Heterogeneous Response of Chemotherapy-Related Cognitive Decline in Patients with Breast Cancer: A Prospective Study

Abstract

Objective: A significant proportion of adjuvant-treated breast cancer patients experience cognitive decline, challenging the person’s ability to return to normal activities after treatment. However, not every patient experiences cognitive problems, and even in patients with impairments, determining clinically important cognitive decline remains challenging. Our objective was to explore differences in neuropsychological performance following adjuvant chemotherapy (CT) in patients with breast cancer. Method: We conducted a prospective observational study in an Oncology Breast Clinic and assessed neuropsychological performance before and after adjuvant CT and in non-CT-treated women with breast cancer and healthy controls (HCs). Standardised between-group differences and regression-based change scores were calculated. Results: CT-treated patients (n = 66) performed significantly different from non-CT-treated patients (n = 39) and HCs (n = 56). There was a significant effect on verbal fluency (p = .0013). CT performed significantly worse than non-CT and HC [effect size (ES) = .89, p < .001 and ES = .61, p ≤ .001, respectively] and from HCs with regard to proactive interference (ES = .62, p ≤ .001). Regression-based scores revealed more severe cognitive decline in the CT-treated group [24.24% (16/66)] than in the non-CT-treated group [15.20% (6/39)] and HC group [7.14% (4/56)]. Patients who underwent CT and showed cognitive decline were less educated and older, with significantly lower baseline scores. Conclusions: CT-treated patients showed more vulnerability on cognitive control and monitoring than non-CT-treated breast cancer patients and HCs. Older patients with less education and lower baseline cognitive performance represent a group at risk for cognitive decline following CT. Identification of patients at risk for decline could improve targeted support and rehabilitation.

Prevalence of cognitive impairment and change in patients with breast cancer: A systematic review of longitudinal studies

“…From T0 to T1, cognitive decline was noted in 24% (205 of 861) of the breast cancer patients and 12% (20 of 171) of the healthy controls 26 27 , 32 , 43 , 45–49 Within the patient group, 25% (179 of 713) of the CT patients were labeled as cognitively declined, compared to 18% (26 of 148) of the no‐CT patients. Simultaneously, 15% (55 of 527) of the breast cancer patients and 12% (14 of 115) of the healthy controls were labeled as cognitively improved 32,43,46–48 .…”

“…This suggests that risk factors for both cancer and cognitive impairment, such as genetic susceptibility, older age and lifestyle might be implicated 28 43 , 49 , 59–62 The study of van der Willik et al 58 . evaluated the longitudinal change of cognitive function prior to disease manifestation using a population‐based cohort that consisted of 2059 cancer patients and 7403 control subjects.…”

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

“…erefore, the quality of life of patients is receiving more and more attention. As an important component of quality of life, cognitive function decline in cancer patients has been reported in numerous studies [1][2][3][4].…”

Imagens de tensores de difusão em mulheres com queixas cognitivas persistentes após quimioterapia para câncer de mama

“…Lange et al (41) evidenciam na revisão de 2019 que ansiedade, depressão e fadiga, frequentes na população oncológica, devem ser levados em consideração nos estudos de CRCI, assim como escolaridade e idade, que tem impacto na reserva cognitiva individual, podendo ser um fator de vulnerabilidade ao ataque do câncer (20,32) e da QT. Assim como demonstrou Schrauwen et al, (90) mulheres tratadas com QT tem piores performances em testes de fluência verbal na comparação com mulheres sem história de câncer e mulheres tratadas sem QT. Já dentro do grupo tratado com QT, a idade mais avançada e menor número de anos de educação estavam correlacionados a piores pontuações.…”

“…Principalmente para o tratamento com QT, idade maior e menor índice escolaridade parecem ser fatores de risco ao declínio cognitivo. (90) Em nosso estudo, composto por mulheres com média de idade de aproximadamente 50 anos em ambos os grupos, acreditamos que o efeito do envelhecimento cerebral natural seja menos pronunciado.…”