Jeanne S Mandelblatt1, Tim A Ahles2, James C Root3,4, Xingtao Zhou5, Jaeil Ahn5, Brent J Small6, Wanting Zhai5, Traci Bethea1, Judith E Carroll7, Harvey Jay Cohen8, Asma Dilawari9, Martine Extermann10, Deena Graham11, Claudine Isaacs12, Paul B Jacobsen13, Heather Jim10,14, Brenna C McDonald15, Zev M Nakamura16, Sunita K Patel17, Kelly Rentscher7, Andrew J Saykin15, Kathleen Van Dyk7. 1. Department of Oncology, Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA. 2. Neurocognitive Research Lab, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th Floor, New York, NY, USA. 3. Neurocognitive Research Lab, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th Floor, New York, NY, USA. rootj@mskcc.org. 4. Departments of Psychiatry and Anesthesiology, Weill Medical College of Cornell University, New York, NY, USA. rootj@mskcc.org. 5. Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown-Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA. 6. School of Aging Studies, University of South Florida, and Senior Member, Health Outcome and Behavior Program and Biostatistics Resource Core, H. Lee Moffitt Cancer Center and Research Institute at the University of South Florida, Tampa, FL, USA. 7. Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Jane and Terry Semel Institute for Neuroscience and Human BehaviorJonsson Comprehensive Cancer Center, UCLA, Los Angeles, CA, USA. 8. Center for the Study of Aging and Human Development and Comprehensive Cancer Center, Duke University School of Medicine, Durham, NC, USA. 9. MedStar Washington Hospital Center, MedStar Georgetown Lombardi Comprehensive Cancer Center, Washington, USA. 10. Department of Oncology, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA. 11. John Theurer Cancer Center, Hackensack, NJ, USA. 12. Departments of Oncology and Medicine, Breast Cancer Program, Georgetown-Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA. 13. Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA. 14. Department of Health Outcomes and Behavior, Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, FL, USA. 15. Center for Neuroimaging, Department of Radiology and Imaging Sciences and the Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana University School of Medicine, Indianapolis, IN, USA. 16. Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. 17. Departments of Population Sciences and Supportive Care Medicine, City of Hope Comprehensive Cancer Center, Duarte, CA, USA.
Abstract
PURPOSE: Tumor features associated with aggressive cancers may affect cognition prior to systemic therapy. We evaluated associations of cognition prior to adjuvant therapy and tumor aggressivity in older breast cancer patients. METHODS: Women diagnosed with non-metastatic breast cancer (n = 705) ages 60-98 were enrolled from August 2010-March 2020. Cognition was measured post-surgery, pre-systemic therapy using self-reported (FACT-Cog Perceived Cognitive Impairment [PCI]) and objective tests of attention, processing speed, and executive function (APE domain) and learning and memory [LM domain]. Linear regression tested associations of pre-treatment tumor features and cognition, adjusting for age, race, and study site. HER2 positivity and higher stage (II/III vs. 0/I) were a priori predictors of cognition; in secondary analyses we explored associations of other tumor features and cognitive impairment (i.e., PCI score < 54 or having 2 tests < 1.5 SD or 1 test < 2 SD from the mean APE or LM domain score). RESULTS: HER2 positivity and the hormone receptor negative/HER2 + molecular subtype were associated with lower adjusted mean self-reported cognition scores and higher impairment rates (p values < .05). Higher stage of disease was associated with lower objective performance in APE. Other tumor features were associated with cognition in unadjusted and adjusted models, including larger tumor size and lower PCI scores (p = 0.02). Tumor features were not related to LM. CONCLUSIONS: Pre-adjuvant therapy cognition was associated with HER2 positivity and higher stage of disease and other features of aggressive tumors. Additional research is needed to confirm these results and assess potential mechanisms and clinical management strategies.
PURPOSE: Tumor features associated with aggressive cancers may affect cognition prior to systemic therapy. We evaluated associations of cognition prior to adjuvant therapy and tumor aggressivity in older breast cancer patients. METHODS: Women diagnosed with non-metastatic breast cancer (n = 705) ages 60-98 were enrolled from August 2010-March 2020. Cognition was measured post-surgery, pre-systemic therapy using self-reported (FACT-Cog Perceived Cognitive Impairment [PCI]) and objective tests of attention, processing speed, and executive function (APE domain) and learning and memory [LM domain]. Linear regression tested associations of pre-treatment tumor features and cognition, adjusting for age, race, and study site. HER2 positivity and higher stage (II/III vs. 0/I) were a priori predictors of cognition; in secondary analyses we explored associations of other tumor features and cognitive impairment (i.e., PCI score < 54 or having 2 tests < 1.5 SD or 1 test < 2 SD from the mean APE or LM domain score). RESULTS: HER2 positivity and the hormone receptor negative/HER2 + molecular subtype were associated with lower adjusted mean self-reported cognition scores and higher impairment rates (p values < .05). Higher stage of disease was associated with lower objective performance in APE. Other tumor features were associated with cognition in unadjusted and adjusted models, including larger tumor size and lower PCI scores (p = 0.02). Tumor features were not related to LM. CONCLUSIONS: Pre-adjuvant therapy cognition was associated with HER2 positivity and higher stage of disease and other features of aggressive tumors. Additional research is needed to confirm these results and assess potential mechanisms and clinical management strategies.
Authors: Jeanne S Mandelblatt; Robert A Stern; Gheorghe Luta; Meghan McGuckin; Jonathan D Clapp; Arti Hurria; Paul B Jacobsen; Leigh Anne Faul; Claudine Isaacs; Neelima Denduluri; Brandon Gavett; Tiffany A Traina; Patricia Johnson; Rebecca A Silliman; R Scott Turner; Darlene Howard; John W Van Meter; Andrew Saykin; Tim Ahles Journal: J Clin Oncol Date: 2014-05-19 Impact factor: 44.544
Authors: Kathleen Van Dyk; Xingtao Zhou; Brent J Small; Jaeil Ahn; Wanting Zhai; Tim Ahles; Deena Graham; Paul B Jacobsen; Heather Jim; Brenna C McDonald; Kelly Nudelman Holohan; Sunita K Patel; G William Rebeck; James C Root; Andrew J Saykin; Harvey Jay Cohen; Jeanne S Mandelblatt; Judith E Carroll Journal: JNCI Cancer Spectr Date: 2021-01-27
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
Authors: Jeanne S Mandelblatt; Wanting Zhai; Jaeil Ahn; Brent J Small; Tim A Ahles; Judith E Carroll; Neelima Denduluri; Asma Dilawari; Martine Extermann; Deena Graham; Arti Hurria; Claudine Isaacs; Paul B Jacobsen; Heather S L Jim; George Luta; Brenna C McDonald; Sunita K Patel; James C Root; Andrew J Saykin; Danielle B Tometich; Xingtao Zhou; Harvey J Cohen Journal: Cancer Date: 2019-12-20 Impact factor: 6.921