Hostname: page-component-cd9895bd7-jn8rn Total loading time: 0 Render date: 2024-12-27T10:04:42.990Z Has data issue: false hasContentIssue false
  • English
  • Français

Persistent Cognitive Changes in Breast Cancer Patients 1 Year Following Completion of Chemotherapy

Published online by Cambridge University Press:  15 November 2013

Barbara Collins ,
Joyce MacKenzie ,
Giorgio A. Tasca ,
Carole Scherling  and
Andra Smith
Barbara Collins*
Affiliation:
Psychology Department, The Ottawa Hospital, Ottawa, Ontario, Canada School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
Joyce MacKenzie
Affiliation:
Psychology Department, The Ottawa Hospital, Ottawa, Ontario, Canada
Giorgio A. Tasca
Affiliation:
Psychology Department, The Ottawa Hospital, Ottawa, Ontario, Canada School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
Carole Scherling
Affiliation:
Memory and Aging Centre, University of California, San Francisco (UCSF), San Francisco, California
Andra Smith
Affiliation:
School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
*
Correspondence and reprint requests to: Barbara Collins, The Ottawa Hospital – Civic Campus, 1053 Carling Avenue, Room A628, Ottawa, Ontario, Canada, K1Y 4E9. E-mail: bcollins@ottawahospital.on.ca
Get access Rights & Permissions [Opens in a new window]

Abstract

Numerous studies have shown that there are acute cognitive side-effects of chemotherapy for breast cancer. Presumably, patients are more concerned about chronic treatment effects. This report from a prospective longitudinal study compares cognitive functioning in 56 breast cancer patients 1 year after chemotherapy to that of 56 healthy individuals. Neuropsychological test scores were combined into verbal memory, visual memory, working memory, and processing speed scores, as well as an overall summary score, and analyzed using multi-level growth modeling. Frequency of cognitive decline was assessed using regression-based change scores. There was significant rebound in the overall summary score from end of treatment to 1-year follow-up as well as a substantial reduction in the frequency of cognitive decline. However, more than one-third of the breast cancer patients who showed cognitive decline immediately following completion of chemotherapy showed persistent cognitive decline 1 year later. Furthermore, recovery was not seen in all cognitive domains. In fact, the rebound was significant only for working memory. Longer multi-site studies are recommended to explore the risk factors for and the permanence of these longer-term cognitive effects. (JINS, 2013, 20, 1–10)

