Breast cancer and neurocognitive outcomes
Creators: name: University Of California Office Of The President
Publisher: name: University of California Office of the President
publisherIdentifier: https://ror.org/00dmfq477
publisherIdentifierScheme: ROR
Year: 2024

description: Non-technical overview and relevance to breast cancer: Cancer patients report cognitive difficulties following diagnosis and are understandably concerned about the potential impact in their daily lives, both for the short term and the future. Patients frequently refer to these symptoms as “chemo brain” because they are widely thought to be a result of chemotherapy effects on the brain. Following research, patients and researchers are now realizing that other factors probably also contribute to the reports of considerable cognitive difficulties expressed by a subgroup of survivors. In particular, patients with breast cancer express concern about the potential cognitive side effects associated with endocrine medications (for example, tamoxifen) that are prescribed to reduce the risk of cancer relapse in hormone-sensitive tumors, and which patients may take for several years. 
 
 
 
 
 
 
 
 Recent research suggests that combing chemotherapy with endocrine therapy is associated with greater cognitive side effects than chemotherapy alone. However, this research has been mostly done in the two years following diagnosis, and so little is known about the long-term effects. It is also not known whether non-cancer factors that are considered as “risk” or “protective” of cognitive decline in the general population, influence cognitive and QOL outcomes in women treated breast cancer. We hypothesize that as breast cancer survivors grow older, and have also taken endocrine medications for longer, cognitive impact may become more apparent. 
 
 
 
 
 
 
 
 We propose to examine the long-term impact of breast cancer and its treatment among a previously understudied group, that of older women, in order to increase the understanding of patients and providers so they know what to expect and to identify factors that may potentially minimize the adverse effects. Specifically, we will assess the long-term impact of endocrine therapy (type, duration, etc) on cognitive outcomes in women treated with and without chemotherapy. This objective is specific to breast cancer because most breast tumors are highly sensitive to circulating hormones, requiring many women to take endocrine therapy for years to reduce the risk of tumor relapse. 
 
 
 
 
 
 
 
 The question(s) of this research are: 
 
 
 
 • Do long-term survivors of breast cancer treated with both chemotherapy and endocrine therapy have worse cognitive functioning when they reach older age than older, age-matched women without a history of cancer?
 
 
 
 • Does having other health conditions, such as diabetes or hypertension, increase the risk for worse cognitive functioning in long-term, older survivors of breast cancer?
 
 
 
 • Are lifestyle factors, such as higher physical activity, higher social connection, and/or higher engagement in cognitive activities, associated with better cognitive functioning in long-term survivors of breast cancer?
 
 
 
 
 
 
 
 General methods: We will conduct neurocognitive testing in two groups of older women (= 60years) from the ongoing California Teachers Study and evaluate them for differences in their current functioning level. One group will contain women who are at least five years post breast cancer diagnosis, and the group for comparison will contain age-matched women without a history of cancer. In addition to the new data collection (i.e., neurocognitive testing and self-report questionnaires), we will also use data that already exists that was collected in 1995, 2000, and 2005 on the women in both our groups to help answer our research questions. 
 
 
 
 
 
 
 
 Innovative elements of the project: The proposed study is innovative because it will focus on understanding the long-term effects of combined chemotherapy and endocrine therapy in older, long-term survivors, a breast cancer subgroup that has been understudied for the neurocognitive impact of treatments. In addition, this study will use data collected from study participants at a time when the women in the breast cancer group did not yet have the diagnosis and this allows cost-effective longitudinal analyses. Finally, this study will conduct neurocognitive assessment using two approaches: traditional in-person testing, and web-based, self-administered, computerized testing (telephone assistance if needed). This approach is an innovative way to obtain neurocognitive data from a large number of participants across the state, who would otherwise not be able to participate.