Cognitive problems of breast cancer survivors on proton pump inhibitors

  • Annelise A. Madison
  • Alex Woody
  • Brittney Bailey
  • Maryam B. Lustberg
  • Bhuvaneswari Ramaswamy
  • Robert Wesolowski
  • Nicole Williams
  • Raquel Reinbolt
  • Jeffrey B. VanDeusen
  • Sagar Sardesai
  • William B. Malarkey
  • Janice K. Kiecolt-GlaserEmail author



Proton pump inhibitors (PPIs) are used in cancer patients to manage treatment-related gastrointestinal symptoms and to prevent damage to the gastric mucosal lining during treatment. However, PPI use may contribute to cognitive problems. To compare PPI-users and non-users, breast cancer survivors reported cognitive problems in three studies.


In Study 1, breast cancer survivors (N = 209; n = 173 non-users, n = 36 PPI-users; stages 0-IIIC) rated their cognitive function on the Kohli scale prior to cancer treatment, as well as one and two years later. In Study 2, women (N = 200; n = 169 non-users, n = 31 PPI-users, stages 0-IIIa, M = 11 months post-treatment) rated their cognitive function on the Kohli scale and BCPT checklist at three visits over a six-month period. In Study 3, participants (N = 142; n = 121 non-users, n = 21 PPI-users; stages I-IIIa, M = 4 years post-treatment) rated their cognitive function on the Kohli scale, BCPT checklist, and Functional Assessment of Cancer Therapy cognitive scale (FACT-cog).


In Study 1, PPI-users reported more severe concentration problems (p = 0.039) but not memory problems (p = 0.17) than non-users. In Study 2, PPI-users reported more severe concentration problems (p = 0.022) than non-users, but not memory problems or symptoms on the BCPT (ps = 0.11). Study 3’s PPI-users reported more severe memory problems (p = 0.002), poorer overall cognitive function (p = 0.006), lower quality of life related to cognitive problems (p = 0.005), greater perceived cognitive impairment (p = 0.013), and poorer cognitive abilities (p = 0.046), but not more severe concentration problems (p = 0.16), compared to non-users.


PPI use may impair breast cancer survivors’ memory, concentration, and quality of life.


Proton pump inhibitors Breast cancer survivors Cognitive symptoms, concentration, memory 



Proton Pump Inhibitor


Breast Cancer Prevention Trial


Functional Assessment of Cancer Therapy cognitive scale


Funding information

This study was supported in part by NIH grants: R01 CA186251, R01 CA126857, R01 CA131029, R01 CA186720, K05 CA172296, UL1RR025755, and T32 DE014320.

Compliance with ethical standards

Conflict of interest

The authors had no conflicts of interest.

Supplementary material

11764_2019_815_MOESM1_ESM.docx (16 kb)
ESM (DOCX 15 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2020

Authors and Affiliations

  • Annelise A. Madison
    • 1
    • 2
  • Alex Woody
    • 1
  • Brittney Bailey
    • 1
  • Maryam B. Lustberg
    • 3
  • Bhuvaneswari Ramaswamy
    • 3
  • Robert Wesolowski
    • 3
  • Nicole Williams
    • 3
  • Raquel Reinbolt
    • 3
  • Jeffrey B. VanDeusen
    • 3
  • Sagar Sardesai
    • 3
  • William B. Malarkey
    • 1
    • 4
  • Janice K. Kiecolt-Glaser
    • 1
    • 5
    Email author
  1. 1.Institute for Behavioral Medicine ResearchThe Ohio State UniversityColumbusUSA
  2. 2.Department of PsychologyThe Ohio State UniversityColumbusUSA
  3. 3.The Ohio State University Comprehensive Cancer CenterColumbusUSA
  4. 4.Department of Internal MedicineThe Ohio State UniversityColumbusUSA
  5. 5.Department of Psychiatry and Behavioral HealthThe Ohio State UniversityColumbusUSA

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