Congress Abstracts 2005

15

A META-ANALYSIS OF THE SENSITIVITY OF VARIOUS NEUROPSYCHOLOGICAL TESTS USED TO DETECT CHEMOTHERAPY-INDUCED IMPAIRMENTS IN COGNITIVE FUNCTION. Catherine Jansen, RN, MS, PhDc, OCN^®, Kaiser Permanente, San Francisco, CA; and Christine Miaskowski, RN, PhD, Marylin Dodd, RN, PhD, Glenna Dowling, RN, PhD, and Joel Kramer, PsyD, University of California, San Francisco, San Francisco, CA.

Impairment in cognitive function is a newly recognized side effect of chemotherapy (CTX). Numerous valid and reliable neuropsychological tests are available to measure the various domains of cognitive function.

However, information regarding the sensitivity and specificity of neuropsychological tests to detect changes in cognitive function from CTX is lacking. The purposes of this meta-analysis were to identify which neuropsychological tests were used to evaluated CTX-induced impairment in various domains of cognitive function in adult cancer patients and to determine the sensitivity of each of the neuropsychological tests, that were used in at least two studies, through an estimation of an effect size.

Lezak’s conceptual framework for neuropsychological testing formed the theoretical basis for this study.

Abstracts from five computerized databases were reviewed to identify studies that included (1) original data; (2) an adult sample; (3) neuropsychological testing of cancer patients who had or were currently receiving CTX; (4) valid and reliable neuropsychological tests with published standardized administration procedures; and (5) sufficient information reported on at least one test of cognitive function, to allow for the estimation of an effect size.

Prior to determining an effect size, each neuropsychological test was assigned to a specific domain of cognitive function. Johnson’s (1993) DSTAT 1.10 meta-analysis software was used to calculate the effect size and confidence intervals. Effect sizes were interpreted as negligible if less than 0.20, small if between 0.20 and 0.50, medium if between 0.50 and 0.80, and large if greater than 0.80. A significance level of 0.05 was inferred when the 95% confidence interval did not cross zero.

This study found sensitive neuropsychological tests for the cognitive domains of language, motor function, verbal memory, and visual memory, but not for attention/concentration, executive function, information processing speed, or visuospatial skill. While this meta-analysis provides initial data on the sensitivity of some neuropsychological tests to determine CTX-induced changes in cognitive function, the limited number of studies makes it difficult to draw any definite conclusions. These results suggest the need for carefully designed, longitudinal studies to evaluate CTX-induced impairments in cognitive function.