Skip to main content Accessibility help
×
Home
  • Get access
    Check if you have access via personal or institutional login
  • Cited by 1
  • Print publication year: 2008
  • Online publication date: August 2009

4 - Role of neuropsychological assessment in cancer patients

Summary

Neurocognitive function is a very important issue in cancer survivorship. When present, neurocognitive deficits explain the lion's share of cancer survivors' reported decreased quality of life. However, scientific study of the neuropsychological sequelae of cancer is just beginning to be undertaken. A Medline search for 1996–2006 of “neuropsychology or neurocognitive” and “cancer” results in only 86 articles. Once those are selected to include only those that include information on cancer in adults (as opposed to pediatric cancer or adult survivors of pediatric cancers), written in English, only 34 papers remain. However, the relative paucity of research is in contrast to the recent attention given to this important topic, most recently in the Institute of Medicine Report From Cancer Patient to Cancer Survivor, in which cognitive dysfunction is listed as one of the important concerns of cancer survivors after treatment (Hewitt et al., 2006).

Neurocognitive deficits in cancer patients are variable. When patients report having neuropsychological impairments, they may note them as being very minor (e.g., “I'm in a fog” or “I have a lot of ‘senior moments’”) or patients may have significant neurocognitive deficits that impair their ability to speak, remember, or act appropriately. Some patients are not aware of their own deficits and only caregivers have noticed the changes. A cancer patient with neurocognitive dysfunction may decline during some periods, such as during active treatment, and improve during inter-treatment intervals; however, often the opposite pattern can be seen.

REFERENCES
Aaronson, N, Ahmedzai, S, Bergman, V, et al. (1993). The European Organization for Research and Treatment of Cancer QLQ-C30: a quality of life instrument for use in international trials in oncology. J Natl Cancer Inst 85: 365–376.
Ahles, TA, Silberfarb, PM, Herndon, J, 2nd, et al. (1998). Psychologic and neuropsychologic functioning of patients with limited small-cell lung cancer treated with chemotherapy and radiation therapy with or without warfarin: a study by the Cancer and Leukemia Group B. J Clin Oncol 16: 1954–1960.
Ahles, TA, Saykin, AJ, Furstenberg, CT, et al. (2002). Neuropsychologic impact of standard-dose systemic chemotherapy in long-term survivors of breast cancer and lymphoma. J Clin Oncol 20: 485–493.
Anderson, SW, Damasio, H, Tranel, D (1990). Neuropsychological impairments associated with lesions caused by tumor or stroke. Arch Neurol 47: 397–405.
Archibald, YM, Lunn, D, Ruttan, , et al. (1994). Cognitive functioning in long-term survivors of high-grade glioma. J Neurosurg 80: 247–253.
Arfken, CL, Lichtenberg, PA, Tancer, ME (1999). Cognitive impairment and depression predict mortality in medically ill older adults. J Gerontol Series A-Biol Sci Med Sci 54: M152–M156.
Armstrong, CL, Goldstein, B, Shera, D, et al. (2003). The predictive value of longitudinal neuropsychologic assessment in the early detection of brain tumor recurrence. Cancer 97: 649–656.
Baile, WF (1996). Neuropsychiatric disorders in cancer patients. Curr Opin Oncol 8: 182–187.
Barona, A, Reynolds, CR, Chastain, R (1984). A demographically based index of premorbid intelligence for the WAIS-R. J Consult Clin Psychol 52: 885–887.
Bender, CM, Paraska, KK, Sereika, SM, Ryan, CM, Berga, SL (2001). Cognitive function and reproductive hormones in adjuvant therapy for breast cancer: a critical review. J Pain Symptom Manage 21: 407–424.
Bezjak, A, Taylor, KM, Ng, P, et al. (1998). Quality-of-life information and clinical practice: the oncologist's perspective. Cancer Prevent Control 2: 230–235.
Bick, PA (1983). Obsessive-compulsive behavior associated with dexamethasone treatment. J Nerv Mental Dis 171: 253–254.
Brezden, CB, Phillips, KA, Abdolell, M, et al. (2000). Cognitive function in breast cancer patients receiving adjuvant chemotherapy. J Clin Oncol 18: 2695–2701.
Cairncross, JG, Kim, JH, Posner, JB (1980). Radiation therapy for brain metastases. Ann Neurol 7: 529–541.
