Summary: A new study reports chemo-brain can affect women with breast cancer for up to six months following chemotherapy.
Source: University of Rochester Medical Center.
The largest study to date of a condition known as “chemo-brain” shows that women with breast cancer report it’s a substantial problem after chemotherapy for as long as six months after treatment, according to investigators at University of Rochester’s Wilmot Cancer Institute.
Scientists have known that cancer-related cognitive impairment, which includes problems with memory, attention, and processing information, is an important issue for patients. Yet limitations in previous studies have left several questions about when and why it occurs and who is most likely to develop the condition.
The Wilmot research was published in the Journal of Clinical Oncology. Led by Michelle C. Janelsins, Ph.D., scientists compared cognitive difficulties among 581 breast cancer patients treated at clinical sites across the U.S. and 364 healthy people, with a mean age of 53 years in both groups. Researchers used a specialized tool called FACT-Cog, a well-validated measurement of cognitive impairment that examines a person’s own perceived impairment as well as cognitive impairment perceived by others. Their goal was to discover whether persistent symptoms existed and to possibly correlate them with other factors such as age, education, race, and menopausal status, for example.
Investigators found that compared to healthy people, the FACT-Cog scores of women with breast cancer exhibited 45 percent more impairment. In fact, over a period of nearly a year (from diagnosis and pre-chemotherapy to post-chemotherapy follow-up at six months) 36.5 percent of women reported a decline in scores compared to 13.6 percent of the healthy women, the study said.
Having more anxiety and depressive symptoms at the onset led to a greater impact on the FACT-Cog scores. Other factors that influenced cognitive decline were younger age and black race. Women who received hormone therapy and/or radiation treatment after chemotherapy had similar cognitive problems to women who received chemotherapy alone, the study noted.
“Our study, from one of the largest nationwide studies to date, shows that cancer-related cognitive problems are a substantial and pervasive issue for many women with breast cancer,” said Janelsins, assistant professor of Surgery in Wilmot’s Cancer Control and Survivorship program. She is also director of the program’s Psychoneuroimmunology Laboratory.
“We are currently assessing these data in the context of objective cognitive measures and to understand the role of possible biologic mechanisms that may confer risk to cognitive problems in patients,” she said.
Funding: The National Institutes of Health and the National Cancer Institute funded the study.
Source: Leslie Orr – University of Rochester Medical Center
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Original Research: Full open access research for “Cognitive Complaints in Survivors of Breast Cancer After Chemotherapy Compared With Age-Matched Controls: An Analysis From a Nationwide, Multicenter, Prospective Longitudinal Study” by Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Charles Kamen, Karen M. Mustian, Supriya G. Mohile, Allison Magnuson, Ian R. Kleckner, Joseph J. Guido, Kelley L. Young, Alison K. Conlin, Lora R. Weiselberg, Jerry W. Mitchell, Christine A. Ambrosone, Tim A. Ahles, and Gary R. Morrow in Journal of Clinical Oncology. Published online December 28 2016 doi:10.1200/JCO.2016.68.5826
Cognitive Complaints in Survivors of Breast Cancer After Chemotherapy Compared With Age-Matched Controls: An Analysis From a Nationwide, Multicenter, Prospective Longitudinal Study
Cancer-related cognitive impairment is an important problem for patients with breast cancer, yet its trajectory is not fully understood. Some previous cancer-related cognitive impairment research is limited by heterogeneous populations, small samples, lack of prechemotherapy and longitudinal assessments, use of normative data, and lack of generalizability. We addressed these limitations in a large prospective, longitudinal, nationwide study.
Patients and Methods
Patients with breast cancer from community oncology clinics and age-matched noncancer controls completed the Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog) at prechemotherapy and postchemotherapy and at a 6-month follow-up as an a priori exploratory aim. Longitudinal models compared FACT-Cog scores between patients and controls at the three assessments and adjusted for age, education, race, menopausal status, and baseline reading ability, anxiety, and depressive symptoms. A minimal clinically important difference cutoff determined percentages of impairment over time.
Of patients, 581 patients with breast cancer (mean age, 53 years; 48% anthracycline-based regimens) and 364 controls (mean age, 53 years) were assessed. Patients reported significantly greater cognitive difficulties on the FACT-Cog total score and four subscales from prechemotherapy to postchemotherapy compared with controls as well as from prechemotherapy to 6-month follow-up (all P < .001). Increased baseline anxiety, depression, and decreased cognitive reserve were significantly associated with lower FACT-Cog total scores. Treatment regimen, hormone, or radiation therapy was not significantly associated with FACT-Cog total scores in patients from postchemotherapy to 6-month follow-up. Patients were more likely to report a clinically significant decline in self-reported cognitive function than were controls from prechemotherapy to postchemotherapy (45.2% v 10.4%) and from prechemotherapy to 6-month follow-up (36.5% v 13.6%).
Patients with breast cancer who were treated in community oncology clinics report substantially more cognitive difficulties up to 6 months after treatment with chemotherapy than do age-matched noncancer controls.
“Cognitive Complaints in Survivors of Breast Cancer After Chemotherapy Compared With Age-Matched Controls: An Analysis From a Nationwide, Multicenter, Prospective Longitudinal Study” by Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Charles Kamen, Karen M. Mustian, Supriya G. Mohile, Allison Magnuson, Ian R. Kleckner, Joseph J. Guido, Kelley L. Young, Alison K. Conlin, Lora R. Weiselberg, Jerry W. Mitchell, Christine A. Ambrosone, Tim A. Ahles, and Gary R. Morrow in Journal of Clinical Oncology. Published online December 28 2016 doi:10.1200/JCO.2016.68.5826