PD04-09: Self-Reported Cognitive Attributes and Fatigue Improve over Long-Term Follow-Up in Breast Cancer Survivors; Some Cognitive Attributes Are Worse in Breast Cancer Survivors Than in Non-Cancer Controls.
Authors: Hsu T , Ennis M , Hood N , Goodwin PJ 
Published: June 2012

Abstract
Background: Cognitive deficits and fatigue have been reported in breast cancer (BC) patients undergoing a variety of treatments, including chemotherapy; in some studies these concerns persist after completion of treatment. We examined these factors over time (median 11 yrs) in a longitudinal study of BC patients and compared the status of long-term BC survivors to non-BC controls.
Methods: 535 T1-3, N0-1, M0 BC patients were enrolled 1989–96; 260 women survived without metastases to participate in long-term follow-up (LTFU) measurements in 2006–8. 161 controls without BC were enrolled 2007–8. Questionnaires examined a range of QOL attributes; here we focus on items related to cognition and fatigue including: EORTC QLQ C30 (cognitive functioning, fatigue), Profile of Mood States (POMS — confusion/bewilderment, fatigue/inertia, vigor/activity), Fatigue Symptom Inventory (FSI — average fatigue past week, total disruption index), Everyday Problems (EDP — forgetfulness, difficulty concentrating, easily distracted). 166 of the BC patients had also completed EORTC and POMS at diagnosis and 1 year, and change in items on these questionnaires was calculated. Age and income adjusted differences between BC (LTFU) and controls were analyzed. Clinical significance was defined as ≥5% of the scale range or an effect size of ≥0.2 and statistical significance as P≤ 0.05.
Results: BC cases were older than controls (62.3 vs 59.1 yr), had lower education (24.6 vs 10.2% high school only) and family income (38.2 vs 19.8% &lt; $60,000 annually) (all P&lt;0.01). Cognitive attributes: BC patients showed clinically and statistically significant improvements between diagnosis and LTFU on POMS confusion/bewilderment but not EORTC cognitive functioning. Comparing BC (LTFU) to controls, in multivariate analyses adjusted for age and income, EORTC cognitive functioning (81.5 vs 87.4) and EDP forgetfulness (0.9 vs 0.6) were clinically and statistically significantly worse in BC patients than controls. In contrast, POMS confusion/bewilderment, EDP difficulty concentrating and EDP easily distracted scores were similar in BC patients at LTFU and controls. Fatigue: BC patients showed clinically and statistically significant improvements between diagnosis and LTFU on EORTC fatigue, POMS fatigue/inertia and POMS vigor/activity. After adjustment for age and income there were no clinically and statistically significant differences between BC (LTFU) and controls on any fatigue items.
Conclusions: Fatigue items, as well as some cognitive items, improved over time in BC patients and scores were comparable to scores in non-BC controls at LTFU. However, scores on some cognitive items were worse in LTFU BC patients than in non-BC controls raising concerns that BC diagnosis and treatment may be associated with long-term adverse effects on some aspects of self-reported cognitive attributes.
(Funded by The Breast Cancer Research Foundation)
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr PD04-09.