Cancer-related cognitive impairment in patients with non-central nervous system malignancies: an overview for oncology providers from the MASCC Neurological Complications Study Group

2021

Support Care Cancer

Self Cite

Purpose Older breast cancer survivors (BCS) may be at greater risk for cognitive dysfunction and other comorbidities; both of which may be associated with physical and emotional well-being. This study will seek to understand these relationships by examining the association between objective and subjective cognitive dysfunction and physical functioning and quality of life (QoL) and moderated by comorbidities in older BCS. Methods A secondary data analysis was conducted on data from 335 BCS (stages I–IIIA) who were ≥ 60 years of age, received chemotherapy, and were 3–8 years post-diagnosis. BCS completed a one-time questionnaire and neuropsychological tests of learning, delayed recall, attention, working memory, and verbal fluency. Descriptive statistics and separate linear regression analyses testing the relationship of each cognitive assessment on physical functioning and QoL controlling for comorbidities were conducted. Results BCS were on average 69.79 (SD = 3.34) years old and 5.95 (SD = 1.48) years post-diagnosis. Most were stage II (67.7%) at diagnosis, White (93.4%), had at least some college education (51.6%), and reported on average 3 (SD = 1.81) comorbidities. All 6 physical functioning models were significant (p < .001), with more comorbidities and worse subjective attention identified as significantly related to decreased physical functioning. One model found worse subjective attention was related to poorer QoL (p < .001). Objective cognitive function measures were not significantly related to physical functioning or QoL. Conclusions A greater number of comorbidities and poorer subjective attention were related to poorer outcomes and should be integrated into research seeking to determine predictors of physical functioning and QoL in breast cancer survivors.

Section: Discussionsupporting

confidence: 61%

Comorbidity, cognitive dysfunction, physical functioning, and quality of life in older breast cancer survivors

2021

Support Care Cancer

Self Cite

“…The percentage of older BCS reporting cognitive concerns were somewhat higher than those demonstrating impairment on neuropsychological exam. This finding is consistent with previous reviews and individual studies of the larger BCS literature in which subjective cognitive concerns are more prevalent than objective cognitive dysfunction [38][39][40]. Some researchers hypothesize that the subjective reports may also be confounded with other correlated symptoms (psychological distress, fatigue, and health status) [38].…”

Section: Discussionsupporting

confidence: 90%

Cognitive dysfunction prevalence and associated factors in older breast cancer survivors

Journal of Geriatric Oncology

Unverzagt

et al. 2022

Self Cite

The purpose of this study was to examine the prevalence and factors associated with objective and subjective cognitive dysfunction in older breast cancer survivors (BCS). Materials and Methods: This cross-sectional descriptive study leveraged previously collected data from older BCS (n = 335). Separate linear regression models were used to determine relationships between demographic factors (age, education), medical factors (comorbidities), disease factors (time since diagnosis, cancer stage), cancer-related symptoms (depressive symptoms, anxiety, fatigue, sleep disturbance) and cognitive dysfunction measures, including objective learning, delayed recall, attention, executive function-working memory, verbal fluency and subjective attentional function. Results: Cognitive dysfunction was prevalent with up to 18.6% of older BCS experiencing mild-moderate dysfunction (1.5 standard deviations below mean of non-cancer controls) in at least one cognitive domain. Poor to moderate subjective attentional function was reported by 26% of older BCS. More depressive symptoms were significantly related to poorer cognitive function including learning (p < .01), delayed recall (p < .05), verbal fluency (p < .001), and subjective attentional function (p < .001) but not attention and executive function-working memory. Age, education, anxiety, and fatigue were also negatively associated with cognitive function in some models (p < .05-0.001). Conclusion:Cognitive dysfunction is common among older BCS and depressive symptoms, anxiety, and fatigue are related factors. Importantly, depressive symptoms were not only related to self-report, but also to cognitive performance. Healthcare providers should be aware of and assess for related factors and cognitive dysfunction itself in older BCS even years after diagnosis and treatment thorough geriatric assessment. Future longitudinal research is needed to discern these relationships.

“…Older BCS in this study who reported better subjective cognitive function reported better QoL. As evidenced by this study and others, cognitive dysfunction following cancer and treatment can have an impact on the functional ability and quality of life of patients, especially in older BCS [45]. Findings from this study provide direction for interventions which include maintenance of physical functioning and QoL and could ultimately support independent living and even mortality.…”

Section: Discussionsupporting

confidence: 66%

Comorbidity, Cognitive Dysfunction, Physical Functioning and Quality of Life in Older Breast Cancer Survivors

2021

Preprint

Self Cite

PurposeOlder breast cancer survivors (BCS) may be at greater risk for cognitive dysfunction and other comorbidities; both of which may be associated with physical and emotional well-being. This study will seek to understand these relationships by examining the association between objective and subjective cognitive dysfunction and physical functioning and quality of life (QoL) and moderated by comorbidities in older BCS. MethodsA secondary data analysis was conducted on using data from 335 BCS (Stage I-IIIA) who were ≥60 years of age, received chemotherapy, and were 3-8 years post-diagnosis. BCS completed a one-time questionnaire and neuropsychological tests of learning, delayed recall, attention, working memory and verbal fluency. Descriptive statistics and separate linear regression analyses testing the relationship of each cognitive assessment on physical functioning and QoL controlling for comorbidities were conducted.ResultsBCS were on average 69.79 (SD=3.34) years old and 5.95 (SD=1.48) years post-diagnosis. Most were stage II (67.7%) at diagnosis, White (93.4%), had at least some college education (51.6%) and reported on average 3 (SD=1.81) comorbidities. All 6 physical functioning models were significant (p<.001); with more comorbidities and worse subjective attention identified as significantly related to decreased physical functioning. One model found worse subjective attention was related to poorer QoL (p<.001). Objective cognitive function measures were not significantly related to physical functioning or QoL. ConclusionsA greater number of comorbidities and poorer subjective attention were related to poorer outcomes and should be integrated into research seeking to determine predictors of physical functioning and QoL in breast cancer survivors.