Role of stress, age and adjuvant therapy in the cognitive function of patients with breast cancer (Review)

Abstract

According to data largely obtained from retrospective studies, it has been postulated that chemotherapy exerts an aggravating effect on the cognitive function of patients with breast cancer. Potential individual factors related to the effects of chemotherapy on cognitive function have been indicated, such as age-related cognitive dysfunction and stress. Elderly patients differ from non-elderly patients as regards higher cognitive related comorbidities, such as dementia, as well as regarding lower stress levels, indicating that ‘chemobrain’ may differentially affect these two age groups. The aim of this review was to discuss the effects of stress and chemotherapy on cognitive dysfunction and identify any potential age-related differences in patients with breast cancer treated with adjuvant chemotherapy. For this purpose, a systematic review of the literature was carried out on the PubMed, Scopus and Web of Science databases. The inclusion criteria were original articles published in peer-reviewed journals, elderly and non-elderly patients with breast cancer, reporting on stress and at least one cognitive parameter pre- and/or post-treatment. Eight studies met the preset criteria and were further analyzed. In total, the data of 1,253 women were included, of whom 800 patients with breast cancer were treated with surgery only, systemic treatment only, or both. Although all the studies included a non-elderly breast cancer patient subpopulation, only two of the studies included patients over 65 years of age. All studies indicated a statistically significant association of stress with various domains of cognitive dysfunction in patients, as shown by either self-completed questionnaires, neuropsychological testing or both. An age over 60 years was linked to fewer cognitive difficulties mediated by lower levels of stress. Thus, the evidence supports the association of stress with cognitive deficits in patients with breast cancer, regardless of the type of cancer-related treatment. Therefore, stress should be appropriately addressed. However, further research is required to investigate the association of stress with cognitive function in elderly patients with breast cancer.

Age-related Differences in Recall of Information and Handling of Chemotherapy-related Side Effects in Cancer Patients: The ReCap Study

“…But there was a tendency toward poorer cognitive screening scores in patients with PC compared with the other two groups, despite their younger median age. The differences seen might be due to the poorer prognosis and thus higher level of distress, which can affect cognitive functioning including memory 38 , 39 and is also in accordance with a cross-sectional study where patients with a poorer prognosis were found to consistently remember less information from medical consultations than patients with a better prognosis. 17 Thus, the poor cognitive screening with Mini-Cog in the present study might also be explained by distress due to of being diagnosed with cancer.…”

Oncology during the COVID‑19 pandemic: challenges, dilemmas and the psychosocial impact on cancer patients (Review)

“…The social isolation and the need to 'stay at home' cause loneliness, which is associated with a higher risk of mortality in cancer patients (18,19). It is well documented that perceived uncertainty increases individual emotional distress, and this, in turn, has negative effects on clinical outcomes in cancer patients (20)(21)(22).…”

Are there sustained psychological impacts in women diagnosed with in-situ or early invasive breast cancers?

“…Cognitive constraints have been observed in various studies as sustained effects of anticancer treatment ( 21 ). There are reports hypothesizing that adverse cognitive effects may be aggravated by individual factors such as stress ( 22 ). Interestingly, the younger women in our study produced a second noticeable result: their level of anxiety was generally moderately raised.…”