: A comprehensive description of cognitive dysfunction and improved understanding of the interrelationships among cognitive dysfunction, reproductive hormone levels, and depression in women with breast cancer receiving adjuvant chemotherapy may hasten the development of interventions for the management of cognitive dysfunction.
Implications for Nursing: Nurses should teach women with breast cancer and their families about the potential for cognitive dysfunction after chemotherapy so the problem can be recognized and interventions can be implemented to help women compensate for the dysfunction.
Jump to a section
References
Beck, A.T., Steer, R.A., & Brown, G.K. (1996). The Beck Depression Inventory (2nd ed.). San Antonio, TX: Psychological Corporation.
Bender, C.M. (1994). Cognitive dysfunction associated with biological response modifier therapy. Oncology Nursing Forum, 21, 515-523.
Bender, C.M., Paraska, K.K., Sereika, S.M., Ryan, C.M., & Berga, S.L. (2001). Cognitive function and reproductive hormones in adjuvant therapy for breast cancer: A critical review. Journal of Pain and Symptom Management, 21, 407-424.
Berglund, G., Bolund, C., Fornander, T., Rutqvist, L.E., & Sjoden, P.O. (1991). Late effects of adjuvant chemotherapy and postoperative radiotherapy on quality of life among breast cancer patients. European Journal of Cancer, 27, 1075-1081.
Bines, J., Oleske, D.M., & Cobleigh, M.A. (1996). Ovarian function in premenopausal women treated with adjuvant chemotherapy for breast cancer. Journal of Clinical Oncology, 14, 1718-1729.
Brezden, C.B., Phillips, K.A., Abdolell, M., Bunston, T., & Tannock, I.F. (2000). Cognitive function in breast cancer patients receiving adjuvant chemotherapy. Journal of Clinical Oncology, 18, 2695-2701.
Chelune, G.J., Heaton, R.K., & Lehman, R.A.W. (1986). Neuropsychological and personality correlates of patients' complaints of disability. In G. Goldstein & R.E. Tarter, (Eds.) Advances in clinical neuropsychology, volume 3 (pp. 95-126). New York: Plenum Press.
Cimprich, B. (1992). A theoretical perspective on attention and patient education. Advances in Nursing Science, 14(3), 39-51.
Cohen, R.M., Weingartner, H., Smallberg, S.A., Pickar, D., & Murphy, D.L. (1982). Effort and cognition in depression. Archives of General Psychiatry, 39, 593-597.
Curran, H.V. (1992). Antidepressant drugs, cognitive function, and human performance. In A.P. Smith & D.M. Jones, (Eds.) Handbook of human performance: Health and performance, volume 2. London: Academic Press, Harcourt, Brace, Jovanovich.
Danforth, D.N., Jr. (1991). How subsequent pregnancy affects outcome in women with a prior breast cancer. Oncology, 5(11), 23-35.
Farrag, A.K., Khedr, E.M., Abdel-Aleem, H., & Rageh, T.A. (2002). Effect of surgical menopause on cognitive functions. Dementia and Geriatric Cognitive Disorders, 13, 193-198.
Grodstein, F., Chen, J., Pollen, D.A., Albert, M.S., Wilson, R.S., Folstein, M.F., et al. (2000). Postmenopausal hormone therapy and cognitive function in healthy older women. Journal of the American Geriatrics Society, 48, 746-752.
Henderson, V.W., Paganini-Hill, A., Emanuel, C.K., Dunn, M.E., & Buckwalter, J.G. (1994). Estrogen replacement therapy in older women. Comparisons between Alzheimer's disease cases and nondemented control subjects. Archives of Neurology, 51, 896-900.
Jemal, A., Murray, T., Samuels, A., Ghafoor, A., Ward, E., & Thun, M.J. (2003). Cancer statistics, 2003. CA: A Cancer Journal for Clinicians, 53, 5-26.
Klove, H. (1963). Clinical neuropsychology. In F.M. Forster (Ed.), The medical clinics of North America (pp. 1647-1658). New York: Saunders.
