Hostname: page-component-cd9895bd7-gbm5v Total loading time: 0 Render date: 2024-12-29T14:42:00.886Z Has data issue: false hasContentIssue false
  • English
  • Français

Neuropsychological effects of treatments for adults with cancer: A meta-analysis and review of the literature

Published online by Cambridge University Press:  12 February 2004

CAY ANDERSON-HANLEY ,
MARNE L. SHERMAN ,
RAINE RIGGS ,
V. BEDE AGOCHA  and
BRUCE E. COMPAS
CAY ANDERSON-HANLEY
Affiliation:
Skidmore College and the Cancer Center at Glens Falls Hospital, Glens Falls, New York
MARNE L. SHERMAN
Affiliation:
University of Missouri–Kansas City and The Cancer Institute, Kansas City, Missouri
RAINE RIGGS
Affiliation:
Brown University School of Medicine, Providence, Rhode Island
V. BEDE AGOCHA
Affiliation:
University of Connecticut, Farmington, Connecticut
BRUCE E. COMPAS
Affiliation:
Vanderbilt University, Nashville, Tennessee
Get access Rights & Permissions [Opens in a new window]

Abstract

A meta-analysis was conducted to evaluate possible neuropsychological effects of treatments for cancer in adults. A search revealed 30 studies, encompassing 29 eligible samples, and leading to inclusion of a total of 838 patients and control participants. A total of 173 effect sizes (Cohen's d) were extracted across 7 cognitive domains and as assessed in the literature via 3 methods of comparison (post-treatment compared with normative data, controls, or baseline performance). Statistically significant negative effect sizes were found consistently across both normative and control methods of comparison for executive function, verbal memory, and motor function. The largest effects were for executive function and verbal memory normative comparisons (−.93 and −.91, respectively). When limiting the sample of studies in the analyses to only those with relatively “less severe” diagnoses and treatments, the effects remained. While these results point toward some specific cognitive effects of systemic cancer therapies in general, no clear clinical implications can yet be drawn from these results. More research is needed to clarify which treatments may produce cognitive decrements, the size of those effects, and their duration, while ruling out a wide variety of possible mediating or moderating variables. (JINS, 2003, 9, 967–982.)

Keywords

Meta-analysisCancerChemotherapyExecutive functionVerbal memoryMotor function
Type
Research Article
Information
Journal of the International Neuropsychological Society , Volume 9 , Issue 7 , November 2003 , pp. 967 - 982
Copyright
© 2003 The International Neuropsychological Society

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Ahles, T.A. & Saykin, A.J. (2001). Cognitive effects of standard-dose chemotherapy in patients with cancer. Cancer Investigator, 19, 812–820.Google Scholar
a

Indicates that this study was included in analyses.

