Hostname: page-component-586b7cd67f-gb8f7 Total loading time: 0 Render date: 2024-11-26T00:54:33.341Z Has data issue: false hasContentIssue false
  • English
  • Français

Heterogeneous Response of Chemotherapy-Related Cognitive Decline in Patients with Breast Cancer: A Prospective Study

Published online by Cambridge University Press:  21 April 2020

Wim Schrauwen Open the ORCID record for Wim Schrauwen [Opens in a new window] ,
Joris Van de Cavey ,
Guy Vingerhoets ,
Stijn Vanheule ,
Rudy Van den Broecke  and
Hannelore Denys
Wim Schrauwen*
Affiliation:
Department of Medical Psychology, Ghent University Hospital, Ghent, Belgium
Joris Van de Cavey
Affiliation:
Karus VZW, Campus Melle, in partnership with Ghent University Hospital, Ghent, Belgium
Guy Vingerhoets
Affiliation:
Department of Experimental Psychology, Ghent University, Ghent, Belgium
Stijn Vanheule
Affiliation:
Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
Rudy Van den Broecke
Affiliation:
Department of Gynaecology, Ghent University Hospital, Ghent, Belgium
Hannelore Denys
Affiliation:
Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
*
*Correspondence and reprint requests to: Wim Schrauwen, Department of Medical Psychology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

A significant proportion of adjuvant-treated breast cancer patients experience cognitive decline, challenging the person’s ability to return to normal activities after treatment. However, not every patient experiences cognitive problems, and even in patients with impairments, determining clinically important cognitive decline remains challenging. Our objective was to explore differences in neuropsychological performance following adjuvant chemotherapy (CT) in patients with breast cancer.

Method:

We conducted a prospective observational study in an Oncology Breast Clinic and assessed neuropsychological performance before and after adjuvant CT and in non-CT-treated women with breast cancer and healthy controls (HCs). Standardised between-group differences and regression-based change scores were calculated.

Results:

CT-treated patients (n = 66) performed significantly different from non-CT-treated patients (n = 39) and HCs (n = 56). There was a significant effect on verbal fluency (p = .0013). CT performed significantly worse than non-CT and HC [effect size (ES) = .89, p < .001 and ES = .61, p ≤ .001, respectively] and from HCs with regard to proactive interference (ES = .62, p ≤ .001). Regression-based scores revealed more severe cognitive decline in the CT-treated group [24.24% (16/66)] than in the non-CT-treated group [15.20% (6/39)] and HC group [7.14% (4/56)]. Patients who underwent CT and showed cognitive decline were less educated and older, with significantly lower baseline scores.

Conclusions:

CT-treated patients showed more vulnerability on cognitive control and monitoring than non-CT-treated breast cancer patients and HCs. Older patients with less education and lower baseline cognitive performance represent a group at risk for cognitive decline following CT. Identification of patients at risk for decline could improve targeted support and rehabilitation.