Keywords

Neuropsychological testsLongitudinal studiesMemoryVerbal learningAnti-estrogensSide effects
Type
Symposia
Information
Journal of the International Neuropsychological Society , Volume 20 , Issue 4 , April 2014 , pp. 370 - 379
Copyright
Copyright © The International Neuropsychological Society 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ahles, T.A., Saykin, A.J., McDonald, B.C., Li, Y., Furstenberg, C.T., Hanscom, B.S., Kaufman, P.A. (2010). Longitudinal assessment of cognitive changes associated with adjuvant treatment for breast cancer: Impact of age and cognitive reserve. Journal of Clinical Oncology, 28, 4434–4440.Google Scholar
Army Individual Test Battery. (1944). Manual of directions and scoring. Washington, DC: War Department, Adjutant General's Office.Google Scholar
Beck, A.T., Steer, R.A., Brown, G.K. (1996). Beck Depression Inventory-Second Edition Manual. San Antonio, TX: Psychological Corporation.Google Scholar
Bender, C.M., Sereika, S.M., Brufsky, A.M., Ryan, C.M., Vogel, V.G., Rastogi, P., Berga, S.L. (2007). Memory impairments with adjuvant anastrozole versus tamoxifen in women with early-stage breast cancer. Menopause, 14, 995–998.CrossRefGoogle ScholarPubMed
Benedict, R. (1997). Brief Visuospatial Memory Test-revised professional manual. Lutz, FL: Psychological Assessment Resources.Google Scholar
Brandt, J., Benedict, R. (2001). Hopkins Verbal Learning Test-revised professional manual. Lutz, FL: Psychological Assessment Resources.Google Scholar
Brown, J. (1958). Some tests of the decay theory of immediate memory. Quarterly Journal of Experimental Psychology, 10, 12–21.CrossRefGoogle Scholar
Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum Associates.Google Scholar
Collins, B., MacKenzie, J., Stewart, A., Bielajew, C., Verma, S. (2009a). Cognitive effects of chemotherapy in post-menopausal breast cancer patients 1 year after treatment. Psychooncology, 18, 134–143.CrossRefGoogle ScholarPubMed
Collins, B., MacKenzie, J., Stewart, A., Bielajew, C., Verma, S. (2009b). Cognitive effects of hormonal therapy in early-stage breast cancer patients: A prospective study. Psychooncology, 18, 811–821.Google Scholar
Collins, B., MacKenzie, J., Tasca, G.A., Scherling, C., Smith, A. (2013). Cognitive effects of chemotherapy in breast cancer patients: A dose-response study. Psychooncology, 22, 1517–1527.Google Scholar
Cutter, G.R., Baier, M.L., Rudick, R.A., Cookfair, D.L., Fischer, J.S., Petkau, J., Willoughby, E. (1999). Development of a multiple sclerosis functional composite as a clinical trial outcome measure. Brain, 122, 871–882.CrossRefGoogle ScholarPubMed
de Ruiter, M.B., Reneman, L., Boogerd, W., Veltman, D.J., Caan, M., Douaud, G., Schagen, S.B. (2012). Late effects of high-dose adjuvant chemotherapy on white and gray matter in breast cancer survivors: Converging results from multimodal magnetic resonance imaging. Human Brain Mapping, 33, 2971–2983.CrossRefGoogle ScholarPubMed
de Ruiter, M.B., Reneman, L., Boogerd, W., Veltman, D.J., van Dam, F.S.A.M., Nederveen, A.J., Schagen, S.B. (2011). Cerebral hyporesponsiveness and cognitive impairment 10 years after chemotherapy for breast cancer. Human Brain Mapping, 32, 1206–1219.Google Scholar
Delis, D.C., Kaplan, E., Kramer, J.H. (2001). Delis Kaplan Executive Function System test manual. San Antonio, TX: Psychological Corporation.Google Scholar
Doolittle, N.D., Korfel, A., Lubow, M.A., Schorb, E., Schlegel, U., Rogowski, S., Neuwelt, E.A. (2013). Long-term cognitive function, neuroimaging, and quality of life in CNS lymphoma. Neurology, 81, 84–92.Google Scholar
Fischer, J.S., Jak, A.J., Kniker, J.E., Rudick, R.A., Cutter, G. (2001). Administration and scoring manual for the Multiple Sclerosis Functional Composite Measure (MSFC). New York: National Multiple Sclerosis Society.Google Scholar
Gualtieri, C.T., Johnson, L.G. (2006). Reliability and validity of a computerized neurocognitive test battery, CNS Vital Signs. Archives of Clinical Neuropsychology, 21, 623–643.CrossRefGoogle ScholarPubMed
