Abstract P4-19-03: A meta-analysis of cognitive impairment in breast cancer survivors treated with chemotherapy
Notice bibliographique
Résumé
Abstract Background: Cognitive impairment in women with breast cancer has long been attributed to chemotherapy, but the evidence for this has been inconsistent, and more recent research suggests that additional cancer- and treatment-related factors also impact cognition. To systematically evaluate and describe “chemobrain,” a multilevel meta-analysis of objective cognitive function in breast cancer survivors treated with chemotherapy was conducted to estimate the magnitude of impairment across 9 cognitive domains and explore moderating variables. Method: PubMed, Embase, CINAHL, Cochrane CENTRAL, Scopus, and PsycINFO were searched from their inception to May 2016 to identify studies that compared the cognitive performance of survivors treated with chemotherapy to a control group or to their own prechemotherapy testing. Multilevel modelling was used to account for the interdependence among effect sizes obtained within the same study. Results: Seventy-seven studies involving 3417 cancer patients treated with chemotherapy yielded 1548 effect sizes. Cross-sectional comparisons revealed worse overall cognitive performance in survivors treated with chemotherapy relative to healthy controls (d = -0.27, 95% CI [-0.32, -0.21]) but not disease-specific controls (d = -0.07, 95% CI [-0.14, 0.00]). Relative to all controls, cognitive impairment in survivors treated with chemotherapy was observed in tests assessing language (d = -0.25), executive function (d = -0.21), processing speed (d = -0.15), delayed recall (d = -0.15), and attention/concentration (d = -0.14), but not in visual/spatial perception, immediate recall, recognition memory, or psychomotor domains. Because patients and controls were not well matched in many studies on age, education, and IQ, which are known to impact cognitive test performance, group differences in these variables were explored as moderators of observed cognitive deficits in post hoc analyses. Results showed that chemotherapy patients and controls performed equivalently when the controls were 6 years older or had 1 less year of education. Longitudinal comparisons showed improved postchemotherapy performance relative to prechemotherapy baseline, but practice effects were not accounted for in these comparisons. Conclusion: Breast cancer survivors treated with chemotherapy show subtle yet diffuse cognitive impairment. Their cognitive performance was equivalent to that of women in comparison groups who were 6 years older, which suggests that chemotherapy accelerates cognitive aging. Results from breast cancer patients who were not treated with chemotherapy, however, indicate that chemotherapy is not the only determinant of cognitive dysfunction. Group differences in age and education moderated the magnitude of cognitive impairment. The cognitive reserve framework, which posits that individuals differ in the degree of neural disruption they can withstand before exhibiting cognitive deficits, should be considered in future studies in order to better understand moderating effects on cancer-related cognitive dysfunction. In particular, both cross-sectional and longitudinal studies should ensure that comparison cohorts are closely matched on age, education, and other relevant cognitive reserve variables. Citation Format: Bernstein LJ, McCreath GA, Rich JB. A meta-analysis of cognitive impairment in breast cancer survivors treated with chemotherapy [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-19-03.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,011 | 0,026 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,013 | 0,048 |
| Bibliométrie | 0,005 | 0,005 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,003 | 0,001 |
| Science ouverte | 0,002 | 0,001 |
| Intégrité de la recherche | 0,002 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».