Capuron, L, Ravaud, A, Gualde, N, et al. (2001). Association between immune activation and early depressive symptoms in cancer patients treated with interleukin-2-based therapy. Psychoneuroendocrinology 26: 797–808.
Carney, DN (1999). Prophylactic cranial irradiation and small-cell lung cancer [editorial; comment]. New Engl J Med 341: 524–526.
Chidel, MA, Suh, JH, Barnett, GH (2000). Brain metastases: presentation, evaluation, and management. Clevel Clin J Med 67: 120–127.
Cummings, J (1990). Introduction. In: Cummings, J (ed.) Subcortical Dementia. New York, Oxford University Press.
DeAngelis, LM (1994). Management of brain metastases. Cancer Invest 12: 156–165.
DeAngelis, LM, Delattre, JY, Posner, JB (1989). Radiation-induced dementia in patients cured of brain metastases. Neurology 39: 789–796.
DiMatteo, MR, Lepper, HS, Croghan, TW (2000). Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med 160: 2101–2107.
Farace, E, Shaffrey, ME (2000). Relationship of neurocognitive impairment to QOL in malignant brain tumor patients [abstract]. J Neuropsychiatry Clin Neurosci 13: 1.
Farace, E, Turkheimer, E, Wilkniss, S (1995). Utility of analyzing lesion location in an outcome study of traumatic brain injury [abstract]. International Neuropsychological Society. Seattle, WA. J Int Neuropsychol Soc 1.
Ferrell, B, Rhiner, M, Rivera, LM (1993). Development and evaluation of the family pain questionnaire. J Psychosocial Oncol 10: 21–35.
Friedman, MA, Meyers, CA, Sawaya, R (2003). Neuropsychological effects of third ventricle tumor surgery. Neurosurgery 52: 791–798; discussion 798.
Ganz, PA (1998). Cognitive dysfunction following adjuvant treatment of breast cancer: a new dose-limiting toxic effect? [letter; comment]. J Natl Cancer Inst 90: 182–183.
Ganz, PA, Desmond, KA, Leedham, B, et al. (2002). Quality of life in long-term, disease-free survivors of breast cancer: a follow-up study. J Natl Cancer Inst 94: 39–49 [erratum in: J Natl Cancer Inst 94:463].
Hahn, CA, Dunn, RH, Logue, PE, et al. (2003). Prospective study of neuropsychologic testing and quality-of-life assessment of adults with primary malignant brain tumors. Int J Radiat Oncol Biol Phys 55: 992–999.
Hecaen, H (1962). Clinical symptomatology in right and left hemisphere lesions. In Mountcastle, VB (ed.) Interhemispheric Relations and Cerebral Dominance in Man:Baltimore, MD: Johns Hopkins University Press.
Heilman, KM, Bowers, D, Valenstein, E (1993). Emotional disorders associated with neurological diseases. In Heilman KM, Valenstein E (eds.) Clinical Neuropsychology, 3rd edn. New York: Oxford University Press.
Hewitt, M, Greenfield, S, Stovall, E (eds.) (2006). From Cancer Patient to Cancer Survivor: Lost in Transition. Washington DC: National Academies Press.
Hirsch, FR, Paulson, OB, Hansen, HH, et al. (1982). Intracranial metastases in small cell carcinoma of the lung: correlation of clinical and autopsy findings. Cancer 50: 2433–2437.
Hochberg, FH, Slotnick, B (1980). Neuropsychologic impairment in astrocytoma survivors. Neurology 30: 172–177.
Hom, J, Reitan, RM (1984). Neuropsychological correlates of rapidly vs. slowly growing intrinsic cerebral neoplasms. J Clin Neuropsychol 6: 309–324.
Imperato, JP, Paleologos, NA, Vick, NA (1990). Effects of treatment on long-term survivors with malignant astrocytomas. Ann Neurol 28: 818–822.
Irle, E, Peper, M, Wowra, B, et al. (1994). Mood changes after surgery for tumors of the cerebral cortex. Arch Neurol 51: 164–174.
Jelic, V, Johansson, SE, Almkvist, O, et al. (2000). Quantitative electroencephalography in mild cognitive impairment: longitudinal changes and possible prediction of Alzheimer's disease. Neurobiol Aging 21: 533–540.
