Hostname: page-component-745bb68f8f-s22k5 Total loading time: 0 Render date: 2025-01-27T19:54:05.078Z Has data issue: false hasContentIssue false
  • English
  • Français

Predictors of Cognitive Decline After Chemotherapy in Breast Cancer Patients

Published online by Cambridge University Press:  01 November 2009

KATHARINE J. VEARNCOMBE ,
MARGARET ROLFE ,
MARGARET WRIGHT ,
NANCY A. PACHANA ,
BROOKE ANDREW  and
GEOFFREY BEADLE
KATHARINE J. VEARNCOMBE*
Affiliation:
The University of Queensland, School of Psychology, Brisbane, Australia The Wesley Research Institute, Wesley Hospital, Brisbane, Australia
MARGARET ROLFE
Affiliation:
Graduate Research College, Southern Cross University, Lismore, Australia School of Mathematical Sciences, Queensland University of Technology, Brisbane, Australia
MARGARET WRIGHT
Affiliation:
Queensland Institute of Medical Research, Brisbane, Australia
NANCY A. PACHANA
Affiliation:
The University of Queensland, School of Psychology, Brisbane, Australia
BROOKE ANDREW
Affiliation:
The University of Queensland, School of Psychology, Brisbane, Australia The Wesley Research Institute, Wesley Hospital, Brisbane, Australia
GEOFFREY BEADLE
Affiliation:
Queensland Institute of Medical Research, Brisbane, Australia
*
*Correspondence and reprint requests to: Katharine J. Vearncombe, School of Psychology, University of Queensland, St Lucia Brisbane, Australia. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

The objective of this study is to identify whether decline in cognitive functioning after chemotherapy in women with breast cancer is associated with health/disease, treatment, and psychological variables. Neuropsychological performance, health/disease, and treatment-related information of 136 women with breast cancer (age M = 49.38; SD = 7.92; range = 25.25–67.92) was assessed pre-chemotherapy and 1-month post-chemotherapy. The Reliable Change Index corrected for practice (RCIp) identified women whose performance significantly declined, while Pearson correlations assessed the relationship between cognitive change and predictor variables. A total of 16.9% of women showed significant decline post-chemotherapy, with affected domains including verbal learning and memory, abstract reasoning, and motor coordination. Decline in hemoglobin levels and increased anxiety over the course of chemotherapy was found to significantly predict impairment in multiple cognitive measures. Change in specific cognitive measures was significantly associated with baseline fatigue, depression, and functional well-being (r = 0.23 to 0.33; p = .01 to < .001). Although the effects are small, there is evidence that psychological and health factors may increase vulnerability to cognitive dysfunction after chemotherapy for breast cancer. Significant associations reported in this study may be useful in the identification and treatment of at-risk individuals. (JINS, 2009, 15, 951–962.)

Keywords

Adjuvant chemotherapyBreast cancerCognitive domainsCognitive impairmentNeurotoxicityMemory
Type
Research Articles
Information
Journal of the International Neuropsychological Society , Volume 15 , Issue 6 , November 2009 , pp. 951 - 962
Copyright
Copyright © The International Neuropsychological Society 2009

