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Biological and psychological predictors of cognitive function in breast cancer patients before surgery

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Abstract

Purpose

Research suggests that cancer-related cognitive impairment (CRCI) can occur before breast cancer (BC) treatment. The limited extant evidence suggests the underlying mechanisms could be stress-related. Potential psychological and biological predictors of CRCI prior to any BC treatment were examined.

Methods

112 treatment-naïve women with BC and 67 healthy controls (HC) completed a neuropsychological test battery to assess cognitive impairment and a self-report battery to assess cognitive complaints, cancer-related stress, depressive and anxiety symptoms. Morning and evening cortisol and α-amylase were collected from saliva. Multilinear regressions were conducted.

Results

Treatment-naïve BC patients were more frequently impaired in verbal memory and processing speed and reported more cognitive complaints (all p < .001) than HC. BC patients and HC did not differ in overall cognitive impairment (p = .21). Steeper α-amylase, lower cancer-related stress and younger age was associated with better overall cognitive function in treatment-naïve BC patients. Higher depressive symptoms predicted higher levels of cognitive complaints in BC patients.

Conclusion

Overall, these findings suggest that stress plays a role in CRCI. This study is the first to associate α-amylase with cognitive function in cancer patients, informing future research. The findings on impairment in processing speed and verbal memory among treatment-naïve BC highlight the need to screen for such impairments among BC patients and indicate that future studies on CRCI should include baseline assessments prior to BC treatment. If replicated, these findings could inform the development and testing of appropriate interventions to decrease CRCI among cancer patients.

Clinical trials registration number

NCT04418856, date of registration: 06.05.2020.

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Data availability

In accordance with the Icelandic data protection laws and the terms of approval for the current study that the National Bioethics Committee of Iceland accepted, these data cannot be made publicly available. Interested researchers who provide a methodologically sound proposal can access deidentified data. Notably, the execution of such a proposal requires approval by the National Bioethics Committee of Iceland. Proposals should be directed to heiddisb@ru.is.

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Acknowledgements

The authors acknowledge our collaborators at the University Hospital of Iceland, who introduced the study to participants before their breast cancer surgery, making this study possible. Furthermore, we would like to thank Rannveig Sigurvinsdóttir, Bryndís Björk Ásgeirsdóttir and Þóra Sigfríður Einarsdóttir who provided us with the contact details of the willing participants from their study, many of whom eventually became our healthy control group. Lastly, we would like to thank all our participants.

Funding

This work was funded by the Icelandic Research Fund [grant number 184999–051], Research Fund of the Icelandic Cancer Society and the Reykjavik University Research Fund.

Author information

Authors and Affiliations

  1. Department of Psychology, School of Social Sciences, Reykjavik University, Reykjavik, Iceland

    Snaefridur Gudmundsdottir Aspelund, Thorhildur Halldorsdottir, Gudjon Agustsson, Hannah Ros Sigurdardottir Tobin, Lisa M. Wu, Kamilla R. Johannsdottir, Huldis Franksdottir Daly, Heiddis B. Valdimarsdottir & Birna Baldursdottir

  2. Department of Oncology, Aarhus University Hospital, Aarhus, Denmark

    Lisa M. Wu

  3. Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Lisa M. Wu

  4. Unit for Psycho-Oncology and Health Psychology, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark

    Lisa M. Wu & Ali Amidi

  5. Department of Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa, USA

    Susan K. Lutgendorf & Rachel Telles

  6. Breast Center, University Hospital of Iceland, Reykjavik, Iceland

    Kristin Sigurdardottir

  7. Department of Population Health Science and Policy, Icahn School of Medicine, Mount Sinai, New York, NY, USA

    Heiddis B. Valdimarsdottir

Authors
  1. Snaefridur Gudmundsdottir Aspelund
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Contributions

S.G.A., H.B.V., K.R.J., H.F.D., T.H., L.M.W., A.A., and B.B. designed the study. S.G.A., G.A., H.R.S.T, K.S. and H.F.D. conducted the study. H.B.V., B.B., L.M.W., A.A., T.H., S.L., H.R.S.T and R.T. guided S.G.A. with the data analaysis. S.G.A. analyzed the data, drafted the manuscript, incorporated comments and finalized the manuscript. H.B.V., B.B., L.M.W., A.A., T.H., S.L., and K.R.J. discussed the results and commented on the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Birna Baldursdottir.

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Aspelund, S.G., Halldorsdottir, T., Agustsson, G. et al. Biological and psychological predictors of cognitive function in breast cancer patients before surgery. Support Care Cancer 32, 88 (2024). https://doi.org/10.1007/s00520-023-08282-5

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