title: Neuropsychological functioning in postmenopausal breast cancer patients treated with tamoxifen or exemestane after AC-chemotherapy: cross-sectional findings from the neuropsychological TEAM-side study.
abstract: BACKGROUND
  Previous studies have indicated that a subset of cancer patients treated with chemotherapy show cognitive deficits and/or experience cognitive complaints, whereas literature about the influence of hormonal therapies on cognition is sparse. Because of the accumulating knowledge about the importance of estrogen for cognitive functioning, there is growing concern about adjuvant hormonal therapy for breast cancer (BC) affecting cognition. We examined the cognitive functioning of postmenopausal BC patients who were, following doxorubicin/cyclophosphamide (AC) chemotherapy, randomized to tamoxifen or exemestane, and compared their performance with that of non-cancer controls.
  
  
  METHODS
  Thirty BC patients using tamoxifen and 50 patients using exemestane underwent interviews, questionnaires and cognitive tests, on average two years after completion of AC chemotherapy. Forty eight healthy controls were tested with similar measures.
  
  
  RESULTS
  Memory complaints were reported by 28% of AC/tamoxifen users, 24% of AC/exemestane users and 6% of healthy controls (p=0.02). Cognitive testing revealed no statistically significant differences between tamoxifen and exemestane users, but suggested that tamoxifen use is possibly related to worse verbal functioning, while exemestane use is possibly related to slower manual motor speed. Both patient groups performed significantly worse than healthy controls on verbal fluency and information processing speed.
  
  
  CONCLUSIONS
  Our findings show that sequential treatment of AC-chemotherapy and hormonal therapy in postmenopausal, primary BC is associated with lower test scores for certain cognitive functions, and provide indications for possibly distinctive associations for different types of hormonal treatment. Future research with larger groups is recommended to obtain a more definite picture.
authors.affiliation: Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands. c.schilder@nki.nl
authors.forename: Christina M
authors.initials: CM
authors.lastname: Schilder
authors.forename: Petronella C
authors.initials: PC
authors.lastname: Eggens
authors.forename: Caroline
authors.initials: C
authors.lastname: Seynaeve
authors.forename: Sabine C
authors.initials: SC
authors.lastname: Linn
authors.forename: Willem
authors.initials: W
authors.lastname: Boogerd
authors.forename: Chad M
authors.initials: CM
authors.lastname: Gundy
authors.forename: Louk V
authors.initials: LV
authors.lastname: Beex
authors.forename: Frits S
authors.initials: FS
authors.lastname: Van Dam
authors.forename: Sanne B
authors.initials: SB
authors.lastname: Schagen
mesh_terms: D000368:Aged; D000730:Androstadienes / Q000008:administration & dosage / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001007:Anxiety / Q000139:chemically induced / Q000209:etiology; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000523:psychology*; D017024:Chemotherapy, Adjuvant; D003071:Cognition / Q000187:drug effects; D003072:Cognition Disorders / Q000139:chemically induced*; D003430:Cross-Sectional Studies; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D003863:Depression / Q000139:chemically induced / Q000209:etiology; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects; D005221:Fatigue / Q000139:chemically induced / Q000209:etiology; D005260:Female; D006801:Humans; D008875:Middle Aged; D017698:Postmenopause; D011446:Prospective Studies; D011788:Quality of Life; D013629:Tamoxifen / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D000730:Androstadienes; D013629:Tamoxifen; D004317:Doxorubicin; D003520:Cyclophosphamide; C056516:exemestane