Cognitive impairment in a subset of breast cancer patients following systemic therapy – results from a longitudinal study

• Published in: Journal of pain and symptom management 2016
• Main Authors: Menning, Sanne, MSc, de Ruiter, Michiel B., PhD, Kieffer, Jacobien M., PhD, van Rentergem, Joost Agelink, MSc, Veltman, Dick J., MD, PhD, Fruijtier, Agnetha, MSc, Oldenburg, Hester S.A., MD, PhD, Boven, Epie, MD, PhD, van der Meij, Suzan, MD, Lustig, Vera, MD, Bos, Monique E.M., MD, PhD, Boogerd, Willem, MD, PhD, Reneman, Liesbeth, MD, PhD, Schagen, Sanne B., PhD
• Format: Article
• Language: English
• Subjects: Anesthesia & Perioperative Care; Pain Medicine
• ISSN: 0885-3924
• DOI: 10.1016/j.jpainsymman.2016.04.012

Abstract Context Studies indicate adverse effects of breast cancer (BC) and cancer treatment on cognitive function. Objectives To investigate the effects of systemic treatment on cognitive performance in BC patients. Methods Participants were BC patients scheduled to receive systemic treatment (BC+SYST; n=31), or no systemic treatment (BC; n=24) and no-cancer controls (NC; n=33). Neuropsychological examinations were used to study cognitive performance on 18 tests grouped into 8 cognitive domains, before adjuvant treatment (T1) and six months after chemotherapy (T2), or at similar intervals. We also assessed health-related quality of life, anxiety and depression, mood, stress, and cognitive problems. ANOVA was used to assess group differences of cognitive performance and multivariate normative comparison (MNC) to classify impairment, comparing scores of each participant against the distribution of the scores of NCs. Results Of BC+SYST, 16% were cognitively impaired at T2, compared to 4% in BC and 6% in NC. Although not significant, we moderate effect sizes for worse performance in the BC+SYST group compared to NC [Flanker congruent (ES=0.44) and stimulus incongruent (ES=0.44)] and compared to BC [COWAT (ES=0.47), Digit Span (ES=0.41), and HVLT immediate (ES=0.71) and delayed recall (ES=0.65)]. Cognitively impaired patients had a significantly lower IQ, worse physical and social functioning, and more distress at T2 compared to unimpaired patients. Conclusion Our findings indicate that cognitive impairment after systemic treatment occurs in a subset of BC patients. The predictive value of demographic and psychosocial factors in cognitive impairment should be further investigated in a larger sample of impaired patients.