Alteraciones cognitivas por quimioterapia en pacientes con cáncer de mama:: una revisión bibliográfica

Bernardo Arce; Nora Grañana

doi:10.31053/1853.0605.v80.n2.40533

Authors

Bernardo Arce Psicologo
Nora Grañana Médica Neuróloga

DOI:

https://doi.org/10.31053/1853.0605.v80.n2.40533

Keywords:

drug therapy, breast neoplasms, chemotherapy related cognitive impairment

Abstract

Background: Patients with breast cancer may experience cognitive difficulties from chemotherapy. This alteration is called Chemoinduced Cognitive Impairment, also known as Chemobrain or Chemofog. Objective: To identify the cognitive profile and the characteristics of the neuropsychological assessment in this population. Method: PubMed, SpringerLink and SciELO databases were revised. Articles from 1994 to September 2021 were selected. Keywords related to the study topic were used. Results: Chemotherapy can cause cognitive impairment between 15 and 50% of women. This disturbance may be from multiple aetiologies and can be associated with biological factors and functional and/or structural changes of the CNS. Sociodemographic, clinical and psychological factors should be considered as modulating variables. It manifests mainly with memory problems, executive function, attention and processing speed impairment. It can be measured through neuropsychological evaluation instruments. Discussion and conclusion: We suggest that chemo-induced cognitive impairment should be included to the informed consent. Further development of longitudinal studies complemented with neuroimages that allow us to advance in the knowledge of this problem is recommended. A neuropsychological protocol is proposed, which includes screening tests, clinical scales, specific cognitive tests and quality of life questionnaires, within the recommendations of the International Cognition and Cancer Task Force

Author Biographies

Bernardo Arce, Psicologo

- Mental Health Service, María Curie Municipal Oncology Hospital, Autonomous City of Buenos Aires, Argentina.
- Specialist in Clinical Neuropsychology (University of Buenos Aires)
- Degree in Psychology (National University of Tucumán)
Nora Grañana, Médica Neuróloga

- Child Neurology Service, Carlos G. Durand Acute General Hospital, Autonomous City of Buenos Aires, Argentina.
- PhD in Psychology with a focus on Applied Cognitive Neuroscience
- Medical Neurologist

References

López-Santiago S, Cruzado JA, Feliú J. Chemobrain: revisión de estudios que evalúan el deterioro cognitivo de supervivientes de cáncer tratados con quimioterapia. Psicooncología. 2011;8(2-3):265-280.

Rubio B, Sirgo A, Forcadell E, Mele M, Guma J. Deterioro cognitivo inducido por los tratamientos oncológicos sistémicos en el cáncer de mama no metastásico: revisión de estudios. Psicooncología. 2009;6(1):83-120.

Vardy J. Neurocognitive effects of chemotherapy in adults. Aust Prescr. 2008;31(1):22-24. doi: 10.18773/austprescr.2008.012.

Feliú J, López-Santiago S, Martínez-Marín V, Custodio AB, Antonio Cruzado J. Bases biológicas del deterioro de la función cognitiva inducido por los tratamientos antineoplásicos. Psicooncología. 2011;8:201-213.

Dijkshoorn ABC, van Stralen HE, Sloots M, Schagen SB, Visser-Meily JMA, Schepers VPM. Prevalence of cognitive impairment and change in patients with breast cancer: A systematic review of longitudinal studies. Psychooncology. 2021 May;30(5):635-648. doi: 10.1002/pon.5623.

Ongnok B, Chattipakorn N, Chattipakorn SC. Doxorubicin and cisplatin induced cognitive impairment: The possible mechanisms and interventions. Exp Neurol. 2020 Feb;324:113118. doi: 10.1016/j.expneurol.2019.113118.

Theoharides TC, Cholevas C, Polyzoidis K, Politis A. Long-COVID syndrome-associated brain fog and chemofog: Luteolin to the rescue. Biofactors. 2021;47(2):232-241. doi: 10.1002/biof.1726.

