PHOENIXBetween 17.5% and 29.8% of 57 nonmetastatic breast
cancer patients had cognitive impairment prior to starting chemotherapy in an
ongoing study exploring the effects of chemotherapy on cognitive functioning
among breast cancer patients. The prevalence of impairment depended on which of
three common definitions was applied to the patients’ scores on a battery of
neuropsychological tests, said Janhavi Desai, MA, of the Center on Outcomes,
Research and Education (CORE), Evanston Northwestern Health Care, Evanston,
Illinois. Ms. Desai presented the results at a poster at the Second Annual
Conference of the American Psychosocial Oncology Society (APOS abstract P2-6).
"In order to better understand the effects of chemotherapy on cognition, a
consensus-driven definition of impairment is needed," she said.
The study population comprised 55 women and 2 men; 43 had
stage II disease; the rest were stage I, III, or unknown; 25 women were
Ten patients (17.5%) were impaired based on a standard that
defined impairment as 1.5 or more standard deviations (SDs) below the norm on
one or more tests, or 2 or more SDs on a single test in the battery. When
impairment was defined as 1 or more SDs below the age-adjusted mean on three or
more neuropsychological measures, 13 patients (22.8%) met the criterion. The
third definitionscores in the lowest quartile for four or more
neuropsychological domainsclassified 17 patients (29.8%) as cognitively
impaired. Five patients (8.8%) met the definition for cognitive impairment by
all three standards.
While deficits were recorded in many domains, the most
common were in visual-spatial skills, immediate memory, and executive
A growing number of studies have linked cognitive impairment
to chemotherapy, but few have looked at the patients’ cognitive performance
prior to treatment, said Ms. Desai, the project coordinator. "We don’t know if
this impairment was there before chemotherapy, occurred after chemotherapy, or
was exacerbated by chemotherapy," she told ONI. Further, she said,
previous studies have not used a consistent standard for defining impairment.
The investigators plan to continue the study, adding more
patients and tracking cognitive functioning during and after chemotherapy. For
more information about the trial, please contact principal investigator Lynne
Wagner, PhD, at LWagner@northwestern.edu.