Trajectories of self-reported cognitive function in postmenopausal women during adjuvant systemic therapy for breast cancer.
In a sample of 368 postmenopausal women, we (1) determined within-cohort and between-cohort relationships between adjuvant systemic therapy for breast cancer and self-reported cognitive function during the first 18 months of therapy and (2) evaluated the influence of co-occurring symptoms, neuropsychological function, and other covariates on relationships.



We evaluated self-reported cognitive function, using the Patient Assessment of Own Functioning Inventory (PAOFI), and potential covariates (e.g., co-occurring symptom scores and neuropsychological function z-scores) in 158 women receiving aromatase inhibitor (AI) therapy alone, 104 women receiving chemotherapy followed by AI therapy, and 106 non-cancer controls. Patients were assessed before systemic therapy and then every 6 months, for a total of four assessments over 18 months. Controls were assessed at matched time points. Mixed-effects modeling was used to determine longitudinal relationships.



Controlling for covariates, patients enrolled before chemotherapy reported poorer global cognitive function (p < 0.001), memory (p < 0.001), language and communication (p < 0.001), and sensorimotor function (p = 0.002) after chemotherapy. These patients reported poorer higher-level cognitive and intellectual functions from before chemotherapy to 12 months after initiation of AI therapy (p < 0.001). Higher levels of depressive symptoms (p < 0.001), anxiety (p < 0.001), and fatigue (p = 0.040) at enrollment were predictors of poorer cognitive function over time. PAOFI total score was a predictor of executive function (p = 0.048) and visual working memory (p = 0.005) z-scores, controlling for covariates.



Findings provide further evidence of poorer self-reported cognitive function after chemotherapy and of relationships between co-occurring symptoms and cognitive changes. AI therapy alone does not have an impact on self-reported cognitive function. Copyright © 2015 John Wiley & Sons, Ltd.
School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA.
John D
JD
Merriman
School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA.
Susan M
SM
Sereika
School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.|University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA.
Adam M
AM
Brufsky
School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.|University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA.
Priscilla F
PF
McAuliffe
School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Kandace P
KP
McGuire
School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA.
Jamie S
JS
Myers
School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
Mary L
ML
Phillips
School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
Christopher M
CM
Ryan
School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA.
Amanda L
AL
Gentry
School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA.
Lindsay D
LD
Jones
School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA.
Catherine M
CM
Bender
D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects; D001943:Breast Neoplasms / Q000523:psychology* / Q000628:therapy; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D003071:Cognition; D003072:Cognition Disorders / Q000209:etiology; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005221:Fatigue / Q000209:etiology; D005260:Female; D006801:Humans; D008568:Memory; D008875:Middle Aged; D017698:Postmenopause / Q000523:psychology*; D057566:Self Report