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Long-term subjective cognitive functioning following adjuvant systemic treatment: 7 – 9 years follow-up of a nationwide cohort of women treated for primary breast cancer

View Article: PubMed Central - PubMed

ABSTRACT

Background:: There is growing concern among breast cancer (BC) patients and survivors about cognitive impairment following systemic treatments. The aim of the present study was to investigate the long-term effects of standard systemic adjuvant therapies on subjective cognitive impairment (SCI) in a large nationwide cohort of BC survivors 7–9 years after primary surgery.

Methods:: Participants were recruited from the nationwide Psychosocial Factors and Breast Cancer inception cohort of Danish women treated for primary BC. SCI was assessed with the Cognitive Failures Questionnaire and women allocated to systemic treatment according to nationwide standard protocols were compared with women who had not received any systemic treatments.

Results:: A total of 1889 recurrence-free survivors were eligible for analysis. No difference in SCI was found between survivors across standardized systemic treatment protocols when analyses were stratified by menopausal status and adjusted for possible sociodemographic and treatment-related confounders. The frequency of significant SCI in a subgroup of survivors in the age range 65–74 years was ∼7%.

Conclusions:: No differences in long-term SCI at 7–9 years post surgery were found between women who had received systemic therapies and those who had not. Furthermore, the observed proportion of survivors with significant SCI was comparable to normative data. These results are important to communicate to patients, survivors, and clinicians alike, especially in the light of increasing concern about cognitive impairment following systemic therapies.

No MeSH data available.


Flowchart of selection of patients.
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fig1: Flowchart of selection of patients.

Mentions: A total of 1889 long-term BC survivors were considered eligible for analysis (see Figure 1). Mean substitution of missing CFQ items were performed for 66 (3%) women. Mean overall age was 63.3 years (s.d.=8.2; median=64.0; range=43.3–79.7 years) with an average of 8.4 years since initial surgery (range: 7.2–9.8 years). The majority were of Danish ethnicity (97%), had an upper secondary education or higher (71%), were occupationally engaged (70%), and were either married or cohabiting (78%) in the year prior to year of primary surgery. At the time of surgery, 39.8% were pre-menopausal. At the time of the 7–9 year follow-up, a total of 777 women (41.1%) had received CT consisting of either seven cycles of CEF, or seven cycles of CMF. Adjuvant ET had been administered to a total of 1234 (65.3%) women and consisted of either 5 years of treatment with Tamoxifen (20 mg) for pre-menopausal women, or a combination of 2.5 years of treatment with Tamoxifen (20 mg) followed by 2.5 years of treatment with Exemestane (25 mg) for postmenopausal women. Demographic, socioeconomic, and clinical variables for the pre- and postmenopausal women are presented in Table 2. In the premenopausal group, differences in demographic variables between participants allocated to different protocols were observed for age, time since surgery, and mean household net-wealth. No differences were observed in the postmenopausal group (see Table 2).


Long-term subjective cognitive functioning following adjuvant systemic treatment: 7 – 9 years follow-up of a nationwide cohort of women treated for primary breast cancer
Flowchart of selection of patients.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4559822&req=5

fig1: Flowchart of selection of patients.
Mentions: A total of 1889 long-term BC survivors were considered eligible for analysis (see Figure 1). Mean substitution of missing CFQ items were performed for 66 (3%) women. Mean overall age was 63.3 years (s.d.=8.2; median=64.0; range=43.3–79.7 years) with an average of 8.4 years since initial surgery (range: 7.2–9.8 years). The majority were of Danish ethnicity (97%), had an upper secondary education or higher (71%), were occupationally engaged (70%), and were either married or cohabiting (78%) in the year prior to year of primary surgery. At the time of surgery, 39.8% were pre-menopausal. At the time of the 7–9 year follow-up, a total of 777 women (41.1%) had received CT consisting of either seven cycles of CEF, or seven cycles of CMF. Adjuvant ET had been administered to a total of 1234 (65.3%) women and consisted of either 5 years of treatment with Tamoxifen (20 mg) for pre-menopausal women, or a combination of 2.5 years of treatment with Tamoxifen (20 mg) followed by 2.5 years of treatment with Exemestane (25 mg) for postmenopausal women. Demographic, socioeconomic, and clinical variables for the pre- and postmenopausal women are presented in Table 2. In the premenopausal group, differences in demographic variables between participants allocated to different protocols were observed for age, time since surgery, and mean household net-wealth. No differences were observed in the postmenopausal group (see Table 2).

View Article: PubMed Central - PubMed

ABSTRACT

Background:: There is growing concern among breast cancer (BC) patients and survivors about cognitive impairment following systemic treatments. The aim of the present study was to investigate the long-term effects of standard systemic adjuvant therapies on subjective cognitive impairment (SCI) in a large nationwide cohort of BC survivors 7–9 years after primary surgery.

Methods:: Participants were recruited from the nationwide Psychosocial Factors and Breast Cancer inception cohort of Danish women treated for primary BC. SCI was assessed with the Cognitive Failures Questionnaire and women allocated to systemic treatment according to nationwide standard protocols were compared with women who had not received any systemic treatments.

Results:: A total of 1889 recurrence-free survivors were eligible for analysis. No difference in SCI was found between survivors across standardized systemic treatment protocols when analyses were stratified by menopausal status and adjusted for possible sociodemographic and treatment-related confounders. The frequency of significant SCI in a subgroup of survivors in the age range 65–74 years was ∼7%.

Conclusions:: No differences in long-term SCI at 7–9 years post surgery were found between women who had received systemic therapies and those who had not. Furthermore, the observed proportion of survivors with significant SCI was comparable to normative data. These results are important to communicate to patients, survivors, and clinicians alike, especially in the light of increasing concern about cognitive impairment following systemic therapies.

No MeSH data available.