• Journal of Korean Academy of Nursing
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• v.49 no.4
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• pp.375-385
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• 2019

Purpose: This study aimed to develop and test a structural model for chemotherapy-related cognitive impairment of breast cancer patients based on a literature review and Hess and Insel's chemotherapy-related cognitive change model. Methods: The Participants consisted of 250 patients who were ${\geq}19$ years of age. The assessment tools included the Menopause Rating Scale, Symptom Experience Scale, Hospital Anxiety and Depression Scale, Everyday Cognition, and Functional Assessment of Cancer Therapy-Breast Cancer. Data were analyzed using the SPSS 21.0 and AMOS 21.0 programs. Results: The modified model was a good fit for the data. The model fit indices were ${\chi}^2=423.18$ (p<.001), ${\chi}^2/df=3.38$, CFI=.91, NFI=.91, TLI=.89, SRMR=.05, RMSEA=.09, and AIC=515.18. Chemotherapy-related cognitive impairment was directly influenced by menopausal symptoms (${\beta}=.38$, p=.002), depression and anxiety (${\beta}=.25$, p=.002), and symptom experiences (${\beta}=.19$, p=.012). These predictors explained 47.7% of the variance in chemotherapy-related cognitive impairment. Depression and anxiety mediated the relations among menopausal symptoms, symptom experiences, and with chemotherapy related cognitive impairment. Depression and anxiety (${\beta}=-.51$, p=.001), symptom experiences (${\beta}=-.27$, p=.001), menopausal symptoms (${\beta}=-.22$, p=.008), and chemotherapy-related cognitive impairment (${\beta}=-.15$, p=.024) had direct effects on the quality of life and these variables explained 91.3%. Conclusion: These results suggest that chemotherapy-related toxicity is highly associated with cognitive decline and quality of life in women with breast cancer. Depression and anxiety increased vulnerability to cognitive impairment after chemotherapy. Nursing intervention is needed to relieve chemotherapy-related toxicity and psychological factor as well as cognitive decline for quality of life in patients undergoing chemotherapy.

• Asian Oncology Nursing
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• v.12 no.3
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• pp.221-229
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• 2012

Purpose: The purpose of this study was to identify correlates influencing cognitive impairment in breast cancer patients receiving chemotherapy. Methods: Study subjects consisted of 102 breast cancer patients who received chemotherapy. Subjects were the members of a breast cancer self-help group. Data were collected using structured self-reporting questionnaires including scales of cognitive impairment, physical status, fatigue, quality of life, emotional status, sleeping, family support, and menopausal symptoms. Statistical Package for Social Sciences was used for statistical analyses. Results: Breast cancer patients receiving chemotherapy appeared to show a high level of cognitive impairment. Among demographic characteristics, the effects of economic status and family type on cognitive impairment were found to be statistically significant. Among disease related characteristics, the effect of duration of chemotherapy on cognitive impairment was statistically significant. Menopausal symptoms were positively associated with cognitive impairment. The model including postmenopausal symptoms and caregiver type explained about 66% of variability in cognitive impairment. Conclusion: These findings highlight the importance of contextual factors in understanding cognitive impairment in breast cancer patients receiving chemotherapy and can be used to develop appropriate, effective nursing interventions.

• The Journal of Korean Medicine
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• v.37 no.3
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• pp.74-86
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• 2016

Objectives: This article aims to review clinical studies related to traditional Korean medicine (TKM) for cancer-related cognitive impairment (CRCI) up to date. Methods: EMBASE, Pubmed and eight Korean databases were searched for clinical studies about TKM for CRCI up to July 2016. We selected articles about subjects with cancer, using TKM interventions including acupuncture, moxibustion or herbal medicine, containing assessment about cognitive function. Results: Two randomized controlled trials (RCTs) and one randomized controlled feasibility study were included. Selected studies were containing assessments about cognitive function but not as primary outcomes. The three studies included one acupuncture study and two herbal-medicine studies. Only one herbal-medicine study showed improvement in cognitive function. Conclusions: Few clinical studies mainly focusing CRCI treated with TKM have been performed and have shown contradictory results until now. Future studies should be performed considering findings from pre-clinical and clinical studies altogether, and they should be controlled to minimize risk of bias thorough out overall courses of designing, conducting and reporting them.

