How Common Is Cognitive Impairment After Chemotherapy in Breast Cancer Survivors?


Key Points

  • Significantly greater cognitive impairment was reported by patients with breast cancer vs controls.
  • More cancer patients reported clinically significant impairment from pre- to postchemotherapy and at 6 months after chemotherapy vs controls over the same intervals.

In a prospective longitudinal study reported in the Journal of Clinical Oncology, Janelsins et al found that nearly half of women with breast cancer reported a clinically significant decline in cognitive function from before to after chemotherapy, compared with only 10% of age-matched noncancer controls over the same interval.

Study Details

The study involved 581 patients with breast cancer (mean age = 53 years) and 364 controls (mean age = 53 years). Patients received chemotherapy at community oncology clinics via the University of Rochester Cancer Center National Cancer Institute Community Oncology Research Program (NCORP); overall, 48% received anthracycline-based regimens. Age-matched noncancer controls were recruited from the same source populations as the patients.

Patients and controls completed the Functional Assessment of Cancer Therapy–Cognitive Function (FACT-Cog) at prechemotherapy (0 months) and postchemotherapy (4.8 months) and at a 6-month follow-up (11.5 months). Analyses were adjusted for age; education; race; menopausal status; and baseline reading ability, anxiety, and depressive symptoms. A minimal clinically important difference cutoff (decrease of ≥ 13.8 points in FACT-Cog using the standard deviation for controls at baseline) was used to determine the percentages of impairment over time.

Increased Cognitive Impairment

Compared with controls, cancer patients reported significantly greater cognitive difficulties, according to the FACT-Cog total score and in the 4 subscales of perceived cognitive impairment, perceived cognitive ability, impact of cognitive impairment on quality of life, and perceived cognitive impairment by others from prechemotherapy to postchemotherapy and from prechemotherapy to 6-month follow-up (P < .001 for all comparisons).

Among cancer patients, lower FACT-Cog total scores were associated with an increased baseline anxiety, depression, and decreased cognitive reserve, whereas treatment regimen, hormone therapy, and radiation therapy were not significantly associated with FACT-Cog total scores from postchemotherapy to 6-month follow-up. A clinically significant decrease in cognitive function was reported by 45.2% of cancer patients vs 10.4% of controls from prechemotherapy to postchemotherapy and by 36.5% vs 13.6% from prechemotherapy to 6-month follow-up.

The investigators concluded: “Patients with breast cancer who were treated in community oncology clinics report substantially more cognitive difficulties up to 6 months after treatment with chemotherapy than do age-matched noncancer controls.”

The study was supported by National Cancer Institute grants.

Michelle C. Janelsins, PhD, MPH, of the University of Rochester Medical Center, James P. Wilmot Cancer Institute, is the corresponding author of the Journal of Clinical Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.