A 3-year prospective study of the effects of adjuvant treatments on cognition in women with early stage breast cancer

Cancer Research UK Psychosocial Oncology Group, Brighton and Sussex Medical School, University of Sussex, East Sussex BN1 9QG, UK.
British Journal of Cancer (Impact Factor: 4.84). 04/2006; 94(6):828-34. DOI: 10.1038/sj.bjc.6603029
Source: PubMed

ABSTRACT The neuropsychological performance of 85 women with early stage breast cancer scheduled for chemotherapy, 43 women scheduled for endocrine therapy and/or radiotherapy and 49 healthy control subjects was assessed at baseline (T1), postchemotherapy (or 6 months) (T2) and at 18 months (T3). Repeated measures analysis found no significant interactions or main effect of group after controlling for age and intelligence. Using a calculation to examine performance at an individual level, reliable decline on multiple tasks was seen in 20% of chemotherapy patients, 26% of nonchemotherapy patients and 18% of controls at T2 (18%, 14 and 11%, respectively, at T3). Patients who had experienced a treatment-induced menopause were more likely to show reliable decline on multiple measures at T2 (OR=2.6, 95% confidence interval (CI) 0.823-8.266 P=0.086). Psychological distress, quality of life measures and self-reported cognitive failures did not impact on objective tests of cognitive function, but were significantly associated with each other. The results show that a few women experienced objective measurable change in their concentration and memory following standard adjuvant therapy, but the majority were either unaffected or even improve over time.

