Cancer-Related Cognitive Outcomes Among Older Breast Cancer Survivors in the Thinking and Living With Cancer Study

被引：127

作者：

Mandelblatt, Jeanne S. ^{[1
]}

Small, Brent J. ^{[3
]}

Luta, Gheorghe ^{[1
]}

Hurria, Arti ^{[4
]}

Jim, Heather ^{[3
]}

McDonald, Brenna C. ^{[6
]}

Graham, Deena ^{[7
]}

Zhou, Xingtao ^{[1
]}

Clapp, Jonathan ^{[1
]}

Zhai, Wanting ^{[1
]}

Breen, Elizabeth ^{[5
]}

Carroll, Judith E. ^{[5
]}

Denduluri, Neelima ^{[8
]}

Dilawari, Asma ^{[1
,2
]}

Extermann, Martine ^{[3
]}

Isaacs, Claudine ^{[1
]}

Jacobsen, Paul B. ^{[9
]}

Kobayashi, Lindsay C. ^{[1
]}

Nudelman, Kelly Holohan ^{[6
]}

Root, James ^{[10
,11
]}

Stern, Robert A. ^{[12
]}

Tometich, Danielle ^{[6
]}

Turner, Raymond ^{[1
]}

VanMeter, John W. ^{[1
]}

Saykin, Andrew J. ^{[6
]}

Ahles, Tim ^{[10
]}

机构：

[1] Georgetown Univ, Washington, DC USA

[2] MedStar Washington Hosp Ctr, Washington, DC USA

[3] H Lee Moffitt Canc Ctr & Res Inst, Tampa, FL USA

[4] City Hope Comprehens Canc Ctr, Duarte, CA USA

[5] Univ Calif Los Angeles, Los Angeles, CA USA

[6] Indiana Univ Sch Med, Indianapolis, IN 46202 USA

[7] John Theurer Canc Ctr, Hackensack, NJ USA

[8] US Oncol, Arlington, VA USA

[9] NCI, Bethesda, MD 20892 USA

[10] Mem Sloan Kettering Canc Ctr, 1275 York Ave, New York, NY 10021 USA

[11] Cornell Univ, Weill Med Coll, New York, NY 10021 USA

[12] Boston Univ, Boston, MA 02215 USA

来源：

JOURNAL OF CLINICAL ONCOLOGY | 2018年 / 36卷 / 32期

关键词：

FUNCTIONAL ASSESSMENT; DEFICIT-ACCUMULATION; SYSTEMIC THERAPY; HORMONAL-THERAPY; CHEMOTHERAPY; IMPAIRMENT; FRAILTY; WOMEN; TAMOXIFEN; DISEASE;

D O I：

10.1200/JCO.18.00140

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

PurposeTo determine treatment and aging-related effects on longitudinal cognitive function in older breast cancer survivors.MethodsNewly diagnosed nonmetastatic breast cancer survivors (n = 344) and matched controls without cancer (n = 347) 60 years of age and older without dementia or neurologic disease were recruited between August 2010 and December 2015. Data collection occurred during presystemic treatment/control enrollment and at 12 and 24 months through biospecimens; surveys; self-reported Functional Assessment of Cancer Therapy-Cognitive Function; and neuropsychological tests that measured attention, processing speed, and executive function (APE) and learning and memory (LM). Linear mixed-effects models tested two-way interactions of treatment group (control, chemotherapy with or without hormonal therapy, and hormonal therapy) and time and explored three-way interactions of ApoE (epsilon 4+ v not) by group by time; covariates included baseline age, frailty, race, and cognitive reserve.ResultsSurvivors and controls were 60 to 98 years of age, were well educated, and had similar baseline cognitive scores. Treatment was related to longitudinal cognition scores, with survivors who received chemotherapy having increasingly worse APE scores (P = .05) and those initiating hormonal therapy having lower LM scores at 12 months (P = .03) than other groups. These group-by-time differences varied by ApoE genotype, where only epsilon 4+ survivors receiving hormone therapy had short-term decreases in adjusted LM scores (three-way interaction P = .03). For APE, the three-way interaction was not significant (P = .14), but scores were significantly lower for epsilon 4+ survivors exposed to chemotherapy (-0.40; 95% CI, -0.79 to -0.01) at 24 months than epsilon 4+ controls (0.01; 95% CI, 0.16 to 0.18; P < .05). Increasing age was associated with lower baseline scores on all cognitive measures (P < .001); frailty was associated with baseline APE and self-reported decline (P < .001).ConclusionBreast cancer systemic treatment and aging-related phenotypes and genotypes are associated with longitudinal decreases in cognitive function scores in older survivors. These data could inform treatment decision making and survivorship care planning.

引用

页码：3211 / +

页数：18

共 73 条

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