Review Neuropsychological functioning following systemic treatment in women treated for breast cancer: a review R. Morse a , J. Rodgers a, *, M. Verrill b , K. Kendell b a Department of Clinical Psychology, School of Neurology, Neurobiology and Psychiatry, Ridley Building, University of Newcastle, Newcastle upon Tyne NE1 7RU, UK b Northern Centre for Cancer Treatment, Newcastle General Hospital, Westgate Road, Newcastle upon Tyne, UK Received 9 December 2002; received in revised form 31 March 2003; accepted 3 July 2003 Abstract The aim of this review was to evaluate the effect of treatment and illness-related factors on neuropsychological functioning in women treated for breast cancer. Eight studies were identified examining neuropsychological test performance following systemic treatment. Six of the eight studies suggest that neuropsychological functioning may be impaired following treatment. However, there are a number of important methodological issues which limit interpretation of these results. Therefore, it is unclear whether neuropsychological outcome differs according to a range of treatment, biomedical and psychological factors. Larger samples with longitudinal follow-up are required in order to examine the treatment-related factors that best predict cognitive deficits. # 2003 Elsevier Ltd. All rights reserved. Keywords: Breast cancer; Adjuvant chemotherapy; Tamoxifen; Cognitive deficits 1. Introduction Although the ultimate goal of cancer treatment is improved survival, increasing emphasis is placed on reducing morbidity associated with treatments and improving quality of life. The physical side-effects of chemotherapy such as myelosuppression, hair loss, nausea, fatigue, mucositis, diarrhoea, weight gain and constipation are well known [1]. Less clear is the effect that cancer treatment may have on cognitive function- ing. Cognition is an aspect of quality of life that has rarely been explored systematically in adult patients with cancer, particularly when treatment does not appear to directly involve the central nervous system [2–4]. Assessment of cognitive functioning in breast cancer patients is important for a number of reasons. The number of anecdotal reports concerning changes in cognition following adjuvant treatment necessitates fur- ther investigation. Accurate information about side- effects must be disclosed to patients in order to enable informed treatment decisions to be made [5]. Informa- tion concerning late effects of treatment will enable health care professionals to help prepare patients to expect and cope with any changes in cognition that may occur [6]. Further research in this area will also lead to an understanding of whether all women undergoing adjuvant treatment are at risk, or what the risk factors for subsequent cognitive impairment might be. In addi- tion, an integrated account of the neural, psychophy- siological and cognitive changes that might result from treatment will enable an understanding of the aetiology and mechanisms underlying cognitive deficits. Systemic treatment for breast cancer involves chemo- therapy or hormone therapy, either alone or in combi- nation. Breast cancer cells that are endocrine-dependent need oestrogen in order to proliferate. Treatment with Selective Oestrogen Receptor Modulators (SERMs), such as tamoxifen, have been shown to improve survival for these patients [7]. At present, tamoxifen is the ‘gold standard’ in adjuvant hormonal therapy [7]; however, it is associated with a number of side-effects, including an increased risk of endometrial cancer and thromboem- bolic disorders. Tamoxifen is generally administered to women for 5 years (20 mg daily). In contrast, chemo- therapy is administered over a much shorter duration, typically 3–6 months. 0959-8049/$ - see front matter # 2003 Elsevier Ltd. All rights reserved. doi:10.1016/S0959-8049(03)00600-2 European Journal of Cancer 39 (2003) 2288–2297 www.ejconline.com * Corresponding author. Tel.: +44-191-222-7562; fax: +44-191- 222-7520. E-mail address: jacqui.rodgers@ncl.ac.uk (J. Rodgers).