Cognitive Complaints in Survivors of Breast Cancer After Chemotherapy Compared With Age-Matched Controls: An Analysis From a Nationwide, Multicenter, Prospective Longitudinal Study

Abstract

Cancer-related cognitive impairment is an important problem for patients with breast cancer, yet its trajectory is not fully understood. Some previous cancer-related cognitive impairment research is limited by heterogeneous populations, small samples, lack of prechemotherapy and longitudinal assessments, use of normative data, and lack of generalizability. We addressed these limitations in a large prospective, longitudinal, nationwide study. Patients and MethodsPatients with breast cancer from community oncology clinics and age-matched noncancer controls completed the Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog) at prechemotherapy and postchemotherapy and at a 6-month follow-up as an a priori exploratory aim. Longitudinal models compared FACT-Cog scores between patients and controls at the three assessments and adjusted for age, education, race, menopausal status, and baseline reading ability, anxiety, and depressive symptoms. A minimal clinically important difference cutoff determined percentages of impairment over time. ResultsOf patients, 581 patients with breast cancer (mean age, 53 years; 48% anthracycline-based regimens) and 364 controls (mean age, 53 years) were assessed. Patients reported significantly greater cognitive difficulties on the FACT-Cog total score and four subscales from prechemotherapy to postchemotherapy compared with controls as well as from prechemotherapy to 6-month follow-up (all P , .001). Increased baseline anxiety, depression, and decreased cognitive reserve were significantly associated with lower FACT-Cog total scores. Treatment regimen, hormone, or radiation therapy was not significantly associated with FACT-Cog total scores in patients from postchemotherapy to 6-month follow-up. Patients were more likely to report a clinically significant decline in self-reported cognitive function than were controls from prechemotherapy to postchemotherapy (45.2% v 10.4%) and from prechemotherapy to 6-month follow-up (36.5% v 13.6%). ConclusionPatients with breast cancer who were treated in community oncology clinics report substantially more cognitive difficulties up to 6 months after treatment with chemotherapy than do age-matched noncancer controls.

Longitudinal Relationship Between Frailty and Cognition in Patients 50 Years and Older with Breast Cancer

“…Subjects were excluded if they had metastatic disease, a prior diagnosis of neurodegenerative disease, currently pregnant, hospitalized within the past year for psychiatric illness, or were receiving concurrent radiation therapy. Age‐matched noncancer control participants were also recruited from the same geographic location as patients . The current study evaluated participants from the parent study that were aged 50 years and older with complete data for cognitive assessment and frailty characteristics.…”

Implications of the tumor immune microenvironment for staging and therapeutics

“…149,152 Anti-PD-1/PD-L1 agents have shown promising results in patients with metastatic TNBC, with higher response rates in patients with PD-L1-positive tumors 152 ; however, a subset of patients with PD-L1-negative tumors also demonstrates clinical response. Clinical trials of immune checkpoint inhibitors in the neoadjuvant setting, 159 as well as coupling traditional therapeutic approaches such as chemotherapy with immune checkpoint inhibition, are also under investigation. 152,158 As in other tumor types, the optimal biomarker for pathological prediction of response and trial inclusion remains unclear.…”

Yoga for the Management of Cancer Treatment-Related Toxicities

“…Depending on cancer type and treatments, studies show that up to 80% of patients experience “chemobrain” during treatment and it persists in up to 35% of survivors post-treatment [58, 59]. Two randomized clinical trials studied the effects of yoga on cognitive impairment in cancer survivors post-chemotherapy and/or radiation therapy [60, 61•].…”