Mechanism and progress of diagnosis and treatment of cognitive impairment in lung cancer patients after chemotherapy_West China Medical Journal

Authors：

HANG Tang ,  LIU Dan

Advanced Technology Research Institute of Brain Science, School of Medicine, Wuhan University of Science and Technology, Wuhan, Hubei 430000, P. R. China;

Corresponding author：

LIU Dan, Email: liudan125@wust.edu.cn

Keywords：

Lung cancer; Chemotherapy; Cognitive function

DOI：

10.7507/1002-0179.202005169

Video：

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Lung cancer ranks first in the incidence of malignant tumors in China, which is seriously harmful to people’s life and health. Chemotherapy is an effective treatment for lung cancer, and it is also an important cause of cognitive dysfunction. Cognitive impairment is usually evaluated by subjective assessment, neuropsychological testing and neuroimaging research. The mechanism of cognitive impairment in patients with lung cancer caused by chemotherapy may include the accumulation of a large amount of endogenous tau protein in hippocampus, the induction of hippocampal neuroinflammation, and the direct killing effect of drugs on nerve cells. There is no effective treatment for chemotherapy-related cognitive impairment (CRCI), but current studies have found that cognitive education in the form of mind map, diet regulation, physical exercise and caring therapy may contribute to the improvement of cognitive function of lung cancer patients after chemotherapy. Based on the current research results, this article provides new ideas for the research and treatment of lung cancer patients with CRCI in terms of clinical characteristics, evaluation methods, influencing factors, mechanism and prevention strategies.

Citation： HANG Tang, LIU Dan. Mechanism and progress of diagnosis and treatment of cognitive impairment in lung cancer patients after chemotherapy. West China Medical Journal, 2021, 36(2): 255-259. doi: 10.7507/1002-0179.202005169 Copy

