Trajectory of cognitive impairment during breast cancer treatment: A prospective analysis

Abstract

8500 Background: Several studies havedocumented cognitive impairment in cancer patients; however these reports are primarily based on cross-sectional comparisons. Prospective evaluation would better elucidate the onset and course of cognitive dysfunction related to chemotherapy. Methods: Of 72 breast cancer patients enrolled, 51 completed a comprehensive neuropsychological battery before chemotherapy (T1), on Day 1 of Cycle 4 (T2), and at 6-month follow-up (T3). Participants scoring ≥ 1 SD below the normative mean on ≥ 3 neuropsychological tests OR ≥ 2 SD below on 1 test were classified as impaired. Reliable change indices (RCI) conservatively estimated significant change over time. Results: Participants were White (70.6%) females (96.1%) with a mean of 15.9 ± 2.3 years of education. Mean age was 51.6 ± 8.6 years and most had Stage II (78%) or Stage III (16%) disease. Hospital Anxiety and Depression Scale scores were in the normal range at all assessments and were unrelated to T1 cognitive impairment. Consistent with previous research, 9 (17.6%) of patients met criteria for cognitive impairment at T1. By T2, 14 (27.4%) were cognitively impaired; however, at T3 follow up only 5 (9.8%) were impaired. As noted in the table, most impairment occurs during chemotherapy. Among patients not impaired before chemotherapy it was uncommon for impairment at T2 to persist at follow-up. Conclusions: Some breast cancer patients indeed develop cognitive impairment during treatment, much of which appears to resolve at 6 months. Domains most affected include attention, visuospatial skills, and working memory. Attention problems resolved by 6 months, while working memory and visuospatial deficits persisted. [Table: see text] No significant financial relationships to disclose.