title: Decision-making impairments in breast cancer patients treated with tamoxifen.
abstract: The selective estrogen receptor modulator tamoxifen (TAM) is most commonly prescribed for patients with hormone-sensitive breast cancer. Although TAM can bind to estrogen receptors in the nervous system, it is unknown whether it acts as an estrogen agonist or antagonist in the human brain. Several studies have reported the negative effects of TAM on cognitive function; however, its effects on decision-making function have not been previously explored. The present study aimed to investigate the decision-making function under ambiguity and risk in breast cancer patients treated with TAM. Participants included breast cancer patients taking TAM (TAM, n=47) and breast cancer patients not taking TAM (non-TAM, n=45) as well as their matched healthy controls (HC, n=50). All participants were given the Iowa Gambling Task (IGT) to assess their decision-making under conditions involving ambiguity, the Game of Dice Task (GDT) to assess their decision-making under conditions involving risk, and a battery of neuropsychological tests. Our results indicated that patients in the TAM group were significantly impaired as assessed by both the IGT and GDT and performed significantly worse on some aspects of various tasks involving memory and information processing. Furthermore, we found that decreased performance on verbal memory testing significantly correlated with IGT performance, and executive dysfunction was associated with poor GDT performance in breast cancer patients undergoing TAM treatment. This study demonstrates that breast cancer patients taking TAM have several decision-making impairments. These findings may support the idea that TAM resulting in cognitive changes plays an antagonistic role in the areas of the brain where estrogen receptors are present, including the prefrontal cortex, hippocampus and amygdala.
authors.affiliation: Laboratory of Neuropsychology, The First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
authors.forename: Xingui
authors.initials: X
authors.lastname: Chen
authors.affiliation: Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Oncology, The Second Hospital of Zhejiang University College of Medicine, Hangzhou, China.
authors.forename: Jingjing
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
authors.forename: Juluo
authors.initials: J
authors.lastname: Chen
authors.affiliation: Laboratory of Neuropsychology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
authors.forename: Dandan
authors.initials: D
authors.lastname: Li
authors.affiliation: Laboratory of Neuropsychology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
authors.forename: Rong
authors.initials: R
authors.lastname: Ye
authors.affiliation: Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
authors.forename: Jingjie
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Laboratory of Neuropsychology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
authors.forename: Chunyan
authors.initials: C
authors.lastname: Zhu
authors.affiliation: Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
authors.forename: Yanghua
authors.initials: Y
authors.lastname: Tian
authors.affiliation: Laboratory of Neuropsychology, The First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China. Electronic address: wangkai1964@126.com.
authors.forename: Kai
authors.initials: K
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects* / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy / Q000523:psychology*; D003657:Decision Making / Q000187:drug effects*; D056344:Executive Function / Q000187:drug effects; D030141:Feedback, Psychological; D005260:Female; D005715:Gambling / Q000523:psychology; D006801:Humans; D008568:Memory / Q000187:drug effects; D008875:Middle Aged; D009483:Neuropsychological Tests; D011597:Psychomotor Performance / Q000187:drug effects; D012309:Risk-Taking; D013629:Tamoxifen / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D018931:Antineoplastic Agents, Hormonal; D013629:Tamoxifen
keywords: Breast cancer; Endocrine therapy; Game of Dice Task; Iowa Gambling Task; Tamoxifen