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Subgroups of cognitively affected and unaffected breast cancer survivors after chemotherapy: a data-driven approach

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Abstract

Purpose

It is assumed that a segment of breast cancer survivors are cognitively affected after chemotherapy. Our aim is to discover whether there is a qualitatively different cognitively affected subgroup of breast cancer survivors, or whether there are only quantitative differences between survivors in cognitive functioning.

Methods

Latent profile analysis was applied to age-corrected neuropsychological data —measuring verbal memory, attention, speed, and executive functioning— from an existing sample of 62 breast cancer survivors treated with chemotherapy. Other clustering methods were applied as sensitivity analyses. Subgroup distinctness was established with posterior mean assignment probability and silhouette width. Simulations were used to calculate subgroup stability, posterior predictive checks to establish absolute fit of the subgrouping model. Subgrouping results were compared to traditional normative comparisons results.

Results

Two subgroups were discovered. One had cognitive normal scores, the other —45%— had lower scores. Subgrouping results were consistent across clustering methods. The subgroups showed some overlap; 6% of survivors could fall in either. Subgroups were stable and described the data well. Results of the subgroup clustering model matched those of a traditional normative comparison method requiring small deviations on two cognitive domains.

Conclusions

We discovered that almost half of breast cancer survivors after chemotherapy form a cognitively affected subgroup, using a data-driven approach. This proportion is higher than previous studies using prespecified cutoffs observed.

Implications for cancer survivors

A larger group of cancer survivors may be cognitively affected than previously recognized, and a less strict threshold for cognitive problems may be needed in this population.

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Data availability

Data supporting the findings of this study are available from the corresponding author upon reasonable request.

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Funding

This work was supported by the Dutch Cancer Society, KWF Kankerbestrijding (grant number KWF 2015–7937).

Author information

Authors and Affiliations

  1. Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Plesmanlaan 121, Room H8.014, 1066 CX, Amsterdam, The Netherlands

    Joost A. Agelink van Rentergem, Philippe R. Lee Meeuw Kjoe & Sanne B. Schagen

  2. Department of Communication Science, Vrije Universiteit Amsterdam, De Boelelaan 1105, 1081 HV, Amsterdam, The Netherlands

    Ivar E. Vermeulen

  3. Department of Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, 1018 WS, Amsterdam, The Netherlands

    Sanne B. Schagen

Authors
  1. Joost A. Agelink van Rentergem
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  2. Philippe R. Lee Meeuw Kjoe
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  3. Ivar E. Vermeulen
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  4. Sanne B. Schagen
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Contributions

All the authors contributed to the study conception and design. Analyses were performed by Joost Agelink van Rentergem and Philippe Lee Meeuw Kjoe. The first draft of the manuscript was written by Joost Agelink van Rentergem and Philippe Lee Meeuw Kjoe, and all the authors commented on previous versions of the manuscript. All the authors read and approved the final manuscript.

Corresponding author

Correspondence to Joost A. Agelink van Rentergem.

Ethics declarations

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. This study was approved by the review board of the Netherlands Cancer Institute.

Consent to participate

All participants provided written informed consent prior to assessment.

Competing interests

The authors declare no competing interests.

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Joost A. Agelink van Rentergem and Philippe R. Lee Meeuw Kjoe shared first authorship.

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Agelink van Rentergem, J.A., Lee Meeuw Kjoe, P.R., Vermeulen, I.E. et al. Subgroups of cognitively affected and unaffected breast cancer survivors after chemotherapy: a data-driven approach. J Cancer Surviv 18, 810–817 (2024). https://doi.org/10.1007/s11764-022-01310-z

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  • DOI: https://doi.org/10.1007/s11764-022-01310-z

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