Shirley M Bluethmann1, Catherine M Alfano2, Jonathan D Clapp3, George Luta4, Brent J Small5, Arti Hurria6, Harvey J Cohen7, Steven Sugarman8, Hyman B Muss9, Claudine Isaacs10, Jeanne S Mandelblatt3,10. 1. Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, 500 University Drive, Hershey, PA, 17033, USA. szb332@psu.edu. 2. American Cancer Society, Inc., 1875 Connecticut Ave NW, Washington, DC, 20009, USA. 3. Department of Oncology, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, 3300 Whitehaven Street NW, suite 4100, Washington, DC, 20007, USA. 4. Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, 3300 Whitehaven Street NW, suite 4100, Washington, DC, 20007, USA. 5. School of Aging Studies, University of South Florida, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA. 6. Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, 1500 Duarte Rd, Duarte, CA, 91010, USA. 7. Department of Medicine and Center for the Study of Aging and Human Development, Duke University, DUMC, Room 3502 Busse Building, Blue Zone, Duke South, Box 3003, Durham, NC, 27710, USA. 8. Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA. 9. Department of Medicine, UNC-Chapel Hill School of Medicine, University of North Carolina, 321 South Columbia Street, Chapel Hill, NC, 27514, USA. 10. Department of Medicine, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, 3300 Whitehaven Street NW, suite 4100, Washington, DC, 20007, USA.
Abstract
PURPOSE: To investigate the effects of cognitive function on discontinuation of hormonal therapy in breast cancer survivors ages 65+ ("older"). METHODS: Older breast cancer survivors with invasive, non-metastatic disease, and no reported cognitive difficulties were recruited from 78 Alliance sites between 2004 and 2011. Eligible survivors (n = 1280) completed baseline interviews; follow-up was conducted annually for up to 7 years. Survivors with estrogen-receptor-positive (ER+) cancers who initiated hormonal therapy (n = 990) were included. Self-reported cognitive function was measured using the EORTC-QLQ30 scale; a difference of eight points on the 0-100 scale was considered clinically significant. Based on varying rates of discontinuation over time, discontinuation was evaluated separately for three time periods: early (<1 year); midpoint (1-3 years); and late discontinuation (>3-5 years). Cox models for each time period were used to evaluate the effects of cognition immediately preceding discontinuation, controlling for age, chemotherapy, and other covariates. RESULTS: Survivors were 65-91 years old (mean 72.6 years), and 79% had stages 1 or 2A disease. Overall, 43% discontinued hormonal therapy before 5 years. Survivors who reported lower cognitive function in the period before discontinuation had greater hazards of discontinuing therapy at the treatment midpoint (HR 1.22 per 8-point difference, CI 1.09-1.40, p < 0.001), considering covariates, but cognition was not related to discontinuation in the other periods. CONCLUSIONS: Self-reported cognitive problems were a significant risk factor for discontinuation of hormonal therapy 1-3 years post-initiation. Additional research is needed on the temporality of cognitive effects and hormonal therapy to support survivorship care needs of older survivors.
PURPOSE: To investigate the effects of cognitive function on discontinuation of hormonal therapy in breast cancer survivors ages 65+ ("older"). METHODS: Older breast cancer survivors with invasive, non-metastatic disease, and no reported cognitive difficulties were recruited from 78 Alliance sites between 2004 and 2011. Eligible survivors (n = 1280) completed baseline interviews; follow-up was conducted annually for up to 7 years. Survivors with estrogen-receptor-positive (ER+) cancers who initiated hormonal therapy (n = 990) were included. Self-reported cognitive function was measured using the EORTC-QLQ30 scale; a difference of eight points on the 0-100 scale was considered clinically significant. Based on varying rates of discontinuation over time, discontinuation was evaluated separately for three time periods: early (<1 year); midpoint (1-3 years); and late discontinuation (>3-5 years). Cox models for each time period were used to evaluate the effects of cognition immediately preceding discontinuation, controlling for age, chemotherapy, and other covariates. RESULTS: Survivors were 65-91 years old (mean 72.6 years), and 79% had stages 1 or 2A disease. Overall, 43% discontinued hormonal therapy before 5 years. Survivors who reported lower cognitive function in the period before discontinuation had greater hazards of discontinuing therapy at the treatment midpoint (HR 1.22 per 8-point difference, CI 1.09-1.40, p < 0.001), considering covariates, but cognition was not related to discontinuation in the other periods. CONCLUSIONS: Self-reported cognitive problems were a significant risk factor for discontinuation of hormonal therapy 1-3 years post-initiation. Additional research is needed on the temporality of cognitive effects and hormonal therapy to support survivorship care needs of older survivors.
