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Breast Cancer Research and Treatment

, Volume 146, Issue 3, pp 599–609 | Cite as

Long-term cognitive function change among breast cancer survivors

  • Ying Zheng
  • Jianfeng Luo
  • Pingping Bao
  • Hui Cai
  • Zhen Hong
  • Ding Ding
  • James C. Jackson
  • Xiao-Ou Shu
  • Qi DaiEmail author
Epidemiology

Abstract

Cognitive decline is a common health problem among breast cancer patients and understanding trajectories of cognitive change following among breast cancer survivors is an important public health goal. We conducted a longitudinal study to investigate the cognitive function changes from 18 month to 3 years after breast cancer diagnosis among participants of the Shanghai Breast cancer survivor study, a population-based cohort study of breast cancer survivors. In our study, we completed cognitive function evaluation for 1,300 breast cancer survivors at the 18th month’s survey and 1,059 at 36th month’s survey, respectively, using a battery of cognitive function measurements. We found the scores in attention and executive function, immediate memory and delayed memory significantly improved from 18 to 36 months after breast cancer diagnosis. The improvements appeared in breast cancer survivors receiving treatments (i.e., surgery, radiotherapy, tamoxifen, or chemotherapy combined with or without tamoxifen), but not in those who received neither chemotherapy nor tamoxifen treatment. The results indicate that cognitive functions, particularly immediate verbal episodic memory, and delayed memory significantly improved among breast cancer survivors from 18 to 36 months after cancer diagnosis. In general, comorbidity was inversely associated with the improvements.

Keywords

Breast cancer Cognitive function Prognosis Survival 

Notes

Acknowledgments

The authors thank the breast cancer patients who participated in the study and the research staff of the Shanghai Breast Cancer Survivor Study for their dedication and contributions to the study. The parent study was supported by grants from the US Department of Defense Breast Cancer Research Program (Grant DAMD 17-02-1-0607), the National Cancer Institute (Grant R01 CA118229) and The Shanghai Public Health Talented Professional Overseas Training Program. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health.

Conflict of interest

The authors indicated no potential conflicts of interest.

