title: Systematic review of pharmacologic and non-pharmacologic interventions to manage cognitive alterations after chemotherapy for breast cancer.
abstract: OBJECTIVE
  Cognitive alterations are reported in breast cancer patients receiving chemotherapy. This has adverse effects on patients' quality of life and function. This systematic review investigates the effectiveness of pharmacologic and non-pharmacologic interventions to manage cognitive alterations associated with breast cancer treatment.
  
  
  METHODS
  Medline via EBSCO host, CINAHL and Cochrane CENTRAL were searched for the period January 1999-May 2014 for prospective randomised controlled trials related to the management of chemotherapy-associated cognitive alterations. Included studies investigated the management of chemotherapy-associated cognitive alterations and used subjective or objective measures in patients with breast cancer during or after chemotherapy. Two authors independently extracted data and assessed the risk of bias.
  
  
  RESULTS
  Thirteen studies involving 1138 participants were included. Overall, the risk of bias for the 13 studies was either high (n=11) or unclear (n=2). Pharmacologic interventions included psychostimulants (n=4), epoetin alfa (n=1) and Ginkgo biloba (n=1). Non-pharmacologic interventions were cognitive training (n=5) and physical activity (n=2). Pharmacologic agents were ineffective except for self-reported cognitive function in an epoetin alfa study. Cognitive training interventions demonstrated benefits in self-reported cognitive function, memory, verbal function and language and orientation/attention. Physical activity interventions were effective in improving executive function and self-reported concentration.
  
  
  CONCLUSIONS
  Current evidence does not favour the pharmacologic management of cognitive alterations associated with breast cancer treatment. Cognitive training and physical activity interventions appear promising, but additional studies are required to establish their efficacy. Further research is needed to overcome methodological shortfalls such as heterogeneity in participant characteristics and non-standardised neuropsychological outcome measures.
authors.affiliation: Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland 4059, Australia; Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland 4029, Australia. Electronic address: Raymond.Chan@health.qld.gov.au.
authors.forename: Raymond J
authors.initials: RJ
authors.lastname: Chan
authors.affiliation: Princess Alexandra Hospital and the Institute of Health and Biomedical Innovation, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, Queensland 4059, Australia. Electronic address: al.mccarthy@qut.edu.au.
authors.forename: Alexandra L
authors.initials: AL
authors.lastname: McCarthy
authors.affiliation: The University of Queensland Library Herston Health Sciences Library, Royal Brisbane and Women's Hospital, Herston, Queensland 4029, Australia. Electronic address: j.devenish@library.uq.edu.au.
authors.forename: Jackie
authors.initials: J
authors.lastname: Devenish
authors.affiliation: School of Psychology and Counseling, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, Queensland 4059, Australia. Electronic address: Karen.Sullivan@qut.edu.au.
authors.forename: Karen A
authors.initials: KA
authors.lastname: Sullivan
authors.affiliation: Department of Pharmacy, National University of Singapore, Singapore 117543, Singapore; Department of Pharmacy, National Cancer Centre, Singapore 117543, Singapore. Electronic address: phaac@nus.edu.sg.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Chan
mesh_terms: D001943:Breast Neoplasms / Q000188:drug therapy* / Q000523:psychology; D000697:Central Nervous System Stimulants / Q000627:therapeutic use; D003072:Cognition Disorders / Q000628:therapy*; D015444:Exercise; D005260:Female; D006801:Humans
chemical_list: D000697:Central Nervous System Stimulants
keywords: Breast cancer; Chemotherapy; Cognitive function; Cognitive training; Physical activity; Psychostimulants