Cognitive Function in Breast Cancer Patients Receiving Adjuvant Chemotherapy

PURPOSE: Breast cancer patients receiving chemotherapy have complained of difficulties in their ability to remember, think, and concentrate. This study assessed whether there are differences in cognitive function between breast cancer patients treated with standard-dose adjuvant chemotherapy compared with healthy controls. PATIENTS AND METHODS: The High Sensitivity Cognitive Screen and the Profile of Mood States (POMS) were used to assess cognitive function and mood in a group of 107 women. The women consisted of 31 breast cancer patients receiving adjuvant chemotherapy (group A), 40 breast cancer patients who had completed adjuvant chemotherapy a median of 2 years earlier (group B), and 36 healthy controls (group C). RESULTS: Univariate analysis showed statistically significant differences (P = .009) in overall cognitive function scores between groups A and C, with poorer function in patients receiving adjuvant chemotherapy. These differences remained significant (P = .046) when controlling for age, education level, and menopausal status. More patients had moderate or severe cognitive impairment in groups A and B than in controls (P ≤ .002). There were no significant differences in POMS scores between the groups, suggesting that the differences seen in cognitive scores were unlikely to be because of mood disturbance. CONCLUSION: Cognitive differences were observed in breast cancer patients receiving adjuvant chemotherapy compared with healthy controls. These differences did not seem to be caused by significant differences in mood disturbance between the two groups. If confirmed, these results have substantial implications for informed consent, counseling, and psychosocial support of patients receiving adjuvant chemotherapy for breast cancer.

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Systemically Treated Breast Cancer Patients and Controls: An Evaluation of the Presence of Noncredible Performance

Journal of the International Neuropsychological Society ◽

10.1017/s1355617714000022 ◽

2014 ◽

Vol 20 (4) ◽

pp. 357-369 ◽

Cited By ~ 1

Author(s):

Jeffrey S. Wefel ◽

Rozemarijn L. Kornet ◽

Sanne B. Schagen

Keyword(s):

Breast Cancer ◽

Cognitive Function ◽

Cancer Patients ◽

Healthy Controls ◽

Performance Validity ◽

Breast Cancer Patients ◽

Post Test ◽

Treated Breast ◽

Performance Calculation ◽

Treated Breast Cancer

AbstractThis study sought to define the frequency of noncredible performance in breast cancer patients before, during and after completion of systemic treatment, as well as predictors of noncredible performance. We examined six datasets investigating the cognitive effects of chemotherapy and/or endocrine therapy. Embedded performance validity test (PVT) measures were identified and used to evaluate the datasets. One dataset included a standalone PVT. Possible noncredible performance was operationally defined as performance below criterion on three or more PVT indices. This was undertaken as cancer patients have been observed clinically to fail PVTs both in the context of external gain and independent of such motivators. A total of 534 breast cancer patients and 214 healthy controls were included in the analysis. Percentages of patients performing below cutoff on one or more PVT varied from 0% to 21.2%. Only 1 patient met the criterion of noncredible performance. Calculation of post-test probabilities indicated a more than 90% chance to detect noncredible performance. There is no evidence to suggest noncredible performance in breast cancer patients and healthy controls who choose to participate in research studies examining cognitive function. Thus, the observational data showing that non-central nervous system (CNS) cancer and therapies not targeting the CNS can have untoward effects on cognitive function are unlikely to be due to noncredible performance. (JINS, 2014, 19, 1–13)

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Persistent cognitive deficits in breast cancer survivors treated with adjuvant chemotherapy: Neuropsychological and neurophysiological evidence

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.8556 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 8556-8556

Author(s):

S. B. Schagen ◽

B. Kreukels ◽

F. Van Dam

Keyword(s):

Breast Cancer ◽

Information Processing ◽

Adjuvant Chemotherapy ◽

Cancer Patients ◽

Neuropsychological Assessment ◽

Cognitive Deficits ◽

Healthy Controls ◽

Breast Cancer Patients ◽

Neurophysiological Assessment ◽

One Year

8556 Background: Cognitive deficits are reported in several studies in women with breast cancer treated with adjuvant chemotherapy. The current aim was to investigate whether breast cancer patients that had deviant cognitive performance on neuropsychological tests one year after treatment, differed from patients with intact performance on neurophysiological parameters and self-reported complaints, this time examined five years post treatment. Methods: 63 breast cancer patients treated with CMF chemotherapy underwent neuropsychological testing one year post therapy. Their performance was compared to that of healthy controls (n=60). 26 of these patients were examined neurophysiologically 4 years after the initial neuropsychological assessment. Neurophysiological assessment included quantitative EEG, auditory oddball task and a visual information processing task with concurrent EEG registration. Patients were also interviewed regarding cognitive complaints experienced in daily life. Results: At the initial neuropsychological assessment 33.3% of breast cancer patients treated with CMF chemotherapy were classified as cognitively impaired compared to 10% of healthy controls (p=.01). At the neurophysiological assessment four years later, patients that scored in the impaired range on the initial neuropsychological examination had significantly longer P3 latencies and reduced P3 amplitudes in an information processing task. The impaired patients also made more errors, had longer reaction times, and reported more cognitive complaints. Conclusion: The results of this study show converging neuropsychological and neurophysiological evidence for the persistence of cognitive problems in breast cancer patients up to five years after completion of CMF chemotherapy. [Table: see text] No significant financial relationships to disclose.

