***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    Input: Background Cancer-related cognitive dysfunction has mostly been attributed to chemotherapy ; this explanation , however , fails to account for cognitive dysfunction observed in chemotherapy-naïve patients . In a controlled , longitudinal , multisite study , we tested the hypothesis that cognitive function in breast cancer patients is affected by cancer-related post-traumatic stress . Methods Newly diagnosed breast cancer patients and healthy control subjects , age 65 or younger , underwent three assessment s within one year , including paper- and -pencil and computerized neuropsychological tests , clinical diagnostics of post-traumatic stress disorder ( PTSD ) , and self-reported cognitive function . Analysis of variance was used to compare three groups of participants -  patients who did or did not receive chemotherapy and healthy control subjects-on  age- and education-corrected cognitive performance and cognitive change . Differences that were statistically significant after correction for false discovery rate were investigated with linear mixed-effects models and mediation models . All statistical tests were two-sided . Results Of 226 participants ( 166 patients and 60 control subjects ) , 206 completed all assessment sessions ( attrition : 8.8 % ) . Patients demonstrated overall cognitive decline ( group*time effect on composite z -score : -0.13 , P = .04 ) and scored consistently worse on Go/Nogo errors . The latter effect was mediated by PTSD symptoms ( mediation effect : B = 0.15 , 95 % confidence interval = 0.02 to 0.38 ) . Only chemotherapy patients showed declined reaction time on a computerized alertness test . Overall cognitive performance correlated with self-reported cognitive problems at one year ( T = -0.11 , P = .02 ) . Conclusions Largely irrespective of chemotherapy , breast cancer patients may encounter very subtle cognitive dysfunction , part of which is mediated by cancer-related post-traumatic stress . Further factors other than treatment side effects remain to be investigated PURPOSE To examine the impact of age and cognitive reserve on cognitive functioning in patients with breast cancer who are receiving adjuvant treatments .  PATIENTS AND METHODS Patients with breast cancer exposed to chemotherapy ( n = 60 ; mean age , 51.7 years ) were evaluated with a battery of neuropsychological and psychological tests before treatment and at 1 , 6 , and 18 months after treatment . Patients not exposed to chemotherapy ( n = 72 ; mean age , 56.6 years ) and healthy controls ( n = 45 ; mean age , 52.9 years ) were assessed at matched intervals . RESULTS Mixed-effects modeling revealed significant effects for the Processing Speed and Verbal Ability domains . For Processing Speed , a three-way interaction among treatment group , age , and baseline cognitive reserve ( P < .001 ) revealed that older patients with lower baseline cognitive reserve who were exposed to chemotherapy had lower performance on Processing Speed compared with patients not exposed to chemotherapy ( P = .003 ) and controls ( P < .001 ) . A significant group by time interaction for Verbal Ability ( P = .01 ) suggested that the healthy controls and no chemotherapy groups improved over time . The chemotherapy group failed to improve at 1 month after treatment but improved during the last two follow-up assessment s. Exploratory analyses suggested a negative effect of tamoxifen on Processing Speed ( P = .036 ) and Verbal Memory ( P = .05 ) in the no-chemotherapy group . CONCLUSION These data demonstrated that age and pretreatment cognitive reserve were related to post-treatment decline in Processing Speed in women exposed to chemotherapy and that chemotherapy had a short-term impact on Verbal Ability . Exploratory analysis of the impact of tamoxifen suggests that this pattern of results may be due to a combination of chemotherapy and tamoxifen Purpose Chemotherapy improves the survival rate of stage III colon cancer patients . The combination of oxaliplatin , 5-fluorouracil , and leucovorin ( the FOLFOX4 regimen ) has emerged as the st and ard of care . This prospect i ve study evaluates potential alterations in cognitive function in FOLFOX4-treated  patients . Methods We evaluated 57 consecutive colorectal cancer patients who received adjuvant chemotherapy with FOLFOX4 .  