近日,，國際著名雜志Cancer刊登了研究人員最新的研究成果“Cognitive functioning after cancer treatment: A 3-year longitudinal comparison of breast cancer survivors treated with chemotherapy or radiation and noncancer controls,。”研究中他們認(rèn)為,，乳腺癌婦女放療后，不管有沒有化療,，幾年后比沒有患癌的婦女存在更多的認(rèn)知問題,。
以前的研究表明,，有些女性病人化療期間或化療后不久會經(jīng)歷精神混亂,，被稱為“化療腦”。另外一項(xiàng)研究發(fā)現(xiàn)接受化療的病人大腦某些區(qū)域的活動性發(fā)生變化,。
但是有一些作者質(zhì)疑這些問題是化療造成的還是癌癥本身造成的,。在這篇新報(bào)告中，乳腺癌幸存者不管有沒有接受化療,，都會存在某些小的精神問題,。問題非常微妙，這群人并不是變得神志不清,、癡呆,、健忘。這群人基本能夠正常工作,，但是會變得困難,，不能夠在同一時間做很多事情。
這個研究包含了129名乳腺癌幸存者,，平均50多歲,。大約一半經(jīng)歷過化療和放療，一半只接受過放療,。
結(jié)束治療后6個月,，以及又過了3年后，這些病人接受一系列思維和記憶測試,。將她們的成績和從沒患過癌癥的184名相匹配的對照組進(jìn)行比較,。
用測試去衡量認(rèn)知的一個缺點(diǎn)是不能弄清楚他們在日常生活中應(yīng)用這些功能到什么程度,，而且研究人員沒有測定他們的基線水平。
5種記憶測試的3種里,，患者和對照組表現(xiàn)類似,。但在兩個測試?yán)铮∪说姆謹(jǐn)?shù)明顯降低,。治療后大約6個月或者幾年后,，癌癥幸存者在執(zhí)行功能上的得分變差。與對照組相比,，兩組乳腺癌病人在處理速度和集中力上下降,，如果平均是50的話，下降1到3個點(diǎn),。對于精神能力的所有測試,，病人不管有沒有接受過化療得分都差不多。
人們討論“化療腦”時,，就會產(chǎn)生一個認(rèn)知,，如果病人癌癥治療后出現(xiàn)認(rèn)知問題，肯定是因?yàn)榻邮芰嘶?。我們提供了最確切的證據(jù),，可以充分懷疑不只是化療導(dǎo)致了乳腺癌病人的認(rèn)知問題。究竟什么是原因,，還有待研究,。
可能有一些與癌癥有關(guān)的東西已經(jīng)影響了認(rèn)知功能，是什么呢,？壓力,？焦慮？抑郁癥,？都有可能,。也有可能是免疫系統(tǒng)對癌癥的反應(yīng)影響了大腦。但是,，大多數(shù)數(shù)據(jù)還是指向化療對某些病人的精神影響,，在這個分析里可能錯過了這兩組病人的微小差異。不能太快去下結(jié)論,，不能因?yàn)橐恍┬〔町?，就說全部是化療的錯。我們必須一步一步來去了解真正的原因是什么,。（生物谷Bioon.com）
doi:10.1002/cncr.26432
PMC:
PMID:
Cognitive functioning after cancer treatment: A 3-year longitudinal comparison of breast cancer survivors treated with chemotherapy or radiation and noncancer controls.
Phillips KM, Jim HS, Small BJ, Laronga C, Andrykowski MA, Jacobsen PB.
BACKGROUND: This study examined the influence of prior treatment on the course of cognitive functioning in breast cancer survivors. Changes in cognitive functioning over time were compared in breast cancer survivors treated with chemotherapy plus radiotherapy, breast cancer survivors treated with radiotherapy only, and women with no history of cancer. METHODS: Stage 0-II breast cancer patients treated with chemotherapy plus radiotherapy (CT group; n = 62) or radiotherapy only (RT group; n = 67) completed neuropsychological assessments 6 months after completing treatment and again 36 months later. Women with no history of cancer (NC group; n = 184) were assessed over a similar interval. RESULTS: A significant group × time effect was found for processing speed (P = .009) that reflected a tendency for the NC group but not the RT and CT groups to improve over time. There was also a significant group effect for executive functioning (P = .006) that reflected the NC group performing better than the CT and RT groups. Additional analyses found the administration of hormonal therapy was not associated with change over time in cognitive performance. CONCLUSIONS: Findings provide limited support for the view that changes in cognitive functioning in cancer survivors are attributable to chemotherapy administration and illustrate the importance of including a radiotherapy comparison group. Future research should seek to examine possible mechanisms that could explain the apparent prolonged impact of both chemotherapy and radiotherapy on cognitive functioning in breast cancer survivors.