Keywords

Breast cancerChemotherapyCognitive dysfunctionNeuropsychologyExecutive functionMemory
Type
Regular Research
Information
Journal of the International Neuropsychological Society , Volume 26 , Issue 8 , September 2020 , pp. 806 - 814
Copyright
Copyright © INS. Published by Cambridge University Press, 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Ahles, T.A. & Hurria, A. (2018). New challenges in psycho-oncology research IV: cognition and cancer: conceptual and methodological issues and future directions. Psycho-Oncology, 27, 3–9.10.1002/pon.4564CrossRefGoogle ScholarPubMed
Ahles, T.A. & Saykin, A.J. (2007). Candidate mechanisms for chemotherapy-induced cognitive changes. Nature Reviews Cancer, 7, 192–201.CrossRefGoogle ScholarPubMed
Ahles, T.A., Saykin, A.J., McDonald, B.C., Li, Y., Furstenberg, C.T., Hanscom, B.S., Mulrooney, T.J., Schwartz, G.N., & Kaufman, P.A. (2010). Longitudinal assessment of cognitive changes associated with adjuvant treatment for breast cancer: impact of age and cognitive reserve. Journal of Clinical Oncology, 28, 4434–4440.CrossRefGoogle ScholarPubMed
Ahles, TA & Root, JC. (2018). Cognitive effects of cancer and cancer treatments. Annual Review of Clinical Psychology;14(1):annurev-clinpsy-050817-084903. doi: 10.1146/annurev-clinpsy-050817-084903CrossRefGoogle ScholarPubMed
Andreotti, C., Root, J.C., Ahles, T.A., McEwen, B.S., & Compas, B.E. (2015). Cancer, coping, and cognition: a model for the role of stress reactivity in cancer-related cognitive decline. Psycho-Oncology, 24, 617–623.10.1002/pon.3683CrossRefGoogle Scholar
Andreotti, C., Root, J.C., Schagen, S.B., McDonald, B.C., Saykin, A.J., Atkinson, T.M., Li, Y., & Ahles, T.A. (2016). Reliable change in neuropsychological assessment of breast cancer survivors. Psycho-Oncology, 25, 43–50.10.1002/pon.3799CrossRefGoogle ScholarPubMed
Andryszak, P., Wiłkość, M., Żurawski, B., & Izdebski, P. (2018). Verbal memory in breast cancer patients treated with chemotherapy with doxorubicin and cyclophosphamide. European Journal of Cancer Care, 27, e12749.10.1111/ecc.12749CrossRefGoogle ScholarPubMed
Benton, A., Hamsher, K., & Sivan, A.B. (1994). Multilingual aphasia examination: manual of instruction. Iowa City: AJA Associates.Google Scholar
Berman, M.G., Askren, M.K., Jung, M., Therrien, B., Peltier, S., Noll, D.C., Zhang, M., Ossher, L., Hayes, D.F., Reuter-Lorenz, P.A., & Cimprich, B. (2014). Pretreatment worry and neurocognitive responses in women with breast cancer. Health Psychology, 33, 222–231.CrossRefGoogle ScholarPubMed
Bernstein, L.J., McCreath, G.A., Komeylian, Z., & Rich, J.B. (2017). Cognitive impairment in breast cancer survivors treated with chemotherapy depends on control group type and cognitive domains assessed: A multilevel meta-analysis. Neuroscience and Biobehavioral Reviews, 83, 417–428.CrossRefGoogle ScholarPubMed
Boele, F.W., Schilder, C.M.T., de Roode, M-L., Deijen, J.B., & Schagen, S.B. (2015). Cognitive functioning during long-term tamoxifen treatment in postmenopausal women with breast cancer. Menopause, 22(1):17–25. doi: 10.1097/GME.0000000000000271CrossRefGoogle ScholarPubMed
Bray, F., Ferlay, J., Soerjomataram, I., Siegel, R.L., Torre, L.A., & Jemal, A. (2018). Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians, 68(6), 394–424. doi: 10.3322/caac.21492.Google ScholarPubMed
Chen, C., Xu, G.H., Li, Y.H., Tang, W.X., & Wang, K. (2016). Selective impairment of attention networks during propofol anesthesia after gynecological surgery in middle-aged women. Journal of the Neurological Sciences, 363, 126–131.10.1016/j.jns.2016.02.037CrossRefGoogle ScholarPubMed
Chen, X., Li, J., Ren, J., Hu, X., Zhu, C., Tian, Y., Ma, H., Yu, F., & Wang, K. (2014). Selective impairment of attention networks in breast cancer patients receiving chemotherapy treatment. Psycho-Oncology, 23, 1165–1171.CrossRefGoogle ScholarPubMed
De Lissnyder, E., Koster, E.H.W., Derakshan, N., & De Raedt, R. (2010). The association between depressive symptoms and executive control impairments in response to emotional and non-emotional information. Cognition and Emotion, 24, 264–280.10.1080/02699930903378354CrossRefGoogle Scholar
