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. To investigate the efficacy of neuroprotective interventions delivered during initial chemotherapy on CRCI in breast cancer (BC) patients. 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. 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. 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.

Background/Objectives: The purpose of this preclinical pilot study was to explore the potential of green tea extract (GTE) to mitigate and/or prevent oxaliplatin-induced allodynia and axonal damage in rats, when compared to duloxetine (DLX), an ASCO-recommended treatment for established neuropathic pain. Methods: Using a randomized, placebo-controlled experimental design, Sprague Dawley rats (N = 41) received 4 intraperitoneal oxaliplatin (2 mg/kg) injections every other day over 7 days. One week prior to the first oxaliplatin dose, animals began 1 of 4 interventions (saline; GTE 100 mg/kg; DLX 3 mg/kg; GTE 100 mg/kg + DLX 3 mg/kg). A naïve group (n = 6) that received no neurotoxic oxaliplatin or intervention was added to serve as a baseline measure for sNfL. Interventions were administered daily for 4 weeks. Mechanical sensitivity (allodynia) was measured 3 times per week using von Frey testing to determine paw withdrawal thresholds. Von Frey testing began one day prior to the start of interventions to establish baselines and continued through Day 35. Groups were compared to their respective baselines to calculate changes in paw withdrawal thresholds. To measure axonal damage, alterations in serum levels of neurofilament light (sNfL) protein were measured at Day 35 using ELISA. Group differences were identified using two-way analysis of variance (ANOVA). Pearson correlation coefficient was used for correlation analysis between paw withdrawal thresholds and sNfL levels at Day 35. Partial eta-squared and Hedges’ g were used to measure effect sizes. Statistical significance was assigned at P ≤ 0.05 with a 95% confidence interval. Results: Overall, the saline group showed significant reductions in mean paw withdrawal thresholds across experimental timepoints, denoting more severe allodynia caused by oxaliplatin. Conversely, intervention groups exhibited mean paw withdrawal thresholds that were significantly greater than the saline group, indicating less allodynia. The average level of sNfL was also significantly higher in the saline group (113.58 ± 43.84 pg/mL) compared to GTE100 (72.75 ± 26.85), DLX3 (59.93 ± 20.57), and DLX3 + GTE100 (77.04 ± 24.35) intervention groups, suggesting less oxaliplatin-induced axonal damage in these groups. The naïve group exhibited the lowest levels of sNfL (45.69 ± 14.64) when compared to the oxaliplatin-receiving groups (saline and intervention). There were large effect sizes between the saline group, naïve (g = 1.88), GTE100 (g = 1.123), DLX3 (g = 1.157), and DLX3 + GTE100 (g = 1.030) groups. There was also a moderate negative correlation [r(30) = −0.38, p = 0.04] between sNfL levels and paw withdrawal thresholds. Conclusions: The preliminary findings from this pilot study suggest that GTE may be an effective, nutraceutical intervention for mitigating OIPN-associated neuropathic pain, warranting further investigation as an intervention to mitigate chemotherapy-associated neurotoxicities like OIPN.

Cognitive intraindividual variability (IIV) refers to the variability in one's ability to sustain consistent cognitive performance. This phenomenon is linked to the emergence of cognitive impairment and dementia. The aim of this concept analysis using Rodger's evolutionary approach was to clarify the unique characteristics of the concept of cognitive IIV in HIV care and research. PubMed, Embase, CINAHL, and PsycINFO were utilized which yielded 22 articles that were analyzed to inform the concept analysis. After considering antecedents, attributes, and consequences, many antecedents may also function as consequences, depending on how they influence or are influenced within the cause-and-effect process. This concept analysis highlights the potential of cognitive IIV as a sensitive indicator of cognitive health in people with HIV (PWH). A better understanding of the variation of cognitive performance in PWH will assist mental health professionals in developing more tailored interventions and achieving improved clinical outcomes.