Preliminary Assessment of Cognitive Function in Breast Cancer Patients Treated with Tamoxifen

Paganini‐Hill, Annlia; Clark, Linda J.

doi:10.1023/a:1006426132338

Cited by 211 publications

(129 citation statements)

References 33 publications

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“…The tendency seems to be that subjective ratings of memory and concentration decrease after treatment with chemotherapy, and that breast cancer patients treated with chemotherapy also seem to be more likely than controls to perceive themselves as impaired [47]. It is also unclear whether tamoxifen used for postoperative endocrine therapy has an effect on cognitive function [48,49], and the effect of aromatase inhibitors, the first option for postmenopausal breast cancer, on cognitive function is also an important issue for further study [50,51].…”

Section: Discussionmentioning

confidence: 99%

Associations among baseline variables, treatment-related factors and health-related quality of life 2 years after breast cancer surgery

Taira

Shimozuma

Shiroiwa

et al. 2011

Breast Cancer Res Treat

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Provision of social support and rehabilitation for patients with physical, mental and functional problems after cancer treatment is important for long-term health-related quality of life (HRQOL). Effective use of human and financial healthcare resources requires identification of patients requiring rehabilitation. The objectives of the current study were to clarify the patterns of physical and psychosocial recovery over time, to evaluate the associations among baseline variables, treatment-related factors and HRQOL at 6 months, 1 and 2 years after breast cancer surgery, and to identify the significant factors predicting HRQOL at each point. A multicenter longitudinal study was performed to evaluate physical conditions, anxiety, depression and HRQOL at one month (baseline), 6 months, and 1 and 2 years after surgery in 196 patients (mean age: 53.3 years old) with early breast cancer and no postoperative recurrence. Physical conditions were evaluated using a patient-reported symptom checklist. HRQOL was rated using the Functional Assessment of Cancer Treatment scale-General (FACT-G) and the Breast Cancer subscale (FACT-B). Anxiety and depression were rated using the Hospital Anxiety and Depression Scale (HADS).More than 50% of patients had local problems of "tightness", "arm weakness" and "arm lymphedema", and systemic problems of "reduced energy, fatigue, and general weakness" postoperatively. The HRQOL score significantly improved one year after surgery, and scores for physical, emotional and functional well-being also increased with time, whereas the score for social well-being was highest at baseline and decreased with time. Depression and anxiety significantly improved with time. Concomitant disease, marital status and the presence of a partner, anxiety and depression at baseline, pathological lymph node involvement, and adjuvant intravenous chemotherapy were significant factors predicting FACT-G scores at 6 months and 1 and 2 years after surgery. Depression at baseline was a strong predictor of HRQOL up to 2 years after surgery. These results suggest that physical rehabilitation is required for tightness and lymphedema to improve long-term postoperative physical function. A further study of psychosocial interventions is required to improve depression and social well-being after breast cancer surgery.

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Section: Discussionmentioning

confidence: 99%

Associations among baseline variables, treatment-related factors and health-related quality of life 2 years after breast cancer surgery

Taira

Shimozuma

Shiroiwa

et al. 2011

Breast Cancer Res Treat

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“…Neither the biological basis for this syndrome, nor the predictors, nor any interventions, are well understood although recent investigations suggest a relationship with structural changes occurring in cerebral white matter and several investigations are underway. 135,136 While much of the prior work has focused on the effects of chemotherapy, ET may also adversely affect cognition, [137][138][139][140] although few specific investigations have been conducted and none in young women. In the ZIPP trial (6 cycles of CMF ± 2 years of goserelin, goserelin plus tamoxifen, or tamoxifen), no effect of treatment on patients' selfevaluation of memory and concentration was shown.…”

Section: Brca Mutation Carriers (Table 8)mentioning

confidence: 99%

Second international consensus guidelines for breast cancer in young women (BCY2)

et al. 2016

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“…Regions of the brain such as the hippocampus and amygdala involved in learning and memory are rich in ER, as oestrogen regulates synapse formation and induces choline transferase and acetylcholinesterase, both critical to memory function (McEwen et al, 1997). While tamoxifen has been implicated in decline in cognitive function (Paganini-Hill and Clark, 2000), these data do not come from double-blind randomised placebo-controlled trials, and so the issue remains controversial. The positive influence of oestrogen on the general health, vitality, mental health, depressive symptoms, or sexual satisfaction has recently been seriously questioned (Rossouw et al, 2002;Hays et al, 2003), and so, while these issues need careful study, the potential of AIs to be unduly toxic in the long run should not be overstated.…”

Section: Toxicity and Tolerabilitymentioning

confidence: 99%

First-line endocrine treatment of breast cancer: aromatase inhibitor or antioestrogen?

Ellis

2004

Br J Cancer

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Until recently, endocrine therapy for breast cancer was relatively simple. If the tumour expressed hormone receptors, regardless of stage and age, tamoxifen was indicated. While this largely remains the case for premenopausal women, clinical trials in postmenopausal women have broadened our choice to include one of three selective aromatase inhibitors (AIs), the nonsteroidal agents anastrozole or letrozole and the steroidal agent exemestane. Comparative data concerning the efficacy, toxicity, tolerability and cost of AI vs tamoxifen continues to evolve with over 40 000 women slated to be involved in clinical trials. Currently, tamoxifen remains an appropriate choice for adjuvant treatment, and will remain so unless a clear survival advantage emerges for adjuvant AI therapy. However, anastrozole is widely seen as a useful alternative, with particular merit for patients prone to the development of serious tamoxifen side effects. For endocrine therapy naïve advanced disease, several trials have provided evidence that a nonsteroidal AI has replaced tamoxifen as optimal treatment. In the neoadjuvant setting, letrozole was also more effective than tamoxifen, both in terms of response rates and the incidence of breast-conserving surgery, and so AI therefore also dominates this evolving indication. The ongoing adjuvant clinical trials ask all the relevant questions regarding tamoxifen and AI in combination, sequence and duration, except for 5 years of an AI vs a longer period. For both the advanced and early-stage disease, resistance remains the key obstacle to overcome, and trials that combine endocrine agents with signal transduction inhibitors such as HER1 and HER2 kinase inhibitors, farnesyl transferase inhibitors, mTOR inhibitors as well as COX2 inhibitors are being developed in a concerted attempt to address this problem.

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Preliminary Assessment of Cognitive Function in Breast Cancer Patients Treated with Tamoxifen

Cited by 211 publications

References 33 publications

Associations among baseline variables, treatment-related factors and health-related quality of life 2 years after breast cancer surgery

Associations among baseline variables, treatment-related factors and health-related quality of life 2 years after breast cancer surgery

Second international consensus guidelines for breast cancer in young women (BCY2)

First-line endocrine treatment of breast cancer: aromatase inhibitor or antioestrogen?

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