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Available from: Valerie Shilling, Sep 28, 2015
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    • "A recurrent finding regarding the relationship between objective and subjective measures of cognitive impairment is that these are not associated ( Hermelink et al , 2010 ; Pullens et al , 2010 ; Hutchinson et al , 2012 ) . Although there is emerging evidence to show that SCI in cancer patients may be related to both neuropsychological outcomes ( Ganz et al , 2013 , 2014 ) and to altered functional , morphological , and electrophysiological brain properties ( Deprez et al , 2011 , 2014 ; McDonald and Saykin , 2013 ; Hunter et al , 2014 ) , SCI appears to be more strongly associated with psychological distress , for example , symptoms of depression and anxiety ( Van Dam et al , 1998 ; Jenkins et al , 2006 ; Pullens et al , 2013 ) . However , even if SCI was not , altogether , related to objective impairment , it inarguably remains an equally important research area in psychosocial cancer research , due to the well - known association between SCI and survivors ' quality of life ( Boykoff et al , 2009 ; Calvio et al , 2010 ; Wu et al , 2011 ; Von et al , 2013 ) . "
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    ABSTRACT: There is growing concern among breast cancer (BC) patients and survivors about cognitive impairment following systemic treatments. The aim of the present study was to investigate the long-term effects of standard systemic adjuvant therapies on subjective cognitive impairment (SCI) in a large nationwide cohort of BC survivors 7-9 years after primary surgery. Participants were recruited from the nationwide Psychosocial Factors and Breast Cancer inception cohort of Danish women treated for primary BC. SCI was assessed with the Cognitive Failures Questionnaire and women allocated to systemic treatment according to nationwide standard protocols were compared with women who had not received any systemic treatments. A total of 1889 recurrence-free survivors were eligible for analysis. No difference in SCI was found between survivors across standardized systemic treatment protocols when analyses were stratified by menopausal status and adjusted for possible sociodemographic and treatment-related confounders. The frequency of significant SCI in a subgroup of survivors in the age range 65-74 years was ∼7%. No differences in long-term SCI at 7-9 years post surgery were found between women who had received systemic therapies and those who had not. Furthermore, the observed proportion of survivors with significant SCI was comparable to normative data. These results are important to communicate to patients, survivors, and clinicians alike, especially in the light of increasing concern about cognitive impairment following systemic therapies.British Journal of Cancer advance online publication, 14 July 2015; doi:10.1038/bjc.2015.243
    British Journal of Cancer 07/2015; 113(5). DOI:10.1038/bjc.2015.243 · 4.84 Impact Factor
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    • "Five meta-analyses have also documented cognitive deficits that survivors experience , suggesting that impairments in memory, attention and concentration, speed of processing, and executive functioning are most common (Anderson-Hanley et al., 2003; Falleti et al., 2005; Jansen et al., 2005; Jim et al., 2012; Stewart et al., 2006). Although results of some prospective studies suggest cognitive impairment may attenuate over time (Jenkins et al., 2006; Tchen et al., 2003; Wefel, Lenzi, Theriault, Davis, & Meyers, 2004), researchers have found that a substantial number of survivors continue to have objectively measured memory deficits for 5, 10, and even as long as 20 years post-treatment (Ahles et al., 2002; Jenkins et al., 2006; Koppelmans et al., 2012; Wefel et al., 2004). "
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    ABSTRACT: Cognitive impairment is a distressing, disruptive, and potentially debilitating symptom that can occur as a direct result of cancer or its treatment. National organizations have identified cognitive impairment as a challenge many survivors face and call for research to address this problem. Despite the priority, research is still relatively limited and questions remain unanswered about prevalence and impact on survivors, as well as coping strategies and effective treatment options available to address this potentially debilitating problem. The purpose of this article is to (a) analyze the prevalence and types of cognitive impairment that commonly affect survivors; (b) delineate the impact that cognitive impairment after cancer and cancer treatment has on self-esteem, social relationships, work ability, and overall quality of life among survivors; and (c) synthesize and appraise commonly used coping strategies used by survivors to address cognitive impairment and evidence-based interventions that may be incorporated into clinical practice. A comprehensive review and synthesis of the literature was conducted. Evidence-based interventions to address cognitive changes after cancer and cancer treatment are limited. However, emerging research has demonstrated that nonpharmacologic treatments, such as cognitive training, are likely to be effective.
    Clinical journal of oncology nursing 02/2015; 19(1):47-56. DOI:10.1188/15.CJON.19-01AP · 0.91 Impact Factor
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    • "Particularly after adjuvant chemotherapy (CT), BC patients frequently report cognitive problems (Poppelreuter et al., 2004; Pullens, De Vries, & Roukema, 2010). Cognitive decline relative to pre-treatment cognitive functioning (Ahles et al., 2010; Jansen, Cooper, Dodd, & Miaskowski, 2011; Jenkins et al., 2006) was observed in numerous prospective studies, and several studies report cognitive impairment up to 20 years after treatment (Collins, Mackenzie, Tasca, Scherling, & Smith, 2013; de Ruiter et al., 2011; Koppelmans, Breteler, et al., 2012; Vearncombe et al., 2009; Wefel, Saleeba, Buzdar, & Meyers, 2010). The incidence of cognitive problems following chemotherapy varies considerably with estimates ranging from 20 to 70% (Wefel & Schagen, 2012). "
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    ABSTRACT: Although adjuvant chemotherapy (CT) for breast cancer (BC) is associated with very late side-effects on cognition and brain function, studies on adverse effects of specific treatment regimens are scarce. Here, neurotoxicity profiles after different treatment strategies were compared in BC survivors randomized to high-dose (HI) or conventional-dose (CON-) CT, in women treated with radiotherapy (RT) -only and a healthy control (HC) group. We administered a neurocognitive test battery, a planning fMRI task (Tower of London) and episodic memory fMRI task (Paired Associates paradigm) in BC survivors who received CON-CT (n=24) and HC (n=27). Data were compared to BC survivors who received HI-CT (n=17) and RT-only (n=15) and who were previously assessed. Testing took place ±11.5 years post-CT. Furthermore, neurocognitive data were compared to neurocognitive data acquired ≤2 years post-treatment. Cognitive assessment revealed sustained cognitive decline in 10.5% of HI-CT, 8.3% of CON-CT, 6.7% of RT-only patients and 0% in the HC. Hypoactivation was found in task-related prefrontal and parietal areas for both CT-groups versus RT-only, with HI-CT showing more pronounced hypoactivation than CON-CT, combined with worse task performance. RT-only survivors performed at a similar level to HC while showing hyperactivation in task-related brain areas. Long after treatment, CT is associated with cognitive problems and task-related hypoactivation that depend on the specific cytotoxic regimen. This worse performance in patients who received CT could be explained by impaired brain functioning that is more severe with more intense CT
    Journal of the International Neuropsychological Society 12/2014; 21(01). DOI:10.1017/S1355617714001015 · 2.96 Impact Factor
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