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3.	中华医学会, 中华医学会肿瘤学分会, 中华医学会杂志社. 中华医学会肺癌临床诊疗指南(2018 版). 肿瘤研究与临床, 2018, 30(12): 793-824.
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5.	Cascella M, Di Napoli R, Carbone D, et al. Chemotherapy-related cognitive impairment: mechanisms, clinical features and research perspectives. Recenti Prog Med, 2018, 109(11): 523-530.
6.	Jim HS, Phillips KM, Chait S, et al. Meta-analysis of cognitive functioning in breast cancer survivors previously treated with standard-dose chemotherapy. J Clin Oncol, 2012, 30(29): 3578-3587.
7.	Douillard JY, Rosell R, De Lena M, et al. Adjuvant vinorelbine plus cisplatin versus observation in patients with completely resected stage ⅠB-ⅢA non-small-cell lung cancer (Adjuvant Navelbine International Trialist Association [ANITA]): a randomized controlled trial. Lancet Oncol, 2006, 7(9): 719-727.
8.	Bray VJ, Dhillon HM, Vardy JL. Systematic review of self-reported cognitive function in cancer patients following chemotherapy treatment. J Cancer Surviv, 2018, 12(4): 537-559.
9.	Grosshans DR, Meyers CA, Allen PK, et al. Neurocognitive function in patients with small cell lung cancer: effect of prophylactic cranial irradiation. Cancer, 2008, 112(3): 589-595.
10.	Komaki R, Meyers CA, Shin DM, et al. Evaluation of cognitive function in patients with limited small cell lung cancer prior to and shortly following prophylactic cranial irradiation. Int J Radiat Oncol Biol Phys, 1995, 33(1): 179-182.
11.	李宜敏, 余春华. 抑郁情绪对肺癌病人化疗后认知功能的影响. 安徽医药, 2019, 23(8): 1539-1542.
12.	van Dyk K, Ganz PA. Doctor, now that my chemotherapy treatment is over, when will my “chemofog” lift. J Clin Oncol, 2017, 35(5): 482-484.
13.	刘伟, 宋晨, 张喜友, 等. 化疗对乳腺癌患者静息态局部脑活动和认知功能的影响. 磁共振成像, 2019, 10(3): 174-178.
14.	Wagner LI, Sweet JJ, Butt Z, et al. Measuring patient self-reported cognitive function: development of the functional assessment of cancer therapy-cognitive function instrument. J Support Oncol, 2009, 7(6): W32-W39.
15.	Reid-Arndt SA, Yee A, Perry MC, et al. Cognitive and psychological factors associated with early posttreatment functional outcomes in breast cancer survivors. J Psychosoc Oncol, 2009, 27(4): 415-434.
16.	Dhillon HM, Tannock IF, Pond GR, et al. Perceived cognitive impairment in people with colorectal cancer who do and do not receive chemotherapy. J Cancer Surviv, 2018, 12(2): 178-185.
17.	汪媛. 肿瘤患者住院睡眠质量调查分析及护理对策. 中国肿瘤外科杂志, 2014, 6(5): 337-338.
18.	周小炫, 谢敏, 陶静, 等. 简易智能精神状态检查量表的研究和应用. 中国康复医学杂志, 2016, 31(6): 694-696, 706.
19.	徐珊瑚, 金煜, 陈林辉, 等. 画钟试验和画钟时长在轻度认知功能障碍诊断中的应用. 中华老年病研究电子杂志, 2018, 5(3): 24-27.
20.	Penadés R, Franck N, González-Vallespí L, et al. Neuroimaging studies of cognitive function in schizophrenia. Adv Exp Med Biol, 2019, 1118: 117-134.
21.	Ahles TA, Saykin AJ. Candidate mechanisms for chemotherapy-induced cognitive changes. Nat Rev Cancer, 2007, 7(3): 192-201.
22.	Cruzado JA, López-Santiago S, Martínez-Marín V, et al. Longitudinal study of cognitive dysfunctions induced by adjuvant chemotherapy in colon cancer patients. Support Care Cancer, 2014, 22(7): 1815-1823.
23.	王佳伟, 王得新. 癌基因 bcl-2 和病毒在神经细胞凋亡中的关系. 中华实验和临床病毒学杂志, 2000, 14(3): 296.
24.	Zhang W, Ning N, Li X, et al. Changes of brain glucose metabolism in the pretreatment patients with non-small cell lung cancer: a retrospective PET/CT study. PLoS One, 2016, 11(8): e0161325.
25.	Ondicova K, Mravec B. Role of nervous system in cancer aetiopathogenesis. Lancet Oncol, 2010, 11(6): 596-601.
26.	Lycke M, Pottel L, Pottel H, et al. Predictors of baseline cancer-related cognitive impairment in cancer patients scheduled for a curative treatment. Psycho-Oncology, 2017, 26(5): 632-639.
27.	Nagasaka M, Gadgeel SM. Role of chemotherapy and targeted therapy in early-stage non-small cell lung cancer. Expert Rev Anticancer Ther, 2017, 18(1): 1-8.
28.	李微绽. 吉西他滨联合顺铂应用于非小细胞肺癌临床治疗的效果研究. 中国医学创新, 2017, 14(5): 116-119.
29.	Virnig BA, Baxter NN, Habermann EB, et al. A matter of race: early- versus late-stage cancer diagnosis. Heal Aff (Mill wood), 2009, 28(1): 160-168.
30.	Zenaro E, Pietronigro E, Della Bianca V, et al. Neutrophils promote Alzheimer’s disease–like pathology and cognitive decline via LFA-1 integrin. Nat Med, 2015, 21(8): 880-886.
31.	Chen H, Wu W, Li Y, et al. A novel brain targeted 5-FU derivative with potential antitumor efficiency and decreased acute toxicity: synthesis, in vitro and in vivo evaluation. Pharmazie, 2014, 69(4): 271-276.
32.	葛均波, 徐永健. 内科学. 8 版. 北京: 人民卫生出版社, 2014.
33.	李淑芳, 王燕, 辛士珍, 等. 化疗对肺癌患者生活质量及焦虑情绪的影响及分析. 中国肺癌杂志, 2012, 15(8): 465-470.
34.	戴静, 刘协和, 马渝根. 老人的生活质量与认知功能. 中国民康医学, 2003, 15(3): 181-185.
35.	Martínez García RM, Jiménez Ortega AI, López Sobaler AM, et al. Estrategias nutricionales que mejoran la función cognitiva [Nutrition strategies that improve cognitive function]. Nutr Hosp, 2018, 35(Spec No6): 16-19.
36.	Tan X, Xiong H, Gui S, et al. Effects of cognitive education on the perceived control and symptom distress of lung cancer patients receiving chemotherapy: a randomised controlled trial. Eur J Cancer Care (Engl), 2019, 28(5): e13120.
37.	陆琴, 韩萍. 思维导图在临床护理工作中的应用现状. 护理管理杂志, 2016, 16(5): 346-347, 355.
38.	罗晶, 王爱民, 张金峰. 思维导图在糖尿病患者小组教育中的应用. 护理学杂志, 2014, 29(9): 72-75.
39.	Murray DK, Sacheli MA, Eng JJ, et al. The effects of exercise on cognition in Parkinson’s disease: a systematic review. Transl Neurodegener, 2014, 3(1): 5.
40.	Missel M, Borregaard B, Schoenau MN, et al. A sense of understanding and belonging when life is at stake-operable lung cancer patients’ lived experiences of participation in exercise. Eur J Cancer Care (Engl), 2019, 28(5): e13126.

1. Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, 2016, 66(2): 115-132.
2. Chen W, Zheng R, Zhang S, et al. Cancer incidence and mortality in China in 2013: an analysis based on urbanization level. Chin J Cancer Res, 2017, 29(1): 1-10.
3. 中华医学会, 中华医学会肿瘤学分会, 中华医学会杂志社. 中华医学会肺癌临床诊疗指南(2018 版). 肿瘤研究与临床, 2018, 30(12): 793-824.
4. 皮慧敏, 符琰, 郑儒君, 等. 情绪障碍对肺癌初治患者化疗毒副作用的影响. 临床肺科杂志, 2019, 24(11): 2008-2012.
5. Cascella M, Di Napoli R, Carbone D, et al. Chemotherapy-related cognitive impairment: mechanisms, clinical features and research perspectives. Recenti Prog Med, 2018, 109(11): 523-530.
6. Jim HS, Phillips KM, Chait S, et al. Meta-analysis of cognitive functioning in breast cancer survivors previously treated with standard-dose chemotherapy. J Clin Oncol, 2012, 30(29): 3578-3587.
7. Douillard JY, Rosell R, De Lena M, et al. Adjuvant vinorelbine plus cisplatin versus observation in patients with completely resected stage ⅠB-ⅢA non-small-cell lung cancer (Adjuvant Navelbine International Trialist Association [ANITA]): a randomized controlled trial. Lancet Oncol, 2006, 7(9): 719-727.
8. Bray VJ, Dhillon HM, Vardy JL. Systematic review of self-reported cognitive function in cancer patients following chemotherapy treatment. J Cancer Surviv, 2018, 12(4): 537-559.
9. Grosshans DR, Meyers CA, Allen PK, et al. Neurocognitive function in patients with small cell lung cancer: effect of prophylactic cranial irradiation. Cancer, 2008, 112(3): 589-595.
10. Komaki R, Meyers CA, Shin DM, et al. Evaluation of cognitive function in patients with limited small cell lung cancer prior to and shortly following prophylactic cranial irradiation. Int J Radiat Oncol Biol Phys, 1995, 33(1): 179-182.
11. 李宜敏, 余春华. 抑郁情绪对肺癌病人化疗后认知功能的影响. 安徽医药, 2019, 23(8): 1539-1542.
12. van Dyk K, Ganz PA. Doctor, now that my chemotherapy treatment is over, when will my “chemofog” lift. J Clin Oncol, 2017, 35(5): 482-484.
13. 刘伟, 宋晨, 张喜友, 等. 化疗对乳腺癌患者静息态局部脑活动和认知功能的影响. 磁共振成像, 2019, 10(3): 174-178.
14. Wagner LI, Sweet JJ, Butt Z, et al. Measuring patient self-reported cognitive function: development of the functional assessment of cancer therapy-cognitive function instrument. J Support Oncol, 2009, 7(6): W32-W39.
15. Reid-Arndt SA, Yee A, Perry MC, et al. Cognitive and psychological factors associated with early posttreatment functional outcomes in breast cancer survivors. J Psychosoc Oncol, 2009, 27(4): 415-434.
16. Dhillon HM, Tannock IF, Pond GR, et al. Perceived cognitive impairment in people with colorectal cancer who do and do not receive chemotherapy. J Cancer Surviv, 2018, 12(2): 178-185.
17. 汪媛. 肿瘤患者住院睡眠质量调查分析及护理对策. 中国肿瘤外科杂志, 2014, 6(5): 337-338.
18. 周小炫, 谢敏, 陶静, 等. 简易智能精神状态检查量表的研究和应用. 中国康复医学杂志, 2016, 31(6): 694-696, 706.
19. 徐珊瑚, 金煜, 陈林辉, 等. 画钟试验和画钟时长在轻度认知功能障碍诊断中的应用. 中华老年病研究电子杂志, 2018, 5(3): 24-27.
20. Penadés R, Franck N, González-Vallespí L, et al. Neuroimaging studies of cognitive function in schizophrenia. Adv Exp Med Biol, 2019, 1118: 117-134.
