A prospective longitudinal study of chemotherapy-induced cognitive changes in breast cancer patients
Evidence for chemotherapy-induced cognitive impairment remains inconclusive. This study was designed to determine the trajectory of cognitive function over time in women with breast cancer, who received doxorubicin and cyclophosphamide (AC) alone or followed by a taxane. Associations between changes in cognitive function and potential covariates including anxiety, depression, fatigue, hemoglobin level, menopausal status, and perception of cognitive function were evaluated.
The Repeatable Battery for the Assessment of Neuropsychological Status, Stroop Test, and Grooved Pegboard were used to assess cognitive function in a group of 71 women prior to chemotherapy, a week after completing the last cycle of AC, as well as 1 week and 6 months after the completion of all chemotherapy.
Cognitive impairment was found in 23% of women prior to chemotherapy. Hierarchical linear modeling showed significant decreases after receiving chemotherapy followed by improvements 6 months after the completion of chemotherapy in the cognitive domains of visuospatial skill (p < 0.001), attention (p = 0.022), delayed memory (p = 0.006), and motor function (p = 0.043). In contrast, immediate memory, language, and executive function scores did not change over time.
These results suggest that having a breast cancer diagnosis may be associated with cognitive impairment. While chemotherapy may have a negative impact on cognitive function, chemotherapy-related impairments appear to be more acute than chronic side effects of therapy. Further studies are needed to provide insight into the clinical significance and potential mechanisms of cancer and treatment-related cognitive impairments.
KeywordsBreast cancer Neuropsychological test Cognitive changes Chemotherapy
We would like to acknowledge that Dr. Jansen was supported by the American Cancer Society Doctoral Scholarship in Cancer Nursing (no. 02-209-03) and a grant from the Oncology Nursing Society Foundation. Drs. Cooper, Dodd, and Miaskowski are supported by grants from the National Cancer Institute and the National Institute of Nursing Research.
Conflict of interest
None of the authors have any conflicts to disclose.
- 3.Hurria A, Rose C, Hudis C et al (2006) Cognitive function of older patients receiving adjuvant chemotherapy for breast cancer: a pilot prospective longitudinal study. J Am Geriatr Soc 54:926–931Google Scholar
- 12.Schagen SB, Muller MJ, Boogerd W et al (2006) Change in cognitive function after chemotherapy: a prospective longitudinal study in breast cancer patients. J Natl Cancer Inst 98:1724–1745Google Scholar
- 16.Randolph C (1998) RBANS Repeatable battery for the assessment of neuropsychological status manual. The Psychological Corporation, San AntonioGoogle Scholar
- 17.Golden CJ, Freshwater SM (2002) Stroop color and word test: a manual for clinical and experimental uses. Stoelting Company, Wood DaleGoogle Scholar
- 18.Lafayette Instrument Company (2002) Grooved pegboard test user instructions. Lafayette Instrument Company, LafayetteGoogle Scholar
- 21.Spielberger CD, Gorsuch RL, Lushene R et al (1983) Manual for the State-Trait Anxiety Inventory (STAI). Consulting Psychologists Press, Palo AltoGoogle Scholar
- 23.Spreen O, Strauss E (1998) A compendium of neuropsychological tests. Oxford University Press, New YorkGoogle Scholar
- 25.Franzen MD, Tishelman AC, Sharp BH, Friedman AG (1987) An investigation of the test–retest reliability of the Stroop Color-Word Test across two intervals. Arch Clin Neuropsychol 32:654–658Google Scholar
- 29.Singer JD, Willett JB (2003) Applied longitudinal data analysis: modeling change and event occurrence. Oxford University Press, New YorkGoogle Scholar
- 30.Rothman KJ (1990) No adjustments are needed for multiple comparisons. Epidemiol 1:45–46Google Scholar