title: Post-treatment Neurocognition and Psychosocial Care Among Breast Cancer Survivors.
abstract: BACKGROUND
  Chemotherapy for breast cancer has been associated with cognitive problems; however, the impact of adjuvant hormone therapy is less clear. No studies have explored provider discussions about cognitive concerns or factors associated with neurocognitive treatment. This study examined cognitive problems, factors associated with having a provider discussion, and receipt of neurocognitive treatment.
  
  
  METHODS
  Female breast cancer survivors (N=2,537) from the Sister Study and the Two Sister Study who were at least 1 year post-treatment were surveyed in 2012 about their cancer therapies (confirmed by medical records); cognitive concerns; related provider discussions; and neurocognitive treatment. A total of 2,296 women were included in the current 2014 analysis. Extensive covariate information was also ascertained for predictive multivariate models.
  
  
  RESULTS
  The prevalence of self-reported cognitive problems after treatment was 60%. Of those reporting cognitive problems, only 37% had discussed those concerns with a provider and 15% had been treated for cognitive symptoms. The odds of reported cognitive concerns that started during and after treatment were elevated for those who received only hormone therapy and no chemotherapy (OR=1.64, 95% CI=1.15, 2.33); chemotherapy and no hormone therapy (OR=5.63, 95% CI=3.52, 9.00); or both (OR=6.33, 95% CI=4.21, 9.54) compared with those reporting neither treatment.
  
  
  CONCLUSIONS
  The high prevalence of cognitive concerns underscores the importance of monitoring breast cancer survivors for potential neurocognitive effects of hormone and chemotherapy, discussions with survivors about those concerns, and treatment referrals. Monitoring changes over time can help to evaluate both psychosocial and neurocognitive care provided for survivors.
authors.affiliation: Division of Cancer Prevention and Control, Epidemiology and Applied Research Branch, CDC, Atlanta, Georgia. Electronic address: nbuchanan@cdc.gov.
authors.forename: Natasha D
authors.initials: ND
authors.lastname: Buchanan
authors.affiliation: Northrop Grumman Corporation, Information Systems, Atlanta, Georgia.
authors.forename: Sabitha
authors.initials: S
authors.lastname: Dasari
authors.affiliation: Division of Cancer Prevention and Control, Epidemiology and Applied Research Branch, CDC, Atlanta, Georgia.
authors.forename: Juan L
authors.initials: JL
authors.lastname: Rodriguez
authors.affiliation: Division of Cancer Prevention and Control, Epidemiology and Applied Research Branch, CDC, Atlanta, Georgia.
authors.forename: Judith
authors.initials: J
authors.lastname: Lee Smith
authors.affiliation: Social and Scientific Systems, Inc., Durham, North Carolina.
authors.forename: M Elizabeth
authors.initials: ME
authors.lastname: Hodgson
authors.affiliation: Biostatistics Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina.
authors.forename: Clarice R
authors.initials: CR
authors.lastname: Weinberg
authors.affiliation: Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina.
authors.forename: Dale P
authors.initials: DP
authors.lastname: Sandler
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects*; D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000523:psychology; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D003071:Cognition / Q000187:drug effects*; D003072:Cognition Disorders / Q000139:chemically induced* / Q000453:epidemiology; D005260:Female; D006296:Health Services; D006801:Humans; D008875:Middle Aged; D010817:Physician-Patient Relations; D011795:Surveys and Questionnaires; D017741:Survivors
chemical_list: D000970:Antineoplastic Agents; D018931:Antineoplastic Agents, Hormonal