Gualtieri, C.T., Johnson, L.G. (2008). A computerized test battery sensitive to mild and severe brain injury. Medscape Journal of Medicine, 10, 90.Google Scholar
Hutchinson, A.D., Hosking, J.R., Kichenadasse, G., Mattiske, J.K., Wilson, C. (2012). Objective and subjective cognitive impairment following chemotherapy for cancer: A systematic review. Cancer Treatment Reviews, 38, 926–934.CrossRefGoogle ScholarPubMed
Ingraham, L.J., Aiken, C.B. (1996). An empirical approach to determining criteria for abnormality in test batteries with multiple measures. Neuropsychology, 10, 120–124.CrossRefGoogle Scholar
Jansen, C.E., Cooper, B.A., Dodd, M.J., Miaskowski, A. (2011). A prospective longitudinal study of chemotherapy-induced cognitive changes in breast cancer patients. Supportive Care in Cancer, 19, 1647–1656.Google Scholar
Jenkins, V., Shilling, V., Fallowfield, L., Howell, A., Hutton, S. (2004). Does hormone therapy for the treatment of breast cancer have a detrimental effect on memory and cognition? A pilot study. Psychooncology, 13, 61–66.CrossRefGoogle ScholarPubMed
Koppelmans, V., Breteler, M.M.B., Boogerd, W., Seynaeve, C., Gundy, C., Schagen, S.B. (2012). Neuropsychological performance in survivors of breast cancer more than 20 years after adjuvant chemotherapy. Journal of Clinical Oncology, 30, 1080–1086.CrossRefGoogle ScholarPubMed
Koppelmans, V., de Ruiter, M.B., van der Lijn, F., Boogerd, W., Seynaeve, C., van der Lugt, A., Schagen, S.B. (2012). Global and focal brain volume in long-term breast cancer survivors exposed to adjuvant chemotherapy. Breast Cancer Research and Treatment, 132, 1099–1106.Google Scholar
Kreukels, B.P.C., Hamburger, H.L., de Ruiter, M.B., van Dam, F.S.A.M., Ridderinkhof, K.R., Boogerd, W., Schagen, S.B. (2008). ERP amplitude and latency in breast cancer survivors treated with adjuvant chemotherapy. Clinical Neurophysiology, 119, 533–541.Google Scholar
Kreukels, B.P.C., Schagen, S.B., Ridderinkhof, K.R., Boogerd, W., Hamburger, H.L., Muller, M.J., van Dam, F.S.A.M. (2006). Effects of high-dose and conventional-dose adjuvant chemotherapy on long-term cognitive sequelae in patients with breast cancer: An electrophysiologic study. Clinical Breast Cancer, 7, 67–78.CrossRefGoogle ScholarPubMed
Kreukels, B.P.C., Schagen, S.B., Ridderinkhof, K.R., Boogerd, W., Hamburger, H.L., van Dam, F.S.A.M. (2005). Electrophysiological correlates of information processing in breast-cancer patients treated with adjuvant chemotherapy. Breast Cancer Research and Treatment, 94, 53–61.CrossRefGoogle ScholarPubMed
Kreukels, B.P.C., van Dam, F.S.A.M., Ridderinkhof, K.R., Boogerd, W., Schagen, S.B. (2008). Persistent neurocognitive problems after adjuvant chemotherapy for breast cancer. Clinical Breast Cancer, 8, 80–87.Google Scholar
Maki, P., Hogervorst, E. (2003). HRT and cognitive decline. Best Practice and Research Clinical Endocrinology and Metabolism, 17, 105–122.CrossRefGoogle ScholarPubMed
Maki, P.M., Zonderman, A.B., Resnick, S.M. (2001). Enhanced verbal memory in nondemented elderly women receiving hormone-replacement therapy. American Journal of Psychiatry, 158, 227–233.CrossRefGoogle ScholarPubMed
McNair, D.M., Lorr, M.L., Droppleman, L.F. (1992). EdITS manual for the profile of mood states. San Diego, CA: Educational and Industrial Testing Service.Google Scholar
Nieuwenhuijsen, K., de Boer, A., Spelten, E., Sprangers, M.A., Verbeek, J.H. (2009). The role of neuropsychological functioning in cancer survivors’ return to work one year after diagnosis. Psychooncology, 18, 589–597.Google Scholar
Palmer, J.L., Trotter, T., Joy, A.A., Carlson, L.E. (2008). Cognitive effects of tamoxifen in premenopausal women with breast cancer compared to healthy controls. Journal of Cancer Survivorship, 2, 275–282.Google Scholar
Phillips, K.A., Aldridge, J., Ribi, K., Sun, Z., Thompson, A., Harvey, V., Bernhard, J. (2011). Cognitive function in post-menopausal breast cancer patients one year after completing adjuvant endocrine therapy with letrozole and/or tamoxifen in the BIG I-98 trial. Breast Cancer Research and Treatment, 126, 221–226.CrossRefGoogle Scholar
