Language and Communication Cognitive Complaints Worsen After Initiation of Endocrine Therapy in Early-Stage Breast Cancer
Data suggest that cancer treatment puts patients at risk of cognitive impairment and that many patients exhibit impairment prior to treatment. In an observational cohort study reported in the Journal of Clinical Oncology, Ganz et al found that language and communication cognitive complaints were significantly worsened soon after the start of endocrine therapy in women with early-stage breast cancer.
Study Details
The study involved evaluation of 173 patients in the Mind Body Study (MBS) observational cohort using self-report questionnaires and neuropsychological testing at baseline and 6 months after initiation of endocrine therapy. Instruments included the Beck Depression Inventory II for assessment of depressive symptoms, Short-Form 36 health survey, and Patient’s Assessment of Own Functioning Inventory (PAOFI). Neuropsychological testing used a standard 120-minute test battery.
Worsening Language and Communication Complaints
Of the 173 patients, 122 (70%) received endocrine therapy, consisting of tamoxifen in 50% and an aromatase inhibitor in 47%. Patients receiving endocrine therapy reported significantly worse language and communication cognitive complaints on PAOFI at 6 months after starting therapy (P = .003) but showed no significant differences in neuropsychological test performance compared with women not receiving endocrine therapy.
Significant Associations
Multivariable regression including age, IQ, chemotherapy and radiation, time from last treatment to baseline, past use of hormone therapy, language and communication score at baseline, endocrine therapy use at 6 months, interaction between past hormone therapy and endocrine therapy, change in neuropsychological domain scores for the psychomotor and executive function domains, and depressive symptoms showed that greater language and communication complaints were significantly associated with language and communication score at baseline (P < .001), use of endocrine therapy at 6 months (P = .004), interaction between endocrine therapy and past hormone therapy (P < .001), and diminished improvement in neuropsychological test psychomotor function (P = .05). There was no significant association with depressive symptoms (P = .10).
The investigators concluded: “Higher [language and communication complaints] complaints are significantly associated with [endocrine therapy] 6 months after starting treatment and reflect diminished improvements in some [neuropsychological] tests. Past [hormone therapy] is a significant predictor of higher [language and communication] complaints after initiation of [endocrine therapy].”
Patricia A. Ganz, MD, of University of California, Los Angeles, is the corresponding author for the Journal of Clinical Oncology article.
The study was supported by the National Cancer Institute, Breast Cancer Research Foundation, and Cousins Center for Psychoneuroimmunology. The study authors reported no potential conflicts of interest.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
