title: Cognitive Complaints in Survivors of Breast Cancer After Chemotherapy Compared With Age-Matched Controls: An Analysis From a Nationwide, Multicenter, Prospective Longitudinal Study.
abstract: Purpose Cancer-related cognitive impairment is an important problem for patients with breast cancer, yet its trajectory is not fully understood. Some previous cancer-related cognitive impairment research is limited by heterogeneous populations, small samples, lack of prechemotherapy and longitudinal assessments, use of normative data, and lack of generalizability. We addressed these limitations in a large prospective, longitudinal, nationwide study. Patients and Methods Patients with breast cancer from community oncology clinics and age-matched noncancer controls completed the Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog) at prechemotherapy and postchemotherapy and at a 6-month follow-up as an a priori exploratory aim. Longitudinal models compared FACT-Cog scores between patients and controls at the three assessments and adjusted for age, education, race, menopausal status, and baseline reading ability, anxiety, and depressive symptoms. A minimal clinically important difference cutoff determined percentages of impairment over time. Results Of patients, 581 patients with breast cancer (mean age, 53 years; 48% anthracycline-based regimens) and 364 controls (mean age, 53 years) were assessed. Patients reported significantly greater cognitive difficulties on the FACT-Cog total score and four subscales from prechemotherapy to postchemotherapy compared with controls as well as from prechemotherapy to 6-month follow-up (all P < .001). Increased baseline anxiety, depression, and decreased cognitive reserve were significantly associated with lower FACT-Cog total scores. Treatment regimen, hormone, or radiation therapy was not significantly associated with FACT-Cog total scores in patients from postchemotherapy to 6-month follow-up. Patients were more likely to report a clinically significant decline in self-reported cognitive function than were controls from prechemotherapy to postchemotherapy (45.2% v 10.4%) and from prechemotherapy to 6-month follow-up (36.5% v 13.6%). Conclusion Patients with breast cancer who were treated in community oncology clinics report substantially more cognitive difficulties up to 6 months after treatment with chemotherapy than do age-matched noncancer controls.
authors.affiliation: Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Charles Kamen, Karen M. Mustian, Supriya G. Mohile, Allison Magnuson, Ian R. Kleckner, Joseph J. Guido, and Gary R. Morrow, University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester; Lora R. Weiselberg, North Shore LIJ Health System-National Cancer Institute Community Clinical Oncology Research Program (NCORP), Lake Success; Christine A. Ambrosone, Roswell Park Cancer Institute, Buffalo; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Kelley L. Young, Kansas City Clinical Oncology Program, Kansas City, MO; Alison K. Conlin, Pacific Cancer Research Consortium NCORP, Seattle, WA; and Jerry W. Mitchell, Columbus NCORP, Columbus, OH.
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Janelsins
authors.affiliation: Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Charles Kamen, Karen M. Mustian, Supriya G. Mohile, Allison Magnuson, Ian R. Kleckner, Joseph J. Guido, and Gary R. Morrow, University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester; Lora R. Weiselberg, North Shore LIJ Health System-National Cancer Institute Community Clinical Oncology Research Program (NCORP), Lake Success; Christine A. Ambrosone, Roswell Park Cancer Institute, Buffalo; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Kelley L. Young, Kansas City Clinical Oncology Program, Kansas City, MO; Alison K. Conlin, Pacific Cancer Research Consortium NCORP, Seattle, WA; and Jerry W. Mitchell, Columbus NCORP, Columbus, OH.
authors.forename: Charles E
authors.initials: CE
authors.lastname: Heckler
authors.affiliation: Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Charles Kamen, Karen M. Mustian, Supriya G. Mohile, Allison Magnuson, Ian R. Kleckner, Joseph J. Guido, and Gary R. Morrow, University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester; Lora R. Weiselberg, North Shore LIJ Health System-National Cancer Institute Community Clinical Oncology Research Program (NCORP), Lake Success; Christine A. Ambrosone, Roswell Park Cancer Institute, Buffalo; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Kelley L. Young, Kansas City Clinical Oncology Program, Kansas City, MO; Alison K. Conlin, Pacific Cancer Research Consortium NCORP, Seattle, WA; and Jerry W. Mitchell, Columbus NCORP, Columbus, OH.
authors.forename: Luke J
authors.initials: LJ
authors.lastname: Peppone
authors.affiliation: Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Charles Kamen, Karen M. Mustian, Supriya G. Mohile, Allison Magnuson, Ian R. Kleckner, Joseph J. Guido, and Gary R. Morrow, University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester; Lora R. Weiselberg, North Shore LIJ Health System-National Cancer Institute Community Clinical Oncology Research Program (NCORP), Lake Success; Christine A. Ambrosone, Roswell Park Cancer Institute, Buffalo; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Kelley L. Young, Kansas City Clinical Oncology Program, Kansas City, MO; Alison K. Conlin, Pacific Cancer Research Consortium NCORP, Seattle, WA; and Jerry W. Mitchell, Columbus NCORP, Columbus, OH.
