Cancer-Related Cognitive Impairment in Patients With a History of Breast Cancer
Cet article analyse les facteurs associés au risque de déficiences cognitives liées aux traitements anticancéreux chez des patientes atteintes d'un cancer du sein, identifie les mécanismes de ces déficiences puis passe en revue les outils d'évaluation ainsi que les stratégies thérapeutiques
Clinical reports of cognitive difficulties in patients with breast cancer began to appear in the literature in the 1990s, coincident with the increasing use of postoperative adjuvant chemotherapy. Symptoms were more frequently reported in women who received very high-dose chemotherapy, raising concerns that cognitive impairment might become a dose-limiting treatment toxicity. However, this has not occurred, in that over the past 2 decades there has been a deescalation of both the intensity and generalized use of adjuvant chemotherapy in patients with breast cancer. Because of the initial association of cognitive symptoms with chemotherapy treatment, early research focused on what was referred to as chemobrain or chemofog, finding preliminary evidence of measurable neurocognitive effects among patients with breast cancer who were exposed to chemotherapy. Subsequent studies have documented cognitive changes before any cancer-directed therapies, as well as in association with other common breast cancer treatments (eg, radiation, endocrine therapy) CRCI is an important clinical issue that can impair daily function, work productivity, childcare, and other responsibilities in patients with a history of breast cancer. Risk for CRCI includes cancer and cancer treatment, as well as patient-related vulnerabilities. Management recommendations include attending to patient-reported symptoms with a thorough symptom-targeted evaluation. Cognitive and behavioral treatments are the primary recommended intervention. More research is needed to establish a solid evidence base for CRCI that evolves alongside modern cancer treatment practices.
JAMA 2021