近日，国际著名杂志Cancer刊登了研究人员最新的研究成果“Cognitive functioning after cancer treatment: A 3-year longitudinal comparison of breast cancer survivors treated with chemotherapy or radiation and noncancer controls。”研究中他们认为，乳腺癌妇女放疗后，不管有没有化疗，几年后比没有患癌的妇女存在更多的认知问题。
以前的研究表明，有些女性病人化疗期间或化疗后不久会经历精神混乱，被称为“化疗脑”。另外一项研究发现接受化疗的病人大脑某些区域的活动性发生变化。
但是有一些作者质疑这些问题是化疗造成的还是癌症本身造成的。在这篇新报告中，乳腺癌幸存者不管有没有接受化疗，都会存在某些小的精神问题。问题非常微妙，这群人并不是变得神志不清、痴呆、健忘。这群人基本能够正常工作，但是会变得困难，不能够在同一时间做很多事情。
这个研究包含了129名乳腺癌幸存者，平均50多岁。大约一半经历过化疗和放疗，一半只接受过放疗。
结束治疗后6个月，以及又过了3年后，这些病人接受一系列思维和记忆测试。将她们的成绩和从没患过癌症的184名相匹配的对照组进行比较。
用测试去衡量认知的一个缺点是不能弄清楚他们在日常生活中应用这些功能到什么程度，而且研究人员没有测定他们的基线水平。
5种记忆测试的3种里，患者和对照组表现类似。但在两个测试里，病人的分数明显降低。治疗后大约6个月或者几年后，癌症幸存者在执行功能上的得分变差。与对照组相比，两组乳腺癌病人在处理速度和集中力上下降，如果平均是50的话，下降1到3个点。对于精神能力的所有测试，病人不管有没有接受过化疗得分都差不多。
人们讨论“化疗脑”时，就会产生一个认知，如果病人癌症治疗后出现认知问题，肯定是因为接受了化疗。我们提供了最确切的证据，可以充分怀疑不只是化疗导致了乳腺癌病人的认知问题。究竟什么是原因，还有待研究。
可能有一些与癌症有关的东西已经影响了认知功能，是什么呢？压力？焦虑？抑郁症？都有可能。也有可能是免疫系统对癌症的反应影响了大脑。但是，大多数数据还是指向化疗对某些病人的精神影响，在这个分析里可能错过了这两组病人的微小差异。不能太快去下结论，不能因为一些小差异，就说全部是化疗的错。我们必须一步一步来去了解真正的原因是什么。（生物谷Bioon.com）
doi:10.1002/cncr.26432
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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.
