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William J. Gradishar, MD, FACP, FASCO


Chronic Inflammation and Cognitive Problems: Potential Link in Older Breast Cancer Survivors

By: Anna Fanelli
Posted: Thursday, December 15, 2022

According to a study called Thinking and Living with Cancer (TLC), published in the Journal of Clinical Oncology, researchers observed longitudinal relationships between C-reactive protein (CRP) and cognition in older breast cancer survivors. They reported that chronic inflammation may play a role in the development of cognitive problems in this population.

“Being able to test for levels of inflammation at the same time that cognition was being rigorously evaluated gave the TLC team a potential window into the biology underlying cognitive concerns,” Elizabeth C. Breen, PhD, of the University of California, Los Angeles, and colleagues, in an institutional press release.

In this study, the authors assessed 400 women older than age 60 as well as 329 controls with CRP specimens. These patients were also newly diagnosed with primary breast cancer from stage 0–III. Women with dementia, neurologic disorders, and other cancers were excluded from the study. Assessments occurred before systemic therapy and enrollment and at annual visits of up to 60 months. Cognition was measured using the Functional Assessment of Cancer Therapy–Cognitive Function (FACT-Cog) and neuropsychological testing.

Most survivors (60.9%) had stage I, estrogen receptor–positive (87.6%) tumors. Survivors had significantly higher adjusted mean natural log CRP than controls at baseline and at 12-, 24-, and 60-month visits (all P < .05). Higher adjusted natural log CRP predicted lower participant-reported cognition on subsequent visits among survivors—but not among controls (P interaction = .008). These effects were unchanged by depression or anxiety. Overall, survivors had adjusted FACT-Cog scores that were 9.5 and 14.2 points lower than controls at CRP levels of 3.0 and 10.0 mg/L. Survivors had poorer neuropsychological test performance (vs. controls).

Therefore, cognitive performance, as measured by standardized neuropsychological tests, failed to show a link between CRP and cognition. This finding suggests that women may be more sensitive to differences in their everyday cognitive function.

Disclosure: The study authors reported no conflicts of interest.

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