Effectiveness of psychosocial interventions for cognitive dysfunction in cancer patients who have received chemotherapy: a systematic review.
BACKGROUND
Chemotherapy related cognitive dysfunction is a condition experienced by patients with cancer who have had chemotherapy. It may cause problems with memory, attention span and/or concentration, which can have a significant negative effect on the patient's quality of life. The exact cause of chemotherapy related cognitive dysfunction is unknown but is presumed to be multifactorial. To date, there is limited research available testing the effectiveness of non-pharmacological treatments for chemotherapy related cognitive dysfunction, despite widespread acceptance that the phenomenon exists, and as yet no meta-analysis has been conducted.


OBJECTIVE
To assess the effectiveness of psychosocial interventions designed to treat chemotherapy related cognitive dysfunction.


METHODS
Participants were over 18, diagnosed with cancer and either currently receiving chemotherapy or had received chemotherapy as part of their treatment.The interventions of interest were methods to improve cognitive function and included cognitive behavioural therapy, psychological counselling and/or education on compensatory mechanisms for managing chemotherapy related cognitive dysfunction.Randomised controlled trials, clinical trials, quasi-experimental and other quantitative research designs were considered for inclusion.The primary outcome of interest was level of cognitive dysfunction, as measured by any reliable and validated scale. Secondary outcome was quality of life, again measured by a valid and reliable tool.


METHODS
A three-step search strategy was utilised to identify published and non-published studies, dated between January 1985 to May, 2011.


METHODS
All studies meeting the criteria were retrieved. Two reviewers critically appraised the studies using the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument.


METHODS
Data was extracted from the included papers using the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument data extraction form. Two authors were contacted to provide further data.


RESULTS
Findings were analysed using the Cochrane Collaboration Review Manager 5.1 program.


RESULTS
The search process identified 3109 potentially relevant articles. From this, 120 full articles were retrieved. Two further papers were identified from the reference lists of retrieved articles. From 122 papers, 6 were suitable for critical appraisal. Meta-analysis was conducted on two trials for the outcome of inability to concentrate.


CONCLUSIONS
The available evidence on psychosocial interventions for chemotherapy related cognitive dysfunction is incomplete. There is some weak evidence to suggest some of the tested interventions may reduce memory and attention problems for some people. A significant positive effect on some Quality of Life measures was shown.


CONCLUSIONS
Symptoms of chemotherapy related cognitive dysfunction can be distressing and limiting to patients and must therefore be acknowledged and validated in a clinical context. There is insufficient strong evidence at this stage to recommend any of the interventions for use in clinical practice.


CONCLUSIONS
There is abundant research identifying that the phenomena of chemotherapy related cognitive dysfunction exists, but little research on interventions to improve symptoms. Further good quality research is required to target specific non-pharmacological interventions which will improve patients' quality of life and functional ability.
1. Nursing Research Centre and the Queensland Centre for Evidence-Based Nursing and Midwifery (NRC & QCEBNM), Mater Health Services; the NRC QCEBNM is a collaborating centre of the Joanna Briggs Institute. 2. BN, Clinical Research Nurse, MAppSc (Research) candidate 3. BN, RN, MAppSc (Research) candidate 4. BN, Research Nurse, MPhil (Clinical Science) candidate 5. Professor of Clinical Nursing, QUT and Director, NRC & QCEBNM.
Sonia
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Hines
Mary-Anne
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Ramis
Shannon
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Pike
Anne M
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Chang