Associations of functional, psychosocial, and medical factors with cognitive impairment in older, chemotherapy naïve patients with early breast cancer

Nakamura, Zev M.; Deal, Allison M.; Nyrop, Kirsten A.; Damone, Emily; Muss, Hyman B.

doi:10.1002/pon.5433

Cited by 4 publications

(11 citation statements)

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“…4 Cognitive problems are among the most concerning of these symptoms, potentially leading to decrements in functioning and social and emotional well-being. [5][6][7][8][9][10][11][12][13][14] Despite decades of recognition of cognitive problems after breast cancer and its therapy, underlying mechanisms remain elusive. [15][16][17] One candidate mechanism is inflammation driven by cellular damage occurring with cancer and its therapies.…”

Section: Introductionmentioning

confidence: 99%

Elevated C-Reactive Protein and Subsequent Patient-Reported Cognitive Problems in Older Breast Cancer Survivors: The Thinking and Living With Cancer Study

Carroll

Nakamura

Small

et al. 2023

JCO

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PURPOSE To examine longitudinal relationships between levels of C-reactive protein (CRP) and cognition in older breast cancer survivors and noncancer controls. METHODS English-speaking women age ≥ 60 years, newly diagnosed with primary breast cancer (stage 0-III), and frequency-matched controls were enrolled from September 2010 to March 2020; women with dementia, neurologic disorders, and other cancers were excluded. Assessments occurred presystemic therapy/enrollment and at annual visits up to 60 months. Cognition was measured using the Functional Assessment of Cancer Therapy-Cognitive Function and neuropsychological testing. Mixed linear effect models tested for survivor-control differences in natural log (ln)-transformed CRP at each visit. Random effect–lagged fluctuation models tested directional effects of ln-CRP on subsequent cognition. All models controlled for age, race, study site, cognitive reserve, obesity, and comorbidities; secondary analyses evaluated if depression or anxiety affected results. RESULTS There were 400 survivors and 329 controls with CRP specimens and follow-up data (average age of 67.7 years, range: 60-90 years). The majority of survivors had stage I (60.9%), estrogen receptor–positive (87.6%) tumors. Survivors had significantly higher adjusted mean ln-CRP than controls at baseline and 12-, 24-, and 60-month visits (all P < .05). Higher adjusted ln-CRP predicted lower participant-reported cognition on subsequent visits among survivors, but not controls ( P interaction = .008); effects were unchanged by depression or anxiety. Overall, survivors had adjusted Functional Assessment of Cancer Therapy-Cognitive Function scores that were 9.5 and 14.2 points lower than controls at CRP levels of 3.0 and 10.0 mg/L. Survivors had poorer neuropsychological test performance ( v controls), with significant interactions with CRP only for the Trails B test. CONCLUSION Longitudinal relationships between CRP and cognition in older breast cancer survivors suggest that chronic inflammation may play a role in development of cognitive problems. CRP testing could be clinically useful in survivorship care.

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Section: Introductionmentioning

confidence: 99%

Elevated C-Reactive Protein and Subsequent Patient-Reported Cognitive Problems in Older Breast Cancer Survivors: The Thinking and Living With Cancer Study

Carroll

Nakamura

Small

et al. 2023

JCO

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“…Four studies (Lange et al, 2016; Mandelblatt et al, 2016, 2018; Small et al, 2022) were longitudinal and three (Crouch, Champion, Unverzagt, et al, 2022; Nakamura et al, 2020; Zhang et al, 2020) cross‐sectional. Five out of seven studies were published in the last 5 years (Crouch, Champion, Unverzagt, et al, 2022; Mandelblatt et al, 2018; Nakamura et al, 2020; Small et al, 2022; Zhang et al, 2020). They included data from 2652 older female BCS with a mean age of 67.8 years.…”

Section: Resultsmentioning

confidence: 99%

“…Most studies ( n = 5) were from the USA (Crouch, Champion, Unverzagt, et al, 2022; Mandelblatt et al, 2016, 2018; Small et al, 2022), the remaining studies were from China (Zhang et al, 2020) and France (Lange et al, 2016). The study period ranged from 1 to 9 years, with the shortest (Lange et al, 2016) from 2016 to 2017 and the longest (Nakamura et al, 2020) from 2009 to 2018. The follow‐up period ranged from 1 (Mandelblatt et al, 2018) to 4.1 years (Mandelblatt et al, 2016).…”

