Skip to main content

Advertisement

SpringerLink
Log in

The relationship of cognitive performance to concurrent symptoms, cancer- and cancer-treatment-related variables in women with early-stage breast cancer: a 2-year longitudinal study

  • Original Article – Cancer Research
  • Published:
Journal of Cancer Research and Clinical Oncology Aims and scope Submit manuscript

Abstract

Purpose

Cognitive dysfunction in women with breast cancer continues to be an area of intense research interest. The prevalence, severity, timing, and cognitive domains that are most affected, as well as the contribution of cancer and its treatments to cognition, remain unresolved. Thus, longitudinal studies are needed that examine cognitive function during different stages of breast cancer treatment and survivorship. This longitudinal trial followed women with early-stage breast cancer, prior to chemotherapy through 2 years survivorship.

Methods

In women with early-stage breast cancer (N = −75), performance-based assessment of nine cognitive domains was performed at five time points beginning prior to chemotherapy and finishing 24 months after initial chemotherapy. Linear mixed effects models were used to examine the temporal changes in cognitive performance domains, while adjusting for cofactors, including those related to individuals, tumor attributes, chemotherapy (adjuvant or neoadjuvant), radiation, endocrine therapy, and concurrent symptoms.

Results

At baseline, scores on reaction time, complex attention, cognitive flexibility, executive function, and visual memory were lower than 90. At 2 years, all domains improved except for the memory domains (verbal, visual, and composite). Scores on six domains (psychomotor speed, reaction time, complex attention, cognitive flexibility, and visual memory) remained lower than 100 at 2 years. Neoadjuvant chemotherapy and fatigue had strong inverse relationship with cognitive functioning at multiple time points.

Conclusion

The low performance-based cognitive scores at baseline and over time warrant further study. Although most scores improved over time, memory did not improve. In all, the level of cognitive function is lower than expected for a majority college-educated sample. Thus, future studies are warranted to replicate these findings and to develop methods for identifying women with cognitive dysfunction pretreatment and into survivorship.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  • Aboalela N et al (2015) Perceived stress levels, chemotherapy, radiation treatment and tumor characteristics are associated with a persistent increased frequency of somatic chromosomal instability in women diagnosed with breast cancer: a one year longitudinal study. PLoS One 10(7):e0133380

    Article  PubMed  PubMed Central  Google Scholar 

  • Ahles TA (2012) Brain vulnerability to chemotherapy toxicities. Psycho-Oncology 21(11):1141–1148

    Article  PubMed  PubMed Central  Google Scholar 

  • Ahles TA, Root JC, Ryan EL (2012) Cancer-and cancer treatment–associated cognitive change: an update on the state of the science. J Clin Oncol 30(30):3675–3686

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Andreotti C et al (2015) Reliable change in neuropsychological assessment of breast cancer survivors. Psycho Oncol. doi:10.1002/pon.3799

    Google Scholar 

  • Alosco ML et al (2013) Reduced memory in fat mass and obesity-associated allele carriers among older adults with cardiovascular disease. Psychogeriatrics. doi:10.1111/j.1479-8301.2012.00424.x

    Google Scholar 

  • Alosco ML et al (2014) Improved memory function two years after bariatric surgery. Obesity 22(1):32–38

    Article  PubMed  Google Scholar 

  • Arpino G et al (2015) Metabolic and anthropometric changes in early breast cancer patients receiving adjuvant therapy. Breast Cancer Res Treat 154(1):127–132

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Bakoyiannis I et al (2015) The impact of endocrine therapy on cognitive functions of breast cancer patients: a systematic review. Clin Drug Investig 36(2):109–118

    Article  Google Scholar 

  • Barker-Collo S et al (2015) Neuropsychological outcome and its correlates in the first year after adult mild traumatic brain injury: a population-based New Zealand study. Brain Inj 29(13–14):1604–1616

    Article  PubMed  Google Scholar 

  • Bender CM et al (2015) Patterns of change in cognitive function with anastrozole therapy. Cancer 121(15):2627–2636

    Article  CAS  PubMed  Google Scholar 

  • Bower JE et al (2000) Fatigue in breast cancer survivors: occurrence, correlates, and impact on quality of life. J Clin Oncol 18(4):743

    CAS  PubMed  Google Scholar 

  • Breckenridge LM et al (2012) Cognitive limitations associated with tamoxifen and aromatase inhibitors in employed breast cancer survivors. Psycho-Oncology 21(1):43–53

    Article  PubMed  Google Scholar 

  • Buchanan ND et al (2015) Post-treatment neurocognition and psychosocial care among breast cancer survivors. Am J Prev Med 49(6):S498–S508

    Article  PubMed  Google Scholar 

  • Calvio L et al (2010) Measures of cognitive function and work in occupationally active breast cancer survivors. J Occup Environ Med 52(2):219–227

    Article  PubMed  Google Scholar 

  • Cheung YT et al (2015) Association of proinflammatory cytokines and chemotherapy-associated cognitive impairment in breast cancer patients: a multi-centered, prospective, cohort study. Ann Oncol 26(7):1446–1451

