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. 2021 Apr 29:11:642382.
doi: 10.3389/fonc.2021.642382. eCollection 2021.

Cognitive Effects and Depression Associated With Taxane-Based Chemotherapy in Breast Cancer Survivors: A Meta-Analysis

Eiman Y Ibrahim  1 , Ilaria Domenicano  2 , Kate Nyhan  3 , Mohamed Elfil  4 , Sarah S Mougalian  5 , Brenda Cartmel  6 , Barbara E Ehrlich  1
Affiliations

Cognitive Effects and Depression Associated With Taxane-Based Chemotherapy in Breast Cancer Survivors: A Meta-Analysis

Eiman Y Ibrahim et al. Front Oncol. .

Abstract

Purpose: This meta-analysis provides a longitudinal assessment of depression and cognitive impairment induced by taxane-based chemotherapy in women with breast cancer after 6 months of treatment. We highlighted the incidence and prevalence, the cognitive pattern in neuropsychological studies, and the relationship between chemotherapy-induced cognitive impairment and different risk factors. We estimated the effect sizes on each cognitive domain and differentiated effect sizes by each method of comparison of effects (i.e., baseline data, or control groups). Methods: The databases MEDLINE and Embase were searched for publications about taxane-related cognitive changes in patients with breast cancer published from 1980 to 2019. Cross-sectional and self-reported outcomes studies were excluded except for the depression item. Included studies were assessed for risk of bias with the Newcastle-Ottawa Scale. We estimated effect sizes for each cognitive domain and differentiated effect sizes by each method of comparison of effects. The review is reported in compliance with the PRISMA Statement; it was registered prospectively in PROSPERO as CRD42020163255. Results: Eleven studies meeting the criteria were analyzed, which resulted in a sample of 1,057 patients with breast cancer who received chemotherapy including 820 patients (77%) who received taxane-based chemotherapy. Attention and concentration, depression, and executive function domains had significant chemotherapy-induced impairment across all comparison types. Statistically significant improvement was found in language and verbal memory when comparing chemotherapy patients' test scores with baseline or matched controls. Taxane-based chemotherapy had a non-significant effect on processing speed, visual memory, visuospatial, and motor function domains. Conclusions: The occurrence of chemotherapy-induced cognitive impairment 6 months or more after the course of treatment in people with breast cancer is frequent in the domains of attention, executive function, and depression. Other domains appear stable or improve with time after treatment cessation.

Keywords: breast cancer; chemobrain; cognitive impairment; neurophysiology; neuropsychology; taxane.

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Conflict of interest statement

BE is the founder of Osmol Therapeutics, a company that is targeting NCS1 for therapeutic purposes. SM receives consulting fees from Eisai Inc. and Celgene Corporation. She has received research funding from Pfizer (as joint funding between Pfizer and NCCN paid directly to her institution) and Genentech (paid directly to her institution). ID is a biostatistician at the West Haven, CT Cooperative Studies Program Coordinating Center, VA Office of Research and Development. The views expressed in this article are those of the author (ID) and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Preferred reporting items for systematic review and meta-analysis statement (PRISMA) flowchart of the included studies.
Figure 2
Figure 2
Summary of critical appraisal of included studies using the Newcastle–Ottawa Scale (NOS).
Figure 3
Figure 3
Forest plots using (A) fixed-effect model for all studies, (B) fixed-effect model for cohort studies only, and (C) random-effect model for 6-month time-point analyses.
Figure 4
Figure 4
Funnel plot of effect sizes by SE for (A) attention and concentration, (B) depression, (C) executive function, and (D) processing speed.
See this image and copyright information in PMC

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