Neuroprotective interventions to prevent chemotherapy-related cognitive impairment in breast cancer survivors: A systematic review

BACKGROUND: Chemotherapy-related cognitive impairment (CRCI) is common among breast cancer survivors (BCS). While numerous rehabilitation interventions exist, these typically occur post-CRCI. Preventive neuroprotective interventions during chemotherapy may improve cognitive outcomes. OBJECTIVE: To investigate the efficacy of neuroprotective interventions delivered during initial chemotherapy on CRCI in breast cancer (BC) patients. METHODS: A systematic review following PRISMA-S identified studies implementing interventions during chemotherapy to prevent CRCI in BC patients. In June 2024, CINAHL, CENTRAL, Embase, OvidMedline, and Web of Science were searched for English-language RCTs or quasi-experimental studies (1990-June 2024) involving interventions initiated during chemotherapy. Reviews, case reports, and non-human studies were excluded. RESULTS: Five studies met inclusion criteria, highlighting limited research in this area. Findings suggest physical exercise, compensatory cognitive training, memantine, and probiotic supplements during chemotherapy are linked to positive cognitive outcomes in BCS. However, small sample sizes, lack of randomization, and absence of blinding limit generalizability. DISCUSSION: Neuroprotective interventions are established in healthy and non-cancer populations. Implementing such interventions during chemotherapy may yield improved cognitive outcomes. Future studies should develop CRCI-specific prevention strategies for BCS.