Lafayette Clinical Repeatable Neuropsychological Test Battery. (1989). Sagamore, IN: Lafayette Clinical Instrument Company.
McCaffrey, R.J., & Westervelt, H.J. (1995). Issues associated with repeated neuropsychological assessments. Neuropsychology Review, 5, 203-221.
Mehta, R.R., Beattie, C.W., & Das Gupta, T.K. (1992). Endocrine profile in breast cancer patients receiving chemotherapy. Breast Cancer Research and Treatment, 20, 125-132.
Michaud, L.B., Valero, V., & Hortobagyi, G. (2000). Risks and benefits of taxanes in breast and ovarian cancer. Drug Safety, 23, 401-428.
Osterrieth, P.A. (1944). Le test de copie d'une figure complexe [Complex figure copy test]. Archives de Psychologie, 30, 206-356.
Paganini-Hill, A., & Clark, L.J. (2000). Preliminary analysis of cognitive function in breast cancer patients treated with tamoxifen. Breast Cancer Research and Treatment, 64, 165-176.
Phillips, S.M., & Sherwin, B.B. (1992). Effects of estrogen on memory function in surgically menopausal women. Psychoneuroendocrinology, 17, 485-495.
Reitan, R.M. (1958). Validity of the Trail Making Test as an indicator of organic brain damage. Perceptual and Motor Skills, 8, 271-276.
Resnick, S.M., & Maki, P.M. (2001). Effects of hormone replacement therapy on cognitive and brain aging. Annals of the New York Academy of Sciences, 949, 203-214.
Rey, A. (1964). L'examen psychologique dans les cas d'encephalopathie traumatique. Archives de Psychologie, 122, 332-340.
Robinson, D., Friedman, L., Marcus, R., Tinklenberg, J., & Yesavage, J. (1994). Estrogen replacement therapy and memory in older women. Journal of the American Geriatrics Society, 42, 919-922.
Schagen, S.B., van Dam, F.S., Muller, M.J., Boogerd, W., Lindeboom, J., & Bruning, P.F. (1999). Cognitive deficits after postoperative adjuvant chemotherapy for breast carcinoma. Cancer, 85, 640-650.
Sherwin, B.B. (1996). Hormones, mood, and cognitive functioning in postmenopausal women. Obstetrics and Gynecology, 87(Suppl. 2), 20S-26S.
Sherwin, B.B., & Gelfand, M.M. (1985). Sex steroids and affect in the surgical menopause: A double-blind, cross-over study. Psychoneuroendocrinology, 10, 325-335.
Sweet, J.J., Newman, P., & Bell, B. (1992). Significance of depression in clinical neuropsychological assessment. Clinical Psychology Review, 12, 21-45.
Tarbuck, A.F., & Paykel, E.S. (1995). Effects of major depression on the cognitive function of younger and older subjects. Psychological Medicine, 25, 285-295.
van Dam, F.S., Schagen, S.B., Muller, M.J., Boogerd, W., Wall, E., Droogleever-Fortuyn, M.E., et al. (1998). Impairment of cognitive function in women receiving adjuvant treatment for high-risk breast cancer: High-dose versus standard-dose chemotherapy. Journal of the National Cancer Institute, 90, 210-218.
Wechsler, D. (1981). Manual for the Wechsler Adult Intelligence Scale-Revised. New York: Psychological Corporation.
Weingartner, H., & Silberman, E. (1982). Models of cognitive impairment: Cognitive changes in depression. Psychopharmacology Bulletin, 18(2), 27-42.
Wieneke, M.H., & Dienst, E.R. (1995). Neuropsychological assessment of cognitive functioning following chemotherapy for breast cancer. Psycho-Oncology, 4, 61-66.
Wilson, B., Cockburn, J., Baddeley, A., & Hiorns, R. (1989). The development and validation of a test battery for detecting and monitoring everyday memory problems. Journal of Clinical and Experimental Neuropsychology, 11, 855-870.