Cognitive Impairment in Patients with Breast Cancer before Surgery: Results from a CANTO Cohort Subgroup

Abstract

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.

Prevalence of Cognitive Impairment before Prostate Cancer Treatment

“…The prevalence of cognitive impairment in the present study, detected with MoCA and with a neuropsychological test battery, was much lower than in previous studies performed in patients with other cancers [ 10 , 11 , 12 , 13 , 14 , 48 ]. Prostate cancer, which is an indolent and localized disease in many men, may not induce the same pattern of systemic pathophysiologic alterations as other cancers, which might be a cause of cognitive impairment.…”

Perceived Cognitive Impairment in Breast Cancer Survivors and Its Relationships with Psychological Factors

“…In some studies, younger participants had more cognitive complaints than older patients, perhaps due to the fact that older patients did not associate their cognitive complaints with cancer treatment, but rather with normal aging [ 5 , 20 , 28 ]. Moreover, younger patients are often well informed, thanks to new information media such as the Internet.…”

Change in cognition before and after non‐central nervous system cancer diagnosis: A population‐based cohort study

“…Previous clinical studies on cognitive effects of specific cancer types or systemic cancer treatments have shown that cancer patients have more often impaired cognitive function than cancer-free controls, sometimes also before start of cancer treatment. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] These studies were often limited to specific cancer types. Animal studies have confirmed findings from clinical studies, showing that, for example, both treatment-naïve rodents with cancer and rodents treated with chemotherapy can have cognitive impairment.…”