Ahles, T.A., Saykin, A.J., Furstenberb, C.T., Cole, B., Mott, L.A., Skalla, K., Whedon, M.B., Bivens, S., Mitchell, T., Greenberg, R., & Silberfarb, P.M. (2002). Neuropsychological impact of standard-dose systemic chemotherapy in long-term survivors of breast cancer and lymphoma. Journal of Clinical Oncology, 20, 485–493.Google Scholar
a Ahles, T.A., Silberfarb, P.M., Rundle, A.C., Holland, J.C., Kornblith, A.B., Canellos, G.P., Green, M.R., & Perry, M.C. (1994). Psychotherapy Psychosomatics, 62, 193–199.
a Ahles, T.A., Tope, D.M., Furstenberg, C., Hann, D., & Mills, L. (1996). Psychologic and neuropsychologic impact of autologous bone marrow transplantation. Journal of Clinical Oncology, 14, 1457–1462.Google Scholar
a Andrykowski, M.A., Schmitt, F.A., Gregg, M.E., Brady, M.J., Lamb, D.G., & Henlsee-Downey, P.J. (1992). Neuropsychological impairment in adult bone marrow transplant candidates. Cancer, 70, 2288–2297.Google Scholar
a Archibald, Y., Lunn, D., Ruttan, L., Macdonald, D., Del Maestro, R., Barr, H., Pexman, W., Fisher, B., Gaspar, L., & Cairncross, G. (1994). Cognitive functioning in long-term survivors of high-grade glioma. Journal of Neurosurgery, 80, 247–253.Google Scholar
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.Google Scholar
Bonadonna, G., Valagussa, V.E., & Rossi, A. (1985). Ten-year experience with CMF-based adjuvant chemotherapy in resectable breast cancer. Breast Cancer Research and Treatment, 5, 95.Google Scholar
Borenstein, M. & Rothstein, H. (2002). Comprehensive Meta Analysis Computer Program and Manual. Englewood Cliffs, NJ: Biostat, Inc.
a Brezden, C.B., Phillips, K., Abdolell, M., Bunston, T., & Tannock, I.F. (2000). Cognitive function in breast cancer patients receiving adjuvant chemotherapy. Journal of Clinical Oncology, 18, 2695–2701.Google Scholar
Brundage, M.D. (1997). Trading treatment toxicity for survival in locally advanced non-small cell lung cancer. Journal of Clinical Oncology, 15, 330–340.Google Scholar
Butler, R.W. (2002). Attentional processes and their remediation in children treated for cancer: a literature review and the development of a therapeutic approach. Journal of the International Neuropsychological Society, 8, 115–124.Google Scholar
a Capuron, L., Ravaud, A., & Dantzer, R. (2001). Timing and specificity of the cognitive changes induced by Interleukin-2 and Interferon-α treatments in cancer patients. Psychosomatic Medicine, 63, 376–386.Google Scholar
a Caraceni, A., Martini, C., Belli, F., Macheroni, L., Rivoltini, L., Arienti, F., & Cascinelli, N. (1992). Neuropsychological and neurophysiological assessment of the central effects of interleukin-2 administration. European Journal of Cancer, 29A, 1266–1269.Google Scholar
Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum Associates.
Cooper, H. & Hedges, L.V. (1994). Handbook of research synthesis. New York: Russell Sage Foundation.
Copeland, D.R., Fletcher, J.M., & Pfefferbaum-Levine, B. (1985). Neuropsychological sequelae of childhood cancer in long-term survivors. Pediatrics, 75, 745–753.Google Scholar
a Cull, A., Gregor, A., Hopwood, P., Macbeth, F., Karnicka-Mlodkowska, H., Thatcher, N., Burt, P., Stepniewska, K., & Stewart, M. (1994). Neurological and cognitive impairment in long-term survivors of small cell lung cancer. European Journal of Cancer, 30a, 1067–1074.Google Scholar
Cull, A., Hay, C., Love, S.B., Mackie, M., Smets, E., & Stewart, M. (1996). What do cancer patients mean when they complain of concentration and memory problems? British Journal of Cancer, 74, 1674–1679.Google Scholar
Daly, E., Komaroff, A.L., Bloomingdale, K., Wilson, S., & Albert, M.S. (2001). Neuropsychological function in patients with chronic fatigue syndrome, multiple sclerosis, and depression. Applied Neuropsychology, 8, 12–22.Google Scholar
a Denicoff, K.D., Rubinow, D.R., Papa, M.Z., Simpson, C., Seipp, C.A., Lotze, M.T., Change, A.E., Rosenstein, D., & Rosenberg, S.A. (1987). The neuropsychiatric effects of treatment with interleukin-2 and lymphokine-activated killer cells. Annals of Internal Medicine, 107, 293–300.Google Scholar
Devlen, J., Maguire, P., Phillips, P., & Crowther, D. (1987a). Psychological problems associated with diagnosis and treatment of lymphomas: II. Prospective study. British Journal of Medicine, 295, 955–957.Google Scholar