Tangpong J, Cole MP, Sultana R, Estus S, Vore M, St Clair W, Ratanachaiyavong S, St Clair DK, Butterfield DA. Adriamycin-mediated nitration of manganese superoxide dismutase in the central nervous system: insight into the mechanism of chemobrain. J Neurochem. 2007 Jan;100(1):191-201. doi: 10.1111/j.1471-4159.2006.04179.x.

Wefel JS, Kesler SR, Noll KR, Schagen SB. Clinical characteristics, pathophysiology, and management of noncentral nervous system cancer-related cognitive impairment in adults. CA Cancer J Clin. 2015 Mar;65(2):123-38. doi: 10.3322/caac.21258.

Andryszak P, Wiłkość M, Izdebski P, Żurawski B. A systemic literature review of neuroimaging studies in women with breast cancer treated with adjuvant chemotherapy. Contemp Oncol (Pozn). 2017;21(1):6-15. doi: 10.5114/wo.2017.66652.

Suberbielle E, Djukic B, Evans M, Kim DH, Taneja P, Wang X, Finucane M, Knox J, Ho K, Devidze N, Masliah E, Mucke L. DNA repair factor BRCA1 depletion occurs in Alzheimer brains and impairs cognitive function in mice. Nat Commun. 2015 Nov 30;6:8897. doi: 10.1038/ncomms9897.

Harrison RA, Rao V, Kesler SR. The association of genetic polymorphisms with neuroconnectivity in breast cancer patients. Sci Rep. 2021 Mar 17;11(1):6169. doi: 10.1038/s41598-021-85768-4.

Horgusluoglu E, Nudelman K, Nho K, Saykin AJ. Adult neurogenesis and neurodegenerative diseases: A systems biology perspective. Am J Med Genet B Neuropsychiatr Genet. 2017 Jan;174(1):93-112. doi: 10.1002/ajmg.b.32429.

Tsavaris N, Kosmas C, Vadiaka M, Kanelopoulos P, Boulamatsis D. Immune changes in patients with advanced breast cancer undergoing chemotherapy with taxanes. Br J Cancer. 2002 Jul 1;87(1):21-7. doi: 10.1038/sj.bjc.6600347.

Ganz PA, Bower JE, Kwan L, Castellon SA, Silverman DH, Geist C, Breen EC, Irwin MR, Cole SW. Does tumor necrosis factor-alpha (TNF-α) play a role in post-chemotherapy cerebral dysfunction? Brain Behav Immun. 2013 Mar;30 Suppl(Suppl):S99-108. doi: 10.1016/j.bbi.2012.07.015.

Cheung YT, Ng T, Shwe M, Ho HK, Foo KM, Cham MT, Lee JA, Fan G, Tan YP, Yong WS, Madhukumar P, Loo SK, Ang SF, Wong M, Chay WY, Ooi WS, Dent RA, Yap YS, Ng R, Chan A. Association of proinflammatory cytokines and chemotherapy-associated cognitive impairment in breast cancer patients: a multi-centered, prospective, cohort study. Ann Oncol. 2015 Jul;26(7):1446-51. doi: 10.1093/annonc/mdv206.

McEwen BS. Stress and hippocampal plasticity. Annu Rev Neurosci. 1999;22:105-22. doi: 10.1146/annurev.neuro.22.1.105.

Argyriou AA, Assimakopoulos K, Iconomou G, Giannakopoulou F, Kalofonos HP. Either called "chemobrain" or "chemofog," the long-term chemotherapy-induced cognitive decline in cancer survivors is real. J Pain Symptom Manage. 2011 Jan;41(1):126-39. doi: 10.1016/j.jpainsymman.2010.04.021.

Gómez-Cruz M. Déficits neuropsicológicos asociados a alteraciones cerebrales secundarias a tratamientos oncológicos. Psicooncología. 2011;8(2-3):215-229.

El Waly B, Macchi M, Cayre M, Durbec P. Oligodendrogenesis in the normal and pathological central nervous system. Front Neurosci. 2014 Jun 12;8:145. doi: 10.3389/fnins.2014.00145.

