Cognitive functioning during long-term tamoxifen treatment in postmenopausal women with breast cancer

Abstract

Our results provide insights into cognitive functioning in women who receive long-term adjuvant tamoxifen treatment. By adding the surgical operation/radiotherapy group, we could control for the mental and physical influences of the diagnosis and treatment of breast cancer. Cognitive domains that rely on verbal abilities (verbal memory and fluency) seem to be at risk for deterioration after treatment with tamoxifen.

Cognitive effects of endocrine therapy for breast cancer: keep calm and carry on?

“…After 3 years of tamoxifen therapy, cognitive domains that rely on verbal abilities (verbal memory and fluency) were found to be at risk of deterioration. 105 These results are in agreement with two earlier studies in which postmenopausal patients using tamoxifen performed worse as compared with noncancer control individuals. 89,104 Out of the four above-mentioned observational studies, the only prospective study on the effects of endocrine therapy reported that postmenopausal patients on either tamoxifen or anastrozole, particularly those receiving anastrozole, have a greater cognitive decline in terms of processing speed and verbal memory when compared with individuals without cancer; 103 however, as this group of anastrazole-treated patients was particularly small (n = 14), these results should be interpreted with caution.…”

“…Of note, similarly to the randomized clinical trials, in many of these observational studies, important information such as HRT use, menopausal status or age since menopause, age at assessment, and hormonal status were often not taken into account. For example, six of the nine observational studies discussed report the percentage of patients who previously used HRT, 102,[104][105][106]109,110 but only two included this information in the analyses. 106,109 All studies included current menopausal status, but none reported on age at menopause, or time since menopause.…”

“…Of note, in several of these studies, subgroups of patients also received chemo therapy, a treatment known to affect cognitive function; 101,102 however, the chemotherapy treatment history was not consistently considered in the evaluation of the effects of endocrine therapy on cognition. 89,102 Only four observational studies have evaluated the cognitive effects of endocrine therapy in truly chemotherapy-naive patients; 89,[103][104][105] all these studies focused on the influence of tamoxifen, and one included a pretreatment cognitive assessment. After 3 years of tamoxifen therapy, cognitive domains that rely on verbal abilities (verbal memory and fluency) were found to be at risk of deterioration.…”

Estrogen–cholinergic interactions: Implications for cognitive aging

“…It is of interest that our results are somewhat at variance with some studies in breast cancer patients that have suggested that long-term treatment with TMX may have negative cognitive consequences (Boele et al, 2015; Schilder et al, 2009). However, our studies were performed in normal postmenopausal women.…”

Association of cancer history with Alzheimer's disease onset and structural brain changes

“…There is some evidence to support the negative impact of hormone therapies on perceived and objective cognitive function (Schilder et al, 2009, 2010a; Boele et al, 2014), and that radiotherapy may also be associated with cognitive dysfunction (Shibayama et al, 2014). Furthermore, although the focus of this research to date has been on the effects of cancer treatments on brain structure and function, several studies of breast cancer patients have also found pre-treatment deficits in neuropsychological performance and brain activation, suggesting that CA+ may be associated with cognitive dysfunction, independent of treatment effects (Cimprich et al, 2010; Schilder et al, 2010b; Scherling et al, 2011).…”