Longitudinal Trajectory and Characterization of Cancer-Related Cognitive Impairment in a Nationwide Cohort Study

Abstract

Purpose Cancer-related cognitive impairment (CRCI) is an important clinical problem in patients with breast cancer receiving chemotherapy. Nationwide longitudinal studies are needed to understand the trajectory and severity of CRCI in specific cognitive domains. Patients and Methods The overall objective of this nationwide, prospective, observational study conducted within the National Cancer Institute Community Clinical Oncology Research Program was to assess trajectories in specific cognitive domains in patients with breast cancer (stage I-IIIC) receiving chemotherapy, from pre- (A1) to postchemotherapy (A2) and from prechemotherapy to 6 months postchemotherapy (A3); controls were assessed at the same time-equivalent points. The primary aim assessed visual memory using the Cambridge Neuropsychological Test Automated Battery Delayed Match to Sample test by longitudinal mixed models including A1, A2, and A3 and adjusting for age, education, race, cognitive reserve score, and baseline anxiety and depressive symptoms. We also assessed trajectories of CRCI in other aspects of memory as well as in attention and executive function with computerized, paper-based, and telephone-based cognitive tests. Results In total, 580 patients with breast cancer (mean age, 53.4 years) and 363 controls (mean age, 52.6 years) were assessed. On the Delayed Match to Sample test, the longitudinal mixed model results revealed a significant group-by-time effect ( P < .005); patients declined over time from prechemotherapy (A1) to 6 months postchemotherapy (A3; P = .005), but controls did not change ( P = .426). The group difference between patients and controls was also significant, revealing declines in patients but not controls ( P = .017). Several other models of computerized, standard, and telephone tests indicated significantly worse performance by patients compared with controls from pre- to postchemotherapy and from prechemotherapy to 6 months postchemotherapy. Conclusion This nationwide study showed CRCI in patients with breast cancer affects multiple cognitive domains for at least 6 months postchemotherapy.

Longitudinal Relationship Between Frailty and Cognition in Patients 50 Years and Older with Breast Cancer

“…This study is a secondary analysis of data from a nationwide multicenter prospective longitudinal study that examined whether chemotherapy is associated with worse cognition in female patients with nonmetastatic breast cancer undergoing treatment at community oncology clinics associated with the University of Rochester Cancer Center (URCC) National Cancer Institute Community Oncology Research Program (NCORP). 19,20 Eligible subjects had a diagnosis of invasive breast cancer, stage I to stage IIIC disease, were chemotherapy naive, and were scheduled to begin adjuvant or neoadjuvant chemotherapy. Subjects were excluded if they had metastatic disease, a prior diagnosis of neurodegenerative disease, currently pregnant, hospitalized within the past year for psychiatric illness, or were receiving concurrent radiation therapy.…”

The Longitudinal Relationship Between Immune Cell Profiles and Frailty in Patients with Breast Cancer receiving Chemotherapy

“…The primary study was a longitudinal cohort study aimed to determine the effects of chemotherapy on cognition (URCC 10055; ClinicalTrials.gov identi er NCT01382082) and enrolled participants from 2011 to 2013. (24,25) Measures were completed within seven days of the rst cycle of chemotherapy (pre-chemotherapy), within four weeks of the last chemotherapy cycle (postchemotherapy), and 6 months after the last chemotherapy cycle. For this study, we included all patients with breast cancer with available total and differential leukocyte data ( Fig.…”

“…Patients were excluded if they were 1) hospitalized at the time of study or had been hospitalized within the last year for a psychiatric illness, 2) diagnosed with a neurodegenerative disease, 3) had any primary central nervous system disease, 4) scheduled to receive concurrent radiation treatment while receiving chemotherapy, 5) have (or have had) metastatic disease, pregnant and/or, 6) colorblind. (24)…”

Aberrant static and dynamic functional connectivity of the executive control network in lung cancer patients after chemotherapy: a longitudinal fMRI study

“…Accompanying the increasing morbidity (ranking first among globally diagnosed cancers (Bray et al 2018)) and overall survival rate of lung cancer, chemotherapy-related cognitive impairment (CRCI) in lung cancer has become a wellrecognized side effect during and after adjuvant chemotherapy treatment (Janelsins et al 2018). Platinum-based chemotherapy was a broadly used global standard of care for advanced lung cancer (Ettinger et al 2017;Scagliotti et al 2008).…”