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., & Saykin, A.J. (2007). Candidate mechanisms for chemotherapy induced cognitive changes. Nature Reviews, 7, 192–201.Google ScholarPubMed
Ahles, T.A., Saykin, A.J., McDonald, B.C., Furstenberg, C.T., Cole, B.F., Hanscom, B.S., et al. (2008). Cognitive function in breast cancer patients prior to adjuvant treatment. Breast Cancer Research and Treatment, 110, 143–152.CrossRefGoogle ScholarPubMed
Bender, C.M., Sereika, S.M., Berga, S.L., Vogel, V.G., Brufsky, A.M., Paraska, K.K., et al. (2006). Cognitive impairment associated with adjuvant therapy in breast cancer. Psychooncology, 15, 422–430.CrossRefGoogle ScholarPubMed
Brady, M.J., Cella, D.F., Bonomi, A.E., Tulsky, D.S., Lloyd, S.R., Deasy, S., et al. (1997). Reliability and validity of the functional assessment of cancer – breast quality-of-life instrument. Journal of Clinical Oncology, 15, 974–986.CrossRefGoogle ScholarPubMed
Castellon, S.A., Ganz, P.A., Bower, J.E., Petersen, L., Abraham, L., & Greendale, G.A. (2004). Neurocognitive performance in breast cancer survivors exposed to adjuvant chemotherapy and Tamoxifen. Journal of Clinical and Experimental Neuropsychology, 26, 955–969.CrossRefGoogle ScholarPubMed
Chelune, G.J., Naugle, R.I., Luders, H., Sedlack, J., & Awad, I.A. (1993). Individual change after epilepsy surgery: Practice effects and base rate information. Neuropsychology, 7, 41–52.CrossRefGoogle Scholar
Cimprich, B. (1992). Attentional fatigue following breast cancer surgery. Research in Nursing and Health, 15, 199–207.CrossRefGoogle ScholarPubMed
Cimprich, B. (1993). Development of an intervention to restore attention in cancer patients. Cancer Nursing, 16, 83–92.CrossRefGoogle ScholarPubMed
Collins, B., Mackenzie, J., Stewart, A., Bielajew, C., & Verma, S. (2009). Cognitive effects of chemotherapy in post-menopausal breast cancer patients 1 year after treatment. Psychooncology, 18, 134–143.CrossRefGoogle ScholarPubMed
Delis, D.C., Kaplan, E., & Kramer, J.H. (2001). D-KEFS: Delis-Kaplan Executive Function System: Examiners Manual. San Antonio: The Psychological Corporation, Harcourt Assessment.Google Scholar
Donovan, K., Small, B.J., Andrykowski, M.A., Schmitt, F.A., Munster, P., & Jacobsen, P.B. (2005). Cognitive functioning after adjuvant chemotherapy and/or radiotherapy for early stage breast carcinoma. Cancer, 104, 2499–2507.CrossRefGoogle ScholarPubMed
Falleti, M.G., Sanfilippo, A., Maruff, P., Weih, L., & Phillips, K. (2005). The nature and severity of cognitive impairment associated with adjuvant chemotherapy in women with breast cancer: A meta-analysis of the current literature. Brain and Cognition, 59, 60–70.CrossRefGoogle ScholarPubMed
Geffen, G.M., Butterworth, P., & Geffen, L.B. (1994). Test-retest reliability of a new form of the Auditory Verbal Learning Test (AVLT). Archives of Clinical Neuropsychology, 9, 303–316.CrossRefGoogle ScholarPubMed
Geffen, G., & Geffen, L. (2000). Auditory Verbal Learning Test: Australian Manual: Computerized Scoring Program and Population Norms. Melbourne: ACER Press.Google Scholar
Golden, C., & Freshwater, S. (2002). Stroop Color and Word Test: Revised Examiners Manual. Wood Dale, Illinois; Stroelting.Google Scholar
Hermelink, K., Henschel, V., Untch, M., Bauerfeind, I., Lux, M.P., & Munzel, K. (2008). Short-term effects of treatment-induced hormonal changes on cognitive function in breast cancer patients: Results of a multicenter, prospective, longitudinal study. Cancer, 113, 2431–2439.CrossRefGoogle ScholarPubMed
Hermelink, K., Untch, M., Lux, M.P., Kreienberg, R., Beck, T., Bauerfeind, I., et al. (2007). Cognitive function during neoadjuvant chemotherapy for breast cancer. Results of a prospective, multicenter, longitudinal study. Cancer, 109, 1905–1913.CrossRefGoogle ScholarPubMed
