A Meta-Analysis of Neuropsychological Outcomes of the Frontal Lobe Following Chemotherapy

Date
2017-08
Authors
Barefoot, Clair Andrea
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Publisher
Faculty of Graduate Studies and Research, University of Regina
Abstract

Cancer affects a large number of people. According to the Canadian Cancer Society (2016), the prevalence of cancer is 2.4% or approximately 1 out of every 42 Canadians. Chemotherapy is a common component of cancer treatment protocols; however, there are varying reports of cognitive dysfunction following administration. A proposed mechanism of dysfunction is that chemotherapy expedites the presentation of outcomes associated with the normal aging process, particularly frontal lobe functions (e.g., verbal fluency, planning, and inhibition). As frontal lobe functions have been shown to be more vulnerable to aging than other cognitive processes, these functions were the focus of the present review. The purpose of the present study was to amalgamate the existing literature to determine if frontal lobe functions are adversely affected by chemotherapy administration. A Cochrane Review-style meta-analysis was conducted, which included 19 studies that examined frontal lobe function objectively in individuals with cancer who received chemotherapy. Generally, effect sizes were small with a pattern of results emerging in which groups treated with chemotherapy performed worse than control groups in between-subjects designs; however, within-subjects designs showed improvement following chemotherapy. Specifically, the chemotherapy groups performed worse than cancer control groups on short-term and working memory, and worse than healthy control groups on short-term memory, working memory, attention, and verbal fluency. Within-subject designs showed improvement on measures of inhibition, working memory, attention, and processing speed post-chemotherapy in comparison to pre-chemotherapy scores. There was some evidence that the chemotherapy group had higher depression scores in comparison to the healthy control group. Worse anxiety prior to chemotherapy was present in within-subjects designs, but this effect did not reach statistical significance. The risk of bias assessment revealed a need for more structured recruitment, better descriptions of published data (e.g., z-score, standard score mean), and considerations for practice effects. Given the weaknesses identified through the risk of bias assessment and the fact that the studies in the meta-analysis were non-randomized, an overall rating of very low quality was assigned to each cognitive domain associated with the frontal lobes. Therefore, the confidence and generalizability of the results should be viewed with some caution. More research is needed to quantify the effects of chemotherapy on cognitive function, with the goal of improving quality of life following cancer treatment.

Description
A Thesis Submitted to the Faculty of Graduate Studies and Research In Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy in Clinical Psychology, University of Regina. xii, 272 p.
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