Investigation of a neuropsychological screen for chemo-fog
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EDITORIAL
Investigation of a neuropsychological screen for chemo-fog Lea Ann Ouimet • Angela Stewart • Barbara Collins • Dwayne Schindler Catherine Bielajew
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Received: 13 June 2011 / Accepted: 26 September 2011 / Published online: 14 October 2011 Ó Springer-Verlag 2011
Abstract Research on chemotherapy-induced cognitive impairment (the term ‘‘chemo-fog’’ is used by many investigators) supports the occurrence of subtle declines in function for a subset of recipients. Identification of vulnerable individuals via comprehensive neuropsychological batteries is complicated due to their lack of clinical utility and increased risk of misclassification. The goal of this paper was to evaluate the ability of a reduced battery to detect chemotherapy-related cognitive impairments. Data from our previous study (Ouimet et al. J Clin Exp Neuropsychol 31:73–89, 2009) were used to compare a comprehensive neuropsychological test battery comprising 23 tests with a reduced battery consisting of a subset of nine tests. A standardized regression-based approach revealed that a comparable numbers of participants were identified by both batteries, suggesting that individuals vulnerable to chemotherapy-induced cognitive impairment can be identified by a more selective battery. Further work is needed to clarify the neuropsychological tests most sensitive to detecting impairments associated with chemotherapy so that assessment batteries can be limited to these tests. Keywords Breast cancer Chemotherapy Cognitive impairment Neuropsychological assessment Misdiagnosis
L. A. Ouimet (&) D. Schindler C. Bielajew School of Psychology, University of Ottawa, 136 Jean Jacques Lussier, Ottawa, ON K1N 6N5, Canada e-mail: [email protected] A. Stewart Royal Ottawa Health Care Group, Ottawa, ON, Canada B. Collins Ottawa Hospital, Civic Campus, Ottawa, ON, Canada
Introduction Breast cancer strikes approximately one in nine women each year in North America [2, 3] and the majority will receive some form of chemotherapy as part of their treatment regimen. In the last few years, there has been increasing evidence to suggest that a subset of these women suffer from chemotherapy-related cognitive impairments that primarily affect memory, attention, concentration, and perseverance [4–16]. While from a statistical standpoint the effects have generally been small; from a clinical perspective, the degree of impairment noted in both self-report research and those using objective measurement might reasonably be expected to have major impacts on quality of life. In fact, deleterious impact of cognitive decline from chemotherapy on quality of life in breast cancer patients has been reported by various researchers [7, 13, 16–24]. Given the incidence of breast cancer, and the standard inclusion of some form of chemotherapy as part of the treatment regimen, if quality of life is negatively impacted, then the identification of chemotherapy-related cognitive impairments becomes an issue of clinical relevance. Unfortunately, various issues in the area of neuro
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