authors.forename: Charles
authors.initials: C
authors.lastname: Kamen
authors.affiliation: Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Charles Kamen, Karen M. Mustian, Supriya G. Mohile, Allison Magnuson, Ian R. Kleckner, Joseph J. Guido, and Gary R. Morrow, University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester; Lora R. Weiselberg, North Shore LIJ Health System-National Cancer Institute Community Clinical Oncology Research Program (NCORP), Lake Success; Christine A. Ambrosone, Roswell Park Cancer Institute, Buffalo; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Kelley L. Young, Kansas City Clinical Oncology Program, Kansas City, MO; Alison K. Conlin, Pacific Cancer Research Consortium NCORP, Seattle, WA; and Jerry W. Mitchell, Columbus NCORP, Columbus, OH.
authors.forename: Karen M
authors.initials: KM
authors.lastname: Mustian
authors.affiliation: Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Charles Kamen, Karen M. Mustian, Supriya G. Mohile, Allison Magnuson, Ian R. Kleckner, Joseph J. Guido, and Gary R. Morrow, University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester; Lora R. Weiselberg, North Shore LIJ Health System-National Cancer Institute Community Clinical Oncology Research Program (NCORP), Lake Success; Christine A. Ambrosone, Roswell Park Cancer Institute, Buffalo; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Kelley L. Young, Kansas City Clinical Oncology Program, Kansas City, MO; Alison K. Conlin, Pacific Cancer Research Consortium NCORP, Seattle, WA; and Jerry W. Mitchell, Columbus NCORP, Columbus, OH.
authors.forename: Supriya G
authors.initials: SG
authors.lastname: Mohile
authors.affiliation: Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Charles Kamen, Karen M. Mustian, Supriya G. Mohile, Allison Magnuson, Ian R. Kleckner, Joseph J. Guido, and Gary R. Morrow, University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester; Lora R. Weiselberg, North Shore LIJ Health System-National Cancer Institute Community Clinical Oncology Research Program (NCORP), Lake Success; Christine A. Ambrosone, Roswell Park Cancer Institute, Buffalo; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Kelley L. Young, Kansas City Clinical Oncology Program, Kansas City, MO; Alison K. Conlin, Pacific Cancer Research Consortium NCORP, Seattle, WA; and Jerry W. Mitchell, Columbus NCORP, Columbus, OH.
authors.forename: Allison
authors.initials: A
authors.lastname: Magnuson
authors.affiliation: Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Charles Kamen, Karen M. Mustian, Supriya G. Mohile, Allison Magnuson, Ian R. Kleckner, Joseph J. Guido, and Gary R. Morrow, University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester; Lora R. Weiselberg, North Shore LIJ Health System-National Cancer Institute Community Clinical Oncology Research Program (NCORP), Lake Success; Christine A. Ambrosone, Roswell Park Cancer Institute, Buffalo; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Kelley L. Young, Kansas City Clinical Oncology Program, Kansas City, MO; Alison K. Conlin, Pacific Cancer Research Consortium NCORP, Seattle, WA; and Jerry W. Mitchell, Columbus NCORP, Columbus, OH.
authors.forename: Ian R
authors.initials: IR
authors.lastname: Kleckner
authors.affiliation: Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Charles Kamen, Karen M. Mustian, Supriya G. Mohile, Allison Magnuson, Ian R. Kleckner, Joseph J. Guido, and Gary R. Morrow, University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester; Lora R. Weiselberg, North Shore LIJ Health System-National Cancer Institute Community Clinical Oncology Research Program (NCORP), Lake Success; Christine A. Ambrosone, Roswell Park Cancer Institute, Buffalo; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Kelley L. Young, Kansas City Clinical Oncology Program, Kansas City, MO; Alison K. Conlin, Pacific Cancer Research Consortium NCORP, Seattle, WA; and Jerry W. Mitchell, Columbus NCORP, Columbus, OH.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Guido
authors.affiliation: Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Charles Kamen, Karen M. Mustian, Supriya G. Mohile, Allison Magnuson, Ian R. Kleckner, Joseph J. Guido, and Gary R. Morrow, University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester; Lora R. Weiselberg, North Shore LIJ Health System-National Cancer Institute Community Clinical Oncology Research Program (NCORP), Lake Success; Christine A. Ambrosone, Roswell Park Cancer Institute, Buffalo; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Kelley L. Young, Kansas City Clinical Oncology Program, Kansas City, MO; Alison K. Conlin, Pacific Cancer Research Consortium NCORP, Seattle, WA; and Jerry W. Mitchell, Columbus NCORP, Columbus, OH.