Patients underwent a complete battery of neuropsychological tests at three different times : before ( T0 ) , at the end ( T1 ) , and 6 months after treatment ( T2 ) . Results We have analyzed cognitive impairment ( Mini Mental State Examination , MMSE ) , visuo-spatial memory ( Clock Drawing Test , CDT , Rey Complex Figure , copy and recall ) , information processing speed ( Trial Making Test-A , TMT-A , and Trial Making Test-B , TMT-B ) , verbal memory ( Rey Auditory Verbal Learning Test , call and recall ) , emotional distress ( Psychological Distress Inventory , PDI ) , anxiety ( State and Trait Anxiety Inventory , STAI-Y1 and Y2 ) , and depression ( Beck Depression Inventory , BDI ) . Then we have calculated , for each test and for each interval of time , mean ± st and ard deviation for the mean . In a subsequent phase , we tested the significance of different results through the ANOVA analysis for repeated measures . In this case , we could not find any statistically significant modification in cognitive function , but we could notice an improvement in emotional performance , anxiety and depression a short time after chemotherapy administration . Conclusions We found no effect on cognitive function related to chemotherapy , the only little modification is about some emotional performance  during chemotherapy . These findings may be explained by the central role of the psychological adaptation process , which occurs during the period from diagnosis to completion of treatment and is characterized by anxiety and adjustment depression . Our results seem to rule out any significant cognitive impairment due to adjuvant FOLFOX4 chemotherapy in colon cancer patients A subset of survivors has cognitive impairment after cancer treatment . This is generally subtle , but may be sustained . In October 2006 , the second international cognitive workshop was held in Venice . The workshop included neuropsychologists , clinical and experimental psychologists , medical oncologists , imaging experts , and patient advocates . The main developments since the first Cognitive Workshop in 2003 have been the following . ( i ) studies evaluating cognitive function in patients receiving chemotherapy for cancers other than breast cancer , and in patients receiving hormonal therapy for cancer . ( ii ) The publication of longitudinal prospect i ve studies which have shown that some patients already exhibit cognitive impairment on neuropsychological testing before receiving chemotherapy , and some patients have deterioration in cognitive functioning from pre- to postchemotherapy . ( iii ) Studies of the underlying mechanisms of cognitive impairment both in patients and in animal models . ( iv ) Use of structural and functional imaging techniques to study changes in brain morphology and activation patterns associated with chemotherapy . ( v ) At present cognitive research in cancer is limited by method ological challenges and the lack of st and ardization in neuropsychological studies . The current workshop addressed many of these issues and established an international task force to provide guidelines for future research and information on how best to manage these symptoms OBJECTIVE To evaluate the efficacy of a brief cognitive-behavioral therapy ( CBT ) that is being developed for management of cognitive dysfunction following chemotherapy among breast cancer survivors .  Memory and Attention Adaptation Training ( MAAT ) is a brief CBT design ed to improve the quality of life and function among cancer survivors with post-chemotherapy cognitive complaints . METHODS An initial , two-group  ( MAAT versus waitlist , no treatment control ) , r and omized clinical trial ( RCT ) was conducted . Forty stage I and II female breast cancer survivors ( mean age = 50 ; SD = 6.4 ) were r and omized to conditions and assessed at baseline , post-treatment ( 8 weeks ) and 2-month follow-up assessment points on measures of : ( 1 ) self-reported daily cognitive failures ; ( 2 ) quality of life ; and ( 3 ) neuropsychological performance . Participants were also assessed for satisfaction with MAAT . RESULTS With education and IQ as covariates , MAAT participants made significant improvements relative to controls on the spiritual well-being subscale of the quality of life measure and on verbal memory , but statistical significance was not achieved on self-report of daily cognitive complaints . However , moderate-to-large effect sizes were observed on these outcomes . Participants gave MAAT high satisfaction ratings . CONCLUSIONS Although this initial RCT is a small study , MAAT participants appear to improve on one measure of quality of life and verbal memory performance relative to no treatment controls and rate MAAT with high satisfaction . These data are encouraging and support the continued development and evaluation of MAAT efficacy Studies suggest that adjuvant chemotherapy for early stage breast cancer ( BC ) is associated with cognitive impairment related to attention , memory , and visuospatial functioning . However , other studies have failed to confirm that relationship . We report one of the first longitudinal , controlled studies of cognitive effects of chemotherapy in older post-menopausal women . Sixty-one post-menopausal women with non-metastatic BC were administered neuropsychological tests before adjuvant therapy ( Time1 ) , six months after treatment ( Time2 ) , and at a final 6-month follow-up ( Time3 ) . Thirty women were treated with chemotherapy ; thirty-one women who received no chemotherapy were controls .  