Abstract
Cancer patients undergoing chemotherapy often face chemotherapy-induced cognitive impairment, known as chemo-brain, which can impact their quality of life. This impairment can manifest during or after treatment, with varying degrees of severity, onset times, and durations, ultimately affecting the patients' quality of life. This chapter explores the potential of natural language processing (NLP) strategies to address cognitive challenges in these patients. The focus is on evaluating the effectiveness of NLP solutions in managing issues like memory deficits, attention problems, language challenges, and executive function impairments. The work assesses NLP techniques in healthcare, emphasizing their role in enhancing cognitive functions and communication for chemo-brain patients through real-world case studies. Specific objectives include an in-depth examination of chemo-brain, critical evaluation of NLP's potential, analysis of case studies, and a discussion of recent NLP advancements.
Top1. Introduction
There are many recent meta-analyses examining cognitive impairments caused by different cancer treatments for example, oncological treatments have shown that patients, those who are in remission, have damage in the areas of memory, concentration, speed of executing an activity, executive function, memory related to visual and verbal activities relative to people with no cancer (Argyriou et al. 2011, Bompaire et al. 2017, Das et al. 2020).
Chemotherapy-induced cognitive impairment (CICI) is an unwanted side effect during cancer treatment. Some cancer patients find chemotherapy to be an intimidating challenge that extends beyond the physical rigors of the disease (chao et al.,2021). CICI manifests as a multifaceted condition characterized by a constellation of cognitive difficulties spanning the realms of memory, learning, concentration, reasoning, executive function, attention, and visuospatial skills. Often colloquially referred to as “chemo fog,” “chemo brain,” or “chemotherapy-related cognitive impairment,” CICI significantly alters the cognitive landscape of those it affects.It is well-proven that cancer chemotherapy can cause cognitive impairment. It has been estimated that > 75% of patients receiving cancer chemotherapy have measurable cognitive impairment (Alhowail and Chigurupati, 2022).
Figure 1 shows the Google trend for the words BreastCancer, MentalDisorder and Chemotherapy.
Figure 1. Google trend for word breast cancer, mental disorder and chemotherapy
The prevalence of CICI varies among individuals, with study results indicating its impact on a range of 16% to 75% of cancer survivors. This wide range underscores the complexity of this condition and the variability in how it affects different patients. With the growing success of cancer treatments leading to increased survivorship rates, the recognition and understanding of CICI have gained prominence. As a result, healthcare providers are increasingly confronted with diagnosing and managing this cognitive challenge.
Importantly, CICI transcends mere discomfort; it can significantly impair the quality of life (QOL) of cancer survivors. Tasks that were once second nature become laborious, and the ability to engage fully in daily life is compromised. However, amidst the challenges posed by CICI, a ray of hope shines through. Physical Therapy has emerged as a vital ally in the quest to improve the QOL of cancer survivors grappling with CICI. Through targeted interventions and support, physical therapists play a pivotal role in navigating the labyrinth of cognitive impairment, offering a path toward enhanced well-being and functionality.(Hassan et al., 2023) (Lewandowska et al.,2020)
In recent years, natural language processing (NLP), a branch of artificial intelligence (AI) technologies, has the potential to accelerate the translation of cancer treatments from the laboratory to the clinic and will be a powerful tool (Ahluwalia et al. 2020). As suggested byYim et al. (2016), it can be used as a tool for evidence-based oncological research and quality improvement. Moreover, NLP has played an essential role in supporting the analysis and management of large-scale textual data and facilitating various tasks such as information extraction, sentiment analysis, emotion detection, and mental health surveillance (Mukherjee et al.,2020). Therefore, taking into account the benefits of NLP, it can be applied to identify chemobrain through text classification for sentiment analysis techniques (Portier et al. 2013). By utilizing NLP methods, we can effectively detect early warning signs, which can aid in the prompt detection, prevention, and treatment of chemobrain.
Key Terms in this Chapter
Text-to-Speech (TTS): A natural language modeling process that takes in spoken words and tries to accurately record them as text.
Remote memory - Remote: The memory of events that occurred in the distant past is a type of episodic memory referred to as remote or long-term memory.
Reactive Oxygen Species (ROS): ROS are reactive species that cause oxidative damage to cellular biomolecules, including proteins, lipids, and nucleic acids.
Neurotransmitter Imbalance: A chemical imbalance in the brain is said to occur when the brain has either excessive or insufficient chemical messengers, called neurotransmitters
Chemotherapy-Induced Cognitive Impairment (CICI): A multifaceted condition characterized by a constellation of cognitive difficulties spanning the realms of memory, learning, concentration, reasoning, executive function, attention, and visuospatial skills.
ChatBot: A computer program designed to simulate conversation with human users, especially over the internet.
Sentiment Analysis: the process of computationally identifying and categorizing opinions expressed in a piece of text, especially in order to determine whether the writer's attitude towards a particular topic, product, etc. is positive, negative, or neutral.
Visual memory: A form of memory which preserves some characteristics of our senses pertaining to visual experience such as visual information which resembles objects, places, animals or people in a mental image.
Virtual Assistant (VA): A software agent that can perform a range of tasks or services for a user based on user input such as commands or questions, including verbal ones.
Speech-to-Text (STT): Text to speech (TTS) - A natural language modeling process that requires changing units of text into units of speech for audio presentation.
Verbal Memory: Refers to memory for verbally presented information such as learning of word lists, story recall (or logical memory), and learning of sequences of paired words.
The blood–Brain Barrier (BBB): A highly selective semipermeable border of endothelial cells that regulates the transfer of solutes and chemicals between the circulatory system and the central nervous system, thus protecting the brain from harmful or unwanted substances in the blood.
Hippocampus: A seahorse-shaped region of the brain that is responsible for learning, emotions, and memory.
Synaptic Plasticity: The ability of neurons to modify their connections involved in brain network remodelling following different types of brain damage (e.g., vascular, neurodegenerative, inflammatory).
Quality of Life (QOL): In medicine, QOL is generally considered as health-related quality of life such as Physical, Mental, Social & Functional Health.
Electronics Health Record (HER): An electronic version of a patient’s medical history, that is maintained by the provider over time, and may include all of the key administrative clinical data relevant to that person’s care under a particular provider, including demographics, progress notes, problems, medications, etc.
Chemo Brain: A common term used by cancer survivors to describe cancer treatment related cognitive impairment or cognitive dysfunction.
Episodic Memory: Episodic memory is defined as the ability to recall and mentally reexperience specific episodes from one's personal past
Named Entity Recognition (NER): A subtask of NLP that focuses on identifying and classifying entities (names of individuals, organizations, locations, dates, numerical values, etc) within textual data.
Cellular Proliferation: Cell proliferation is defined as the cellular growth rate or as the quantified value for the daughter cell population.
Working Memory: The part of short-term memory which is concerned with immediate conscious perceptual and linguistic processing.
Neurogenesis: the growth and development of nervous tissue.
Natural Language Processing (NLP): A branch of artificial intelligence (AI) that enables computers to comprehend, generate, and manipulate human language.