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Breast Cancer Treatment and Cognitive Function: The Current State of Evidence, Underlying Mechanisms and Potential Treatments

Women s Health ◽

10.2217/whe.09.36 ◽

2009 ◽

Vol 5 (5) ◽

pp. 503-516 ◽

Cited By ~ 18

Author(s):

Andrea Vodermaier

Keyword(s):

Breast Cancer ◽

Cognitive Function ◽

Cancer Patients ◽

Verbal Memory ◽

Menopausal Status ◽

Future Research ◽

Breast Cancer Patients ◽

Cross Sectional ◽

Confounding Variables ◽

Wide Range

Within the last decade, several studies have investigated whether adjuvant treatment of breast cancer affects cognitive function. A number of prospective studies have demonstrated inconsistent results regarding whether chemotherapy affects cognitive function. Approximately half of the studies demonstrated subtle cognitive decline in a wide range of domains among some breast cancer patients following chemotherapy, and half did not. Concomitant changes in brain structure and function have been identified in neuroimaging and neurophysiologic studies. Estrogenic therapy has been specifically associated with deterioration in verbal memory and processing speed. However, evidence is mostly based on smaller studies with cross-sectional data. Breast cancer patients who underwent both chemotherapy and estrogenic therapy showed the most deterioration and the most persistant decline in cognitive function. Since cognitive impairment is subtle, if evident at all, discrepant findings are due to hormonal, physiological, psychological or temporal confounding variables and differences in study design. Neuropsychological training has been demonstrated to improve cognitive dysfunction experienced by breast cancer patients after chemotherapy. Future research may examine the unique impact of endocrine therapy on cognitive function with prospective, controlled trials, as well as the role of further confounding variables (e.g., menopausal status, cytokine deregulation, cortisol and concurrent medication).

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Outcome of Patients With Early-Stage Breast Cancer Treated With Doxorubicin-Based Adjuvant Chemotherapy As a Function ofHER2andTOP2AStatus

Journal of Clinical Oncology ◽

10.1200/jco.2008.20.1566 ◽

2009 ◽

Vol 27 (24) ◽

pp. 3881-3886 ◽

Cited By ~ 52

Author(s):

Raymond Tubbs ◽

William E. Barlow ◽

G. Thomas Budd ◽

Eric Swain ◽

Peggy Porter ◽

...

Keyword(s):

Breast Cancer ◽

Adjuvant Chemotherapy ◽

Early Stage ◽

Univariate Analysis ◽

Menopausal Status ◽

Disease Free Survival ◽

Early Stage Breast Cancer ◽

Breast Cancer Patients ◽

Her2 Amplification ◽

Amplification Ratio

PurposeAmplification and deletion of the TOP2A gene have been reported as positive predictive markers of response to anthracycline-based therapy. We determined the status of the HER2 and TOP2A genes in a large cohort of breast cancer patients treated with adjuvant doxorubicin (A) and cyclophosphamide (C).Patients and MethodsTOP2A/CEP17 and HER2/CEP17 fluorescent in situ hybridization (FISH) were performed on tissue microarrays (TMAs) constructed from 2,123 of the 3,125 women with moderate-risk primary breast cancer who received equivalent doses of either concurrent adjuvant chemotherapy with A plus C (n = 1,592) or sequential A followed by C (n = 1,533).ResultsAn abnormal TOP2A genotype was identified for 153 (9.4%) of 1,626 patients (4.0% amplified; 5.4% deleted). An abnormal HER2 genotype was identified for 303 (20.4%) of 1,483 patients (18.8% amplified; 1.6% deleted). No significant differences in either overall survival (OS) or disease-free survival (DFS) were identified for TOP2A. In univariate analysis, OS and DFS rates were strongly and adversely associated only with higher levels of HER2 amplification (ratio ≥ 4.0). Survival was not associated with low-level HER2 amplification (ratio ≥ 2; OS hazard ratio [HR], 1.14; P = .39; DFS HR, 1.07; P = .62), but it was associated for a ratio ≥ 4 (OS HR, 1.45; P = .03; DFS HR, 1.38; P = .033), in which analysis was adjusted for menopausal status, hormone receptor status, treatment, number of positive nodes, and tumor size.ConclusionIn this population of patients with early-stage breast cancer who were treated with adjuvant AC chemotherapy, TOP2A abnormalities were not associated with outcome. HER2 high-level amplification was a prognostic marker in anthracycline-treated patients.