Devlen, J., Maguire, P., Phillips, P., Crowther, D., & Chambers, H. (1987b). Psychological problems associated with diagnosis and treatment of lymphomas. I: Retrospective study. British Journal of Medicine, 295, 953–954.Google Scholar
Dikmen, S.S., Heaton, R.K., Grant, I., & Temkin, N.R. (1999). Test–retest reliability and practice effects of Expanded Halstead-Reitan Neuropsychological Test Battery. Journal of the International Neuropsychological Society, 5, 346–356.Google Scholar
Eiser, C.J. (1998). Practitioner review: Long-term consequences of childhood cancer. Child Psychology and Psychiatry, 39, 621–633.Google Scholar
Ferguson, R.J. & Ahles, T.A. (2002). Brief cognitive-behavioral treatment of chemotherapy-associated attention and memory complaints among breast cancer survivors: Pilot data. Poster presented at the Annual Meeting of the Society of Behavioral Medicine, Washington, DC.
Fisher, B., Costantino, J.P., & Redmond, C.K. (1994). Endometrial cancer in tamoxifen-treated breast cancer patients: Findings from the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-14. Journal of the National Cancer Institute, 86, 527.Google Scholar
Fleishman, S.B. & Kalash, G.R. (1998). Chemotherapeutic agents and neuropsychiatric side effects. In J.C. Holland (Ed.), Psycho-oncology (pp. 630–658). New York: Oxford University Press.
Ganz, P.A. (1998). Cognitive dysfunction following adjuvant treatment of breast cancer: A new dose-limiting toxic effect? Journal of the National Cancer Institute, 90, 182–183.Google Scholar
Gotay, C.C. (1987). Quality of life among survivors of childhood cancer: A critical review and implications for intervention. Journal of Psychosocial Oncology, 5, 5–23.Google Scholar
Harder, H., Cornelissen, J.J., Van Gool, A.R., Duivenvoorden, H.J., Eijkenboom, W.M., & van den Bent, M.J. (2002). Cognitive functioning and quality of life in long-term adult survivors of bone marrow transplantation. Cancer, 95, 183–192.Google Scholar
a Kaasa, S., Olsnes, B.T., & Mastekaasa, A. (1988a). Neuropsychological evaluation of patients with inoperable non-small cell lung cancer treated with combination chemotherapy or radiotherapy. Acta Oncologica, 27, 241–246.Google Scholar
a Kaasa, S., Olsnes, B.T., Thorud, E., & Host, H. (1988b). Reduced short-term neuropsychological performance in patients with nonsmall-cell lung cancer treated with cisplatin and etoposide. Antibiotics and Chemotherapy, 41, 226–231.Google Scholar
a Komaki, R., Meyers, C.A., Dong, M.S., Garden, A.S., Byrne, K., Nickens, J.A., & Cox, J.D. (1995). Evaluation of cognitive function in patients with small cell lung cancer prior to and shortly following prophylactic cranial irradiation. International Journal of Radiation Oncology, Biology, and Physiology, 33, 179–182.Google Scholar
Mann, D. (1999). Memory lock: Is chemobrain making you forgetful? MAMM: Women, Cancer and Community, December/January, 67–69.Google Scholar
a Mayerhofer, K., Bodner-Adler, B., Bodner, K., Saletu, B., Schindl, M., Kaider, A., Hefler, L., Leodolter, S., & Kainz, C. (2000). A Paclitaxel-containing chemotherapy does not cause central nervous adverse effects: A prospective study in patients with ovarian cancer. Anticancer Research, 20, 4051–4056.Google Scholar
McCaffrey, R.J., Duff, K., & Westervelt, H.J. (2000). Practitioner's guide to evaluating change with intellectual assessment instruments. New York: Kluwer Academic.
Meyers, C.A. (2000). Neurocognitive dysfunction in cancer patients. Oncology, 14, 75–79.Google Scholar
Meyers, C.A. (2001). Mental status changes associated with biotherapy. In P.T. Rieger (Ed.), Biotherapy: A comprehensive overview (2nd ed., pp. 605–621). Boston: Jones and Bartlett Publishers.
a Meyers, C.A. & Abbruzzese, J.L. (1992). Cognitive functioning in cancer patients: Effect of previous treatment. Neurology, 42, 434–436.Google Scholar
a Meyers, C.A., Byrne, K., & Komaki, R. (1995). Cognitive deficits in patients with small cell lung cancer before and after chemotherapy. Lung Cancer, 12, 231–235.Google Scholar
Meyers, C.A. & Scheibel, R.S. (1990). Early detection and diagnosis of neurobehavioral disorders associated with cancer and its treatment. Oncology, 4, 115–122.Google Scholar