Section: Resultsmentioning

confidence: 99%

“…Corresponding to the quality assessment criteria, five studies were of high quality (Crouch, Champion, Unverzagt, et al, 2022; Mandelblatt et al, 2016, 2018; Nakamura et al, 2020; Small et al, 2022), two of medium quality (Lange et al, 2016; Zhang et al, 2020) and none were low quality (Tables 3 and 4). The mean quality assessment scores for longitudinal and cross‐sectional studies were 7.5 (NOS) and 8.7 (AHRQ), respectively.…”

Section: Resultsmentioning

confidence: 99%

“…Over half of the studies (4/7) estimated prevalence of CRCI, including two cross‐sectional studies (Crouch, Champion, Unverzagt, et al, 2022; Nakamura et al, 2020; n = 666) and two longitudinal studies (Mandelblatt et al, 2016; Small et al, 2022; n = 1338). The prevalence of CRCI range from 18.6% to 27.0%, and 7.6% to 49.0% was reported using objective and subjective cognitive assessment tools, respectively (Tables 1 and 2).…”

Section: Resultsmentioning

confidence: 99%

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Prevalence and associated factors of chemotherapy‐related cognitive impairment in older breast cancer survivors

Zhou,

Zhang,

Zhong

et al. 2023

Journal of Advanced Nursing

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AimsTo examine the prevalence and associated factors of chemotherapy‐related cognitive impairment (CRCI) in older breast cancer survivors (BCS).DesignSystematic review.Data SourcesWe searched EMBASE, PubMed, PsychInfo, CINAHL, Cochrance Library, Web of Science, CNKI and SinoMed, without language restrictions, for studies published from the establishment of the database to September 2022.Review MethodsTwo researchers independently examined the full texts, data extraction and quality assessment, and any discrepancies were resolved through discussion with a third reviewer. Quality of evidence was assessed using the Newcastle‐Ottawa Scale and the Agency for Healthcare Research and Quality Scale.ResultsThe seven included studies showed that the estimated prevalence of CRCI in older BCS ranged from 18.6% to 27% on objective neuropsychological tests and from 7.6% to 49% on subjective cognitive assessments. The areas most affected were attention, memory, executive functioning and processing speed. CRCI was associated with 10 factors in six categories, including sociodemographic (e.g. age, education level), physiological (e.g. sleep disorders, fatigue and comorbidities), psychological (e.g. anxiety, depression), treatment modalities (e.g. chemotherapy cycles, chemotherapy regimens), genetic (e.g. APOE2, APOE4) and lifestyle factor (e.g. physical inactivity).ConclusionCRCI is multifactorial and has a relatively high prevalence. However, the results of subjective and objective cognitive examinations were inconsistent, possibly due to variations in tools used to evaluate different definitions of CRCI. Nevertheless, as there are few published studies of older BCS, this conclusion still require verification by well‐designed studies in the future.ImpactWe found that the prevalence of CRCI in older adults is relatively high and multifactorial, providing evidence for further health care for this population.No Patient or Public ContributionThere was no patient or public involvement.

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Prevalence and clinical correlates of cognitive impairment in adults with plasma cell disorders

Nakamura¹,

Vohra²,

Jensen³

et al. 2022

Journal of Geriatric Oncology

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Associations of functional, psychosocial, and medical factors with cognitive impairment in older, chemotherapy naïve patients with early breast cancer

Cited by 4 publications

References 10 publications

Elevated C-Reactive Protein and Subsequent Patient-Reported Cognitive Problems in Older Breast Cancer Survivors: The Thinking and Living With Cancer Study

Elevated C-Reactive Protein and Subsequent Patient-Reported Cognitive Problems in Older Breast Cancer Survivors: The Thinking and Living With Cancer Study

Prevalence and associated factors of chemotherapy‐related cognitive impairment in older breast cancer survivors

Prevalence and clinical correlates of cognitive impairment in adults with plasma cell disorders

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