Pullens, M.J.J., De Vries, J., Roukema, J.A. (2010). Subjective cognitive dysfunction in breast cancer patients: A systematic review. Psychooncology, 19, 1127–1138.Google Scholar
Rao, S.M., Leo, G.J., Bernardin, L., Unverzagt, F. (1991). Cognitive dysfunction in multiple sclerosis. I. Frequency, patterns, and prediction. Neurology, 41, 685–691.Google Scholar
Ryan, J., Scali, J., Carriere, I., Ritchie, K., Ancelin, M.-L. (2008). Hormonal treatment, mild cognitive impairment and Alzheimer's disease. Psychogeriatrics, 20, 47–56.Google Scholar
Schilder, C.M., Eggens, P.C., Seynaeve, C., Linn, S.C., Boogerd, W., Gundy, C.M., Schagen, S.B. (2009). Neuropsychological functioning in post-menopausal breast cancer patients treated with tamoxifen or exemestane after AC chemotherapy: Cross-sectional findings from the neuropsychological TEAM-Side Study. Acta Oncologica, 48, 76–85.Google Scholar
Schilder, C.M., Seynaeve, C., Beex, L.V., Boogerd, W., Linn, S.C., Gundy, C.M., Schagen, S.B. (2010). Effects of tamoxifen and exemestane on cognitive functioning of post-menopausal patients with breast cancer: Results from the neuropsychological side study of the Tamoxifen and Exemestane Adjuvant Multinational Trial. Journal of Clinical Oncology, 28, 1294–1300.CrossRefGoogle Scholar
Shilling, V., Jenkins, V. (2007). Self-reported cognitive problems in women receiving adjuvant therapy for breast cancer. European Journal of Oncology Nursing, 11, 6–15.Google Scholar
Shilling, V., Jenkins, V., Fallowfield, L., Howell, T. (2003). The effects of hormone therapy on cognition in breast cancer. Journal of Steroid Biochemistry and Molecular Biology, 86, 405–412.Google Scholar
Silverman, D.H., Dy, C.J., Castellon, S.A., Lai, J., Pio, B.S., Abraham, L., Ganz, P. (2007). Altered fronto-cortical, cerebellar and basal ganglia activity in adjuvant-treated breast cancer survivors 5-10 years after chemotherapy. Breast Cancer Research and Treatment, 103, 303–311.Google Scholar
Singer, J.D., Willett, J.B. (2003). Applied longitudinal data analysis: Modeling change and event occurrence. New York: Oxford University Press.Google Scholar
Vardy, J., Tannock, I. (2007). Cognitive function after chemotherapy in adults with solid tumours. Critical Reviews in Oncology/Hematology, 63, 183–202.CrossRefGoogle ScholarPubMed
Walker, C.H., Drew, B.A., Antoon, J.W., Kalueff, A.V., Beckman, B.S. (2012). Neurocognitive effects of chemotherapy and endocrine therapies in the treatment of breast cancer: Recent perspectives. Cancer Investigation, 30, 135–148.Google Scholar
Wechsler, D. (1997). Wechsler Adult Intelligence Scale (3rd ed.). San Antonio, TX: Harcourt, Brace, & Co.Google Scholar
Wefel, J.S., Lenzi, R., Theriault, R.L., Davis, R.N., Meyers, C.A. (2004). The cognitive sequelae of standard-dose adjuvant chemotherapy in women with breast carcinoma. Cancer, 100, 2292–2299.Google Scholar
Wefel, J.S., Saleeba, A.K., Buzdar, A.U., Meyers, C.A. (2010). Acute and late onset cognitive dysfunction associated with chemotherapy in women with breast cancer. Cancer, 116, 3348–3356.Google Scholar
Wefel, J.S., Schagen, S.B. (2012). Chemotherapy-related cognitive dysfunction. Current Neurology and Neuroscience Reports, 12, 267–275.CrossRefGoogle ScholarPubMed
Weis, J., Poppelreuter, M., Bartsch, H.H. (2009). Cognitive deficits as long-term side-effects of adjuvant therapy in breast cancer patients: Subjective complaints and objective neuropsychological test results. Psychooncology, 18, 775–782.Google Scholar
Wolf, O.T., Kudielka, B.M., Hellhammer, D.H., Torber, S., McEwen, B.S., Kirschbaum, C. (1999). Two weeks of transdermal estradiol treatment in postmenopausal elderly women and its effect on memory and mood: Verbal memory changes are associated with the treatment induced estradiol levels. Psychoneuroendocrinology, 24, 727–741.Google Scholar