Li TY, Chen VC, Yeh DC, Huang SL, Chen CN, Chai JW, Chen CC, Weng JC. Investigation of chemotherapy-induced brain structural alterations in breast cancer patients with generalized q-sampling MRI and graph theoretical analysis. BMC Cancer. 2018 Dec 4;18(1):1211. doi: 10.1186/s12885-018-5113-z.

Bai X, Zheng J, Zhang B, Luo Y. Cognitive Dysfunction and Neurophysiologic Mechanism of Breast Cancer Patients Undergoing Chemotherapy Based on Resting State Functional Magnetic Resonance Imaging. World Neurosurg. 2021 May;149:406-412. doi: 10.1016/j.wneu.2020.10.066.

Blommaert J, Schroyen G, Vandenbulcke M, Radwan A, Smeets A, Peeters R, Sleurs C, Neven P, Wildiers H, Amant F, Sunaert S, Deprez S. Age-dependent brain volume and neuropsychological changes after chemotherapy in breast cancer patients. Hum Brain Mapp. 2019 Dec 1;40(17):4994-5010. doi: 10.1002/hbm.24753.

Tong T, Lu H, Zong J, Lv Q, Chu X. Chemotherapy-related cognitive impairment in patients with breast cancer based on MRS and DTI analysis. Breast Cancer. 2020 Sep;27(5):893-902. doi: 10.1007/s12282-020-01094-z.

Miao H, Chen X, Yan Y, He X, Hu S, Kong J, Wu M, Wei Y, Zhou Y, Wang L, Wang K, Qiu B. Functional connectivity change of brain default mode network in breast cancer patients after chemotherapy. Neuroradiology. 2016 Sep;58(9):921-8. doi: 10.1007/s00234-016-1708-8.

McDonald BC, Conroy SK, Smith DJ, West JD, Saykin AJ. Frontal gray matter reduction after breast cancer chemotherapy and association with executive symptoms: a replication and extension study. Brain Behav Immun. 2013;30 Suppl(0):S117-S125. doi: 10.1016/j.bbi.2012.05.007.

Apple AC, Ryals AJ, Alpert KI, Wagner LI, Shih PA, Dokucu M, Cella D, Penedo FJ, Voss JL, Wang L. Subtle hippocampal deformities in breast cancer survivors with reduced episodic memory and self-reported cognitive concerns. Neuroimage Clin. 2017 Mar 16;14:685-691. doi: 10.1016/j.nicl.2017.03.004.

Henneghan A, Rao V, Harrison RA, Karuturi M, Blayney DW, Palesh O, Kesler SR. Cortical Brain Age from Pre-treatment to Post-chemotherapy in Patients with Breast Cancer. Neurotox Res. 2020 Apr;37(4):788-799. doi: 10.1007/s12640-019-00158-z.

Silverman DH, Dy CJ, Castellon SA, Lai J, Pio BS, Abraham L, Waddell K, Petersen L, Phelps ME, Ganz PA. Altered frontocortical, cerebellar, and basal ganglia activity in adjuvant-treated breast cancer survivors 5-10 years after chemotherapy. Breast Cancer Res Treat. 2007 Jul;103(3):303-11. doi: 10.1007/s10549-006-9380-z.

Sousa H, Almeida S, Bessa J, Pereira MG. The Developmental Trajectory of Cancer-Related Cognitive Impairment in Breast Cancer Patients: A Systematic Review of Longitudinal Neuroimaging Studies. Neuropsychol Rev. 2020 Sep;30(3):287-309. doi: 10.1007/s11065-020-09441-9.

Gururangan S. Late effects of chemotherapy. Cancer Treat Res. 2009;150:43-65. doi: 10.1007/b109924_4.

Bernabeu Verdú, J., Cañete Nieto, A., Founier del Castillo, C., López-Luengo, B., Barahona Clemente, T., Grau Rubio, C., Castel Sánchez, V. Evaluación y rehabilitación neuropsicológica en oncología pediátrica. Psicooncología. 2003;1:117-134.

