title: Cognitive function in older women with breast cancer treated with standard chemotherapy and capecitabine on Cancer and Leukemia Group B 49907.
abstract: Cognitive changes in older women receiving chemotherapy are poorly understood. We examined self-reported cognitive function for older women who received adjuvant chemotherapy on Cancer and Leukemia Group B (CALGB) 49907. CALGB 49907 randomized 633 women aged ≥65 with stage I-III breast cancer to standard adjuvant chemotherapy (cyclophosphamide-methotrexate-5-fluorouracil or doxorubicin-cyclophosphamide) versus capecitabine. We examined self-reported cognitive function in 297 women (CALGB 361002) who enrolled on the quality of life substudy and had no gross impairment on cognitive screening. Women were evaluated using an 18-item instrument at six time points (baseline through 24 months). At each time point for each patient, we calculated a cognitive function score (CFS) defined as the mean response of items 1-18 and defined impairment as a score >1.5 standard deviations above the overall average baseline score. Differences in scores by patient characteristics were evaluated using a Kruskal-Wallis test. A linear mixed-effects model was used to assess CFSs by treatment over time. Among 297 women, the median age was 71.5 (range 65-85) and 73 % had performance status of 0. Baseline depression and fatigue were reported in 6 and 14 % of patients, respectively. The average CFS at baseline was 2.08 (corresponding to "normal ability"), and baseline cognitive function did not differ by treatment regimen (p = 0.350). Over 24 months, women reported minimal changes at each time point and insignificant differences by treatment arm were observed. In a healthy group of older women, chemotherapy was not associated with longitudinal changes in self-reported cognitive function.
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA. rafreedman@partners.org
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Freedman
authors.forename: Brandelyn
authors.initials: B
authors.lastname: Pitcher
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Keating
authors.forename: Karla V
authors.initials: KV
authors.lastname: Ballman
authors.forename: Jeanne
authors.initials: J
authors.lastname: Mandelblatt
authors.forename: Alice B
authors.initials: AB
authors.lastname: Kornblith
authors.forename: Gretchen G
authors.initials: GG
authors.lastname: Kimmick
authors.forename: Arti
authors.initials: A
authors.lastname: Hurria
authors.forename: Eric P
authors.initials: EP
authors.lastname: Winer
authors.forename: Clifford A
authors.initials: CA
authors.lastname: Hudis
authors.forename: Harvey Jay
authors.initials: HJ
authors.lastname: Cohen
authors.forename: Hyman B
authors.initials: HB
authors.lastname: Muss
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology*; D000069287:Capecitabine; D003071:Cognition; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000031:analogs & derivatives; D006801:Humans; D009483:Neuropsychological Tests; D011788:Quality of Life; D012307:Risk Factors; D011795:Surveys and Questionnaires
chemical_list: D003841:Deoxycytidine; D000069287:Capecitabine; D005472:Fluorouracil