Cancer-related cognitive impairment and its relation to PTSD (2017)

It is with great interest that we read the paper of Ramalho et al. [ [1] Ramalho M. Fontes F. Ruano L. Pereira S. Lunet N. Cognitive impairment in the first year after breast cancer diagnosis: a prospective cohort study. Breast. 2017; 32: 173-178 Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar ] regarding "Cognitive impairment in the first year after breast cancer diagnosis: a prospect cohort study". This impressively large study involving 418 newly diagnosed breast cancer patients had a counterintuitive finding for which the authors provide no explanation: "There was a statistically significantly increased risk of incident cognitive impairment, among patients with no anxiety prior to treatment with schemes including doxorubicin and cyclophosphamide [ [1] Ramalho M. Fontes F. Ruano L. Pereira S. Lunet N. Cognitive impairment in the first year after breast cancer diagnosis: a prospective cohort study. Breast. 2017; 32: 173-178 Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar ]. The authors also observed that cognitive impairment was four-fold higher with regimens that included doxorubicin and cyclophosphamide [ [1] Ramalho M. Fontes F. Ruano L. Pereira S. Lunet N. Cognitive impairment in the first year after breast cancer diagnosis: a prospective cohort study. Breast. 2017; 32: 173-178 Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar ]. Significantly, these drugs do not cross the blood brain barrier [ [2] Chang J.E. Robins H.I. Mehta M.P. Therapeutic advances in the treatment of brain metastases. Clin Adv Hematol Oncol. 2007; 5: 54-64 PubMed Google Scholar ]; they are, however, notable for their toxicity. In this regard, many authors have raised the issue of possible post-traumatic stress disorder (PTSD), leading to cognitive dysfunction. As reviewed by Andrykowski et al., PTSD can be precipitated by the diagnosis and/or treatment of breast cancer [ [3] Andrykowski M.A. Cordova M.J. Studts J.L. Miller T.W. Posttraumatic stress disorder after treatment for breast cancer: prevalence of diagnosis and use of the PTSD Checklist-Civilian Version (PCL-C) as a screening instrument. J Consult Clin Psychol. 1998; 66: 586-590 Crossref PubMed Scopus (364) Google Scholar ]. Indeed this patient population is exposed to the psychological stress of a life threatening diagnosis, physical disfigurement, and the imposition of noxious therapy. Interesting, a recently published paper addressing the same patient group noted that prior to any chemotherapy, FACT-Cog scores were significantly lower in patients with breast cancer compared to controls [ [4] Janelsins M.C. Heckler C.E. Peppone L.J. Kamen C. Mustian K.M. Mohile S.G. et al. Cognitive complaints in survivors of breast cancer after chemotherapy compared with age-matched controls: an analysis from a nationwide, multicenter, prospective longitudinal study. J Clin Oncol. 2017; 35 (JCO2016685856) Crossref Scopus (182) Google Scholar ] as has also been seen in other studies [ 5 Ahles T.A. Saykin A.J. McDonald B.C. Furstenberg C.T. Cole B.F. Hanscom B.S. et al. Cognitive function in breast cancer patients prior to adjuvant treatment. Breast Cancer Res Treat. 2008; 110: 143-152 Crossref PubMed Scopus (260) Google Scholar , 6 Wefel J.S. Saleeba A.K. Buzdar A.U. Meyers C.A. Acute and late onset cognitive dysfunction associated with chemotherapy in women with breast cancer. Cancer. 2010; 116: 3348-3356 Crossref PubMed Scopus (371) Google Scholar ]. Thus, it is relatively easy and intuitively obvious to model a group of patients with Acute Distress Disorder (AST), as defined in DSM-5 [ [7] American Psychiatric Association Diagnostic and statistical manual of mental disorders. fifth ed. American Psychiatric Publishing, Arlington, VA2013 Crossref Google Scholar ], leading to PTSD, as this migration is well recognized [ [7] American Psychiatric Association Diagnostic and statistical manual of mental disorders. fifth ed. American Psychiatric Publishing, Arlington, VA2013 Crossref Google Scholar ]. Cognitive impairment in the first year after breast cancer diagnosis: A prospective cohort studyThe BreastVol. 32PreviewThe objective of this study was to assess the relation between cancer treatments and incident cognitive impairment in breast cancer patients, taking into account the levels of anxiety before treatment. Full-Text PDF Reply to H. Ian RobinsThe BreastVol. 34PreviewWe have read the interesting hypothesis put forward by Ian Robins et al. in the letter to the editor concerning our paper "Cognitive impairment in the first year after breast cancer diagnosis: a prospect cohort study". We agree that, especially in the short time span of one year after diagnosis, the stress associated with the diagnosis, surgery and incapacitating treatments, and the consequent post-traumatic stress disorder (PTSD), could affect the cognitive performance, especially as measured in short screening tests such as the MoCA. Full-Text PDF