Cognitive Deficits in Breast Cancer Survivors After Chemotherapy and Hormonal Therapy

Abstract

Adjuvant treatments, specifically chemotherapy and hormonal therapy, have dramatically increased breast cancer survival, resulting in increased attention to the residual effects of treatment. Breast cancer survivors (BCS) frequently report that cognitive deficits are a particular source of distress, interfering with many aspects of quality of life. The literature on neuropsychological performance measures in BCS supports the reality of subtle cognitive deficits after both chemotherapy and hormonal therapy. This premise is supported by recent imaging studies, which reveal anatomical changes after chemotherapy as well as changes in patterns of neural activation while performing cognitive tasks. This review suggests that, even when performance on neuropsychological performance measures is within normal limits, BCS may be using increased cognitive resources in the face of reduced cognitive reserve. Potential interventions for cognitive deficits after adjuvant therapy include prescriptions for healthy living, pharmacotherapy, complementary therapy, and cognitive remediation therapy directed toward specific cognitive deficits or a combination of several strategies.

Pathogenesis, Assessments, and Management of Chemotherapy-Related Cognitive Impairment (CRCI): An Updated Literature Review

“…Therefore, reduced hormone levels may cause CRCI. Surprisingly, multiple studies have shown that impaired cognitive function areas such as speech memory, vocabulary fluency, and decision-making function appear after breast cancer patients undergo endocrine therapy [ 46 – 48 ], which may be related to the menopause period and timing of treatment [ 49 ]. Recently, Kathleen et al conducted a six-year prospective longitudinal study and found no endocrine therapy to adversely affect the cognitive function of breast cancer survivors.…”

On the role of brain aromatase in females: why are estrogens produced locally when they are available systemically?

“…Yet, to my knowledge, whether post-menopausal cognitive decline is associated with a lower brain estrogen synthesis, due to lower circulating androgens and/or a failure of brain estrogen synthesis or action, is unknown and deserves further attention. In addition, aromatase inhibitors, which are a common treatment in breast cancer, have been associated with cognitive impairment (Frank et al 2015), psychiatric effects (Goodwin 2006; Rocha-Cadman et al 2012) or sexual dysfunction (Derzko et al 2007). As chemotherapy is provided systemically, aromatase blockade concerns all potential sources of estrogens.…”

Initial evaluation of the validity and reliability of the culturally adapted Spanish CaSUN (S-CaSUN)

“…While numerous quality of life (QOL) measures currently exist, they do not directly assess supportive care needs. Typically, needs are inferred from identified deficits in functioning, obtained by patients rating the presence and/or severity of an item but not whether it is a problem for which they need help [1, 25, 26]. In contrast, needs assessments directly identify and evaluate patients’ specific needs, as well as the perceived magnitude of those needs.…”