Cognitive domains measured included motor , language , attention/concentration/working memory , visuospatial , and memory ( verbal and visual ) . Time-by-treatment interaction was significant in the motor domain ( P = 0.007 ) with poorer performance in women treated with chemotherapy . For the other domains , scores did not significantly vary over time by group . In post-menopausal women , chemotherapy was not associated with changes in cognitive function in areas reported by BC survivors : attention , memory , and information processing . Motor slowing in women treated with chemotherapy could be secondary to peripheral neuropathy rather than an indication of more general declines in cognitive processing . Future studies should control for the independent effects of slowed motor functioning when looking to study possible chemotherapy related cognitive processing deficits Aim : To assess cognitive function prospect ively in women with early breast cancer before , during and after the administration of adjuvant chemotherapy OBJECTIVES To report on the longitudinal cognitive functioning of older women receiving adjuvant chemotherapy for breast cancer . DESIGN Neuropsychological and functional status testing were performed before chemotherapy and 6 months after chemotherapy . SETTING Cancer center . PARTICIPANTS Thirty-one patients aged 65 and older with Stage I to III breast cancer . Of the 31 patients enrolled , three refused post-testing , and 28 were evaluable . MEASUREMENTS The following domains of cognitive function were examined : attention ; verbal memory ; visual memory ; and verbal , spatial , psychomotor , and executive functions . RESULTS Participants had a mean age of 71 ( range 65 - 84 ) : 39 % Stage I , 50 % Stage II , and 11 % Stage III . The number of scores 2 st and ard deviations ( SDs ) below the norm were calculated for each patient before and 6 months after chemotherapy ; 14 ( 50 % ) had no change , 11 ( 39 % ) worsened , and three ( 11 % ) improved ( P=.05 ) . Seven patients ( 25 % ) experienced a decline in cognitive function , defined as a 1-SD decline from pre- to post-testing in two or more neuropsychological domains . Exploratory analyses revealed no significant difference between functional status , comorbidity , and depression scale scores and change in overall quality -of-life scores before and after chemotherapy . CONCLUSION In this cohort of older women receiving adjuvant chemotherapy , a subset experienced a decline in cognitive function from before chemotherapy to 6 months after chemotherapy . Further prospect i ve study is needed to confirm these observations and to identify the subgroup at special risk Long‐term chemotherapy‐related cognitive dysfunction ( CRCD ) affects a large number of cancer survivors . To the authors ' knowledge , to date there is no established treatment for this survivorship problem . The authors herein report results of a small r and omized controlled trial of a  cognitive behavioral therapy ( CBT ) , Memory and Attention Adaptation Training ( MAAT ) , compared with an attention control condition . Both treatments were delivered over a videoconference device OBJECTIVE A number of cross-sectional studies have reported reduced cognitive function in cancer patients receiving chemotherapy  compared with other cancer patients and healthy controls , suggesting that chemotherapy could be associated with cognitive side-effects . Recently published prospect i ve studies question this hypothesis , but it is still unclear whether cancer patients should regard cognitive problems as a potential risk when receiving chemotherapy . METHODS In the present study we examine whether cancer patients ( n=34 ) receiving chemotherapy  differed in cognitive changes during treatment compared with cardiac patients ( n=12 ) and healthy controls ( n=12 ) tested at 3 - 4 months interval . RESULTS Our results showed no differences with respect to changes in cognitive performance over time between cancer patients in chemotherapy  , cardiac patients , and healthy controls . In addition , the number of individuals showing reliable decline or improvement on cognitive tests did not differ between groups . CONCLUSION Taken together , our results do not support a hypothesis of cognitive side-effects of st and ard-dose chemotherapy in breast cancer patients PURPOSE Whether adjuvant therapy impairs cognitive function in women with breast cancer ( BC ) is unclear . We determined the effects of adjuvant therapy on cognitive function in women with early BC . METHODS We consecutively and prospect ively enrolled women aged 40 - 69 years who had a positive radiographic finding from the mammography screening program at Stockholm South General Hospital . All women completed the Headminder Web-based neuropsychological battery Cognitive Stability Index ( CSI ) for response speed , processing speed , memory , and attention before diagnosis ( T1 ) , after surgery and before adjuvant treatment ( T2 ) , 6 months after start of adjuvant treatment ( T3 ) 
    Output:
    
The majority of studies find cognitive impairment in patients with cancer treated with chemotherapy .
Neuroimaging studies show changes in structure and activation in patients undergoing chemotherapy .
Non-pharmacological treatment is effective for improving cognition and quality of life .
This review highlights the importance of recognizing that this cognitive dysfunction is frequent , mild to moderate in nature but with great impact on quality of life