title: Cognitive Impairment in a Subset of Breast Cancer Patients After Systemic Therapy-Results From a Longitudinal Study.
abstract: Studies indicate adverse effects of breast cancer (BC) and cancer treatment on cognitive function.
  
  
  
  To investigate the effects of systemic treatment on cognitive performance in BC patients.
  
  
  
  Participants were BC patients scheduled to receive systemic treatment (BC + SYST; n = 31), or no systemic treatment (BC; n = 24) and no-cancer (NC) controls (n = 33). Neuropsychological examinations were used to study cognitive performance on 18 tests grouped into eight cognitive domains, before adjuvant treatment (T1) and six months after chemotherapy (T2), or at similar intervals. We also assessed health-related quality of life, anxiety and depression, mood, stress, and cognitive problems. Analysis of variance was used to assess group differences of cognitive performance and multivariate normative comparison to classify impairment, comparing scores of each participant against the distribution of the scores of NC controls.
  
  
  
  Of BC + SYST, 16% were cognitively impaired at T2, compared to 4% in BC and 6% in NC. Although not significant, we observed moderate effect sizes for worse performance in the BC + SYST group compared to NC (Flanker congruent [effect size {ES} = 0.44] and stimulus incongruent [ES = 0.44]) and compared to BC (Controlled Oral Word Association Test [ES = 0.47], digit span [ES = 0.41], and Hopkins Verbal Learning Test immediate [ES = 0.71] and delayed recall [ES = 0.65]). Cognitively impaired patients had a significantly lower estimated premorbid intelligence, worse physical and social functioning, and more distress at T2 compared to unimpaired patients.
  
  
  
  Our findings indicate that cognitive impairment after systemic treatment occurs in a subset of BC patients. The predictive value of demographic and psychosocial factors in cognitive impairment should be further investigated in a larger sample of impaired patients.
authors.affiliation: Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Sanne
authors.initials: S
authors.lastname: Menning
authors.affiliation: Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Michiel B
authors.initials: MB
authors.lastname: de Ruiter
authors.affiliation: Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors.forename: Jacobien M
authors.initials: JM
authors.lastname: Kieffer
authors.affiliation: Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Joost
authors.initials: J
authors.lastname: Agelink van Rentergem
authors.affiliation: Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Dick J
authors.initials: DJ
authors.lastname: Veltman
authors.affiliation: Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors.forename: Agnetha
authors.initials: A
authors.lastname: Fruijtier
authors.affiliation: Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors.forename: Hester S A
authors.initials: HS
authors.lastname: Oldenburg
authors.affiliation: Department of Medical Oncology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Epie
authors.initials: E
authors.lastname: Boven
authors.affiliation: Department of Surgery, Flevo Hospital, Almere, The Netherlands; Breast Cancer Department, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Suzan
authors.initials: S
authors.lastname: van der Meij
authors.affiliation: Department of Medical Oncology, Flevo Hospital, Almere, The Netherlands.
authors.forename: Vera
authors.initials: V
authors.lastname: Lustig
authors.affiliation: Department of Internal Medicine, Reinier de Graaf Hospital, Delft, The Netherlands.
authors.forename: Monique E M
authors.initials: ME
authors.lastname: Bos
authors.affiliation: Department of Neuro-Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors.forename: Willem
authors.initials: W
authors.lastname: Boogerd
authors.affiliation: Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Liesbeth
authors.initials: L
authors.lastname: Reneman
authors.affiliation: Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands. Electronic address: s.schagen@nki.nl.
authors.forename: Sanne B
authors.initials: SB
authors.lastname: Schagen
mesh_terms: D000704:Analysis of Variance; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy*; D060825:Cognitive Dysfunction / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D015999:Multivariate Analysis; D009483:Neuropsychological Tests; D011446:Prospective Studies
chemical_list: D000970:Antineoplastic Agents
keywords: Breast cancer; adverse effects; chemotherapy; cognitive impairment; longitudinal study