a Meyers, C.A., Weitzner, M., Byrne, K., Valentine, A., Champlin, R.E., & Przepiorka, D. (1994). Evaluation of the neurobehavioral functioning of patients before, during and after bone marrow transplantation. Journal of Clinical Oncology, 12, 820–826.Google Scholar
National Cancer Institute (1998). Surveillance, Epidemiology, and End Results (SEER) Program public-use data (1973–1998), National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch, released April 2001, based on the August 2000 submission. Bethesda, MD: Author.
Olin, J.J. (2001). Cognitive function after systemic therapy for breast cancer. Oncology, 15, 613–624.Google Scholar
a Oxman, T.E. & Silberfarb, P.M. (1980). Serial cognitive testing in cancer patients receiving chemotherapy. American Journal of Psychiatry, 137, 1263–1265.Google Scholar
Paganini-Hill, A. & Clark, L.J. (2000). Preliminary assessment of cognitive function in breast cancer patients treated with Tamoxifen. Breast Cancer Research and Treatment, 64, 165–176.Google Scholar
a Parth, P., Dunlap, W.P., Kennedy, R.S., Ordy, J.M., & Lane, N.E. (1989). Motor and cognitive testing of bone marrow transplant patients after chemoradiotherapy. Perceptual Motor Skills, 68, 1227–1241.Google Scholar
a Pavol, M.A., Meyers, C.A., Rexer, J.L., Valentine, A.D., Mattis, P.J., & Talpaz, M. (1995). Pattern of neurobehavioral deficits associated with interferon-alfa therapy for leukemia. Neurology, 45, 947–950.Google Scholar
a Peace, K., Freeman, J., Perez, D., & Tripp, G. (2002). Long-term effects of adjuvant chemotherapy on cognitive functioning in patients with breast or bowel cancer: Preliminary findings. Poster presented at the Annual Meeting of the International Neuropsychological Society; Stockholm, Sweden.
Peterson, L.G. & Popkin, M.K. (1980). Neuropsychiatric effects of chemotherapeutic agents for cancer. Psychosomatics, 21, 141–153.Google Scholar
Petros, W.P. (2002). Association of high-dose cyclophosphamide, cisplatin, and carmustine pharmacokinetics with survival, toxicity, and dosing weight in patients with primary breast cancer. Clinical Cancer Research, 8, 698–705.Google Scholar
Piper, B.F. (1998). The revised Piper Fatigue Scale: psychometric evaluation in women with breast cancer. Oncology Nursing Forum, 25, 677–684.Google Scholar
Redd, W.H., Silberfarb, P.M., Anderson, B.L., Andrykowski, M.A., Bovbjerg, D.H., Burish, T.G., Carpenter, P.J., Cleeland, C., Dolgin, M., & Levy, S.M. (1991). Physiological and psychobehavioral research in oncology. Cancer, 67(suppl.), 813–822.Google Scholar
a Riggs, R., Sherman, M., Muss, H., Anderson-Hanley, C., O'Brien, P., & Compas, B. (May, 2001). A Prospective Study of the Neuropsychological Effects of Systemic Treatments for Early Stage Breast Cancer. Abstract published in the Proceedings of the American Society for Clinical Oncology, 20, 29b.Google Scholar
Roman, D.D. & Sperduto, P.W. (1995). Neuropsychological effects of cranial radiation: Current knowledge and future directions. International Journal of Radiation Oncology, Biology and Physics, 31, 983–998.Google Scholar
Rosenthal, R. (1991). Meta-analytic procedures for social research (Rev. ed.). Newbury Park, CA: Sage.
Rosenthal, R. & DiMatteo, M.R. (2001). Meta-Analysis: Recent developments in quantitative methods for literature reviews. Annual Review of Psychology, 52, 59–82.Google Scholar
Salinsky, M.C., Storzbach, D., Dodrill, C.B., & Binder, L.M. (2001). Test–retest bias, reliability, and regression equations for neuropsychological measures repeated over a 12–16-week period. Journal of the International Neuropsychological Society, 7, 597–605.Google Scholar
Saphner, T., Tormey, D.C., & Gray, R. (1991). Venous and arterial thrombosis in patients who received adjuvant therapy for breast cancer. Journal of Clinical Oncology, 9, 286–294.Google Scholar
a Schagen, S.B., van Dam, S.B., Muller, M.J., Boogerd, W., Lindeboom, J., & Bruning, P.F. (1999). Cognitive deficits after postoperative adjuvant chemotherapy for breast carcinoma. Cancer, 85, 640–650.Google Scholar
Shadish, W.R. & Haddock, C.K. (1994). Combining estimates of effect size. In H. Cooper & L.V. Hedges, (Eds.), Handbook of Research Synthesis, (pp. 261–281). New York: Russell Sage Foundation.
Silberfarb, P.M. (1983). Chemotherapy and cognitive defects in cancer patients. Annual Review of Medicine, 34, 35–46.Google Scholar