    CAS  PubMed  PubMed Central  Google Scholar 

  • Cohen S, Williamson G (1988) Perceived stress in a probability sample of the United States. Soc Psychol Health 13:123–128

    Google Scholar 

  • Cohen S, Kamarck T, Mermelstein R (1983) A global measure of perceived stress. J Health Soc Behav 24(4):385–396

    Article  CAS  PubMed  Google Scholar 

  • Crawford RD, Jonassaint CR (2015) Adults with sickle cell disease may perform cognitive tests as well as controls when processing speed is taken into account: a preliminary case-control study. J Adv Nurs. doi:10.1111/jan.12755

    Google Scholar 

  • Fan HGM et al (2005) Fatigue, menopausal symptoms, and cognitive function in women after adjuvant chemotherapy for breast cancer: 1- and 2-year follow-up of a prospective controlled study. J Clin Oncol 23(31):8025–8032

    Article  PubMed  Google Scholar 

  • Gualtieri CT, Johnson LG (2006) Reliability and validity of a computerized neurocognitive test battery, CNS Vital Signs. Arch Clin Neuropsychol 21(7):623–643

    Article  PubMed  Google Scholar 

  • Gunstad J et al (2013) Obesity is associated with memory deficits in young and middle-aged adults. Eat Weight Disord Stud Anorex Bulim Obes 11(1):e15–e19

    Article  Google Scholar 

  • Henneghan A (2016) Modifiable factors and cognitive dysfunction in breast cancer survivors: a mixed-method systematic review. Support Care Cancer 24(1):481–497

    Article  PubMed  Google Scholar 

  • Hermelink K (2015) Chemotherapy and cognitive function in breast cancer patients: the so-called chemo brain. JNCI Monogr 2015(51):67–69

    Article  Google Scholar 

  • Hermelink K et al (2007) Cognitive function during neoadjuvant chemotherapy for breast cancer. Cancer 109(9):1905–1913

    Article  CAS  PubMed  Google Scholar 

  • Jansen C et al (2011) A prospective longitudinal study of chemotherapy-induced cognitive changes in breast cancer patients. Support Care Cancer 19(10):1647–1656

    Article  PubMed  Google Scholar 

  • Jenkins V et al (2006) A 3-year prospective study of the effects of adjuvant treatments on cognition in women with early stage breast cancer. Br J Cancer 94(6):828–834

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Kesler SR, Blayney DW (2015) Neurotoxic effects of anthracycline-vs nonanthracycline-based chemotherapy on cognition in breast cancer survivors. JAMA Oncol 2(2):185–192

    Article  Google Scholar 

  • Kool M et al (2015) Long term effects of extended adjuvant endocrine therapy on quality of life in breast cancer patients. Breast 24(3):224–229

    Article  CAS  PubMed  Google Scholar 

  • Kyranou M et al (2013) Predictors of initial levels and trajectories of anxiety in women before and for 6 months after breast cancer surgery. Cancer Nurs 37(6):406–417

    Article  Google Scholar 

  • Lyon D et al (2015) Randomized sham controlled trial of cranial microcurrent stimulation for symptoms of depression, anxiety, pain, fatigue and sleep disturbances in women receiving chemotherapy for early-stage breast cancer. SpringerPlus 4(1):1–9

    Article  Google Scholar 

  • Mandelblatt JS et al (2014) Cognitive impairment in older patients with breast cancer before systemic therapy: is there an interaction between cancer and comorbidity?. J Clin Oncol. doi:10.1200/JCO.2013.54.2050

    Google Scholar 

  • McDonald BC et al (2010) Gray matter reduction associated with systemic chemotherapy for breast cancer: a prospective MRI study. Breast Cancer Res Treat 123(3):819–828

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • McDonald BC et al (2012) Alterations in brain activation during working memory processing associated with breast cancer and treatment: a prospective functional magnetic resonance imaging study. J Clin Oncol 30(20):2500–2508

    Article  PubMed  PubMed Central  Google Scholar 

  • Mendoza TR et al (1999) The rapid assessment of fatigue severity in cancer patients: use of the Brief Fatigue Inventory. Cancer 85(5):1186–1196

    Article  CAS  PubMed  Google Scholar 

  • Meeske K et al (2007) Fatigue in breast cancer survivors two to five years post diagnosis: a HEAL study report. Qual Life Res 16(6):947–960

    Article  PubMed  Google Scholar 

  • Meskal I et al (2015) Cognitive improvement in meningioma patients after surgery: clinical relevance of computerized testing. J Neurooncol 121(3):617–625

    Article  PubMed  Google Scholar 

  • Myers JS (2012) Chemotherapy-related cognitive impairment: the breast cancer experience. Oncol Nurs Forum 39:1

    Article  Google Scholar 

  • Ono M et al (2015) A meta-analysis of cognitive impairment and decline associated with adjuvant chemotherapy in women with breast cancer. Front Oncol 5:59

