A Study of Chemotherapy-Related Cognitive Impairment in Gynecologic Cancer Patients
Abstract: Objectives: 1) To evaluate post-chemotherapy cognitive functions in gynecology oncology patients; 2) To analyze the factors that influence memory impairment in those patients. Methods: The expe-rimental group (Group A) consisted of 53 patients admitted between year 2009-2011, with age ranging from 18 - 66 years old, suffering from cervical cancer (n = 22), ovarian cancer (n = 24), and other gynecologic cancer types grouped together (n = 7), treated with adjuvant TP regimen chemotherapy (n = 47) or other regimen chemotherapy grouped together (n = 6). The chemothe-rapy patients are grouped according to their age (pre-perimenopausal <45 years old and post-pe- rimenopausal period ≥45 years old), education level (lower educated of less than 9 years of edu-cation and higher educated of more than 9 years of education), types of cancer (cervical cancer, ovarian cancer, other cancer), types of chemotherapy regimen received (TP regimen, other regi-men). The control group is divided into 2 groups, non-chemotherapy patients (Group B) and heal- thy controls (Group C). According to patients’ chemotherapy is divided into five group, control group is divided into 2 groups. Using two subjective questionnaires (Everyday Memory Questionnaires and CAMDEX) and 1 objective problems Test (Random Number Test), right and wrong points according to the problem, determine subjects of cognitive function damage. Problems before test in patients who did not receive any treatment (T1) and patients received two or more than 3 to 4 weeks after chemotherapy regimen (T2) after the test. The patient test results comparing with control group. Results: 1) The data show that chemotherapy patients have more cognitive problems than chemotherapy patients and healthy controls. 2) Found in its own control study before and after chemotherapy, the cognitive dysfunction after chemotherapy and before chemotherapy is statistically significant (p = 0.039). 3) Gynecological cancer after chemotherapy in patients with cognitive dysfunction, and in the scarf premenopausal and postmenopausal group, has statistical difference (p = 0.031). 4) Gynecological cancer after chemotherapy in patients with cognitive dys-function, and in the cultural level between high and low degree of cultural groups, is statistically significant (p = 0.010). 5) Gynecological cancer after chemotherapy in patients with cognitive dys-function, between cervical cancer and ovarian cancer group, has no statistical difference (p = 0.304). Conclusions: 1) There was a statistically significant difference of cognitive impairment prevalence between chemotherapy patients and non-chemotherapy control groups. 2) Among chemotherapy patients participated in baseline cognitive assessment, there was a statistically significant difference in cognitive impairment prevalence between pre- and post-chemotherapy assessment. 3) Among chemotherapy patients, there was a statistically significant difference in cognitive impairment prevalence between pre-perimenopausal patients and post-perimenopausal patients. 4) Among chemotherapy patients, there was a statistically significant difference in cognitive impairment prevalence between lower educated patients and higher educated patients. 5) Among TP regimen chemotherapy patients, there was no statistically significant difference in cognitive impairment prevalence between ovarian cancer patients and cervical cancer patients.
文章引用: 陈志辽 , 张睿 , 张小兰 , 李玉珠 , 陈必近 , 钟沅月 , 周荣辉 (2016) 妇科癌症患者化疗后与认知功能障碍相关的研究。 医学诊断， 6， 40-46. doi: 10.12677/MD.2016.61008
Minisini, A., Atalay, G. et al. (2004) What Is the Effect of Systemic Anticancer Treatment on Cognitive Function? Lancet Oncology, 5, 273-282.
 Luo, L. and Craik, F.I. (2008) Aging and Memory: A Cognitive Approach. Canadian Journal of Psychiatry, 53, 346- 353.
Hannon, B. and Daneman, M. (2009) Age-Related Changes in Reading Comprehension: An Individual-Differences Perspective. Experimental Aging Research, 35, 432-456.