Keime-Guibert, F, Napolitano, M, Delattre, JY (1998). Neurological complications of radiotherapy and chemotherapy. J Neurol 245: 695–708.
Klein, M, Taphoorn, MJB, Heimans, JJ, et al. (2001). Neurobehavioral status and health-related quality of life in newly diagnosed high-grade glioma patients. J Clin Oncol 19: 4037–4047.
Laws, ER, Shaffrey, ME, Morris, A, et al. (2003). Surgical management of intracranial gliomas – does radical resection improve outcome?Acta Neurochir Suppl 85: 47–53.
Lezak, MD, O'Brien, KP (1988). Longitudinal study of emotional, social, and physical changes after traumatic brain injury. J Learn Disabil 21:456–463.
Lezak, MD, Howieson, DB, Loring, DW (2004). Neuropsychological Assessment (4th edn.). New York: Oxford University Press.
Lieberman, AN, Foo, SH, Ransohoff, J, et al. (1982). Long term survival among patients with malignant brain tumors. Neurosurgery 10: 450–453.
Litofsky, NS, Farace, E, Anderson, F, et al. (2004). Depression in patients with high-grade glioma: results of the Glioma Outcomes Project. Neurosurgery 54: 358–366; discussion 366–367.
Loberiza, FR, Rizzo, JD, Bredeson, CN, et al. (2002). Association of depressive syndrome and early deaths among patients after stem-cell transplantation for malignant diseases. J Clin Oncol 20: 2118–2126.
Mechanick, JI, Hochberg, FH, Larocque, A (1986). Hypothalamic dysfunction following whole-brain irradiation. J Neurosurg, 65: 490–494.
Meyers, CA (2000). Quality of life of brain tumor patients. In Bernstein, M, Berger, MS (eds.) Neuro-Oncology: The Essentials. New York: Thieme Medical Publishers.
Meyers, CA, Brown, PD (2006). The role and relevance of neurocognitive assessment in clinical trials of patients with central nervous system tumors. J Clin Oncol 24: 1305–1309.
Meyers, CA, Hess, KR (2003). Multifaceted end points in brain tumor clinical trials: cognitive deterioration precedes MRI progression. Neurooncology 5: 89–95.
Meyers, CA, Geara, F, Wong, PF, et al. (2000a). Neurocognitive effects of therapeutic irradiation for base of skull tumors. Int J Radiat Oncol Biol Phys 46: 51–55.
Meyers, CA, Hess, KR, Yung, WKA, et al. (2000b). Cognitive function as a predictor of survival in patients with recurrent malignant glioma. J Clin Oncol 18: 646–650.
Meyers, CA, Mehta, MP, Rodrigus, P, et al. (2002). Motexafin gadolinium (MGD) delays neurocognitive progression in patients with brain metastases from lung cancer: results of a randomized phase III trial. Neurooncology 4: 372.
Meyers, CA, Smith, JA, Bezjak, A, et al. (2004). Neurocognitive function and progression in patients with brain metastases treated with whole-brain radiation and motexafin gadolinium: results of a randomized phase III trial. J Clin Oncol 22: 157–165.
Murray, KJ, Scott, C, Zachariah, B, et al. (2000). Importance of the mini-mental status examination in the treatment of patients with brain metastases: a report from the Radiation Therapy Oncology Group protocol 91–04. Int J Radiat Oncol Biol Phys 48: 59–64.
Olin, JJ (2001). Cognitive function after systemic therapy for breast cancer. Oncology (Williston Park) 15: 613–618; discussion 618: 621–624.
Packer, RJ, Miller, DC, Shaffrey, MS, et al. (1998). Intracranial neoplasms. In Rosenberg, RN, Pleasure, (eds.) Comprehensive Neurology (2nd edn.) New York: John Wiley & Sons.
Paganini-Hill, A, Clark, LJ (2000). Preliminary assessment of cognitive function in breast cancer patients treated with tamoxifen. Breast Cancer Res Treat 64: 165–176.
Patchell, RA (1995). Metastatic brain tumors. Neurol Clin 13: 915–925.
Patchell, R, Tibbs, P (1990). A randomised trial of surgery in the treatment of single metastases to the brain. New Engl J Med 22: 494–500.