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Effect of chemotherapy on serum nitric oxide levels in advanced stage breast cancer patients

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20195905 ◽

2019 ◽

Vol 8 (1) ◽

pp. 189

Author(s):

Charushila Y. Kadam ◽

Subodhini A. Abhang

Keyword(s):

Breast Cancer ◽

Nitric Oxide ◽

Adjuvant Chemotherapy ◽

Cancer Patients ◽

Stage Iv ◽

Chemotherapy Cycle ◽

Stage Iii ◽

Healthy Controls ◽

Advanced Stage ◽

Breast Cancer Patients

Background: The role of nitric oxide is still unclear in advanced breast cancer patients undergoing adjuvant chemotherapy. This study was undertaken to investigate the effect of chemotherapy on serum nitric oxide levels in advanced stage breast cancer patients.Methods: In this observational study, clinically and histopathologically proven sixty female patients with advanced stage breast cancer were included. According to Tumor-Node-Metastasis (TNM) classification, patients were further grouped as stage III and stage IV. Thirty healthy and age-matched female controls were selected for comparison. Blood was collected from healthy controls and from breast cancer patients after surgery prior to chemotherapy and after three weeks of administration of first adjuvant chemotherapy cycle. Serum nitric oxide levels were measured by spectrophotometric method.Results: Significantly higher concentrations of serum nitric oxide were observed in breast cancer patients before chemotherapy in stage III (p<0.0001) and stage IV (p<0.0001) of the disease as compare to concentrations in healthy controls. The serum levels of nitric oxide were significantly decreased in stage III as well as stage IV of breast cancer patients after three weeks of receiving first adjuvant chemotherapy cycle as compare to levels before chemotherapy (p<0.0001), however serum nitric oxide levels were higher in stage III (p=0.0036) and stage IV (p<0.0001) of the disease as compare to healthy controls.Conclusions: Chemotherapy drug administration causes decrease in serum nitric oxide levels in advanced stages of breast cancer patients. Monitoring serum nitric oxide levels could be used to predict patients’ response to chemotherapy treatment in breast cancer.

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Cognitive Function in Breast Cancer Patients Receiving Adjuvant Chemotherapy

Asian Oncology Nursing ◽

10.5388/aon.2012.12.1.1 ◽

2012 ◽

Vol 12 (1) ◽

pp. 1 ◽

Cited By ~ 5

Author(s):

Kyung Hae Kim ◽

Bok Yae Chung ◽

Gyung Duck Kim ◽

Hye Sun Byun ◽

Eun Hee Choi ◽

...

Keyword(s):

Breast Cancer ◽

Cognitive Function ◽

Adjuvant Chemotherapy ◽

Cancer Patients ◽

Breast Cancer Patients

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Racial/ethnic differences in comprehension of biospecimen sharing/banking: University of Rochester Cancer Center NCI Community Oncology Research Program (URCC-NCORP) nationwide study in 710 cancer and healthy subjects.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e18077 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e18077-e18077

Author(s):

Matthew Asare ◽

Charles Stewart Kamen ◽

Gary R. Morrow ◽

Charles E. Heckler ◽

Luke Joseph Peppone ◽

...

Keyword(s):

Breast Cancer ◽

Informed Consent ◽

Cognitive Function ◽

Cancer Patients ◽

Linear Models ◽

Consent Form ◽

Research Purpose ◽

Healthy Controls ◽

Breast Cancer Patients ◽

Racial Ethnic

e18077 Background: Informed consent documents containing language about biospecimen storage/sharing (BSS) may be a barrier to minority participation in cancer research. We explored this issue in a nationwide URCC-NCORP observational study by assessing whether breast cancer patients and healthy control subjects, who provided consent to a cognitive function study, differed in their understanding of the ways their BSS could be used by researchers. Methods: We analyzed cross-sectional data from female breast cancer patients scheduled to receive chemotherapy at NCORPs and healthy controls. After reading a consent form related to BSS and consenting to participate in a study about cognitive function, participants’ understanding of BSS was evaluated using four items for biospecimen sharing (score 0-4); three items for relevance to care (score 0-3); nine items for biospecimen use (score 0-9); and six for research purpose (score 0-6); a higher score indicates better understanding. Linear models were used to compare the mean scores between white and non-white subjects, adjusting for education and baseline reading comprehension (WRAT). Results: 461Breast cancer patients and 249 healthy controls completed the survey. The adjusted linear models showed that white subjects scored higher than non-whites (mean scores 14.43 vs. 13.43) on the survey questions overall (p < 0.05), after accounting for education and WRAT. White subjects were more likely than non-whites to correctly answer all the questions for the biospecimen use (42.1% vs. 34.4%, p < 0.22), biospecimen sharing (31.3% vs. 28.1%, p < 0.74), relevance to care (35.1% vs. 17.2%, p < 0.01), and research purpose (4.1% vs. 1.4%, p < 0.97). Conclusions: Our research suggests that informed consent comprehension related to BSS is low overall across all racial/ethnic backgrounds, but non-white subjects’ scores remained lower than whites even after adjusting for education and WRAT. Efforts should be made by researchers to make it easier for all study subjects, especially non-white subjects, to understand informed consent form and BSS.

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