References

  1. 1.
    Boyle P, Levin B (eds) (2008) World Cancer Report. International Agency for Research on Cancer, LyonGoogle Scholar
  2. 2.
    Brenner H (2002) Long-term survival rates of cancer survivors achieved by the end of the 20th century: a period analysis. Lancet 360(1131–1135):2002Google Scholar
  3. 3.
    Shu XO, Zheng Y, Cai H, GuK Chen Z, Zheng W, Lu W (2009) Soy food intake and breast cancer survival. JAMA 302:2437–2443PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Wefel JS, Meyers CA (2005) Cancer as a risk factor for dementia: a house built on shifting sand. J Natl Cancer Inst 97:788–789PubMedCrossRefGoogle Scholar
  5. 5.
    Wefel JS, Lenzi R, Theriault RL, Davis RN, Meyers CA (2004) The cognitive sequelae of standard-dose adjuvant chemotherapy in women with breast carcinoma: results of a prospective, randomized, longitudinal trial. Cancer 100:2292–2299PubMedCrossRefGoogle Scholar
  6. 6.
    Bender CM, Sereika SM, Berga SL, Vogel VG, Brufsky AM, Paraska KK, Ryan CM (2006) Cognitive impairment associated with adjuvant therapy in breast cancer. Psycho-oncology 15:422–430PubMedCrossRefGoogle Scholar
  7. 7.
    Jenkins V, Shilling V, Deutsch G, Bloomfield D, Morris R, Allan S, Bishop H, Hodson N, Mitra S, Sadler G 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 94:828–834PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Shilling V, Jenkins V, Morris R, Deutsch G, Bloomfield D (2005) The effects of adjuvant chemotherapy on cognition in women with breast cancer–preliminary results of an observational longitudinal study. Breast 14:142–150PubMedCrossRefGoogle Scholar
  9. 9.
    Bender CM, Paraska KK, Sereika SM, Ryan CM, Berga SL (2001) Cognitive function and reproductive hormones in adjuvant therapy for breast cancer: a critical review. J Pain Symptom Manage 21:407–424PubMedCrossRefGoogle Scholar
  10. 10.
    Asher A (2011) Cognitive Dysfunction Among Cancer Survivors. Am J Phys Med Rehabil 90:S16–S26PubMedCrossRefGoogle Scholar
  11. 11.
    Hurria A, Somlo G, Ahles T (2007) Renaming ‘Chemobrain’. Cancer Invest 25:373–377PubMedCrossRefGoogle Scholar
  12. 12.
    Vardy J, Rourke S, Tannock IF (2007) Evaluation of cognitive function associated with chemotherapy: a review of published studies and recommendations for future research. J Clin Oncol 25:2455–2463PubMedCrossRefGoogle Scholar
  13. 13.
    Argyriou AA, Assimakopoulos K, Iconomou G, Giannakopoulou F, Kalofonos HP (2011) Either called ‘Chemobrain’ or ‘Chemofog’, the long-term chemotherapy-induced cognitive decline in cancer survivors is real. J Pain Symptom Manage 41:126–139CrossRefGoogle Scholar
  14. 14.
    McAllister TW, Ahles TA, Saykin AJ, Ferguson RJ, McDonald BC, Lewis LD, Flashman LA, Rhodes CH (2004) Cognitive effects of cytotoxic cancer chemotherapy: predisposing risk factors and potential treatments. Curr Psychiatry Rep 6:364–371PubMedCrossRefGoogle Scholar
  15. 15.
    Barton D, Loprinzi C (2002) Novel approaches to preventing chemotherapy-induced cognitive dysfunction in breast cancer: the art of the possible. Clin Breast Cancer 3:S121–S127PubMedCrossRefGoogle Scholar
  16. 16.
    Conroy SK, McDonald BC, Smith DJ, Moser LR, West JD, Kamendulis LM, Klaunig JE, Champion VL, Unverzagt FW, Saykin AJ (2013) Alterations in brain structure and function in breast cancer survivors: effect of post-chemotherapy interval and relation to oxidative DNA damage. Breast Cancer Res Treat 137:493–502PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    Reuter-Lorenz PA, Cimprich B (2013) Cognitive function and breast cancer: promise and potential insights from functional brain imaging. Breast Cancer Res Treat 137:33–43PubMedCrossRefGoogle Scholar
  18. 18.
    Avisar A, River Y, Schiff E, Bar-Sela G, Steiner M, Ben-Arye E (2012) Chemotherapy-related cognitive impairment: does integrating complementary medicine have something to add? review of the literature. Breast Cancer Res Treat 136:1–7PubMedCrossRefGoogle Scholar
  19. 19.
    Mar Helen G, Fan Nadine Houédé-Tchen, Yi Qi-Long, 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 23:8025–8032CrossRefGoogle Scholar
  20. 20.
    Chen Xiaoli, Wei Lu, Ying Zheng GuK, Chen Z, Zheng W, Shu XO (2010) Exercise, tea consumption, and depression among breast cancer survivors. J Clin Oncol 28:991–998PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Epplein M, Zheng Y, Zheng W, Chen Z, Gu K, Penson D, Lu W, Shu XO (2011) Quality of Life after Breast Cancer Diagnosis and Survival. J Clin Oncol 29:406–412PubMedCentralPubMedCrossRefGoogle Scholar
  22. 22.
    Salmon DP, Jin H, Zhang M, Grantc I, Yud E (1995) Neuropsychological assessment of Chinese elderly in the Shanghai Dementia survey. Clin Neuropsychol 9:159–168CrossRefGoogle Scholar
  23. 23.
    Chan AS, Poon MW (1999) Performance of 7- to 95-year-old individuals in a Chinese version of the category fluency test. J Int Neuropsychol Soc 5:525–533PubMedCrossRefGoogle Scholar
  24. 24.
    Lee TM, Chan CC (2000) Stroop interference in Chinese and English. J Clin Exp Neuropsychol 22:465–471PubMedCrossRefGoogle Scholar
  25. 25.
    He J, Iosif AM, Lee DY, Martinez O, Ding D, Carmichael O, Mortimer JA, Zhao QH, Chu SG, Guo QH et al (2010) Brain morphology and cerebrovascular risk in mild cognitive impairment and dementia: sCOBHI-P study. Arch Neurol 67:1231–1237PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Bano D, Agostini M, Melino G, Nicotera P (2011) Ageing, neuronal connectivity and brain disorders: an unsolved ripple effect. Mol Neurobiol. 43:124–130PubMedCrossRefGoogle Scholar
  27. 27.
    Cullum S, Huppert FA, McGee M, Dening T, Ahmed A, Paykel ES, Brayne C (2000) Decline across different domains of cognitive function in normal ageing: results of a longitudinal population-based study using CAMCOG. Int J Geriatr Psychiatry 15:853–862PubMedCrossRefGoogle Scholar
  28. 28.
    Badgio PC, Worden BL (2007) Cognitive functioning and aging in women. J Women Aging 19:13–30PubMedCrossRefGoogle Scholar
  29. 29.
    Klepin H, Mohile S, Hurria A (2009) Geriatric assessment in older survivors with breast cancer. J Natl Compr Cancer Netw 7:226–236Google Scholar
  30. 30.
    Mitsiades N, Correa D, Gross CP, Hurria A, Slovin SF (2008) Cognitive effects of hormonal therapy in older adults. Semin Oncol 35:569–581PubMedCrossRefGoogle Scholar
  31. 31.
    Rossi A, Colantuoni G, Maione P, Ferrara C Airoma, G, Barzelloni, M. L., Castaldo, V, Gridelli, C, (2005) Chemotherapy of breast cancer in the elderly. Curr Med Chem 12:297–310PubMedCrossRefGoogle Scholar
  32. 32.
    Bourbonniere M, Kagan SH (2004) Nursing intervention and older adults who have cancer: specific science and evidence based practice. Nurs Clin North Am 39:529–543PubMedCrossRefGoogle Scholar
  33. 33.
    Vodermaier A (2009) Breast cancer treatment and cognitive function: the current state of evidence, underlying mechanisms and potential treatments. Womens Health 5:503–516Google Scholar
  34. 34.
    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 28:4434–4440PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Ying Zheng
    • 1
  • Jianfeng Luo
    • 2
  • Pingping Bao
    • 1
  • Hui Cai
    • 3
  • Zhen Hong
    • 4
  • Ding Ding
    • 4
  • James C. Jackson
    • 5
  • Xiao-Ou Shu
    • 3
  • Qi Dai
    • 3
    Email author
  1. 1.Department of Cancer Prevention and ControlShanghai Municipal Center for Disease Control and PreventionShanghaiChina
  2. 2.Department of Health Statistics and Social Medicine, School of Public HealthFudan UniversityShanghaiChina
  3. 3.Division of Epidemiology, Department of MedicineVanderbilt University School of MedicineNashvilleUSA
  4. 4.Department of Neurology, Shanghai Hua Shan HospitalFudan UniversityShanghaiChina
  5. 5.Division of Critical Care, Department of MedicineVanderbilt University School of MedicineNashvilleUSA

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