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Cognitive effects of adjuvant endocrine therapy in older women treated for early-stage breast cancer: a 1-year longitudinal study

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Evidence suggests endocrine therapy (ET) for breast cancer (BC) has adverse cognitive effects, but its specific effects on older women are unknown. This is despite the fact that older women are at increased risk of both breast cancer (BC) and cognitive decline relative to younger women. This study prospectively examined the cognitive effects of ET in a cohort of older BC patients. Our primary outcome measure was change in verbal memory, the cognitive domain most consistently affected by estrogen deprivation.


Forty-two chemotherapy-naïve women age 60+, without dementia and recently diagnosed with hormone receptor-positive BC, completed neuropsychological tests at the time of ET initiation and after 1 year of treatment. Change in age-standardized verbal memory performance was examined using paired t tests. To assess a broader range of potential cognitive effects, we also examined changes in visual memory, processing speed, frontal executive function, and perceptual reasoning.


Participants exhibited significant decline from baseline to 1 year in verbal memory (p = 0.01). This decline was small to moderate in effect size (d = − 0.40). Performance on other domains did not change significantly over the year (all p > 0.05).


Our findings suggest potentially detrimental effects of ET on verbal memory in older women after just 1 year of treatment. Given that ET is prescribed for courses of 5 to 10 years, additional studies examining longer-term effects of treatment in older women are critical.

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We thank the oncologists, nurses, and radiation therapists at the cancer centers involved in this study for their assistance with patient recruitment. Kathy Zhang (Research Assistant, Sunnybrook Research Institute, Toronto, ON) assisted with data entry. Aspects of this work were presented in poster format at the American Association for Cancer Research Annual Meeting 2018 and were published as an abstract in conference proceedings. This full-text manuscript has not been published elsewhere.


This study was supported by a Sunnybrook Alternative Funding Plan Association Innovation Fund. E.A.U. was supported by a Canadian Federation of University Women fellowship and an Ontario Graduate Scholarship during her Master’s training at the Institute of Medical Science, University of Toronto. M.C.T. is supported by a Clinician Scientist award from the Department of Family & Community Medicine, University of Toronto and Sunnybrook Health Sciences Centre. P.A.R holds the Retired Teachers of Ontario/ERO Chair in Geriatric Medicine.

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Correspondence to M. C. Tierney.

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K.I.P. has served in consulting and advisory roles for and received honoraria and travel support from AstraZeneca, Pfizer, Roche, Amgen, Novartis, and Eisai. K.J.J has served as a consultant for and/or attended advisory boards for Genomic Health Inc., Novartis, Purdue Pharma and Roche. No other authors have any conflicts of interest to report. M.C.T has full control of all primary data and agrees to allow the journal to review the data if requested.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Underwood, E.A., Jerzak, K.J., Lebovic, G. et al. Cognitive effects of adjuvant endocrine therapy in older women treated for early-stage breast cancer: a 1-year longitudinal study. Support Care Cancer 27, 3035–3043 (2019).

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