Hurria, A., Somlo, G., & Ahles, T. (2007). Renaming “Chemobrain”. Cancer Investigations, 25, 373–377.CrossRefGoogle ScholarPubMed
Jansen, C.E., Miaskowski, C., Dodd, M., Dowling, G., & Kramer, J. (2005). A metaanalysis of studies of the effects of cancer chemotherapy on various domains of cognitive function. Cancer, 104, 2222–2233.CrossRefGoogle ScholarPubMed
Jacobson, P.B., Garland, L.L., Booth-Jones, M., Donovan, K.A., Thors, C.L., Winters, E., et al. (2004). Relationship of hemoglobin levels to fatigue and cognitive functioning among cancer patients receiving chemotherapy. Journal of Pain and Symptom Management, 28, 7–18.CrossRefGoogle Scholar
Lezak, M.D. (1995). Neuropsychological Assessment (3rd ed.). New York: Oxford University Press.Google Scholar
McSweeny, A.J., Naugle, R.I., Chelune, G.J., & Luders, H. (1993). “T scores for Change”: An illustration of a regression approach to depicting change in clinical neuropsychology. The Clinical Neuropsychologist, 7, 300–312.CrossRefGoogle Scholar
Mehlsen, M., Pedersen, A.D., Jensen, A.B., & Zachariae, R. (2009). No indications of cognitive side-effects in a prospective study of breast cancer patients receiving adjuvant chemotherapy. Psychooncology, 18, 248–257.CrossRefGoogle Scholar
Mehnert, A., Scherwath, A., Schirmer, L., Schleimer, B, Petersen, C., Schulz-Kindermann, F., et al. (2007). The association between neuropsychological impairment, self-perceived cognitive deficits, fatigue and health related quality of life in breast cancer survivors following standard adjuvant versus high-dose chemotherapy. Patient Education and Counseling, 66, 108–118.CrossRefGoogle ScholarPubMed
Nelson, H.E., & Willison, J. (1991). National Adult Reading Test (NART) Manual. NFER-NELSON.Google Scholar
Quesnel, C., Savard, J., & Ivers, H. (2009). Cognitive impairments associated with breast cancer treatments: Results from a longitudinal study. Breast Cancer Research and Treatment, 116, 113–123.CrossRefGoogle ScholarPubMed
Robertson, I.H., Ward, T., Ridgeway, V., & Nimmo-Smith, I. (1994). The Test of Everyday Attention: Manual. Bury St Edmunds, UK: Thames Valley Test Company.Google Scholar
Schagen, S.B., Muller, M.J., Boogerd, W., Mellenbergh, G.J., & van Dam, F.S.A.M. (2006). Change in cognitive function after chemotherapy: A prospective longitudinal study in breast cancer patients. Journal of the National Cancer Institute, 98, 1742–1745.CrossRefGoogle ScholarPubMed
Schagen, S.B., Muller, M.J., Boogerd, W., Rosenbrand, R.M., van Rhijn, D., Rodenhuis, S., et al. (2002). Late effects of adjuvant chemotherapy on cognitive function: A follow-up study in breast cancer patients. Annals of Oncology, 13, 1387–1397.CrossRefGoogle ScholarPubMed
Schagen, S.B., van Dam, F.S.A.M., Muller, M.J., Boorgerd, W., Lindeboom, J., & Bruning, P.F. (1999). Cognitive deficits after postoperative adjuvant chemotherapy for breast carcinoma. Cancer, 85, 640–650.3.0.CO;2-G>CrossRefGoogle ScholarPubMed
Scherwath, A., Mehnert, A., Schleimer, B., Schirmer, L., Fehlauer, F., Kreienberg, R., et al. (2006). Neuropsychological function in high-risk breast cancer survivors after stem-cell supported high-dose therapy verses standard-dose chemotherapy: Evaluation of long-term treatment effects. Annals of Oncology, 17, 415–423.CrossRefGoogle Scholar
Silverman, D.H.S., Dy, C.J., Castellon, S.A., Lai, J., Pio, B.S., Abraham, L., et al. (2007). Altered frontocortical, cerebellar, and basal ganglia activity in adjuvant-treated breast cancer survivors 5-10 years after chemotherapy. Breast Cancer Research and Treatment. 103, 303–311.CrossRefGoogle ScholarPubMed
