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If one does a MEDLINE® search using as keywords chemo fog or chemo brain or their hyphenated equivalents, fewer than 30 ‘hits’ appear. The oldest dates back to 2003. This small number of hits in some way captures one aspect of the current state of the phenomenon (or phenomena). In contrast, if one does the search using ‘cognitive × cancer × chemotherapy’, hundreds more hits appear. This...
An unknown, but significant subgroup (perhaps the majority), of patients who have undergone chemotherapy treatment for their cancer report a subsequent decline in cognitive performance (e.g., difficulty in balancing a checkbook; forgetting or mixing up names of friends or relatives, etc.). The condition has been termed chemo fog, chemo brain, or some similar term to reflect the fact that...
Oncology nurses are increasingly recognizing the importance of chemotherapy-related cognitive impairment (CRCI) in the lives of their patients and are contributing to the state of the knowledge in this field of study. The Oncology Nursing Society has included treatment related changes in cognitive function as a priority in the 2009–2013 “Oncology Nursing Society Research Agenda and Priorities”...
The pharmacist’s role places them squarely on the front line of the benefit-risk analysis of drug administration. They are often the ones who explain the drugs to the patients and, in the process, supply part of the information about which patients must make an informed decision about their chemotherapy. This chapter presents the reflections of one oncology/pain specialty pharmacist.
Health-related quality of life for patients with high-grade gliomas has always been poor. The multiple insults to the brain—tumor existence and surgical procedures, irradiation, the level of stress and anxiety suffered and the adjuvant medications— steroids and anti-convulsants, all combine to diminish their health-related quality of life. Prior to the development of chemotherapy agents...
With changes in the approach to treatment of childhood leukemia and brain tumors, more children are surviving into adulthood. With this increase in long-term survivorship, long-term neurocognitive side effects have emerged. Research has shown that these survivors suffer a variety of neurocognitive effects including changes in attention span, concentration, school performance and executive...
Not only is chemo fog a troublesome medical problem for the sufferers, but in addition it is the source of nearly $300 million in direct and indirect expense in the United States alone each year. And since it often persists for extended periods of time, the indirect costs, which stem mainly from lost productivity, continue to accumulate with another nearly $250 million added to the overall...
Any well-designed biobehavioral research will begin with a comprehensive understanding and stated conceptual approach to the issue to be studied and the hypotheses to be tested. Following this conceptual orientation, the research protocol can be designed. This chapter reviews these factors to guide conceptual model-based research of chemotherapy-related changes in cognitive function.
No standard has been established for neuropsychologic testing to identify and quantify chemotherapy-related cognitive impairment (CRCI). A number of issues exist related to the complexity of the phenomenon and lack of correlation between standardized objective tests and subjective tests by patient self-report. Review of the issues related to current neuropsychologic tests used to evaluate...
The chemotherapy-related cognitive impairment (chemo fog/chemo brain) that is reported by many cancer patients is supported to varying degrees primarily by evidence from prospective and retrospective clinical studies. However, the inherent difficulty in conducting such trials (including ethical issues of placebo-controlled designs), the fact that the cognitive impairment is characteristically...
Chemotherapy is commonly associated with harmful effects to multiple organ systems, including the central nervous system (CNS). Neurotoxicity may manifest as both acute and delayed complications, which is particularly a concern for long-term survivors. Patients may experience a wide range of neurotoxic syndromes, ranging from neuro-vascular complications and focal neurological deficits to...
The existence of chemo brain has become almost universally accepted, although many details of the concept are controversial. Data about the different types of cognitive impairment and their duration are not always consistent in the literature. We still do not know which cytotoxic agents are responsible, which characteristics make patients vulnerable and which biologic mechanisms are involved...
Although it is now clear that cognitive dysfunction is a common accompaniment of cancer chemotherapy, its implications await further research and direction. Most of the clinical research relies on standard neuropsychological tests that were developed to diagnose stable traits. Cognitive dysfunction in patients undergoing treatment varies with time, however. Its dimensions will vary during...
Most, if not all, of the studies that report cognitive impairments in patients who have been treated with cancer chemotherapy also report deficits involving the visual system (e.g., visual-spatial function or visual memory). The visual system seems like a likely susceptible target of cytotoxic drugs. Therefore, some portion of the vision-related cognitive deficits of chemo fog/chemo brain...
Proinflammatory cytokines play a significant role in the body’s immune response to pathogens, including malignant cells. Proinflammatory cytokines are associated with tumor invasion and progressive disease and are released in response to many antineoplastic agents. Exogenous administration and endogenous production of cytokines is related to a pattern of behaviors known as sickness behavior...
Pharmacokinetics of anticancer drugs used in breast cancer therapy are well established. This chapter reviews preclinical and clinical pharmacokinetics of the following drugs: cyclophosphamide, docetaxel, doxorubicin, 5-fluorouracil, methotrexate and tam oxifen. The absorption, distribution, metabolism and elimination of drugs are discussed in the context of breast cancer. The effect of...
This chapter describes quantitative methodology that is directed toward assessing interactions between a combination of agonist drugs that individually produce overtly similar effects. Drugs administered in combination may show exaggerated, reduced or predictable effects that are dependent on the specific drug pair and the doses of the constituents. The basis for quantitating these unusual...
As clinical studies reveal that chemotherapeutic agents may impair several different cognitive domains in humans, the development of preclinical animal models is critical to assess the degree of chemotherapy-induced learning and memory deficits and to understand the underlying neural mechanisms. In this chapter, the effects of various cancer chemotherapeutic agents in rodents on sensory...
Doxorubicin (ADRIAMYCIN, RUBEX) is a chemotherapeutic agent that is commonly administered to breast cancer patients in standard chemotherapy regimens. As true of all such therapeutic cytotoxic agents, it can damage normal, noncancerous cells and might affect biochemical processes in a manner that might lead to, or contribute to, chemotherapy-induced cognitive deficits when administered either...
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