• Journal of Korean Academy of Nursing
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• v.45 no.1
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• pp.118-128
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• 2015

Purpose: Evidence suggests that some patients with breast cancer experience cognitive difficulties following chemotherapy. This longitudinal study was done to examine the prevalence of cognitive impairment and trajectory of cognitive function over time in women with breast cancer, who received adjuvant chemotherapy. Methods: Participants were 137 patients with breast cancer. They completed neuropsychological tests and the Functional Assessment of Cancer Therapy-Cognitive Function before adjuvant therapy (pretest), toward the end of adjuvant therapy (posttest), and 6 months after the completion of adjuvant therapy (follow-up test). Of the patients, 91 were treated with adjuvant chemotherapy and 46 patients who did not receive chemotherapy made up the comparison group. A reliable-change index and repeated-measure ANOVA were used for statistical analyses. Results: At the posttest point, over 30% of patients showed complex cognitive impairment and reported greater difficulty in subjective cognitive function. At the follow-up test point, 22.0% of patients exhibited complex cognitive impairment and 30.8% of patients complained of subjective cognitive impairment. Repeated-measure ANOVA showed significant decreases after receiving chemotherapy followed by small improvements 6 months after the completion of chemotherapy in cognitive domains of change for attention and concentration, memory, executive function, and subjective cognitive function. Conclusion: These results suggest that chemotherapy in patients with breast cancer may be associated with objective and subjective cognitive impairments. Further studies are needed to explore the potential risk factors and predictor of chemotherapy-related cognitive changes. Also nursing interventions for prevention and intervention of cognitive impairments should be developed and tested.

• Journal of Korean Academy of Nursing
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• v.42 no.5
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• pp.644-658
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• 2012

Purpose: The purpose of this study was to evaluate the cognitive effects of chemotherapy in patients with breast cancer. Methods: Using several databases, prospective studies were collected up to August 2011. Of 2,106 publications identified, 12 met the inclusion criteria, and 8 studies were used to estimate the effect size of chemotherapy on cognitive impairment. Results: Twelve studies were done since 2005 and most of the research was performed in Europe or North America. Eight studies were used to generate effect size across the cognitive domains of attention/concentration, verbal and visual memory, executive function, visuospatial skill, language, and subjective cognitive function. Each of the cognitive domains showed small effect sizes (-0.02 ~ -0.26), indicating diminished cognitive function for the chemotherapy group compared with non-chemotherapy groups. Conclusion: Finding suggests that breast cancer patients who undergo chemotherapy may experience mild cognitive decline. Further study is needed to generate knowledge and guideline for interventions to address chemotherapy related cognitive impairment in these patients.

• Journal of Korean Academy of Nursing
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• v.46 no.3
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• pp.420-430
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• 2016

Purpose: The purpose of this study was to test a hypothetical model of chemotherapy-related cognitive impairment (CRCI) and depression in people with gastrointestinal cancer. Methods: A purposive sample of 198 patients undergoing chemotherapy was recruited from November 2014 to July 2015. The instruments were Everyday Cognition (ECog), Hospital Anxiety Depression Scale (HADS), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), and M. D. Anderson Symptom Inventory-Gastrointestinal Cancer Module. Data were analyzed using descriptive statistics, correlation, and path analysis. Results: CRCI was directly affected by cancer symptoms (${\beta}=.19$, p=.004) and fatigue (${\beta}=.56$, p<.001)($R^2=47.2%$). Depression was directly affected by fatigue (${\beta}=.48$, p<.001) and CRCI (${\beta}=.27$, p<.001). However, The impact of cancer symptoms on depression was confirmed through the mediating effect of CRCI. Conclusion: Results indicate that in patients with gastrointestinal cancer undergoing chemotherapy along with the direct physiologic effects (fatigue, symptoms) of cancer treatment may have altered cognitive function leading to depression.

• Journal of Korean Academy of Nursing
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• v.46 no.1
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• pp.19-28
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• 2016

Purpose: The purpose of this study was to test the mediating effect of psychological distress in the relationship between chemotherapy related cognitive impairment (CRCI) and quality of life (QOL) in people with cancer. Methods: A purposive sample of 130 patients undergoing chemotherapy was recruited for the cross-sectional survey design. Data were collected from November 2014 to June 2015. The instruments were K-MMSE (Korean Mini-Mental State Examination), Everyday Cognition (ECog), Hospital Anxiety Depression Scale (HADS), and Functional Assessment of Cancer Therapy-General (FACT-G). Data were analyzed using descriptive statistics, correlation, and multiple regression using Baron and Kenny steps for mediation. Results: The mean score for objective cognitive function was 27.95 and 69.32 for perceived cognitive decline. Overall quality of life was 91.74. The mean score was 17.52 for psychological distress. The prevalence was 56.2% for anxiety and 63.1% for depression, and 20.0% for CRCI. There were significant correlations among the variables, objective cognitive function and self-reported cognitive decline, psychological distress, and quality of life. Psychological distress was directly affected by CRCI. ($R^2=29%$). QOL was directly affected by CRCI. Psychological distress and CRCI effected QOL ($R^2=43%$). Psychological distress had a partial mediating effect (${\beta}=-.56$, p <.001) in the relationship between self-reported cognitive decline and quality of life (Sobel test: Z= -5.08, p <.001). Conclusion: Based on the findings of this study, nursing intervention programs focusing on managing cognitive decline, and decreasing psychological distress are highly recommended to improve quality of life in cancer patients.