De Vries, J., Den Oudsten, B.L., Jacobs, P.M., & Roukema, J.A. (2014). How breast cancer survivors cope with fear of recurrence: a focus group study. Supportive Care in Cancer, 22, 705–712.10.1007/s00520-013-2025-yCrossRefGoogle ScholarPubMed
Delis, D., Kaplan, E., & Kramer, J.H. (2001). Delis-Kaplan Executive Function System (D-KEFS): Examiner’s manual. San Antonio, TX: The Psychological Cooperation.Google Scholar
Henneghan, A.M., Carter, P., Stuifbergan, A., Parmelee, B., & Kesler, S. (2018). Relationships between self-reported sleep quality components and cognitive functioning in breast cancer survivors up to 10 years following chemotherapy. Psycho-Oncology, 27, 1937–1943.CrossRefGoogle ScholarPubMed
Hermelink, K. (2015). Chemotherapy and cognitive function in breast cancer patients: the so-called chemo brain. Journal of the National Cancer Institute. Monographs, 2015, 67–69.CrossRefGoogle ScholarPubMed
Jenkins, V., Shilling, V., Deutsch, G., Bloomfield, D., Morris, R., Allan, S., Bishop, H., Hodson, N., Mitra, S., Sadler, G., Shah, E., Stein, R., Whitehead, S., & Winstanley, J. (2006). A 3-year prospective study of the effects of adjuvant treatments on cognition in women with early stage breast cancer. British Journal of Cancer, 94, 828–834.CrossRefGoogle ScholarPubMed
Lord, C., Buss, C., Lupien, S.J., & Pruessner, J.C. (2008). Hippocampal volumes are larger in postmenopausal women using estrogen therapy compared to past users, never users and men: a possible window of opportunity effect. Neurobiology of Aging, 29, 95–101.10.1016/j.neurobiolaging.2006.09.001CrossRefGoogle ScholarPubMed
McSweeny, A.J., Naugle, R.I., Chelune, G.J., & Lüders, H. (1993). “T Scores for Change”: an illustration of a regression approach to depicting change in clinical neuropsychology. Clinical Neuropsychologist, 7, 300–312.10.1080/13854049308401901CrossRefGoogle Scholar
Menning, S., de Ruiter, M.B., Kieffer, J.M., Agelink van Rentergem, J., Veltman, D.J., Fruijtier, A., Hester, S.A., Oldenburg, M.D., Boven, E., van der Meij, S., Lustig, V., Bos, M.E.M., Boogerd, W., Reneman, L., & Schagen, S.B. (2016). Cognitive impairment in a subset of breast cancer patients after systemic therapy – results from a longitudinal study. Journal of Pain and Symptom Management, 52, 560–569.e1.CrossRefGoogle Scholar
Menning, S., de Ruiter, M.B., Veltman, D.J., Koppelmans, V., Kirschbaum, C., Boogerd, W., Reneman, L., & Schagen, S.B. (2015). Multimodal MRI and cognitive function in patients with breast cancer prior to adjuvant treatment – the role of fatigue. NeuroImage: Clinical, 7:547–554. doi: 10.1016/j.nicl.2015.02.005CrossRefGoogle Scholar
Miatton, M.W.M., Lannoo, E., & Vingerhoets, G. (2004). Updated and extended Flemish normative data of commonly used neuropsychological tests. Psychologica Belgica, 44, 189–216.Google Scholar
Mitchell, T. (2007). The social and emotional toll of chemotherapy – patients’ perspectives. European Journal of Cancer Care, 16, 39–47.10.1111/j.1365-2354.2006.00701.xCrossRefGoogle ScholarPubMed
Mols, F., Vingerhoets, A.J., Coebergh, J.W., & van de Poll-Franse, L.V. (2005). Quality of life among long-term breast cancer survivors: a systematic review. European Journal of Cancer (Oxford, England), 41, 2613–2619.10.1016/j.ejca.2005.05.017CrossRefGoogle ScholarPubMed
Nelson, H. & Willison, J. (1991). National Adult Reading Test Manual (2nd ed.). Windsor: NFER-Nelson.Google Scholar
Nelson, W.L. & Suls, J. (2013) New approaches to understand cognitive changes associated with chemotherapy for non-central nervous system tumors. Journal of Pain and Symptom Management, 46(5), 707–721.CrossRefGoogle ScholarPubMed
Noone, A.M., Howlader, N., Krapcho, M., Miller, D., Brest, A., Yu, M., Ruhl, L., Tatalovich, Z., Mariotto, A., Lewis, D.R., Chen, H.S., Feuer, E.J., & Cronin, K.A. (eds). (2018). SEER Cancer Statistics Review, 1975-2015, National Cancer Institute. Bethesda, MD, USA. https://seer.cancer.gov/csr/1975_2015/, based on November 2017 SEER data submission, posted to the SEER web site, April 2018.Google Scholar
Ono, M., Ogilvie, J.M., Wilson, J.S., Green, H.J., Chambers, S.K., Ownworth, T., & Shum, D.H.K. (2015). A meta-analysis of cognitive impairment and decline associated with adjuvant chemotherapy in women with breast cancer. Frontiers in Oncology 5: 59 doi: 10.3389/fonc.2015.00059CrossRefGoogle ScholarPubMed
