Cognitive Impairment Associated With Breast Cancer Treatment

Treatment with certain chemotherapies for early-stage breast cancer was tied to cognitive impairment, but only in those without a history of anxiety, according to a paper published in The Breast.¹

A coauthor of the study, Susana Pereira, PhD, wrote to Psychiatry Advisor and noted that breast cancer is a frequent diagnosis with improving survival, which highlights the importance of studying cognitive impairment after breast cancer.

Cognitive complaints are common in clinical practice, and “many of these patients are young, and there is the expectation of resuming their professional activity after the treatments,” Dr Pereira continued.

Excluding some types of skin cancer, breast cancer is the most common cancer in women in the United States. Approximately, 230,000 women were diagnosed and more than 40,000 died from breast cancer in the United States in 2013.²

Further, treatments for breast cancer including chemotherapy, radiotherapy, and endocrine therapy have been tied to cognitive impairment.¹

The cognitive impairment associated with breast cancer treatment may include difficulty with attention, processing speed, executive function, memory, and quality of life.³

Mariana Ramalho, MD, from the Instituto de Saúde Pública da Universidade do Porto in Portugal, and colleagues sought to understand the connection between breast cancer treatment and cognitive impairment. The investigators took into account the patient’s baseline anxiety level because higher levels of anxiety may be associated with poor performance on cognitive testing.¹

The study included 418 women aged 18 years or older with newly diagnosed and histologically confirmed breast cancer without previous chemotherapy or radiation. Participants with baseline cognitive impairment and stage IV cancer were excluded. Data were collected on sociodemographics; cancer stage; treatment; baseline anxiety, using the Hospital Anxiety and Depression Scale; and cognitive performance, using the Montreal Cognitive Assessment. Participants were followed and reassessed at 1 year.¹

More than half of the participants were 55 years of age or older (52.5%) and were diagnosed with stage 0 or 1 breast cancer (54.0%). Participants were treated with breast conserving surgery (50.7%), mastectomy (49.3%), axillary lymph node dissection (34.4%), endocrine therapy (84.0%), radiation therapy (72.5%), and chemotherapy (51.9%). At baseline, approximately 38% scored in the range for anxiety on the Hospital Anxiety and Depression Scale.¹

Follow-up at 1 year found that 8.1% of participants met criteria for cognitive impairment (95% CI, 5.8%-11.2%). Although there was not a significant association between baseline anxiety and development of cognitive impairment, the investigators found a significant interaction between baseline anxiety and the incidence of cognitive impairment after chemotherapy (P =.028). Patients without a history of baseline anxiety were found to have a 4-fold increased risk for cognitive impairment after treatment with doxorubicin and cyclophosphamide (adjusted relative risk, 4.22; 95% CI, 1.22-14.65).¹

The authors noted the study was limited by only including women with an early breast cancer stage, with the goal of limiting brain metastasis from being a factor in the participant’s cognition scores.¹

Among participants treated with doxorubicin and cyclophosphamide “[t]here was a statistically significant association between chemotherapy and cognitive impairment, but only among women with no anxiety at baseline,” the authors write.¹

References

1. Ramalho M, Fontes F, Ruano L, Pereira S, Lunet N. Cognitive impairment in the first year after breast cancer diagnosis: a prospective cohort study. Breast. 2017;32:173-178. doi: 10.1016/j.breast.2017.01.018
2. Breast cancer statistics. Centers for Disease Control and Prevention. https://www.cdc.gov/cancer/breast/statistics/index.htm. Updated March 23, 2016. Accessed February 27, 2017.
3. Janelsins MC, Heckler CE, Peppone LJ, et al. Cognitive complaints in survivors of breast cancer after chemotherapy compared with age-matched controls: an analysis from a nationwide, multicenter, prospective longitudinal study. J Clin Oncol. 2017;35(5):506-514. doi: 10.1200/JCO.2016.68.5826