 (2010) Hyperin-tensities. Neuropsychology, Development, and Cognition. Section B, Aging, Neuropsychology and Cognition, 19, 1-17.
Ahles, T.A., Saykin, A.J., et al. (2002) Neuropsychologic Impact of Standard-Dose Systemic Chemothe-rapy in Long- Term Survivors of Breast Cancer and Lymphoma. Journal of Clinical Oncology, 485-493.
Poppelreuter, R.C., Mannes, A.J., Clark, U.S. and Bennett, G.J. (2004) Cognitive Dysfunction and Subjective Complaints of Cancer Patients: A Cross-Sectional Study in a Cancer Rehabilitation Centre. European Journal of Cancer, 40, 43-49.
Cimprich, B., So, H. et al. (2005) Pre-Treatment Factors Re-lated to Cognitive Functioning in Women Newly Diagnosed with Breast Cancer. Psychooncology, 14, 70-78.
Tangpong, J., Cole, M.P., Sultana, R., et al. (2007) Adriamycin-Mediated Nitration of Manganese Superoxide Dismutase in the Central Nervous System: Insight into the Mechanism of Chemobrain. Journal of Neurochemistry, 100, 191- 201.
Weiss, B. (2008) Chemobrain: A Translational Chal-lenge for Neurotoxicology. Neurotoxicology, 29, 891-898.
Konat, G.W., Kraszpulski, M., James, I., Zhang, H.T. and Abraham, J. (2008) Cognitive Dysfunction Induced by Chronic Administration of Common Cancer Chemotherapeu-tics in Rats. Metabolic Brain Disease, 23, 325-333.
Dietrich, J., Han, R.L., Yang, Y., Mayer-Prösche, M. and Noble, M. (2006) CNS Progenitor Cells and Oligodendrocytes Are Targets of Chemotherapeutic Agents in Vitro and in Vivo. Journal of Biology, 5, 22.
Han, R.L., Yang, Y.M., Dietrich, J., Luebke, A., Mayer-Pröschel, M. and Noble, M. (2008) Systemic 5-Fluorouracil Treatment Causes a Syndrome of Delayed Myelin Destruction in the Central Nervous System. Journal of Biology, 7, 12.
Tannock, I., Winocur, G., et al. (2006) The Effects of the Anti-Cancer Drugs, MTX and 5-FU on Cognitive Function in Mice. Pharmacology Bi-ochemistry and Behavior, 85, 66-75.
Inagaki, M., Yoshikawa, E., Matsuoka, Y., et al. (2007) Smaller Regional Volumes of Brain Gray and White Matter Demonstrated in Breast Cancer Survivors Exposed to Adjuvant Chemotherapy. Cancer, 109, 146-156.
Silverman, D.H., Dy, C.J., Castellon, S.A., et al. (2007) Altered Fron-tocortical, Cerebellar, and Basal Ganglia Activity in Adjuvant-Treated Breast Cancer Survivors 5-10 Years after Chemotherapy. Breast Cancer Research and Treatment, 103, 303-311.
 Mock, V., Atkinson, A., et al. (2000) NCCN Practice Guide-lines for Cancer-Related Fatigue. Oncology (Huntingt), 14, 115-161.
Jenkins, V., Shilling, V., et al. (2006) A 3-Year Prospective Study of the Effects of Adjuvant Treatments on Cognition in Women with Early Stage Breast Cancer. British Journal of Cancer, 94, 828-834.
 Hermelink, K. (2007) Cognitive Function during Neoadjuvant Chemotherapy for Breast Cancer: Results of a Prospective, Multicenter, Longitudinal Study. Cancer, 109, 1905-1913.
Bender, C.M., Sereika, S.M., et al. (2006) Cognitive Impairment Associated with Adjuvant Therapy in Breast Cancer. Psycho-Oncology, 15, 422-430.
Wefel, J.S., Lenzi, R., et al. (2004) Chemobrain in Breast Carcinoma? A Prologue. Cancer, 101, 46.