Table 1: Cross-sectional Studies of Neuropsychological Deficits in BCS following Adjuvant Therapy
Author (Date)
Van Dam et al.
(1998)
Schagen et al.
(1999)
Brezden et al.
(2000)
Castellon et al.
(2004)
Donovan et al.
(2005)
Subjects
- BCS treated with high-dose
chemotherapy and bone
marrow transplant (N = 34, Mage
= 45.5, Mtyears post-chemo = 2)
- BCS with high risk disease
treated with conventional
chemotherapy (N = 36, Mage =
48.1, Myears post-chemo = 2)
- Low risk BCS treated without
chemotherapy (N = 34, Mage =
46.1)
- BCS treated with
chemotherapy (N = 39,
Mage=47.1, Mtyears post-chemo = 1.9)
- BCS not treated with
chemotherapy (N = 34, Mage =
46.1)
- BCS undergoing
chemotherapy (N = 31, Mage =
49)
- BCS 2-years postchemotherapy (N = 40, Mage =
46)
- Healthy Controls (N = 36, Mage
= 41.5)
- BCS treated with
chemotherapy (N = 18, Mage =
46.8)
- BCS treated with chemo +
tamoxifen 2-5 years previously
(N = 18, Mage = 46.8,
- BCS treated without adjuvant
therapy (N = 17, Mage = 48.3)
- Healthy Controls (N = 19, Mage
= 49.2)
- BCS treated with
chemotherapy (N = 60, Mage=
52.3 , Mtime post-chemo = 6 months
Data Source/
Domains Impaired
NP Performance
Measures
Findings
BCS in the high-dose group have
an 8.2 times higher risk of
cognitive deficits than BCS not
treated with chemotherapy. BCS
in the standard-dose group had
3.5 times the risk as BCS not
treated with chemotherapy.
Seventeen percent of the
standard-dose group was found to
have cognitive deficits.
Study Strengths/
Study Limitations
- Early study of cognitive effects of
chemotherapy
- Randomized design
- Lack of baseline measures
- All BCS also treated with tamixfen
- No healthy control group
NP Performance
Measures
- Memory
- Language
- Visuospatial Skills
Cognitive deficits were defined as
performance falling below the 5th
percentile of the untreated group.
Chemotherapy treated BCS were
significantly more likely to show
cognitive deficits than untreated
BCS.
- Examined prevalence of cognitive deficits
in addition to group means
Screening test for
cognitive deficits
- Memory,
- Language,
- Visuospatial Skills
The prevalence of cognitive
deficits was significantly higher in
both chemotherapy groups than in
healthy controls. BCS currently
undergoing chemotherapy
performed significantly worse than
healthy controls.
- Compared BCS undergoing treatment to
BCS after two years of recovery
- Also tested a healthy control group
NP Performance
Measures
- Verbal Learning,
- Visuospatial Skills,
- Visual Memory
BCS treated with chemotherapy
had a significantly lower summary
score on the NP performance
measures.
-Two control groups (healthy women and
BCS not treated with adjuvant therapy)
NP Performance
Measures
Using a stringent criterion for
cognitive deficit, there were no
effects of treatment group.
- Larger sample sizes than other studies
- All BCS received radiation therapy
- Lack of baseline measures
- No healthy control group
- Used a screening test rather than a
complete NP battery
- Small sample sizes
- Did not report individual differences (group
means can obscure individual results).
Adams-Price et
al. (2009)
Yamada et al.
(2010)
- BCS not treated with
chemotherapy (N = 83, Mage =
57.6)
- BCS treated with
chemotherapy (N = 38, Mage =
55.3, Mtime post-treatment = 19.1
months)
- Healthy Controls (N = 55, Mage
= 55.3)
- Lack of baseline measures
- Did not report individual differences
- Useful Field of View
Test (measures 3
components of
attention)
- Processing Speed
- BCS treated with
NP Performance
chemotherapy (N = 60, Mage =
Measures
72.8, Mtime post-chemotherapy = 16.8
- Executive Function
years)
- Working Memory
- Healthy Controls matched to
- Attention
each BCS from an existing
database (N = 30)
Koppelmans et
- BCS treated with
NP Performance
chemotherapy (N = 196, Mage = Measures
al. (2012)
64.1, Mtime post-treatment = 21.2
- Memory (immediate
years)
and delayed)
- Healthy controls from an
-Executive Function
existing database (N = 1509,
- Processing Speed
Mage = 57.9)
- Psychomotor Speed
Note. M = mean; BCS = breast cancer survivor; NP = neuropsychological
There was a significant interaction
between age and treatment group
such that older BCS performed
significantly worse on the
processing speed component of
the task
BCS scored significantly worse
than healthy controls in several
domains after an extended
interval post-chemotherapy.
BCS had significantly lower NP
summary scores than healthy
controls, scoring the same or
worse than controls on all
measures.
-Examined interaction of age and treatment
- The BCS sample included a small number
of older participants
- Healthy Controls performed at ceiling for
the processing speed measure. An effect of
age may have been masked.
-Long interval post-chemotherapy.
-Lack of untreated BCS control group
-Global NP performance measures were not
reported.
-Long interval post-chemotherapy
-Large sample size
Lack of untreated BCS control group