Pretreatment Psychoneurological Symptoms and Their Association With Longitudinal Cognitive Function and Quality of Life in Older Breast Cancer Survivors

Abstract

Context. Symptoms affect quality of life (QOL), functional status, and cognitive function in cancer survivors, but older survivors are understudied.Objectives. The objectives of this study were to identify prototypical presystemic therapy psychoneurological symptom clusters among older breast cancer survivors and determine whether these symptom clusters predicted cognition and QOL over time.Methods. Women with newly diagnosed nonmetastatic breast cancer (n ¼ 319) and matched noncancer controls (n ¼ 347) aged 60þ years completed questionnaires and neuropsychological tests before systemic therapy and 12 and 24 months later. Latent class analysis identified clusters of survivors based on their pretherapy depression, anxiety, fatigue, sleep disturbance, and pain. Linear mixed-effects models examined changes in objective cognition, perceived cognition, and functional status (Instrumental Activities of Daily Living disability, functional well-being, and breast cancerespecific QOL) by group, controlling for covariates.Results. Nearly one-fifth of older survivors were classified as having high pretherapy symptoms (n ¼ 51; 16%); the remainder had low symptoms (n ¼ 268; 84%); both groups improved over time on all outcomes. However, compared to the low symptom group and controls, survivors with high symptoms had lower baseline objective cognition and lower perceived cognition at baseline and 24 months, lower functional well-being at baseline and 12 months, greater Instrumental Activities of Daily Living disability at baseline, and lower breast cancerespecific QOL at all time points (all P < 0.05). Conclusion.Nearly one-fifth of older breast cancer survivors had high psychoneurological symptoms at diagnosis, which predicted clinically meaningful decrements in perceived cognition and function in the first 24 months after diagnosis. Pretreatment psychoneurological symptom clusters could identify survivors for monitoring or intervention.

Cognitive Functioning and Psychological Well-being in Breast Cancer Patients on Endocrine Therapy

“…Tometich et al (24), in a longitudinal study, investigated the effects of baseline anxiety and depression together with fatigue, pain and sleep disturbances on perceived and objective cognitive functions in 319 BC patients and 347 non-cancer controls, all aged ≥60 years. Although all groups showed improvements in neuropsychological scores over time, 16% of the patients who had high symptoms at baseline had lower perceived and objective cognition at that time point, and lower perceived cognition all along the observation time (24). Lower functional well-being at baseline predicted lower BC-specific QOL at all time points.…”

“…The understanding of previous findings on cognitive functioning after ET is complicated by the use of different methods (neuropsychological batteries, definitions of cognitive impairment or longitudinal decline, the involvement of BC or healthy controls), the confounding effects of various cancer treatments, the varying times of menopause, the patients' psychological status and treatment compliance and, many times small sample sizes (4,5). Limited experience is gained on old patients (2,16,23,24). Gaining knowledge on cancer therapy-induced cognitive impairment would yield practical implications.…”

Symptom burden among older breast cancer survivors: The Thinking and Living With Cancer (TLC) study

“…We selected the 8 symptoms/illnesses described above because they tend to cluster and/or include known treatment effects (eg, neuropathy) . We included myocardial infarction, congestive heart failure, arrhythmia, and angina as possible treatment‐toxicity–related.…”

“…These older survivors may be especially vulnerable to a high symptom burden, and their symptoms tend to affect functioning, given comorbidities and aging . We previously reported that presystemic therapy symptoms predicted 24‐month function . However, there are few data on changes in symptom burden over time in older survivors.…”

“…7 We previously reported that presystemic therapy symptoms predicted 24-month function. 8 However, there are few data on changes in symptom burden over time in older survivors. In addition, recommended healthy lifestyles 9 have not been examined for their ability to moderate symptoms or improve function in older survivors.…”