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Cognitive Impairment Associated With Chemotherapy for Cancer: Report of a Workshop

From the Department of Medical Oncology and Hematology, Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada; Center for Psycho-Oncology Research, Dartmouth Medical School, Lebanon, NH; University of California Los Angeles Schools of Medicine and Public Health; Jonsson Comprehensive Cancer Center, Los Angeles, CA; and the Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands

Address reprint requests to Ian F. Tannock, MD, PhD, Department of Medical Oncology and Hematology, Princess Margaret Hospital, 610 University Ave, Toronto, ON M5G 2M9, Canada; e-mail: ian.tannock{at}uhn.on.ca

Cognitive dysfunction may occur in some patients who receive chemotherapy. We provide a summary of an April 2003 workshop on this topic, that included medical oncologists, radiologists, clinical and experimental psychologists, and patient advocates. Current studies indicate that cognitive deficits are often subtle, although they are observed consistently in a proportion of patients, may be durable, and can be disabling. Deficits have been observed in a range of cognitive functions. Underlying mechanisms are unknown, although preliminary studies suggest there may be genetic predisposition and that cognitive impairment may be accompanied by changes in the brain detectable by neuroimaging. The following priorities were established for future research: (1) large-scale clinical studies that use both a longitudinal design and concurrent evaluation of patients with cancer who do not receive chemotherapy—such studies should address the probability and magnitude of cognitive deficits, factors that predict them, and underlying mechanisms; (2) exploration of discrepancies between subjective reports of cognitive dysfunction and the objective results of cognitive testing; (3) studies of cognitive function in patients receiving treatment for diseases other than breast cancer, and in both men and women, to address the hypothesis that underlying mechanisms relate to changes in serum levels of sex hormones and/or to chemotherapy-induced menopause; (4) development of interventions to alleviate these problems; and (5) development of animal models and the use of imaging techniques to address mechanisms that might cause cognitive impairment associated with chemotherapy.

This workshop was held in Banff, Alberta, Canada, on April 23, 2003. It was supported by a grant from Hurricane Voices Breast Cancer Foundation and is dedicated in memory of Lois Egasti, founder of Hurricane Voices.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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