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Endocrine treatment-associated cognitive impairment in breast cancer survivors: evidence from published studies

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Abstract

Endocrine-based treatments are the mainstay of therapy for postmenopausal women with breast cancer; yet concern has been raised about potential adverse cognitive effects. We performed a systematic review of the published literature to evaluate whether endocrine-based treatments for breast cancer are associated with changes in cognitive domains and whether these effects are more pronounced with advanced age. An electronic database search was performed. Original investigations that examined the effects of endocrine treatment on cognitive function were identified. Data were abstracted and studies were assessed for risk of bias. A total of 21 unique studies (n = 2398) were identified. Ten were short-term (duration ≤ 2 years) and 11 were long-term (duration > 2 years). Nine (43 %) studies had a sample size ≤100 subjects; 9 (43 %) were longitudinal, with baseline measurement before treatment initiation. No studies were primary randomized clinical trials. While there was heterogeneity in the neuropsychological measures used, tests could be grouped into the cognitive domains that they assessed. Compared to breast cancer or healthy controls, endocrine therapy was associated with impaired performance on neuropsychological testing. No study explored the association between age and changes in cognitive performance. Overall, endocrine therapies were associated with greater cognitive deficits compared to surgical and healthy controls; yet, lack of randomized trial data and heterogeneity in design of many studies limited any definitive conclusions. Despite older women being at highest risk for the development of cognitive impairment, advanced age has not been adequately explored.

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Disclaimers

None to declare. The funding organizations did not participate in the design or conduct of the study, in the collection, analysis, or interpretation of the data, or in the preparation, review, or approval of the manuscript.

Funding

This study was conducted with the support of the Ontario Institute for Cancer Research and Cancer Care Ontario through funding provided by the Government of Ontario. Dr. Tierney was supported by a Clinician Scientist Award from the Department of Family & Community Medicine, University of Toronto and Sunnybrook Health Sciences Centre.

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Authors and Affiliations

  1. Division of Geriatric Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada

    Philip E. Lee

  2. Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada

    Wei Wu & Paula A. Rochon

  3. Department of Family & Community Medicine Faculty of Medicine, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Canada

    Mary C. Tierney

  4. Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada

    Mary C. Tierney & Kathleen I. Pritchard

  5. Department of Medicine, University of Toronto, Toronto, ON, Canada

    Kathleen I. Pritchard & Paula A. Rochon

  6. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada

    Paula A. Rochon

  7. Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada

    Paula A. Rochon

  8. AD Clinic, Centre for Brain Health, 2nd Floor 2215, Wesbrook Mall, Vancouver, V6T 1Z3, BC, Canada

    Philip E. Lee

Authors
  1. Philip E. Lee
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  2. Mary C. Tierney
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Correspondence to Philip E. Lee.

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Lee, P.E., Tierney, M.C., Wu, W. et al. Endocrine treatment-associated cognitive impairment in breast cancer survivors: evidence from published studies. Breast Cancer Res Treat 158, 407–420 (2016). https://doi.org/10.1007/s10549-016-3906-9

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  • DOI: https://doi.org/10.1007/s10549-016-3906-9

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