    Article  PubMed  PubMed Central  Google Scholar 

  • Opdebeeck C et al (2015) Does cognitive reserve moderate the association between mood and cognition? A systematic review. Rev Clin Gerontol 25(03):181–193

    Article  Google Scholar 

  • Pérez S et al (2014) Posttraumatic stress symptoms in breast cancer patients: temporal evolution, predictors, and mediation. J Trauma Stress 27(2):224–231

    Article  PubMed  Google Scholar 

  • Ramaiah R, Lam AM (2009) Postoperative cognitive dysfunction in the elderly. Anesthesiology clinics 27(3):485–496

    Article  PubMed  Google Scholar 

  • Rele S et al (2015) An 8-week randomized, double-blind trial comparing efficacy, safety, and tolerability of 3 vilazodone dose-initiation strategies following switch from SSRIs and SNRIs in major depressive disorder. Prim Care Companion CNS Disord 17(4). doi:10.4088/PCC.4014m01734

  • Schagen SB et al (1999) Cognitive deficits after postoperative adjuvant chemotherapy for breast carcinoma. Cancer 85(3):640–650

    Article  CAS  PubMed  Google Scholar 

  • Scherling C et al (2011) Pre-chemotherapy differences in visuospatial working memory in breast cancer patients compared to controls: an FMRI study. Front Hum Neurosci 5:122. doi: 10.3389/fnhum.2011.00122

    Article  PubMed  PubMed Central  Google Scholar 

  • Scherling C et al (2012) Prechemotherapy differences in response inhibition in breast cancer patients compared to controls: a functional magnetic resonance imaging study. J Clin Exp Neuropsychol 34(5):543–560

    Article  PubMed  Google Scholar 

  • Schrepf A, Lutgendorf SK, Pyter LM (2015) Pre-treatment effects of peripheral tumors on brain and behavior: neuroinflammatory mechanisms in humans and rodents. Brain Behav Immun 49:1–7

    Article  PubMed  Google Scholar 

  • Snaith RP (2003) The Hospital Anxiety and Depression Scale. Health Qual Life Outcomes 1:29

    Article  PubMed  PubMed Central  Google Scholar 

  • Theadom A et al (2015) Frequency and impact of recurrent traumatic brain injury in a population-based sample. J Neurotrauma 32(10):674–681

    Article  PubMed  Google Scholar 

  • van Dam FS et al (1998) Impairment of cognitive function in women receiving adjuvant treatment for high-risk breast cancer: high-dose versus standard-dose chemotherapy. J Natl Cancer Inst 90(3):210–218

    Article  PubMed  Google Scholar 

  • Wefel JS et al (2011) International cognition and cancer task force recommendations to harmonise studies of cognitive function in patients with cancer. Lancet Oncol 12(7):703–708

    Article  PubMed  Google Scholar 

  • Zwart W et al (2015) Cognitive effects of endocrine therapy for breast cancer: keep calm and carry on? Nat Rev Clin Oncol 12(10):597–606

    Article  PubMed  Google Scholar 

  • Zygouris S, Tsolaki M (2014) Computerized cognitive testing for older adults: A review. Am J Alzheimer’s Dis Other Demen 30(1):13–28

    Article  Google Scholar 

Download references

Acknowledgments

This research was supported by the National Institute of Nursing Research (Jackson-Cook/Lyon; MPI; R01 NR012667). Dr. Jackson-Cook (NIH/NIA R01AG037986) and Dr. A. Starkweather (R01 NR013932) are currently receiving grants. The content of this publication is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Nursing Research (NINR), National Institute on Aging (NIA), or the National Institutes of Health (NIH).

Author information

Authors and Affiliations

  1. University of Florida, Gainesville, FL, USA

    Debra E. Lyon, Ronald Cohen, Huaihou Chen, Debra L. Kelly & Hyo-Chol Ahn

  2. University of Connecticut, Storrs Hall, Room 112B, 231 Glenbrook Road, Unit 4026, Storrs, CT, 06269, USA

    Angela Starkweather

  3. School of Medicine, Virginia Commonwealth University, 1101 E. Marshall Street, Richmond, VA, 23298-0662, USA

    Colleen K. Jackson-Cook

Authors
  1. Debra E. Lyon
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ronald Cohen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Huaihou Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Debra L. Kelly
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Angela Starkweather
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hyo-Chol Ahn
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Colleen K. Jackson-Cook
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Debra E. Lyon.

Ethics declarations

Conflict of interest

None.

Ethical standards

The experiments used in this study complied with the current laws of the country in which they were performed.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lyon, D.E., Cohen, R., Chen, H. et al. The relationship of cognitive performance to concurrent symptoms, cancer- and cancer-treatment-related variables in women with early-stage breast cancer: a 2-year longitudinal study. J Cancer Res Clin Oncol 142, 1461–1474 (2016). https://doi.org/10.1007/s00432-016-2163-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00432-016-2163-y

Keywords

Search

Navigation