This is the first large series assessing baseline cognitive functions in elderly EBC patients. More than 40% presented objective CD before any adjuvant therapy, which is higher than what is reported among younger patients. Our results reinforce the hypothesis that age is a risk factor for CD in EBC patients.

Background: Twenty to 30% of patients with breast cancer have cognitive impairment after surgery and before adjuvant treatment, but very few studies have focused on cognition before any treatment. This study used a subgroup of women with newly diagnosed breast cancer from the French cancer and toxicities (CANTO) cohort to describe cognition before any treatment in comparison with a group of healthy controls (HC).Methods: Cognitive assessment was performed before any breast cancer treatment (surgery or neoadjuvant treatment) on women with newly diagnosed invasive stage I-III breast cancer and HCs. Objective cognitive performance, cognitive complaints, anxiety, depression, and fatigue were assessed. Objective cognitive impairment was defined according to International Cognition and Cancer Task Force recommendations.Results: Of the 264 included patients with breast cancer (54 AE 11 years) and 132 age-matched HCs (53 AE 9 years), overall objective cognitive impairment was observed in 28% of patients with breast cancer and 8% of HCs (P < 0.001). Cognitive complaints were reported by 24% of patients versus 12% of HCs (P < 0.01). Patients reported significantly more anxiety and emotional and cognitive fatigue than HCs (P < 0.01). After adjustment, significantly more patients with breast cancer had overall objective cognitive impairment than HCs [OR ¼ 3.01; 95% confidence interval (CI): 1.31-6.88] without significant difference between groups for cognitive complaints (OR ¼ 1.38; 95% CI: 0.65-2.92). Cognitive complaints were positively associated with fatigue (OR ¼ 1.03; 95% CI: 1.02-1.05).Conclusions: In this prospective study, compared with HCs, patients with localized breast cancer had more objective cognitive impairment before any treatment. Cognitive complaints were mostly related to fatigue.Impact: Baseline assessment before treatment is important to assess the impact of each cancer treatment on cognition.

Objective Cognitive complaints are more frequent in women with breast cancer (BC) than in healthy controls and can be present before any treatment. Findings regarding contributive factors remain inconsistent. This study aimed to identify different groups of patients with cognitive complaints at BC diagnosis and to determine whether these different groups were associated with demographic, medical, or psychological characteristics. Methods Cognitive complaints were assessed in a subset of 264 women from the French multicenter prospective CANTO cohort, at baseline before any treatment. Clustering analyzes were performed using the six‐cognitive dimension Costa's scoring of the FACT‐Cog V3. Univariable analyses were used to study how cognitive function (standardized neuropsychological tests, ICCTF), anxiety, depression, fatigue, and quality of life (HADS, FA12, QLQ‐C30) were associated with specific cognitive complaints groups. Results Results included 263 women (54±11 years), newly diagnosed with BC (69% stages I–III). Four distinct groups emerged, ranged from “no complaints” (22.8%), “low complaints” (55.1), “mixed complaints” (14.5%), to “consistent complaints” (7.6%). No significant differences were found in terms of demographic and medical factors between the four groups. However, the groups with higher proportions of patients with complaints were found to have more impairment in executive function, higher scores of anxiety, depressive symptoms, and fatigue, and lower quality of life, than the groups with lower proportions of cognitive complaints. Conclusion Using complete cognitive assessment prior to BC treatment, we identified four distinct cognitive complaints groups with specific characteristics. This work provides valuable clinical basis to further investigations for a better understanding of cognitive complaints and their associates.

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Background Using the large nationwide CANTO cohort, we assessed cognitive functioning change after cancer treatments in a subgroup of breast cancer patients. Methods We included patients with newly diagnosed invasive stage I-III breast cancer enrolled in the CANTO sub-study focused on cognitive evaluation and healthy control women matched for age and education. Episodic and working memory, executive functions, processing speed, attention, self-report cognitive difficulties (SRCD), fatigue, anxiety/depression were assessed with neuropsychological tests and self-report questionnaires, before treatment (baseline), about 1 (year-1) and 2 years (year-2) after diagnosis. We used linear mixed models to study changes in cognition and tested the effect of adjuvant chemotherapy. Results We studied 276 localized breast cancer patients (62% chemotherapy (CT+)) compared to 135 healthy controls. After adjustment, patients had lower baseline working memory, processing speed and attention scores than healthy controls (p ≤ 0.001), and the difference remained significant over follow-up for working memory and processing speed. Executive function scores were similar between groups at baseline but decreased at year-1 among patients compared to healthy controls (p for change = 0.006). This decrease in CT+ patients was significant when compared to healthy controls scores (p for change &lt; 0.001). After adjustment, SRCD were similar between breast cancer patients and healthy controls at baseline but increased in patients after treatment at year-1 (p for change = 0.002). Conclusions Cognitive difficulties are an important concern in breast cancer patients, starting at diagnosis. Cancer treatments induce executive function decline and SRCD, which decrease over follow-up.