Long‐term trajectories of self‐reported cognitive function in a cohort of older survivors of breast cancer: CALGB 369901 (Alliance)

Abstract

BACKGROUNDThe number of survivors of breast cancer aged ≥65 years (“older”) is growing, but to the authors' knowledge, little is known regarding the cognitive outcomes of these individuals.METHODSA cohort of cognitively intact older survivors with nonmetastatic, invasive breast cancer was recruited from 78 sites from 2004 through 2011; approximately 83.7% of the survivors (1280 survivors) completed baseline assessments. Follow‐up data were collected at 6 months and annually for up to 7 years (median, 4.1 years). Cognitive function was self‐reported using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ‐C30); scores ranged from 0 to 100, with a higher score indicating better function. Group‐based trajectory modeling determined trajectories; women were assigned to a trajectory group based on the highest predicted probability of membership. Multinomial logistic regression evaluated the association between receipt of chemotherapy (with or without hormonal treatment) and trajectory group.RESULTSSurvivors were aged 65 to 91 years; approximately 41% received chemotherapy. There were 3 cognitive trajectories: “maintained high” (42.3% of survivors); “phase shift” (50.1% of survivors), with scores slightly below but parallel to maintained high; and “accelerated decline” (7.6% of survivors), with the lowest baseline scores and greatest decline (from 71.7 [standard deviation, 19.8] to 58.3 [standard deviation, 21.9]). The adjusted odds of being in the accelerated decline group (vs the maintained high group) were 2.1 times higher (95% confidence interval, 1.3‐3.5) for survivors who received chemotherapy (with or without hormonal therapy) versus those treated with hormonal therapy alone. Greater comorbidity and frailty also were found to be associated with accelerated decline.CONCLUSIONSTrajectory group analysis demonstrated that the majority of older survivors maintained good long‐term self‐reported cognitive function, and that only a small subset who were exposed to chemotherapy manifested accelerated cognitive decline. Future research is needed to determine factors that place some older survivors at risk of experiencing cognitive decline. Cancer 2016;122:3555–3563. © 2016 American Cancer Society

Frailty and long-term mortality of older breast cancer patients: CALGB 369901 (Alliance)

“…This group is generally clinically apparent, but recognition of this subset is important since they had more steeply rising death rates than the other groups starting one year after diagnosis, suggestive of a group with accelerating aging. 2,22 This group is very likely to experience treatment toxicity 9 and to require monitoring and assistance during survivorship care. The pre-frail group constituted almost one-fifth of the cohort, and also had significantly higher mortality rates than robust patients, but their death rates increased over time in parallel with the robust group, suggesting a phase shift.…”

“…The study has been described elsewhere. 22,24 Briefly, breast cancer patients signed an IRB-approved consent to participate in a study evaluating preferences for systemic therapy and effects of treatment on quality of life and survival. Follow-up data were used to conduct a planned secondary analysis of mortality as a function of frailty.…”

“…12,19 The adaptation for breast cancer patients has been shown to predict hormonal therapy initiation 21 and trajectories of cognitive function. 22 …”

“…12,17-19 However, they are not frequently used in older cancer populations, 20 despite greater ease of use than comprehensive clinical geriatric assessments. When deficits accumulation indices have been applied in oncology settings, they have predicted initiation of hormonal therapy in older breast cancer patients, 21 chemotherapy toxicity, 7 accelerated cancer-related cognitive decline, 22 and two-year all-cause mortality. 20 However, there are no modern data on the ability of deficits accumulation indices to predict long-term breast cancer outcomes.…”

Relationship of systemic cytokine concentrations to cognitive function over two years in women with early stage breast cancer

“…Higher levels of circulating proinflammatory cytokines and their receptors have been found in individuals with cancer prior to treatment, during chemotherapy, and in survivorship. In addition to chemotherapy, cytokine interactions may be affected by other cancer treatments, including radiation therapy (Bentzen, 2006) and hormonal therapies, (Collins et al, 2009, Lee et al, 2016) as well as multiple host factors including older age, (Hurria et al, 2006, Mandelblatt et al, 2016) menopausal status and symptoms, (Miura et al, 2016) and adiposity (Hartman et al, 2015). Although cytokines have been implicated in breast cancer development and progression for many years (Dethlefsen et al, 2013), the understanding of the multiple roles of cytokines in the central nervous system has been appreciated only in the more recent past (Maier, Goehler et al 1998; Wilson, 2002).…”