Smith, A. (1982). Symbol Digit Modalities Test: Manual Revised. Los Angeles: Western Psychological Services.Google Scholar
Stewart, A., Bielajew, C., Collins, B., Parkinson, M., & Tomiak, E. (2006). A meta-analysis of the neuropsychological effects of adjuvant chemotherapy treatment in women treated for breast cancer. Clinical Neuropsychology, 20, 76–89.CrossRefGoogle ScholarPubMed
Stewart, A., Collins, B., Mackenzie, J., Tomiak, E., Verma, S., & Bielajew, C. (2008). The cognitive effects of adjuvant chemotherapy in early stage breast cancer: A prospective study. Psychooncology, 17, 122–130.CrossRefGoogle ScholarPubMed
Strauss, E., Sherman, E.M.S., & Spreen, O. (2006). A Compendium of Neuropsychological Tests: Administration, Norms and Commentary. New York: Oxford University Press.Google Scholar
Tchen, N., Juffs, H.G., Downie, F.P., Yi, Q., Hu, H., Chemerynsky, I., et al. (2003). Cognitive function, fatigue, and menopausal symptoms in women receiving adjuvant chemotherapy for breast cancer. Journal of Clinical Oncology, 21, 4175–4183.CrossRefGoogle ScholarPubMed
Temkin, N.R., Heaton, R.K., Grant, I., & Dikmen, S.S. (1999). Detecting significant change in neuropsychological test performance: A comparison of four models. Journal of the International Neuropsychological Society, 5, 357–369.CrossRefGoogle ScholarPubMed
Tiffin, J. (1968). Purdue Pegboard: Examiner Manual. Chicago: Science Research Associates.Google Scholar
van Dam, F.S.A.M., Schagen, S., Muller, M.J., Boogerd, W., Wall, E., Fortuym, D., et al. (1998). Impairment of cognitive function in women receiving adjuvant treatment for high-risk breast cancer: High dose versus standard-dose chemotherapy. Journal of the National Cancer Institute, 90, 210–218.CrossRefGoogle ScholarPubMed
Vardy, J., & Tannock, I. (2007). Cognitive function after chemotherapy in adults with solid tumours. Critical Reviews in Oncology/Hematology, 63, 183–202.CrossRefGoogle ScholarPubMed
Verstappen, C.C.P., Heimans, J.J., Hoekman, K., & Postma, T.J. (2003). Neurotoxic complications of chemotherapy in patients with cancer. Clinical signs and optimal management. Drugs, 63, 1549–1563.CrossRefGoogle ScholarPubMed
Waters, G.S., & Caplan, D. (2003). The reliability and stability of verbal working memory measures. Behavior Research Methods, Instruments and Computers, 35, 550–564.CrossRefGoogle ScholarPubMed
Wechsler, D. (1997a). Wechsler Memory Scale: Administration and Scoring Manual (3rd ed.). San Antonio: The Psychological CorporationGoogle Scholar
Wechsler, D. (1997b) Wechsler Adult Intelligence Scale: Administration and Scoring Manual (3rd ed.). New York: The Psychological Corporation.Google Scholar
Wefel, J.S., Lenzi, R., Theriault, R., Buzdar, A.U., Cruickshank, S., & Meyers, C.A. (2004a). ‘Chemobrain’ in breast carcinoma? A prologue. Cancer, 101, 466–475.CrossRefGoogle ScholarPubMed
Wefel, J.S., Lenzi, R., Theriault, R.L., Davis, R.N., & Meyers, C.A. (2004b). The cognitive sequelae of standard-dose adjuvant chemotherapy in women with breast carcinoma: Results of a prospective, randomized, longitudinal trial. Cancer, 100, 2292–2299.CrossRefGoogle ScholarPubMed
Wieneke, M.H., & Dienst, E.R. (1995). Neuropsychological assessment of cognitive functioning following chemotherapy for breast cancer. Psychooncology, 4, 61–66.CrossRefGoogle Scholar
Yellen, S.B., Cella, D.F., Webster, K., Blendowski, C., & Kaplan, E. (1997). Measuring fatigue and other anemia-related symptoms with the Functional Assessment of Cancer Therapy (FACT) measurement system. Journal of Pain and Symptom Management, 13, 63–74.CrossRefGoogle ScholarPubMed
Zigmond, A.S, & Snaith, R.P. (1983). The hospital anxiety and depression scale. Acta Psychiatricia Scandinavica, 67, 361–370.CrossRefGoogle ScholarPubMed