化疗相关的认知障碍和针对神经系统的非药物干预：系统综述

摘要(中文译文)

化疗相关认知障碍（CRCI）是美国及全球日益庞大的癌症幸存者群体中一个越来越受到关注的问题。CRCI以记忆、持续注意力和执行功能缺陷为特征，显著恶化癌症幸存者的生活质量。越来越多的研究采用新型干预方法以减轻CRCI。在本系统综述中，我们旨在总结接受具有神经刺激作用的非药物干预后，化疗后癌症幸存者认知改善的现有证据。我们检索了五个数据库（Embase、MEDLINE、PubMED、Scopus和PsycINFO），筛选报告使用任何类型脑刺激或针对中枢和/或外周神经系统的补充/替代疗法以改善报告CRCI的癌症幸存者认知结局的原创文章。我们依据Cochrane推荐，采用参与者、干预、对照、结局和研究设计（PICOS）框架系统提取每项符合条件研究的信息。我们使用Joanna Briggs研究所的批判性评价工具评估偏倚风险。在筛选2，708篇稿件后，我们对77篇论文进行了全文审查，最终确定17项符合纳入标准的研究：9项随机对照试验、4项病例报告、1项病例系列、2项准实验研究和1项队列研究。我们确定了7项聚焦于CRCI的研究，以及另外10项对认知功能进行了适当报告而符合纳入条件的研究。在接受了经颅直流电刺激、经颅磁刺激、多感官刺激、Flexyx神经治疗系统、针刺和电针治疗的患者中，评估了反映整体表现、注意力、工作记忆、处理速度和生活质量的主观和客观认知结局指标，并单独报告了认知功能。所有研究均观察到部分认知结局指标的轻度改善。这些研究的不足可归因于统计效能和检验不足、缺乏对照组、随机化、盲法以及统计方法不正确。我们发现仅有少数试验报告了CRCI干预的认知结局，样本量小和研究设计存在偏倚限制了统计学显著发现的有效性。我们的系统综述为在大规模随机对照试验中评估非药物神经刺激技术对CRCI的影响提供了依据。

Abstract

Chemotherapy-related cognitive impairment (CRCI) represents an increasingly recognized problem in the growing cancer survivor population within the US and worldwide. CRCI is characterized by deficits in memory, sustained attention, and executive function, which significantly worsens the cancer survivors' quality of life. An increasing number of studies have been conducted using novel intervention approaches aimed at mitigating CRCI. In this systematic review, we sought to summarize the current evidence of cognitive improvement in cancer survivors receiving non-pharmacological interventions with neurostimulatory effects following chemotherapy. We screened five databases (Embase, MEDLINE, PubMED, Scopus, and PsycINFO) for original articles reporting the administration of any type of brain stimulation or complementary/alternative therapies targeting the central and/or peripheral nervous system to improve cognitive outcomes in cancer survivors reporting CRCI. We systematically extracted information from each eligible study using participant, intervention, comparison, outcome(s), and study design (PICOS) framework according to Cochrane recommendations. We used the critical appraisal tool by Joanna Briggs Institute to assess the risk of bias. After screening 2,708 manuscripts, we performed a full-text review of 77 papers and identified 17 studies that met our inclusion criteria: nine randomized controlled trials, four case reports, one case series, two quasi-experimental study, and one cohort study. We identified seven studies which focused on CRCI and 10 others where cognitive function was properly reported for inclusion. Subjective and objective cognitive outcome measures reflecting overall performance, attention, working memory, processing speed, and quality of life with separate cognitive function reporting were assessed in patient(s) treated with transcranial direct current stimulation, transcranial magnetic stimulation, multisensory stimulation, Flexyx neurotherapy system, acupuncture, and electroacupuncture. Mild improvements in some of the cognitive outcome measures were observed in all studies. The weaknesses of these studies can be attributed to insufficient statistical power and testing, lack of a control group, randomization, blinding, and incorrect statistical methods. We found only a handful of trials reporting cognitive outcomes in CRCI interventions, with small sample sizes and biased study designs limiting the validity of the statistically significant findings. Our systematic review provides rationale for assessing the impact of non-pharmacological neurostimulatory techniques on CRCI in large-scale randomized controlled trials.

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