title: Cognitive complaints after breast cancer treatments: examining the relationship with neuropsychological test performance.
abstract: BACKGROUND
  Cognitive complaints are reported frequently after breast cancer treatments. Their association with neuropsychological (NP) test performance is not well-established.
  
  
  METHODS
  Early-stage, posttreatment breast cancer patients were enrolled in a prospective, longitudinal, cohort study prior to starting endocrine therapy. Evaluation included an NP test battery and self-report questionnaires assessing symptoms, including cognitive complaints. Multivariable regression models assessed associations among cognitive complaints, mood, treatment exposures, and NP test performance.
  
  
  RESULTS
  One hundred eighty-nine breast cancer patients, aged 21-65 years, completed the evaluation; 23.3% endorsed higher memory complaints and 19.0% reported higher executive function complaints (>1 SD above the mean for healthy control sample). Regression modeling demonstrated a statistically significant association of higher memory complaints with combined chemotherapy and radiation treatments (P = .01), poorer NP verbal memory performance (P = .02), and higher depressive symptoms (P < .001), controlling for age and IQ. For executive functioning complaints, multivariable modeling controlling for age, IQ, and other confounds demonstrated statistically significant associations with better NP visual memory performance (P = .03) and higher depressive symptoms (P < .001), whereas combined chemotherapy and radiation treatment (P = .05) approached statistical significance.
  
  
  CONCLUSIONS
  About one in five post-adjuvant treatment breast cancer patients had elevated memory and/or executive function complaints that were statistically significantly associated with domain-specific NP test performances and depressive symptoms; combined chemotherapy and radiation treatment was also statistically significantly associated with memory complaints. These results and other emerging studies suggest that subjective cognitive complaints in part reflect objective NP performance, although their etiology and biology appear to be multifactorial, motivating further transdisciplinary research.
authors.affiliation: Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA 90095-6900, USA. pganz@mednet.ucla.edu
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Ganz
authors.forename: Lorna
authors.initials: L
authors.lastname: Kwan
authors.forename: Steven A
authors.initials: SA
authors.lastname: Castellon
authors.forename: Amy
authors.initials: A
authors.lastname: Oppenheim
authors.forename: Julienne E
authors.initials: JE
authors.lastname: Bower
authors.forename: Daniel H S
authors.initials: DH
authors.lastname: Silverman
authors.forename: Steve W
authors.initials: SW
authors.lastname: Cole
authors.forename: Michael R
authors.initials: MR
authors.lastname: Irwin
authors.forename: Sonia
authors.initials: S
authors.lastname: Ancoli-Israel
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Belin
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001007:Anxiety / Q000209:etiology / Q000523:psychology; D001943:Breast Neoplasms / Q000188:drug therapy / Q000523:psychology* / Q000532:radiotherapy / Q000628:therapy*; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D003071:Cognition / Q000187:drug effects* / Q000528:radiation effects; D060825:Cognitive Dysfunction / Q000139:chemically induced* / Q000209:etiology*; D003863:Depression / Q000209:etiology / Q000523:psychology; D005221:Fatigue / Q000209:etiology / Q000523:psychology; D005260:Female; D006613:Higher Nervous Activity / Q000187:drug effects* / Q000528:radiation effects; D006801:Humans; D016014:Linear Models; D008137:Longitudinal Studies; D008568:Memory / Q000187:drug effects* / Q000528:radiation effects; D008875:Middle Aged; D015999:Multivariate Analysis; D009483:Neuropsychological Tests; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D057566:Self Report; D011795:Surveys and Questionnaires
chemical_list: D000970:Antineoplastic Agents