Peyser, JM, Rao, SM, Larocca, NG, et al. (1990). Guidelines for neuropsychological research in multiple sclerosis. Arch Neurol 47: 94–97.
Pignatti, F, Bent, M, Curran, D, et al. (2002). Prognostic factors for survival in adult patients with cerebral low-grade glioma. J Clin Oncol 20: 2076–2084.
Price, BH, Mesulam, M (1985). Psychiatric manifestations of right hemisphere infarctions. J Nerv Mental Dis 173: 610–614.
Robinson, B (1983). Validation of a caregiver strain index. J Gerontol 38: 344–388.
Rohling, ML, Green, P, Allen, LM, et al. (2002). Depressive symptoms and neurocognitive test scores in patients passing symptoms validity tests. Arch Clin Neuropsychol 17: 205–222.
Roman, GC, Tatemichi, TK, Erkinjuntti, T, et al. (1993). Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology 43: 250–260.
Routh, A, Khansur, T, Hickman, BT, et al. (1994). Management of brain metastases: past, present, and future. Southern Med J 87: 1218–1226.
Salander, P, Karlsson, T, Bergenheim, T, et al. (1995). Long-term memory deficits in patients with malignant gliomas. J Neurooncol 25: 227–238.
Sawaya, R, Rambo, WM, Hammoud, MA, et al. (1995). Advances in surgery for brain tumors. Neurol Clin 13: 757–771.
Schagen, SB, Dam, FS, Muller, MJ, et al. (1999). Cognitive deficits after postoperative adjuvant chemotherapy for breast carcinoma. Cancer 85: 640–650.
Scheibel, RS, Meyers, CA, Levin, VA (1996). Cognitive dysfunction following surgery for intracerebral glioma: influence of histopathology, lesion location, and treatment. J Neurooncol 30: 61–69.
Sheline, GE, Wara, WM, Smith, V (1980). Therapeutic irradiation and brain injury. Int J Radiat Oncol Biol Phy 6: 1215–1228.
Spiegel, D (1996). Cancer and depression. Br J Psychiatry Suppl30: 109–116.
Sundaresan, N, Galicich, JH, Deck, MD, et al. (1981). Radiation necrosis after treatment of solitary intracranial metastases. Neurosurgery 8: 329–333.
Surma-Aho, O, Niemela, M, Vilkki, J, et al. (2001). Adverse long-term effects of brain radiotherapy in adult low-grade glioma patients. Neurology 56: 1285–1290.
Taphoorn, MJ, Schiphorst, AK, Snoek, FJ, et al. (1994). Cognitive functions and quality of life in patients with low-grade gliomas: the impact of radiotherapy. Ann Neurol 36: 48–54.
Tashiro, M, Itoh, M, Kubota, K, et al. (2001). Relationship between trait anxiety, brain activity and natural killer cell activity in cancer patients: a preliminary PET study. Psychooncology 10: 541–546.
Tucha, O, Smely, C, Preier, M, et al. (2000). Cognitive deficits before treatment among patients with brain tumors. Neurosurgery 47: 324–333; discussion 333–334.
Dam, FS, Schagen, SB, Muller, MJ, et al. (1998). Impairment of cognitive function in women receiving adjuvant treatment for high-risk breast cancer: high-dose versus standard-dose chemotherapy. J Natl Cancer Inst 90: 210–218.
Pol, M, Ten Velde, GP, Wilmink, JT, et al. (1997). Efficacy and safety of prophylactic cranial irradiation in patients with small cell lung cancer. J Neurooncol 35: 153–160.
Oosterhout, AG, Ganzevles, PG, Wilmink, JT, et al. (1996). Sequelae in long-term survivors of small cell lung cancer. Int J Radiat Oncol Biol Phys 34: 1037–1044.
Vecht, CJ, Hovestadt, A, Verbiest, HB, et al. (1994). Dose-effect relationship of dexamethasone on Karnofsky performance in metastatic brain tumors: a randomized study of doses of 4, 8, and 16 mg per day. Neurology 44: 675–680.
Vermeulen, SS (1998). Whole brain radiotherapy in the treatment of metastatic brain tumors. Sem in Surg Oncol 14: 64–69.
Walker, LG, Heys, SD, Walker, MB, et al. (1999). Psychological factors can predict the response to primary chemotherapy in patients with locally advanced breast cancer. Eur J Cancer 35: 1783–1788.