Cognitive Impairment in Breast Cancer a Substantial Problem, Study Finds

A recent study aimed to determine the when and why chemotherapy-induced cognitive impairment, or chemobrain, occurs, who is most likely to develop it, and whether certain factors (such as age, race, menopausal status, etc) play any role.

Michelle C. Janelsins, PhD

Women with breast cancer who experience problems with memory, attention, and processing information and the healthcare practitioners who treat them understandably wonder what’s behind this cancer-related cognitive impairment (CRCI), a condition often referred to as “chemobrain.”

The causes of CRCI are varied and complex and medical, psychological, and demographic factors can play a role. To shed more light on subject, researchers at the University of Rochester Medical Center’s Wilmot Cancer Institute embarked on the largest study to date, with a focus on when and why the condition occurs, who is most likely to develop it, and whether age, education, race, and menopausal status, among other factors, have an effect.

Their findings: the condition known as “chemobrain” is a pervasive—and persistent—problem in women with breast cancer.

Michelle C. Janelsins, PhD, an assistant professor of Surgery in Wilmot’s Cancer Control and Survivorship program, looked at the cognitive difficulties of 581 patients with breast cancer recruited from community oncology clinics across the United States. Results were compared to those of a control group of 364 healthy individuals, some of whom were friends or family of patients or unrelated. The groups were balanced in age, ethnicity, and marital status.

Both groups were assessed using the FACT-Cog tool, which examines perceived cognitive impairment, cognitive abilities, impact of cognitive impairment on quality of life, and cognitive impairment as perceived by others. In addition to separate scores for each category, investigators generated an overall cognitive function score. Researchers conducted the FACT-Cog at 3 different points: 7 days before chemotherapy, within 4 weeks of chemotherapy completion, and 6 months after the second assessment.

In addition to the FACT-Cog, researchers also assessed participants’ reading ability and depressive symptoms, the latter, with an item from the Multidimensional Fatigue Symptom Inventory where participants responded to the statement “I feel depressed” using a scale ranging from “not at all” to “very much.”

Before chemotherapy began, patients with breast cancer had lower FACT-Cog scores than their healthy counterparts. Investigators found that when compared with participants who did not have cancer, FACT-Cog scores of women with breast cancer exhibited 45% more impairment. In fact, over the period of nearly 1 year from diagnosis and prechemotherapy to the postchemotherapy follow-up at six months) 36.5% percent of women reported a decline in scores compared with 13.6% of the healthy women, according to the study.

“Our study suggests that perceived CRCI is a complex, multifactorial problem for patients with breast cancer and that it is likely that a combination of demographic, medical, and psychological factors plays a role in predisposing someone to CRCI,” study authors wrote.

“Before any chemotherapy, patients reported lower FACT-Cog scores than did controls; however, we found this effect was influenced by age, race, cognitive reserve, and higher anxiety and depressive symptoms, as our results became a trend after including these covariates.”

Overall, the study found that predictors of perceived cognitive impairment included:

  • Increased baseline levels of anxiety and depressive symptoms,
  • Lower baseline cognitive reserve
  • Perimenopausal or postmenopausal status
  • Younger age and black race

Additionally, women who underwent hormone therapy and/or radiation treatment following chemotherapy had similar cognitive problems as women who solely received chemotherapy.

“Our study, from one of the largest nationwide studies to date, shows that cancer-related cognitive problems are a substantial and pervasive issue for many women with breast cancer,” explained Janelsins, in a statement.

“We are currently assessing these data in the context of objective cognitive measures and to understand the role of possible biologic mechanisms that may confer risk to cognitive problems in patients."

Janelsins MC, Heckler CE, Peppone LJ, 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 [published online before print December 28, 2016]. J Clin Oncol. doi: JCO2016685856.