• Asian Oncology Nursing
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• v.12 no.1
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• pp.1-11
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• 2012

Purpose: This study reviewed articles related to breast cancer, cognitive function and chemotherapy available in 4 databases. Methods: The researcher reviewed 32 pieces of literature that were published between January 2001 and November 2011. Results: Within the last decade, several studies have investigated whether adjuvant treatment of breast cancer affects cognitive function. A number of prospective studies have reported inconsistent results regarding whether chemotherapy affects cognitive function. Approximately half of the studies reported subtle cognitive decline in a wide range of domains among some breast cancer patients following chemotherapy, and others did not. Conclusion: Breast cancer patients receiving adjuvant chemotherapy showed the most deterioration and the most persistent decline in cognitive function. Since cognitive impairment is subtle, if evident at all, discrepant findings are due to hormonal, physiological, psychological or temporal confounding variables and differences in study design. Especially, that chemotherapy may impair memory, executive function, attention and visuospatial function in women with breast cancer.

• Journal of Hospice and Palliative Care
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• v.17 no.3
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• pp.170-178
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• 2014

Purpose: Delirium is a common and serious neuropsychiatric complication among terminally ill cancer patients. We investigated risk factors related to the development of delirium among hospice care patients. Methods: Between May 2011 and September 2012, we included patients who were mentally alert and had no psychiatric disease or drug addiction at the hospice ward of two local hospitals. Among them, participants who had been diagnosed with delirium by two doctors according to the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders-4th edition) criteria were grouped as Delirium Group. We analyzed results of psychometric and other laboratory tests performed at the time of patient's admission - psychometric tests included cognitive function (mini-mental status examination, MMSE), depression (Beck Depression Inventory, BDI), anxiety, and insomnia (Insomnia Severity Index, ISI). Logistic regression analysis was used to compare delirium and the related factors. Cox's proportional hazard model was performed using significant factors of logistic regression analysis. Results: Of the 96 patients who met the inclusion criteria, 41 (42.7%) developed delirium. According to the logistic regression analysis, primary cancer site, cognitive impairment (MMSE < 24), depression ($BDI{\geq}16$), and insomnia ($ISI{\geq}15$) were significant factors related to delirium. Among the four factors, depression (OR 5.130; 95% CI, 2.009~13.097) and cognitive impairment (OR 5.130; 95% CI, 2.009~13.097) were found significant using Cox's proportional hazard model. Conclusion: The development of delirium was significantly related to depression and cognitive impairment among patients receiving hospice care. It is necessary to carefully monitor depression and cognitive function in hospice care.

• The Korean Journal of Physiology and Pharmacology
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• v.28 no.2
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• pp.145-152
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• 2024

Chemotherapy-induced cognitive impairment is recognized as the most typical symptom in patients with cancer that occurs during and following the chemotherapy treatment. Recently many studies focused on pharmaceutical strategies to control the chemotherapy side effects, however it is far from satisfactory. There may be a need for more effective treatment options. The aim of this study was to investigate the protective effect of exercise on cisplatin-induced neurotoxicity. Eight-week-old C57BL6 mice were separated into three group: normal control (CON, n = 8); cisplatin injection control (Cis-CON, n = 8); cisplatin with aerobic exercise (Cis-EXE, n = 8). Cisplatin was administered intraperitoneally at a dose of 3.5 mg/kg/day. The Cis-EXE group exercise by treadmill running (14-16 m/min for 45 min daily, 3 times/week) for 12 weeks. Compared to the CON group, the cisplatin injection groups showed significant decrease in body weight and food intake, indicating successful induction of cisplatin toxicity. The Cis-CON group showed significantly increased levels of pro-inflammatory cytokines including IL-6, IL-1β, and TNF-α in the hippocampus, while the Cis-EXE group was significantly decreased in the expression of IL-6, IL-1β, and TNF-α. In addition, compared to the CON group, the levels of synapse-related proteins including synapsin-1 and -2 were significantly reduced in the Cis-CON group, and there was a significant difference between the Cis-CON and Cis-EXE groups. Antioxidant and apoptosis factors were significantly improved in the Cis-EXE group compared with the Cis-CON group. This study suggest that exercise could be meaningful approach to prevent or improve cisplatin-induced cognitive impairment.