Cognitive functioning and quality of life following chemotherapy in pre- and peri-menopausal women with breast cancer
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The purpose of the study was to prospectively examine changes in subjective and objective cognitive functions and quality of life (QOL) for pre- and peri-menopausal women receiving chemotherapy for breast cancer and to explore potential predictors of cognitive changes.
Participants were assessed as follows: prior to chemotherapy (T1), after cycle 3 (T2), within 2–3 weeks of completing adjuvant chemotherapy (T3) (N = 20), and 8+ years later (T4; n = 18). Objective cognitive function was measured with the High Sensitivity Cognitive Screen (T1, T3, T4). Subjective measures for cognitive function, depressive symptoms, fatigue, and mental and physical QOL were assessed at all time points. Estradiol levels were measured at T1, T2, and T3. The Functional Assessment of Cancer Therapy-Cognition and the MD Anderson Cancer Symptom Inventory item for neuropathy were administered at T4.
No significant changes in objective cognitive function were found. However, participants reported decreased cognitive function over the course of treatment accompanied by depressive symptoms and fatigue. Depression and fatigue returned to near-baseline levels at T4, but over half of the participants continued to report mild to moderate depression. Estradiol levels were not associated with cognitive function. Neuropathy and higher body mass index (BMI) were associated with persistent cognitive complaints at T4 (adjusted R 2 = 0.712, p = 0.001). Higher QOL was correlated with better subjective cognitive function (r = 0.705, p = 0.002) and lower body mass index (r = − 0.502, p = 0.017) at T4.
Further investigation of BMI, neuropathy, and depressive symptoms as predictors of persistent cognitive dysfunction following chemotherapy for breast cancer is warranted.
KeywordsBreast cancer Cognitive function Pre-menopausal Chemotherapy Quality of life
This research and Dr. Klemp’s efforts were supported in part by the Department of Defense Breast Cancer Research Program Pre-Doctoral Fellowship: DAMD-17-03-1-0670 and Amgen Inc. A portion of Dr. Myers’ efforts were supported by the National Institution of Nursing Research (NINR) T32 and Interdisciplinary Training of Nurse Scientists in Cancer Survivorship while being a Postdoctoral Scholar at the University of Pittsburgh School of Nursing. The University of Virginia Center for Research in Reproduction Ligand Assay and Analysis Facility Core was supported by the NIH Grant U54-HD28934.
Compliance with ethical standards
Institutional Review Board (IRB) approvals were obtained. All procedures performed in this study were in accordance with the ethical standards of the institutions and were performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
Informed consent was obtained prior to any data collection from all individual participants included in the study.
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