User:22ilovecats22/Post-chemotherapy cognitive impairment

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Post-chemotherapy cognitive impairment (PCCI) (also known in the scientific community as "CRCIs or Chemotherapy-Related Cognitive Impairments" and in lay terms as chemotherapy-induced cognitive dysfunction or impairment, chemo brain, or chemo fog) describes the cognitive impairment that can result from chemotherapy treatment. While there is no concrete statistic for the number of patients that experience some level of post-chemotherapy cognitive impairment, the estimated percentage is between 13 to 70 percent of patients. The phenomenon first came to light because of the large number of breast cancer survivors who complained of changes in memory, fluency, and other cognitive abilities that impeded their ability to function as they had pre-chemotherapy.

Signs and symptoms
The systems of the body most affected by chemotherapy drugs include visual and semantic memory, attention, motor coordination and executive functioning. These effects can impair a chemotherapy patient's ability to understand and make decisions regarding treatment, perform in school or employment and can reduce quality of life. Survivors often report difficulty multitasking, comprehending what they have just read, following the thread of a conversation, and retrieving words.

Post-chemotherapy cognitive impairment comes as a surprise to many cancer survivors. Often, survivors think their lives will return to normal when the cancer is gone, only to find that the lingering effects of post-chemotherapy cognitive impairment impede their efforts. Working, connecting with loved ones, carrying out day-to-day tasks—all can be very challenging for an impaired brain. Due to such challenges, patients have reported difficulty concentrating to be as significant a stressor as dealing with thoughts of mortality. Although post-chemotherapy cognitive impairment appears to be temporary, it can be quite long-lived, with some cases lasting 10 years or more.

Management
Hypothesized treatment options include the use of antioxidants, cognitive behavioral therapy, erythropoietin and stimulant drugs such as methylphenidate, though as the mechanism of PCCI is not well understood the potential treatment options are equally theoretical. '''Patients who engage in cognitive behavioral therapy to treat CRCI routinely report improved symptoms, and studies have shown self-reported improvement of depression, anxiety, fatigue and cognitive complaints.  A specific form of CBT shown to have successful improvement of cognitive impairment is Memory and Attention Adaptation Training, which mostly focuses on working memory and has reported high satisfaction by patients and increase in quality of life. While these physical and mental forms of management for PCCI symptoms show subjective improvements, they are less supported in regards to objective assessment and still require further testing.'''

Modafinil, approved for narcolepsy, has been used off-label in trials with people with symptoms of PCCI. Modafinil is a wakefulness-promoting agent that can improve alertness and concentration, and studies have shown it to be effective at least among women treated for breast cancer. (added another source)

While estrogen hormone supplementation may reverse the symptoms of PCCI in women treated for breast cancer, this carries health risks, including possibly promoting the proliferation of estrogen-responsive breast cancer cells.

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'''There are other proposed forms of managing PCCI symptoms, one being physical activity. Studies have shown that when compared with control groups, breast cancer patients with a diagnosis within the last two years who were apart of the exercise trial group experienced improved processing speed and reduction in cognitive symptoms. Additionally, yoga and meditation have been seen to improve cognitive flexibility and attention, as well as decrease some of the other psychological stressors that contribute to cognitive complaints such as anxiety and depression.'''

ADDING SECTION ABOUT OBJECTIVE AND SUBJECTIVE MEASURES OF CRCI

Objective and Subjective Measures
When measuring cancer related cognitive impairments, there are both objective and subjective measures. Objective measures of CRCI include neuropsychological tests of cognitive function, while subjective tests include self-reported data such as survey's and interviews. A controversy in PCCI that presents trouble for researchers is the significant difference between objectively assessed cognitive impairment and levels of self-reported cognitive impairment in patients. Data shows that as few as 12% of cancer survivors may objectively experience mild cognitive impairment while 80% of the same population subjectively reported impairments. An explanation for the differences between objective and subjective measures may be due to confounding factors that influence complaints and cognitive struggles in subjective reports, such as emotional distress, anxiety, depression and fatigue. These large discrepancies cause confusion as to how common PCCI is and which cognitive functions are actually being impaired, which can have harmful impacts on the future of research for treatments and implementation of interventions. Regardless of the lack of correlation between objective and subjective measures, there are statistically significant relationships between subjective measures of cognitive impairment and executive function, attention, processing speed, visuospatial performance, response inhibition, cognitive flexibility and total cognitive performance. Both objective and subjective measures of cognitive impairment help to assess quality of life and day to day concerns for cancer patients, and therefore is important to consider in the development of treatment plans and psychological assessments.

Incidence
PCCI affects a subset of cancer survivors, though the overall epidemiology and prevalence is not well known and may depend on many factors. As previously mentioned, PCCI affects between 13-70% of the general cancer patient population.

It generally affects about 10–40% of breast cancer patients, with higher rates among pre-menopausal women and patients who receive high-dose chemotherapy. Additionally, there are high complaints of cognitive impairment in glioblastoma patients, 60-85% of patients report cancer-related cognitive impairments following surgery and adjunctive treatment.