Abstract P2-12-05: Neuropsychological assessment, neuroimaging, and tumor markers to explore cognitive decline in early stage breast cancer patients

Abstract

Background. It is widely demonstrated that a high percentage of early stage breast cancer patients achieves a long-term survival. However, it seems that some of them show a cognitive decline during and after the oncology treatment, affecting their quality of life. Fortunately, the neuropsychological impairment in cancer patients is nowadays a known issue in oncology literature. Our aim is to assess the effects of chemotherapy and endocrine therapy on neurocognitive functions in patients with early stage breast cancer. If the hypothesis that the patients suffer from neurocognitive impairments related to the oncology treatment will be confirmed, this would imply the possibility of an early neuropsychological rehabilitation since the first diagnosis, to prevent the worsening of the quality of life and to avoid the use of additional medications to regulate for example the severity of fatigue and mood. Methods. The study population includes 45 patients diagnosed of breast cancer undergoing chemotherapy +/- endocrine treatment (CT), 15 patients undergoing endocrine treatment (HT), and 9 healthy controls (HC). Throughout each evaluation at three points time, we administered the Mini-Mental State Examination (MMSE), some tests of the Cogstateneurocognitive battery, the Trail Making Test (TMTA and TMTB), and the Controlled Oral Word Association Test (COWAT). Moreover, each subject was asked to complete the EORTC QLQ-C30 and the QLQ-BR23 quality of life tests, the MD Anderson Symptoms Inventory questionnaire, the Hospital Anxiety and Depression scale, and a self-report of the neurocognitive impairment perceived. In addition, we are performing a pilot neuroimaging study aimed to enroll 20 patients with early stage breast cancer, of whom 10 treated with chemotherapy, and 10 with hormone therapy alone. Patients undergo a structural and functional brain magnetic resonance imaging (fMRI). S100 protein, and neuro specific enolase are also collected to explore their possible relationship with the neurocognitive decline. Results. Both CT and HT Groups performed lower results than HC in visuo-motor processing speed test (TMTA) at baseline and at month 12 (p=0.00). At month 6 only the HT Group had lower results than HC (p=0.00). We found a correlation between the lower results of TMTA and the level of depression (p=0.02), distress (p=0.00), anxiety (p=0.01), severity of symptoms (p=0.00) in CT Group at baseline. The MMSE scores were slightly lower in both CT and HT Groups compared to HC (p=0.04) at month 6. The MMSE results at month 12 were lower in HT Groups compared to HC (p=0.04). In addition, the neurocognitive impairment perceived is higher in CT Group (p<0.00) once having stopped the chemotherapy treatment until the last follow up. The results of TMTB and COWAT increased in CT Group during the last follow up (p=0.00), and it seems to have a positive correlation with the neurocognitive tasks the patients performed (p=0.02 and p=0.03 respectively). Concerning the pilot study, we analysed the first 10 patients enrolled in the study: 5 subjects treated with chemotherapy and 5 with hormone therapy alone. No statistically significant differences were found concerning the alteration of the tumor markers values. On the contrary, we found changes between the baseline and the post-treatment brain fMRI. Conclusions. Our results suggest a decline in few cognitive domains in cancer patients as consequence of the oncology treatment. In some tests the neurocognitive decline was also observed in cancer groups at baseline, and it was associated with the low state of mind in CT Group. We infer that the increasing of scores in CT Group at month 12 was positively associated with the cognitive tasks the patients were performing during the study-period. Citation Format: Claudia Panciroli, Carles Biarnes, Josep Puig, Jose Anton Anton, Vanesa Quiroga, Eudald Felip, Beatriz Cirauqui, Margarita Romeo, Iris Teruel, Salvador Pedraza, Mireia Margeli. Neuropsychological assessment, neuroimaging, and tumor markers to explore cognitive decline in early stage breast cancer patients [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-12-05.