Authors: Shirley M Bluethmann; Caitlin C Murphy; Jasmin A Tiro; Michelle A Mollica; Sally W Vernon; Leona Kay Bartholomew Journal: Oncol Nurs Forum Date: 2017-05-01 Impact factor: 2.172
Authors: Catherine M Bender; John D Merriman; Amanda L Gentry; Gretchen M Ahrendt; Sarah L Berga; Adam M Brufsky; Frances E Casillo; Meredith M Dailey; Kirk I Erickson; Frances M Kratofil; Priscilla F McAuliffe; Margaret Q Rosenzweig; Christopher M Ryan; Susan M Sereika Journal: Cancer Date: 2015-04-23 Impact factor: 6.860
Authors: Kelly-Anne Phillips; Julie Aldridge; Karin Ribi; Zhuoxin Sun; Alastair Thompson; Vernon Harvey; Beat Thürlimann; Fatima Cardoso; Olivia Pagani; Alan S Coates; Aron Goldhirsch; Karen N Price; Richard D Gelber; Jürg Bernhard Journal: Breast Cancer Res Treat Date: 2010-11-03 Impact factor: 4.872
Authors: A Buzdar; A Howell; J Cuzick; C Wale; W Distler; G Hoctin-Boes; J Houghton; G Y Locker; J M Nabholtz Journal: Lancet Oncol Date: 2006-08 Impact factor: 41.316
Authors: M Kool; D B Y Fontein; E Meershoek-Klein Kranenbarg; J W R Nortier; E J T Rutgers; P J Marang-van de Mheen; C J H van de Velde Journal: Breast Date: 2015-02-20 Impact factor: 4.380
Authors: Alfred I Neugut; Grace Clarke Hillyer; Lawrence H Kushi; Lois Lamerato; S David Nathanson; Christine B Ambrosone; Dana H Bovbjerg; Jeanne S Mandelblatt; Carol Magai; Wei-Yann Tsai; Judith S Jacobson; Dawn L Hershman Journal: Breast J Date: 2012-04-05 Impact factor: 2.431
Authors: Mackenzi Pergolotti; Nicolò Matteo Luca Battisti; Lynne Padgett; Alix G Sleight; Maya Abdallah; Robin Newman; Kathleen Van Dyk; Kelley R Covington; Grant R Williams; Frederiek van den Bos; YaoYao Pollock; Elizabeth A Salerno; Allison Magnuson; Isabella F Gattás-Vernaglia; Tim A Ahles Journal: J Geriatr Oncol Date: 2019-10-14 Impact factor: 3.599
Authors: Niklas Paul Grusdat; Alexander Stäuber; Marion Tolkmitt; Jens Schnabel; Birgit Schubotz; Henry Schulz Journal: Oncol Res Treat Date: 2021-10-13 Impact factor: 2.825
Authors: Brenna C McDonald; Kathleen Van Dyk; Jeanne S Mandelblatt; Andrew J Saykin; Rachael L Deardorff; Jessica N Bailey; Wanting Zhai; Judith E Carroll; James C Root; Tim A Ahles Journal: Breast Cancer Res Treat Date: 2022-04-27 Impact factor: 4.624
Authors: Kevin T Liou; Tim A Ahles; Sheila N Garland; Q Susan Li; Ting Bao; Yuelin Li; James C Root; Jun J Mao Journal: JNCI Cancer Spectr Date: 2019-06-07
Authors: Annelieke A Lemij; Nienke A de Glas; Marloes G M Derks; Esther Bastiaannet; Jos W S Merkus; Titia E Lans; Carmen C van der Pol; Thijs van Dalen; Annelie J E Vulink; Leander van Gerven; Onno R Guicherit; Eugenie M H Linthorst-Niers; Frederiek van den Bos; Judith R Kroep; Gerrit Jan Liefers; Johanneke E A Portielje Journal: Breast Cancer Res Treat Date: 2022-04-19 Impact factor: 4.624
Authors: Jeanne S Mandelblatt; Brent J Small; Gheorghe Luta; Arti Hurria; Heather Jim; Brenna C McDonald; Deena Graham; Xingtao Zhou; Jonathan Clapp; Wanting Zhai; Elizabeth Breen; Judith E Carroll; Neelima Denduluri; Asma Dilawari; Martine Extermann; Claudine Isaacs; Paul B Jacobsen; Lindsay C Kobayashi; Kelly Holohan Nudelman; James Root; Robert A Stern; Danielle Tometich; Raymond Turner; John W VanMeter; Andrew J Saykin; Tim Ahles Journal: J Clin Oncol Date: 2018-10-03 Impact factor: 44.544