Biological and psychological predictors of cognitive function in breast cancer patients before surgery

Purpose Research suggests that cancer-related cognitive impairment (CRCI) can occur before breast cancer (BC) treatment. The limited extant evidence suggests the underlying mechanisms could be stress-related. Potential psychological and biological predictors of CRCI prior to any BC treatment were examined.Methods 112 treatment-naive women with BC and 67 healthy controls (HC) completed a neuropsychological test battery to assess cognitive impairment and a self-report battery to assess cognitive complaints, cancer-related stress, depressive and anxiety symptoms. Morning and evening cortisol and alpha-amylase were collected from saliva. Multilinear regressions were conducted.Results Treatment-naive BC patients were more frequently impaired in verbal memory and processing speed and reported more cognitive complaints (all p < .001) than HC. BC patients and HC did not differ in overall cognitive impairment (p = .21). Steeper alpha-amylase, lower cancer-related stress and younger age was associated with better overall cognitive function in treatment-naive BC patients. Higher depressive symptoms predicted higher levels of cognitive complaints in BC patients.Conclusion Overall, these findings suggest that stress plays a role in CRCI. This study is the first to associate alpha-amylase with cognitive function in cancer patients, informing future research. The findings on impairment in processing speed and verbal memory among treatment-naive BC highlight the need to screen for such impairments among BC patients and indicate that future studies on CRCI should include baseline assessments prior to BC treatment. If replicated, these findings could inform the development and testing of appropriate interventions to decrease CRCI among cancer patients.Clinical trials registration number NCT04418856, date of registration: 06.05.2020.