title: Decline in Cognitive Function in Older Adults With Early-Stage Breast Cancer After Adjuvant Treatment.
abstract: BACKGROUND
  The impact of chemotherapy on cognition among elderly patients has received little attention, although such patients are more prone to presenting with age-related cognitive deficits and/or cognitive decline during chemotherapy. The present study assessed the cognitive function in older adults treated for early-stage breast cancer (EBC).
  
  
  METHODS
  The participants were newly diagnosed EBC patients aged ≥65 years without previous systemic treatment or neurological or psychiatric disease and matched healthy controls. They underwent two assessments: before starting adjuvant therapy and after the end of chemotherapy (including doxorubicin ± docetaxel [CT+ group],n= 58) or radiotherapy for patients who did not receive chemotherapy (CT- group,n= 61), and at the same interval for the healthy controls (n= 62). Neuropsychological and geriatric assessments were performed. Neuropsychological data were analyzed using the Reliable Change Index.
  
  
  RESULTS
  Forty-nine percent of the patients (mean age, 70 ± 4 years) had objective cognitive decline after adjuvant treatment that mainly concerned working memory. Among these patients, 64% developed a cognitive impairment after adjuvant treatment. Comorbidity was not associated with cognitive decline. No significant difference in objective cognitive decline was found between the two groups of patients; however, the CT+ group had more subjective cognitive complaints after treatment (p= .008). The oldest patients (aged 70-81 years) tended to have more objective decline with docetaxel (p= .05).
  
  
  CONCLUSIONS
  This is the largest published study assessing cognitive function in older adults with EBC that included a group of patients treated with modern chemotherapy regimens. Approximately half the patients had objective cognitive decline after adjuvant treatment. The oldest patients were more likely to have cognitive decline with chemotherapy, particularly with docetaxel.
  
  
  CONCLUSIONS
  This is the largest published study assessing cognitive function in older adults with early-stage breast cancer that included a group of patients treated with modern chemotherapy regimens. Approximately half the patients had objective cognitive decline after adjuvant treatment. The oldest patients were more likely to have cognitive decline with chemotherapy, particularly with docetaxel. Cognitive deficits could affect patients' quality of life and their compliance to treatment. Assessing cognitive dysfunctions in the elderly cancer population is a challenge in clinical practice, but it could influence the choice of the most appropriate therapy, including the use of oral drugs.
authors.affiliation: Normandie University, UNICAEN, INSERM, U1086, Caen, France.|Clinical Research Department, Centre François Baclesse, Caen, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Lange
authors.affiliation: Normandie University, UNICAEN, INSERM, U1086, Caen, France.|Clinical Research Department, Centre François Baclesse, Caen, France.
authors.forename: Natacha
authors.initials: N
authors.lastname: Heutte
authors.affiliation: Care Support Department, Centre Henri-Becquerel, Rouen, France.|Medical Oncology Department, Centre Henri-Becquerel, Rouen, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Rigal
authors.affiliation: Breast Committee, Centre François Baclesse, Caen, France.
authors.forename: Sabine
authors.initials: S
authors.lastname: Noal
authors.affiliation: Oncology-Hematology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
authors.forename: Jean-Emmanuel
authors.initials: JE
authors.lastname: Kurtz
authors.affiliation: Breast Committee, Centre François Baclesse, Caen, France.
authors.forename: Christelle
authors.initials: C
authors.lastname: Lévy
authors.affiliation: Breast Committee, Centre François Baclesse, Caen, France.
authors.forename: Djelila
authors.initials: D
authors.lastname: Allouache
authors.affiliation: Clinical Research Department, Centre François Baclesse, Caen, France.
authors.forename: Chantal
authors.initials: C
authors.lastname: Rieux
authors.affiliation: Care Support Department, Centre Henri-Becquerel, Rouen, France.
authors.forename: Johan
authors.initials: J
authors.lastname: Lefel
authors.affiliation: Clinical Research Department, Centre François Baclesse, Caen, France.
authors.forename: Bénédicte
authors.initials: B
authors.lastname: Clarisse
authors.affiliation: Medical Oncology Department, Centre Henri-Becquerel, Rouen, France.
authors.forename: Corinne
authors.initials: C
authors.lastname: Veyret
authors.affiliation: Oncology-Hematology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Barthélémy
authors.affiliation: Oncology-Hematology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
authors.forename: Nadine
authors.initials: N
authors.lastname: Longato
authors.affiliation: Normandie University, UNIROUEN, INSERM, U982, Rouen, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Castel
authors.affiliation: Normandie University, UNICAEN, EPHE Paris, INSERM, U1077, Caen, France.
authors.forename: Francis
authors.initials: F
authors.lastname: Eustache
authors.affiliation: Normandie University, UNICAEN, EPHE Paris, INSERM, U1077, Caen, France.
authors.forename: Bénédicte
authors.initials: B
authors.lastname: Giffard
authors.affiliation: Normandie University, UNICAEN, INSERM, U1086, Caen, France f.joly@baclesse.fr.|Clinical Research Department, Centre François Baclesse, Caen, France.|Medical Oncology, CHU de Caen, Caen, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Joly
keywords: Breast cancer; Chemotherapy; Cognition deficits; Elderly; Neuropsychology