Silberfarb, P.M. & Oxman, T.E. (1988). The effects of cancer therapies on the central nervous system. Advances in Psychosomatic Medicine, 18, 13–25.Google Scholar
a Silberfarb, P.M., Philibert, D., & Levine, P.M. (1980). Psychosocial aspects of neoplastic disease, II: Affective and cognitive effects of chemotherapy in cancer patients. American Journal of Psychiatry, 137, 597–601.Google Scholar
Temkin, N.R., Heaton, R.K., Grant, I., & Dikmen, S.S. (1999). Detecting significant change in neuropsychological test performance: A comparison of four models. Journal of International Neuropsychological Society, 5, 357–369.Google Scholar
Tiersky, L.A., Johnson, S.K., Lange, G., Natelson, B.H., & DeLuca, J. (1997). Neuropsychology of chronic fatigue syndrome: A critical review. Journal of Clinical and Experimental Neuropsychology, 19, 560–586.Google Scholar
Tope, D.M., Ahles, T.A., & Silberfarb, P.M. (1993). Psycho-oncology: Psychological well-being as one component of quality of life. Psychotherapy Psychosomatics, 60, 129–147.Google Scholar
Trask, P.C., Esper, P., Riba, M., & Redman, B. (2000). Psychiatric side effects of interferon therapy: Prevalence, proposed mechanisms, and future directions. Journal of Clinical Oncology, 18, 2316–2326.Google Scholar
Troy, L., McFarland, K., Littman-Power, S., Kelly, B.J., Walpole, E.T., Wyld, D., & Thompson, D. (2000). Cisplatin-based therapy: A neurological and neuropsychological review. Psycho-Oncology, 9, 29–39.Google Scholar
a Tucker, J., Prior, P.F., Green, C.R., Ede, G.M., Stevenson, J.F., Gawler, J., Jamal, G.A., Charlesworth, M., Thakkar, C.M., Patel, P., & Lister, T.A. (1989). Minimal neuropsychological sequelae following prophylactic treatment of the central nervous system in adult leukemia and lymphoma. British Journal Cancer, 60, 775–780.Google Scholar
a van Dam, F.S.A.M., Schagen, S.B., Muller, M.J., Boogerd, W., Wall, E., Fortuyn, M.E.D., & Rodenhuis, S. (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.Google Scholar
a van Oosterhout, A.G., Ganzevles, P.G., Wilmink, J.T., De Geus, B.W., Van Vonderen, R.G., & Twijnstra, A. (1996). Sequelae in long-term survivors of small cell lung cancer. International Journal of Oncology, Biology and Physics, 34, 1037–1044.Google Scholar
Videtic, G.M. (2001). Using treatment interruptions to palliate the toxicity from concurrent chemoradiation for limited small cell lung cancer decreases survival and disease control. Lung Cancer, 33, 249–258.Google Scholar
Walch, S.E., Ahles, T.A., & Saykin, A.J. (1998). Neuropsychological impact of cancer and cancer treatments. In J.C. Holland (Ed.), Psycho-oncology, (pp. 500–508). New York: Oxford University Press.
a Walker, L.G., Walker, M.B., Heys, S.D., Lolley, J., Wesnes, K., & Eremin, O. (1997). The psychological and psychiatric effects of rIL-2 therapy: A controlled clinical trial. Psycho-oncology, 6, 290–301.3.0.CO;2-G>CrossRefGoogle Scholar
a Walker, L.G., Wesnes, K.P., Heys, S.D., Walker, M.B., Lolley, J., & Eremin, O. (1996). The cognitive effects of recombinant Interleukin-2 (rIL-2) therapy: A controlled clinical trial using computerized assessments. European Journal of Cancer, 32A, 2275–2283.Google Scholar
Weiss, H.D., Walker, M.D., & Wiernik, P.H. (1974a). Neurotoxicity of commonly used antineoplastic agents (first of two parts). New England Journal of Medicine, 291, 75–81.Google Scholar
Weiss, H.D., Walker, M.D., & Wiernik, P.H. (1974b). Neurotoxicity of commonly used antineoplastic agents (second of two parts). New England Journal of Medicine, 291, 127–133.Google Scholar
Weitzner, M.A. & Meyers, C.A. (1997). Cognitive functioning and quality of life in malignant glioma patients: A review of the literature. Psycho-Oncology, 6, 169–177.Google Scholar
Weitzner, M.A., Meyers, C.A., & Valentine, A.D. (1995). Methylphenidate in the treatment of neurobehavioral slowing associated with cancer and cancer treatment. Journal of Neuropsychiatry and Clinical Neurosciences, 7, 347–350.Google Scholar
a Wieneke, M.H. & Dienst, E.R. (1995). Neuropsychological assessment of cognitive functioning following chemotherapy for breast cancer. Psycho-Oncology, 4, 61–66.Google Scholar
Yaffe, K., Krueger, K., Sarkar, S., Grady, D., Barrett-Connor, E., Cox, D.A., & Nickelsen, T. (2001). Cognitive function in postmenopausal women treated with Raloxifene. New England Journal of Medicine, 344, 1207–1213.Google Scholar