Abstract P6-09-02: Pre-treatment cognitive function (CF) in women with locally advanced breast cancer (LABC) and in healthy controls.
Authors: Bernstein LJ , Seruga B , Pond G , Tirona KM , Dodd A , Tannock IF 
Published: August 2014

Background: Several studies have reported that women with breast cancer may have cognitive dysfunction prior to chemotherapy (ChT), and that cognitive dysfunction may be related to the cancer itself or to the psychological impact of a cancer diagnosis. Previous studies assessing CF in breast cancer patients pre-ChT have done so after surgery. Women with LABC receive ChT prior to surgery, and therefore provide a unique opportunity to assess CF without the confounding factor of surgery. This study reports CF in women with newly diagnosed LABC compared to healthy controls.

Methods: Baseline information including participant demographics, smoking/alcohol history, co-morbidities, and medications were collected. Women with LABC underwent a 2-hour battery of CF tests prior to neoadjuvant ChT. Six cognitive domains using standardized, validated, and reliable neuropsychological tests were assessed: verbal, visual-spatial, memory, attention, processing speed, and executive function. Performance on each test was transformed to z-scores using normative data (average range z-score = −1 to 1). Participants also completed self-report questionnaires for CF (FACT-COG3 and PAOFI), fatigue (FACIT-F subscale) and affect (HADS). Data obtained were compared to those for age-matched healthy women who were administered the same battery of tests and measures.

Results: Forty-seven women with LABC and 22 controls were assessed. All women completed the CF tests and questionnaires within 2 hours. There were no significant differences between patients and controls in age (pts median age=49; controls=48), education (median years in school=16 for both), smoking or alcohol history, co-morbidities, mood disorders (anxiety, depression), previous history of concussion, or current medication for mood or sleep problems. Objective CF testing demonstrated no significant difference in the mean performance of women with LABC vs that of controls in any objective domain, nor were there statistically significant differences in the frequency of deficits (e.g., 96% of pts had &lt; 2 deficits; 86% of controls had &lt; 2 deficits). Women with LABC did not report worse CF, fatigue, or depressive symptoms compared to controls. Anxiety was the only self-reported measure where patients had more symptoms (mean HADS 7.6 vs 5.4, p &lt; .036). Consistent with the literature, only weak to no association was observed between any of the objective measures of CF and the self-reported measures. Multivariate regression analyses found for both patients and controls, low education level (≤12 years), smoking history (≥10 pack year), alcohol intake (≥10 drinks/week), and currently taking medication for anxiety, depression, or sleep to be associated with poorer CF as measured on at least one objective domain.

Conclusion: When assessed prior to ChT and surgery, no significant difference in objectively assessed or self-reported CF was observed between women with LABC and healthy controls. The effects of cancer treatment will be evaluated as part of a longitudinal study.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P6-09-02.