Decline in Cognitive Function in Older Adults With Early-Stage Breast Cancer After Adjuvant Treatment.

Oncologist 2016 Nov 29;21(11):1337-1348. Epub 2016 Jul 29.

Normandie University, UNICAEN, INSERM, U1086, Caen, France

Background: The impact of chemotherapy on cognition among elderly patients has received little attention, although such patients are more prone to presenting with age-related cognitive deficits and/or cognitive decline during chemotherapy. The present study assessed the cognitive function in older adults treated for early-stage breast cancer (EBC).

Patients And Methods: The participants were newly diagnosed EBC patients aged ≥65 years without previous systemic treatment or neurological or psychiatric disease and matched healthy controls. They underwent two assessments: before starting adjuvant therapy and after the end of chemotherapy (including doxorubicin ± docetaxel [CT+ group], = 58) or radiotherapy for patients who did not receive chemotherapy (CT- group, = 61), and at the same interval for the healthy controls ( = 62). Neuropsychological and geriatric assessments were performed. Neuropsychological data were analyzed using the Reliable Change Index.

Results: Forty-nine percent of the patients (mean age, 70 ± 4 years) had objective cognitive decline after adjuvant treatment that mainly concerned working memory. Among these patients, 64% developed a cognitive impairment after adjuvant treatment. Comorbidity was not associated with cognitive decline. No significant difference in objective cognitive decline was found between the two groups of patients; however, the CT+ group had more subjective cognitive complaints after treatment ( = .008). The oldest patients (aged 70-81 years) tended to have more objective decline with docetaxel ( = .05).

Conclusion: This is the largest published study assessing cognitive function in older adults with EBC that included a group of patients treated with modern chemotherapy regimens. Approximately half the patients had objective cognitive decline after adjuvant treatment. The oldest patients were more likely to have cognitive decline with chemotherapy, particularly with docetaxel.

Implications For Practice: This is the largest published study assessing cognitive function in older adults with early-stage breast cancer that included a group of patients treated with modern chemotherapy regimens. Approximately half the patients had objective cognitive decline after adjuvant treatment. The oldest patients were more likely to have cognitive decline with chemotherapy, particularly with docetaxel. Cognitive deficits could affect patients' quality of life and their compliance to treatment. Assessing cognitive dysfunctions in the elderly cancer population is a challenge in clinical practice, but it could influence the choice of the most appropriate therapy, including the use of oral drugs.

Download full-text PDF

Source
http://dx.doi.org/10.1634/theoncologist.2016-0014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5189619PMC
November 2016

Publication Analysis

Top Keywords

cognitive decline
32
adjuvant treatment
20
older adults
16
objective cognitive
16
function older
16
cognitive
16
cognitive function
16
patients
14
decline chemotherapy
12
decline adjuvant
12
breast cancer
12
oldest patients
12
assessing cognitive
12
early-stage breast
12
decline
10
patients aged
8
group patients
8
treated modern
8
adults early-stage
8
modern chemotherapy
8

Similar Publications

Cognitive Changes After Adjuvant Treatment in Older Adults with Early-Stage Breast Cancer.

Oncologist 2019 01 22;24(1):62-68. Epub 2018 Jun 22.

INSERM, U1086, ANTICIPE, Caen, France

Background: Group-based trajectory modeling is particularly important to identify subgroups of patients with pathological cognitive changes after cancer treatment. To date, only one study has explored cognitive trajectories in older patients with cancer. The present article describes objective cognitive changes before to after adjuvant treatment in older adults with early-stage breast cancer (EBC) after adjuvant treatment compared with healthy controls. Read More

View Article and Full-Text PDF
January 2019

Baseline cognitive functions among elderly patients with localised breast cancer.

Eur J Cancer 2014 Sep 20;50(13):2181-9. Epub 2014 Jun 20.

Normandie Université, UMR-S1077, Caen, France; INSERM, U1086, Caen, France; Unité de Recherche Clinique, Centre François Baclesse, Caen, France; CHU de Caen, Service d'Oncologie, Caen, France. Electronic address:

Purpose: Cognitive deficits (CD) are reported among cancer patients receiving chemotherapy, but may also be observed before treatment. Though elderly patients are expected to be more prone to present age-related CD, poor information is available regarding the impact of cancer and chemotherapy on this population. This study assessed baseline cognitive functions (before adjuvant treatment) in elderly early stage breast cancer (EBC) patients. Read More

View Article and Full-Text PDF
September 2014

Assessing brain volume changes in older women with breast cancer receiving adjuvant chemotherapy: a brain magnetic resonance imaging pilot study.

Breast Cancer Res 2018 05 2;20(1):38. Epub 2018 May 2.

Center for Cancer and Aging, City of Hope National Medical Center, Duarte, CA, 91010, USA.

Background: Cognitive decline is among the most feared treatment-related outcomes of older adults with cancer. The majority of older patients with breast cancer self-report cognitive problems during and after chemotherapy. Prior neuroimaging research has been performed mostly in younger patients with cancer. Read More

View Article and Full-Text PDF
May 2018

Cognitive function of older patients receiving adjuvant chemotherapy for breast cancer: a pilot prospective longitudinal study.

J Am Geriatr Soc 2006 Jun;54(6):925-31

Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA.

Objectives: To report on the longitudinal cognitive functioning of older women receiving adjuvant chemotherapy for breast cancer.

Design: Neuropsychological and functional status testing were performed before chemotherapy and 6 months after chemotherapy.

Setting: Cancer center. Read More

View Article and Full-Text PDF
June 2006