Chemotherapy, neurotoxicity, and cognitive changes in breast cancer

Chemotherapy-induced cognitive changes have come under immense speculation in recent years. This mild cognitive impairment evinced in the form of short-term memory loss, and attention and concentration problems, finds itself unavoidably attached to the terms 'chemobrain' or 'chemofog'. The predicament between chemotherapy (CT) and neurotoxicity has been considerably examined and most of its attributes have been documented through neuropsychological studies. Although a sizeable portion of literature now covers this phenomenon, certain methodological reservations come in the way of its full appreciation, limited mostly by standardization issues in neuropsychological studies. The current review discusses some of these issues, with emphasis on the underlying mechanisms of progressing cognitive dysfunction in the breast cancer population, accentuating a frontosubcortical involvement and the use of competent neuropsychological batteries and structural and functional imaging techniques, to analyze the changes associated with chemotherapy. The relevance of prospective longitudinal studies with culture-centric norms has been emphasized, with the need for clinical guidelines, to assess and follow the course of neurotoxicity. Keeping track of the patient's own perceptive cognitive loss will help harmonize the decision-making process during chemotherapy.