Pomykala, K.L., de Ruiter, M.B., Deprez, S., McDonald, B.C., & Silverman, D.H. (2013). Integrating imaging findings in evaluating the post-chemotherapy brain. Brain Imaging and Behavior, 7, 436–452.CrossRefGoogle ScholarPubMed
Root, J.C., Andreotti, C., Tsu, L., Ellmore, T.M., & Ahles, T.A. (2016). Learning and memory performance in breast cancer survivors 2 to 6 years post-treatment: the role of encoding versus forgetting. Journal of Cancer Survivorship: Research and Practice, 10, 593–599.10.1007/s11764-015-0505-4CrossRefGoogle ScholarPubMed
Schagen, S.B., Klein, M., Reijneveld, J.C., Brain, E., Deprez, S., Joly, F., Scherwath, A., Schrauwen, W., & Wefel, J.S. (2014). Monitoring and optimising cognitive function in cancer patients: present knowledge and future directions. EJC Supplements, 12, 29–40.10.1016/j.ejcsup.2014.03.003CrossRefGoogle ScholarPubMed
Schagen, S.B., Muller, M.J., Boogerd, W., Mellenbergh, G.J., & van Dam, F.S. (2006). Change in cognitive function after chemotherapy: a prospective longitudinal study in breast cancer patients. Journal of the National Cancer Institute, 98, 1742–1745.10.1093/jnci/djj470CrossRefGoogle ScholarPubMed
Scherling, C., Collins, B., MacKenzie, J., Bielajew, C., Smith, A.M. (2011). Pre-chemotherapy differences in working memory in breast cancer patients compared to controls: an fMRI study. Frontiers in Human Neuroscience, 5, 1–21.10.3389/fnhum.2011.00122CrossRefGoogle ScholarPubMed
Schilder, C.M., Seynaeve, C., Linn, S.C., Boogerd, W., Gundy, C.M., Beex, L.V., van Dam, F.S., & Schagen, S.B. (2010). The impact of different definitions and reference groups on the prevalence of cognitive impairment: a study in postmenopausal breast cancer patients before the start of adjuvant systemic therapy. Psycho-Oncology, 19, 415–422.10.1002/pon.1595CrossRefGoogle ScholarPubMed
Schmand, B., Lindeboom, J., & Harskamp, F. (1992). De Nederlandse leestest voor volwassenen (the dutch adult reading test). Lisse, The Netherlands: Swets & Zeitlinger.Google Scholar
Seigers, R., Schagen, S.B., Van Tellingen, O., & Dietrich, J. (2013). Chemotherapy-related cognitive dysfunction: current animal studies and future directions. Brain Imaging and Behavior, 7, 453–459.10.1007/s11682-013-9250-3CrossRefGoogle ScholarPubMed
Shilling, V., Jenkins, V., & Trapala, I.S. (2006). The (mis)classification of chemo-fog--methodological inconsistencies in the investigation of cognitive impairment after chemotherapy. Breast Cancer Research and Treatment, 95, 125–129.CrossRefGoogle ScholarPubMed
Tager, F.A., McKinley, P.S., Schnabel, F.R., El-Tamer, M., Cheung, Y.K., Fang, Y., Golden, C.R., Frosch, M.E., Habif, U., Mulligan, M.M., Chen, I.S., & Hershman, D.L. (2010). The cognitive effects of chemotherapy in post-menopausal breast cancer patients: a controlled longitudinal study. Breast Cancer Research and Treatment, 123, 25–34.CrossRefGoogle ScholarPubMed
Vearncombe, K.J. & Pachana, N.A. (2009). Is cognitive functioning detrimentally affected after early, induced menopause? Menopause (New York, N.Y.), 16, 188–198.CrossRefGoogle ScholarPubMed
Wefel, J.S., Saleeba, A.K., Buzdar, A.U., & Meyers, C.A. (2010). Acute and late onset cognitive dysfunction associated with chemotherapy in women with breast cancer. Cancer, 116, 3348–3356.CrossRefGoogle ScholarPubMed
Wefel, J.S. & Schagen, S.B. (2012). Chemotherapy-related cognitive dysfunction. Current Neurology and Neuroscience Reports, 12, 267–275.CrossRefGoogle ScholarPubMed
Wohldmann, E.L., Healy, A.F., & Bourne, L.E. (2008). A mental practice superiority effect: less retroactive interference and more transfer than physical practice. Journal of Experimental Psychology. Learning, Memory, and Cognition, 34, 823–833.CrossRefGoogle ScholarPubMed
Yao, C., Bernstein, L.J., & Rich, J.B. (2017). Executive functioning impairment in women treated with chemotherapy for breast cancer: a systematic review. Breast Cancer Research and Treatment, 166, 15–28.CrossRefGoogle ScholarPubMed
Supplementary material: File

Schrauwen et al. supplementary material

Appendix

Download Schrauwen et al. supplementary material(File)
File 42.7 KB