Dwek MR, Rixon L, Simon A, Hurt C, Newman S. Examining the effects of adjuvant chemotherapy on cognition and the impact of any cognitive impairment on quality of life in colorectal cancer patients: study protocol. BMC Psychol. 2015 Nov 26;3:43. doi: 10.1186/s40359-015-0100-5.

Cerulla Torrente N, Navarro Pastor JB, de la Osa Chaparro N. Systematic review of cognitive sequelae of non-central nervous system cancer and cancer therapy. J Cancer Surviv. 2020 Aug;14(4):464-482. doi: 10.1007/s11764-020-00870-2.

McDougall GJ Jr, Oliver JS, Scogin F. Memory and cancer: a review of the literature. Arch Psychiatr Nurs. 2014 Jun;28(3):180-6. doi: 10.1016/j.apnu.2013.12.005.

Yao C, Bernstein LJ, Rich JB. Executive functioning impairment in women treated with chemotherapy for breast cancer: a systematic review. Breast Cancer Res Treat. 2017 Nov;166(1):15-28. doi: 10.1007/s10549-017-4376-4.

Schrauwen W, Van de Cavey J, Vingerhoets G, Vanheule S, Van den Broecke R, Denys H. Heterogeneous Response of Chemotherapy-Related Cognitive Decline in Patients with Breast Cancer: A Prospective Study. J Int Neuropsychol Soc. 2020 Sep;26(8):806-814. doi: 10.1017/S1355617720000296.

Vardy J. Cognitive function in survivors of cancer. American Society of Clinical Oncology Educational. 2009;1:570-574.

Baumann, D., Burin. D. "Evaluación de la inteligencia." En: Burin D, Drake M, Harris P. Evaluación neuropsicológica en adultos. Buenos Aires: Paidós (2007): 97-128.

Wefel JS, Vardy J, Ahles T, Schagen SB. International Cognition and Cancer Task Force recommendations to harmonise studies of cognitive function in patients with cancer. Lancet Oncol. 2011 Jul;12(7):703-8. doi: 10.1016/S1470-2045(10)70294-1.

López-Santiago S, Cruzado J A, Feliú J. Daños Neuropsicológicos Asociados a los Tratamientos Quimioterapéuticos: Una Propuesta de Evaluación. Clínica y Salud. 2012;23(1):3-24.

Butman J, Arizaga R, Harris P, Drake M, Baumann D, Pascale A, et al. El Mini- Mental State Examination en español. Normas para Buenos Aires. Revista de Neurología Argentina. 2001;26:11-15.Drake, M, Burin-D., Harris P. Evaluación neuropsicológica en adultos. Buenos Aires: Paidós, 2007.

Torralva T, Roca M, Gleichgerrcht E, López P, Manes F. INECO Frontal Screening (IFS): a brief, sensitive, and specific tool to assess executive functions in dementia. J Int Neuropsychol Soc. 2009 Sep;15(5):777-86. doi: 10.1017/S1355617709990415.

Gercovich D, Torrente F, Lopez P, Bortolato D, Margiolakis P, Morgenfeld M, et al. Evaluación de propiedades psicométricas de la escala de ansiedad y depresión hospitalaria en pacientes oncológicos de Buenos Aires. Acta Psiquiat Psicol Am Lat. 2009;55(2):84-91.

Margulis LE, Squillace MR, Ferreres AR. Baremo del Trail Making Test para Capital Federal y Gran Buenos Aires. Revista Argentina de Ciencias del Comportamiento. 2018;10(2):58-67.

Strauss E, Sherman E, Spreen O. A compendium of neuropsychological tests: administration, norms, and commentary. Third Edition. Oxford University Press;2006.

Butman J, Allegri R, Harris P, Drake M. Fluencia verbal en español: datos normativos en argentina. Medicina. 2000;60:561-564.

Wechsler D, de la Guía E, Vallar F. WAIS-IV: escala de inteligencia de Wechsler para adultos-IV. Madrid: Pearson; 2012.

Arrarás JI, Illarramendi JJ, Valerdi JJ. El cuestionario de Calidad de Vida de la EORTC, QLQ-C30. Estudio estadístico de validación con una muestra española. Revista de Psicología de la Salud. 1995;7:13-30.