Cognitive function in older women with breast cancer treated with standard chemotherapy and capecitabine on Cancer and Leukemia Group B 49907
- 495 Downloads
Cognitive changes in older women receiving chemotherapy are poorly understood. We examined self-reported cognitive function for older women who received adjuvant chemotherapy on Cancer and Leukemia Group B (CALGB) 49907. CALGB 49907 randomized 633 women aged ≥65 with stage I–III breast cancer to standard adjuvant chemotherapy (cyclophosphamide–methotrexate–5-fluorouracil or doxorubicin–cyclophosphamide) versus capecitabine. We examined self-reported cognitive function in 297 women (CALGB 361002) who enrolled on the quality of life substudy and had no gross impairment on cognitive screening. Women were evaluated using an 18-item instrument at six time points (baseline through 24 months). At each time point for each patient, we calculated a cognitive function score (CFS) defined as the mean response of items 1–18 and defined impairment as a score >1.5 standard deviations above the overall average baseline score. Differences in scores by patient characteristics were evaluated using a Kruskal–Wallis test. A linear mixed-effects model was used to assess CFSs by treatment over time. Among 297 women, the median age was 71.5 (range 65–85) and 73 % had performance status of 0. Baseline depression and fatigue were reported in 6 and 14 % of patients, respectively. The average CFS at baseline was 2.08 (corresponding to “normal ability”), and baseline cognitive function did not differ by treatment regimen (p = 0.350). Over 24 months, women reported minimal changes at each time point and insignificant differences by treatment arm were observed. In a healthy group of older women, chemotherapy was not associated with longitudinal changes in self-reported cognitive function.
KeywordsCognitive function Older women Breast cancer Age
We thank all of the breast cancer patients who shared their experiences while participating in this study. We also thank Dr. Andrew Saykin for his guidance in using his cognitive function measure and Jacqueline Lafky for her administrative and logistical support. We acknowledge support from Celgene provided through the Cancer and Leukemia Group B Foundation Young Investigator Award [RF]. This research was also supported in part by the National Cancer Institute at the National Institutes of Health [Grant # U10 CA 84131, CA 127617, CA096940, and CA129769 to JSM] and by the National Institute on Aging at the National Institutes of Health [Grant #CA85850 to HM]. The research for CALGB 49907 was also supported, in part, by the National Cancer Institute at the National Institutes of Health [Grant # CA31946 to the Cancer and Leukemia Group B (Monica Bernagnoli, MD, Chairman) and Grant # CA33601 to the CALGB Statistical Center (Stephen George, PhD)].
The content of this manuscript is solely the responsibility of the authors and does not represent the official views of the National Cancer Institute at the National Institutes of Health or the Cancer and Leukemia Group B. Cancer and Leukemia Group B is presently part of the Alliance for Clinical Trials in Oncology. The sponsors had no role in the design, methods, subject recruitment, data collection, analysis, or preparation of this manuscript.
Conflict of interest
The authors declare that they have no conflicts of interest.
- 1.Surveillance Epidemiology and End Results Cancer Statistics Review 1975–2006. http://www.seer.cancer.gov/csr/1975_2006/index.html. Accessed 20 Dec 2009
- 4.http://chemobrain.org/. Accessed 2 Aug 2013
- 5.American Cancer Society. “Chemo Brain” http://www.cancer.org/treatment/treatmentsandsideeffects/physicalsideeffects/chemotherapyeffects/chemo-brain. Accessed 2 Aug 2013
- 6.Hutchinson AD, Hosking JR, Kichenadasse G, Mattiske JK, Wilson C (2012) Objective and subjective cognitive impairment following chemotherapy for cancer: a systematic review. Cancer Treat Rev 38(7):926–934Google Scholar
- 9.Fan HG, Houede-Tchen N, Yi QL, Chemerynsky I, Downie FP, Sabate K, Tannock IF (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):8025–8032PubMedCrossRefGoogle Scholar
- 10.van Dam FS, Schagen SB, Muller MJ, Boogerd W, vd Wall E, Droogleever Fortuyn ME, Rodenhuis S (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):210–218PubMedCrossRefGoogle Scholar
- 18.Ganz PA, Bower JE, Kwan L, Castellon SA, Silverman DH, Geist C, Breen EC, Irwin MR, Cole SW (2012) Does tumor necrosis factor-alpha (TNF-alpha) play a role in post-chemotherapy cerebral dysfunction? Brain Behav Immun suppl:S99–108Google Scholar
- 19.Cimprich B, Hayes DF, Askren MK, Jung MS, Berman MG, Ossher L, Therrien B, Reuter-Lorenz PA, Zhang M, Peltier S et al (2012) Neurocognitive impact in adjuvant chemotherapy for breast cancer linked to fatigue: a prospective MRI study. San Antonio Breast Cancer Symposium; Presented as oral abstract on December 7, 2012. Abstract #S6-3Google Scholar
- 20.Ahles TA, Saykin AJ, McDonald BC, Li Y, Furstenberg CT, Hanscom BS, Mulrooney TJ, Schwartz GN, Kaufman PA (2010) Longitudinal assessment of cognitive changes associated with adjuvant treatment for breast cancer: impact of age and cognitive reserve. J Clin Oncol 28(29):4434–4440PubMedCrossRefGoogle Scholar
- 21.Hurria A, Rosen C, Hudis C, Zuckerman E, Panageas KS, Lachs MS, Witmer M, van Gorp WG, Fornier M, D’Andrea G et al (2006) Cognitive function of older patients receiving adjuvant chemotherapy for breast cancer: a pilot prospective longitudinal study. J Am Geriatr Soc 54(6):925–931PubMedCrossRefGoogle Scholar
- 28.Shaffer VA, Merkle EC, Fagerlin A, Griggs JJ, Langa KM, Iwashyna TJ (2012) Chemotherapy was not associated with cognitive decline in older adults with breast and colorectal cancer: findings from a prospective cohort study. Med Care 50(10):849–855Google Scholar
- 34.Kornblith AB, Lan L, Archer L, Partridge A, Kimmick G, Hudis C, Winer E, Casey R, Bennett S, Cohen HJ et al (2011) Quality of life of older patients with early-stage breast cancer receiving adjuvant chemotherapy: a companion study to cancer and leukemia group B 49907. J Clin Oncol 29(8):1022–1028PubMedCrossRefGoogle Scholar
- 40.Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JC et al (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85(5):365–376PubMedCrossRefGoogle Scholar
- 41.Sprangers MA, Cull A, Bjordal K, Groenvold M, Aaronson NK (1993) The European Organization for Research and Treatment of Cancer. Approach to quality of life assessment: guidelines for developing questionnaire modules. EORTC Study Group on Quality of Life. Qual Life Res 2(4):287–295PubMedCrossRefGoogle Scholar