21. Ahles TA, Saykin AJ. Candidate mechanisms for chemotherapy-induced cognitive changes. Nat Rev Cancer, 2007, 7(3): 192-201.
22. Cruzado JA, López-Santiago S, Martínez-Marín V, et al. Longitudinal study of cognitive dysfunctions induced by adjuvant chemotherapy in colon cancer patients. Support Care Cancer, 2014, 22(7): 1815-1823.
23. 王佳伟, 王得新. 癌基因 bcl-2 和病毒在神经细胞凋亡中的关系. 中华实验和临床病毒学杂志, 2000, 14(3): 296.
24. Zhang W, Ning N, Li X, et al. Changes of brain glucose metabolism in the pretreatment patients with non-small cell lung cancer: a retrospective PET/CT study. PLoS One, 2016, 11(8): e0161325.
25. Ondicova K, Mravec B. Role of nervous system in cancer aetiopathogenesis. Lancet Oncol, 2010, 11(6): 596-601.
26. Lycke M, Pottel L, Pottel H, et al. Predictors of baseline cancer-related cognitive impairment in cancer patients scheduled for a curative treatment. Psycho-Oncology, 2017, 26(5): 632-639.
27. Nagasaka M, Gadgeel SM. Role of chemotherapy and targeted therapy in early-stage non-small cell lung cancer. Expert Rev Anticancer Ther, 2017, 18(1): 1-8.
28. 李微绽. 吉西他滨联合顺铂应用于非小细胞肺癌临床治疗的效果研究. 中国医学创新, 2017, 14(5): 116-119.
29. Virnig BA, Baxter NN, Habermann EB, et al. A matter of race: early- versus late-stage cancer diagnosis. Heal Aff (Mill wood), 2009, 28(1): 160-168.
30. Zenaro E, Pietronigro E, Della Bianca V, et al. Neutrophils promote Alzheimer’s disease–like pathology and cognitive decline via LFA-1 integrin. Nat Med, 2015, 21(8): 880-886.
31. Chen H, Wu W, Li Y, et al. A novel brain targeted 5-FU derivative with potential antitumor efficiency and decreased acute toxicity: synthesis, in vitro and in vivo evaluation. Pharmazie, 2014, 69(4): 271-276.
32. 葛均波, 徐永健. 内科学. 8 版. 北京: 人民卫生出版社, 2014.
33. 李淑芳, 王燕, 辛士珍, 等. 化疗对肺癌患者生活质量及焦虑情绪的影响及分析. 中国肺癌杂志, 2012, 15(8): 465-470.
34. 戴静, 刘协和, 马渝根. 老人的生活质量与认知功能. 中国民康医学, 2003, 15(3): 181-185.
35. Martínez García RM, Jiménez Ortega AI, López Sobaler AM, et al. Estrategias nutricionales que mejoran la función cognitiva [Nutrition strategies that improve cognitive function]. Nutr Hosp, 2018, 35(Spec No6): 16-19.
36. Tan X, Xiong H, Gui S, et al. Effects of cognitive education on the perceived control and symptom distress of lung cancer patients receiving chemotherapy: a randomised controlled trial. Eur J Cancer Care (Engl), 2019, 28(5): e13120.
37. 陆琴, 韩萍. 思维导图在临床护理工作中的应用现状. 护理管理杂志, 2016, 16(5): 346-347, 355.
38. 罗晶, 王爱民, 张金峰. 思维导图在糖尿病患者小组教育中的应用. 护理学杂志, 2014, 29(9): 72-75.
39. Murray DK, Sacheli MA, Eng JJ, et al. The effects of exercise on cognition in Parkinson’s disease: a systematic review. Transl Neurodegener, 2014, 3(1): 5.
40. Missel M, Borregaard B, Schoenau MN, et al. A sense of understanding and belonging when life is at stake-operable lung cancer patients’ lived experiences of participation in exercise. Eur J Cancer Care (Engl), 2019, 28(5): e13126.

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