Cognitive Impairment in a Subset of Breast Cancer Patients After Systemic Therapy—Results From a Longitudinal Study

Menning, Sanne; Ruiter, Michiel B. de; Kieffer, Jacobien M.; Rentergem, Joost A. Agelink van; Veltman, Dick J.; Fruijtier, Agnetha D; Oldenburg, Hester S. A.; Boven, Epie; Meij, Suzan van der; Lustig, Vera; Bos, Monique E.M.M.; Boogerd, Willem; Reneman, Liesbeth; Schagen, Sanne B.

doi:10.1016/j.jpainsymman.2016.04.012

Cited by 50 publications

(70 citation statements)

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“…As our fMRI tasks were only partly sensitive to group differences, future studies should employ fMRI paradigms that allow for detection of subtle differences in BOLD signal, as well as performance. Although the sample size of the current study was larger than previous longitudinal studies, our neuropsychological analyses showed that cognitive decline ‘only’ occurred in 16% patients who received systemic treatment [16]. This percentage is arguably too low to detect differences at the group level.…”

Section: Discussionmentioning

confidence: 62%

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Changes in brain activation in breast cancer patients depend on cognitive domain and treatment type

et al. 2017

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BackgroundCognitive problems in breast cancer patients are common after systemic treatment, particularly chemotherapy. An increasing number of fMRI studies show altered brain activation in breast cancer patients after treatment, suggestive of neurotoxicity. Previous prospective fMRI studies administered a single cognitive task. The current study employed two task paradigms to evaluate whether treatment-induced changes depend on the probed cognitive domain.MethodsParticipants were breast cancer patients scheduled to receive systemic treatment (anthracycline-based chemotherapy +/- endocrine treatment, n = 28), or no systemic treatment (n = 24) and no-cancer controls (n = 31). Assessment took place before adjuvant treatment and six months after chemotherapy, or at similar intervals. Blood oxygen level dependent (BOLD) activation and performance were measured during an executive functioning task and an episodic memory task. Group-by-time interactions were analyzed using a flexible factorial design.ResultsTask performance did not differ between patient groups and did not change over time. Breast cancer patients who received systemic treatment, however, showed increased parietal activation compared to baseline with increasing executive functioning task load compared to breast cancer patients who did not receive systemic treatment. This hyperactivation was accompanied by worse physical functioning, higher levels of fatigue and more cognitive complaints. In contrast, in breast cancer patients who did not receive systemic treatment, parietal activation normalized over time compared to the other two groups.ConclusionsParietal hyperactivation after systemic treatment in the context of stable levels of executive task performance is compatible with a compensatory processing account of hyperactivation or maintain adequate performance levels. This over-recruitment of brain regions depends on the probed cognitive domain and may represent a response to decreased neural integrity after systemic treatment. Overall these results suggest different neurobehavioral trajectories in breast cancer patients depending on treatment type.

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Section: Discussionmentioning

confidence: 62%

“…The current report will focus on longitudinal analyses of task-related functional MRI. Analyses of neuropsychological performance are described in [16]. Findings for other MRI modalities will be described elsewhere.…”

Section: Methodsmentioning

confidence: 99%

Changes in brain activation in breast cancer patients depend on cognitive domain and treatment type

et al. 2017

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“…Patients' ages varied. To avoid age‐related cognitive impairment, nine studies selected patients younger than 75 . Three studies specifically targeted elders .…”

Section: Resultsmentioning

confidence: 99%

“…Eight of these reported significantly different longitudinal changes between the CTX group and controls, with the CTX group experiencing more impairment after initiating chemotherapy than controls . Two publications from the same data set reported higher levels of SCI in the CTX group than controls after initiating chemotherapy (see Table for differences). All of these findings supported the impact of chemotherapy on SCI.…”

Section: Resultsmentioning

confidence: 99%

Systematic review of longitudinal studies on chemotherapy‐associated subjective cognitive impairment in cancer patients

et al. 2020

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Objectives: This systematic review of longitudinal studies, assessing subjective cognitive impairment (SCI) reported by adult cancer patients, aimed to summarize evidence on the impact of chemotherapy on SCI, identify moderators of SCI, and evaluate methodological issues. Methods: Data accrued from Pubmed, EMBASE, CINAHL, PsychInfo, and the Cochrane library. Inclusion criteria were original studies, an exclusively adult sample, valid and reliable subjective cognitive measures, and at least one baseline data point prior to and another after the initiation of chemotherapy. Data were collected on the sample composition, data-collection time points, outcome measures, statistical analysis, and major findings (ie, longitudinal changes in prevalence, severity, and associated factors).Results: Forty articles published between 2004 and 2019 were retained: 21 examined chemotherapy-treated patients only, and 19 employed control groups. Findings were mixed, with slightly more studies supporting the impact of chemotherapy on SCI. SCI tended to be more prevalent and severe after initiating chemotherapy, compared with patients' own baseline and controls not treated with chemotherapy. Impact appeared to be acute and more likely limited to subsamples. Most studies examining non-breast-cancer samples reported the lack or limited impact of chemotherapy on SCI. The most consistent moderators were depression and fatigue. Methodological issues regarding sampling design, measurement, and statistical analysis were discussed.Conclusion: More rigorously designed longitudinal studies would clarify direct and indirect effects of chemotherapy on SCI. K E Y W O R D S anxiety, cancer, cognitive function, cognitive impairment, depression, fatigue, oncology, systematic review

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“…Several longitudinal studies 6,10,11,[17][18][19][20][21][22] examined factors associated with cognitive decline or cognitive change, after initiating chemotherapy. Yet, results need to be replicated due to contradictory outcomes, small sample sizes, and the inclusion of limited numbers of possible risk factors.…”

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confidence: 99%

Chemotherapy‐associated cognitive impairments in Korean cancer patients: Risk factors and functional outcome

2018

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Cognitive Impairment in a Subset of Breast Cancer Patients After Systemic Therapy—Results From a Longitudinal Study

Abstract: Our findings indicate that cognitive impairment after systemic treatment occurs in a subset of BC patients. The predictive value of demographic and psychosocial factors in cognitive impairment should be further investigated in a larger sample of impaired patients.

Cited by 50 publications

References 37 publications

Changes in brain activation in breast cancer patients depend on cognitive domain and treatment type

Changes in brain activation in breast cancer patients depend on cognitive domain and treatment type

Systematic review of longitudinal studies on chemotherapy‐associated subjective cognitive impairment in cancer patients

Chemotherapy‐associated cognitive impairments in Korean cancer patients: Risk factors and functional outcome

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