Breast Cancer Coverage from Every Angle

Update on Cancer-Related Cognitive Outcomes Among Older Breast Cancer Survivors

By: Hillary Ojeda
Posted: Monday, December 3, 2018

The majority of patients treated for breast cancer do not experience cancer-related cognitive problems, according to the Thinking and Living With Cancer study published in the Journal of Clinical Oncology. However, Jeanne S. Mandelblatt, MD, MPH, of the Lombardi Comprehensive Cancer Center, Washington, DC, and colleagues found that older breast cancer survivors with aging-related phenotypes and genotypes may be at risk for cognitive decline, especially after chemotherapy.

“In this study, patients who were more likely to have cognitive issues were a small group who have one or two copies of the ApoE4 gene, but the data are inconclusive, and we are examining this more thoroughly,” stated Dr. Mandelblatt in an institutional press release.

The researchers compared 344 patients with breast cancer between the ages of 60 and 98 before and after treatment with a matched group of 347 cancer-free women. They collected information regarding cognitive outcomes through biospecimens, surveys, self-reported Functional Assessment of Cancer Therapy–Cognitive Function, and neuropsychological tests. The tests were given before treatment, 12 months after treatment, and 24 months after treatment.

Treatment appeared to be related to longitudinal cognition scores. For instance, survivors who received chemotherapy seemed to have increasingly worse attention, processing speed, and executive function scores (P = .05), and those who initiated hormonal therapy had lower learning and memory scores at 12 months (P = .03) than other groups.

Of note, about 95% of the participants in each group provided biospecimens for ApoE4 testing. As mentioned, patients who were more likely to have cognitive issues were those who have one or two copies of the ApoE gene. This small group showed a steady decline in cognitive function test scores after chemotherapy compared with those without the gene and participants who did not have cancer.

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