Cognitive impairment following chemotherapy for breast cancer: The impact of practice effect on results.

Chemotherapy-Related Cognitive Impairment (CRCI) can be an adverse effect in women treated for breast cancer. Some longitudinal studies reported deficits in attention, memory, and executive function following treatment, but other studies did not find cognitive changes. It is known that practice effects (PE) on repeated assessments with cognitive tests contribute to the discrepancies in these results, but its influence on scores has not been systematically explored. The present study examines the impact of PE on retest scores in a group of women with breast cancer treated with chemotherapy and evaluated longitudinally. METHOD: 51 women with breast cancer treated with a combination of 5-fluorouracil, epirubicin, and cyclophosphamide with or without taxanes were assessed after surgery but before chemotherapy (T1), post-chemotherapy (T2), and at one year after T2 (T3). Longitudinal changes on cognitive performance were analyzed twice: when retest scores were not corrected for PE and when correction for PE was applied to T2 and T3 scores. RESULTS: When PE was not corrected, progressive improvement over time in measures of memory and divided attention at T2 and T3 was observed. In contrast, when PE was corrected, worsening was found in measures of memory, fluency, executive function, and attention at T2 and in attention and executive function at T3. Results after correction for PE are in line with previous longitudinal studies that report cognitive impairment after treatment with chemotherapy for breast cancer. CONCLUSION: Accounting for PE is recommended to identify true change on cognition through treatment with chemotherapy for breast cancer.

Brief mental health screening questionnaire for children and adolescents in primary care settings.

UNLABELLED: Early detection of mental health problems is important. The implication of primary care professionals and the adequacy of instruments could be of great help. OBJECTIVE: To study the validity of a brief questionnaire based on psychosocial functioning to detect mental health problems in a high-risk general population. STUDY GROUP: 151 children and adolescents were assessed as part of a longitudinal 3 year follow-up study of two cohorts born in 1989 and 1993, respectively. METHOD: semi-structured diagnostic interviews were used to evaluate their psychopathological condition, to test for functional impairment, and to determine whether it would be appropriate for them to be referred to Mental Health Services. Parents also answered a Brief Mental Health Screening Questionnaire (BMHSQ) containing questions about main psychosocial functioning areas. Logistic and multiple regressions were applied to study the predictive power of the questionnaire. RESULTS: The BMHSQ showed good clinical screening properties and was useful in determining who should be addressed to a specialized psychopathological service. CONCLUSION: General practitioners could play an essential role in detecting and referring such disorders if provided with the proper tools. The use of brief questionnaires on functioning and outcomes in pediatric practice could improve comprehensive health care for children and adolescents. Rapid detection of mental health problems in a primary care setting is possible, as is better use and planning of health services.