authors.forename: Kelley L
authors.initials: KL
authors.lastname: Young
authors.affiliation: Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Charles Kamen, Karen M. Mustian, Supriya G. Mohile, Allison Magnuson, Ian R. Kleckner, Joseph J. Guido, and Gary R. Morrow, University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester; Lora R. Weiselberg, North Shore LIJ Health System-National Cancer Institute Community Clinical Oncology Research Program (NCORP), Lake Success; Christine A. Ambrosone, Roswell Park Cancer Institute, Buffalo; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Kelley L. Young, Kansas City Clinical Oncology Program, Kansas City, MO; Alison K. Conlin, Pacific Cancer Research Consortium NCORP, Seattle, WA; and Jerry W. Mitchell, Columbus NCORP, Columbus, OH.
authors.forename: Alison K
authors.initials: AK
authors.lastname: Conlin
authors.affiliation: Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Charles Kamen, Karen M. Mustian, Supriya G. Mohile, Allison Magnuson, Ian R. Kleckner, Joseph J. Guido, and Gary R. Morrow, University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester; Lora R. Weiselberg, North Shore LIJ Health System-National Cancer Institute Community Clinical Oncology Research Program (NCORP), Lake Success; Christine A. Ambrosone, Roswell Park Cancer Institute, Buffalo; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Kelley L. Young, Kansas City Clinical Oncology Program, Kansas City, MO; Alison K. Conlin, Pacific Cancer Research Consortium NCORP, Seattle, WA; and Jerry W. Mitchell, Columbus NCORP, Columbus, OH.
authors.forename: Lora R
authors.initials: LR
authors.lastname: Weiselberg
authors.affiliation: Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Charles Kamen, Karen M. Mustian, Supriya G. Mohile, Allison Magnuson, Ian R. Kleckner, Joseph J. Guido, and Gary R. Morrow, University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester; Lora R. Weiselberg, North Shore LIJ Health System-National Cancer Institute Community Clinical Oncology Research Program (NCORP), Lake Success; Christine A. Ambrosone, Roswell Park Cancer Institute, Buffalo; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Kelley L. Young, Kansas City Clinical Oncology Program, Kansas City, MO; Alison K. Conlin, Pacific Cancer Research Consortium NCORP, Seattle, WA; and Jerry W. Mitchell, Columbus NCORP, Columbus, OH.
authors.forename: Jerry W
authors.initials: JW
authors.lastname: Mitchell
authors.affiliation: Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Charles Kamen, Karen M. Mustian, Supriya G. Mohile, Allison Magnuson, Ian R. Kleckner, Joseph J. Guido, and Gary R. Morrow, University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester; Lora R. Weiselberg, North Shore LIJ Health System-National Cancer Institute Community Clinical Oncology Research Program (NCORP), Lake Success; Christine A. Ambrosone, Roswell Park Cancer Institute, Buffalo; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Kelley L. Young, Kansas City Clinical Oncology Program, Kansas City, MO; Alison K. Conlin, Pacific Cancer Research Consortium NCORP, Seattle, WA; and Jerry W. Mitchell, Columbus NCORP, Columbus, OH.
authors.forename: Christine A
authors.initials: CA
authors.lastname: Ambrosone
authors.affiliation: Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Charles Kamen, Karen M. Mustian, Supriya G. Mohile, Allison Magnuson, Ian R. Kleckner, Joseph J. Guido, and Gary R. Morrow, University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester; Lora R. Weiselberg, North Shore LIJ Health System-National Cancer Institute Community Clinical Oncology Research Program (NCORP), Lake Success; Christine A. Ambrosone, Roswell Park Cancer Institute, Buffalo; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Kelley L. Young, Kansas City Clinical Oncology Program, Kansas City, MO; Alison K. Conlin, Pacific Cancer Research Consortium NCORP, Seattle, WA; and Jerry W. Mitchell, Columbus NCORP, Columbus, OH.
authors.forename: Tim A
authors.initials: TA
authors.lastname: Ahles
authors.affiliation: Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Charles Kamen, Karen M. Mustian, Supriya G. Mohile, Allison Magnuson, Ian R. Kleckner, Joseph J. Guido, and Gary R. Morrow, University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester; Lora R. Weiselberg, North Shore LIJ Health System-National Cancer Institute Community Clinical Oncology Research Program (NCORP), Lake Success; Christine A. Ambrosone, Roswell Park Cancer Institute, Buffalo; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Kelley L. Young, Kansas City Clinical Oncology Program, Kansas City, MO; Alison K. Conlin, Pacific Cancer Research Consortium NCORP, Seattle, WA; and Jerry W. Mitchell, Columbus NCORP, Columbus, OH.
authors.forename: Gary R
authors.initials: GR
authors.lastname: Morrow
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000523:psychology; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D003071:Cognition / Q000187:drug effects / Q000502:physiology*; D003072:Cognition Disorders / Q000139:chemically induced / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D009483:Neuropsychological Tests; D011446:Prospective Studies; D057566:Self Report; D017741:Survivors / Q000706:statistics & numerical data*; D014481:United States; D055815:Young Adult