Sanne Menning1, Michiel B de Ruiter1, Jacobien M Kieffer2, Joost Agelink van Rentergem3, Dick J Veltman4, Agnetha Fruijtier2, Hester S A Oldenburg5, Epie Boven6, Suzan van der Meij7, Vera Lustig8, Monique E M Bos9, Willem Boogerd10, Liesbeth Reneman11, Sanne B Schagen12. 1. Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. 2. Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands. 3. Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands. 4. Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands. 5. Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands. 6. Department of Medical Oncology, VU University Medical Center, Amsterdam, The Netherlands. 7. Department of Surgery, Flevo Hospital, Almere, The Netherlands; Breast Cancer Department, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. 8. Department of Medical Oncology, Flevo Hospital, Almere, The Netherlands. 9. Department of Internal Medicine, Reinier de Graaf Hospital, Delft, The Netherlands. 10. Department of Neuro-Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands. 11. Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. 12. Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands. Electronic address: s.schagen@nki.nl.
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 (NC) controls (n = 33). Neuropsychological examinations were used to study cognitive performance on 18 tests grouped into eight 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. Analysis of variance was used to assess group differences of cognitive performance and multivariate normative comparison to classify impairment, comparing scores of each participant against the distribution of the scores of NC controls. RESULTS: Of BC + SYST, 16% were cognitively impaired at T2, compared to 4% in BC and 6% in NC. Although not significant, we observed moderate effect sizes for worse performance in the BC + SYST group compared to NC (Flanker congruent [effect size {ES} = 0.44] and stimulus incongruent [ES = 0.44]) and compared to BC (Controlled Oral Word Association Test [ES = 0.47], digit span [ES = 0.41], and Hopkins Verbal Learning Test immediate [ES = 0.71] and delayed recall [ES = 0.65]). Cognitively impaired patients had a significantly lower estimated premorbid intelligence, 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.
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 (NC) controls (n = 33). Neuropsychological examinations were used to study cognitive performance on 18 tests grouped into eight 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. Analysis of variance was used to assess group differences of cognitive performance and multivariate normative comparison to classify impairment, comparing scores of each participant against the distribution of the scores of NC controls. RESULTS: Of BC + SYST, 16% were cognitively impaired at T2, compared to 4% in BC and 6% in NC. Although not significant, we observed moderate effect sizes for worse performance in the BC + SYST group compared to NC (Flanker congruent [effect size {ES} = 0.44] and stimulus incongruent [ES = 0.44]) and compared to BC (Controlled Oral Word Association Test [ES = 0.47], digit span [ES = 0.41], and Hopkins Verbal Learning Test immediate [ES = 0.71] and delayed recall [ES = 0.65]). Cognitively impairedpatients had a significantly lower estimated premorbid intelligence, 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.
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