Almost 50 percent of women with breast cancer have cognitive decline during chemotherapy, and 30 percent have it a year after treatment, according to a recent study. These findings highlight the need for a tool to screen and help manage patients at risk of cognitive impairment, researchers say.
The study “Distinct and heterogeneous trajectories of self‐perceived cognitive impairment among Asian breast cancer survivors” was published in the journal Psycho-Oncology.
Chemotherapy-associated cognitive dysfunction, often referred to as “chemo brain,” includes self-reported and objectively measured problems with cognition following chemotherapy.
Increasing evidence suggests that 17% to 75% of breast cancer survivors experience cognitive deficits — problems with attention, concentration, planning, and working memory — from a few months to several years after receiving chemotherapy.
Cognitive decline can significantly affect the daily life of patients, and even mild cognitive problems can have functional and psychiatric consequences, especially when persistent and left untreated.
“Knowing when patients experience these cognitive problems, and how long the symptoms persist, can aid the development of suitable screening and clinical management measures,” Alexandre Chan, the study’s lead researcher, said in a press release.
Chan and his team at National University of Singapore (NUS) evaluated the trajectories of cognitive decline associated with chemotherapy in patients with stage 1-3 breast cancers.
The study included 131 Asian female breast cancer patients, with a mean age of 50.7 years. Patients were evaluated at four time points: before chemotherapy; six weeks after chemotherapy started; 12 weeks after chemotherapy started; and 15 months after the start of chemotherapy (which corresponded to 9-12 months after the end of chemotherapy).
The Functional Assessment of Cancer Therapy-Cognitive (version 3) questionnaire (FACT-Cog) was used to evaluate patients’ self-perceived cognitive problems, and Headminder — an objective computerized test — was used to evaluate patients’ memory, attention, response speed, and processing speed.
Sixty-one patients (46.6%) reported cognitive decline at some point over the course of the study, and 40 patients (30.5%) up to a year after chemotherapy. According to the Headminder results, memory issues were found in 12 patients (14.6%) and response speed problems in seven patients (8.5%), about a year after treatment.
While in some patients (16%) the cognitive decline reported during treatment was temporary — as it disappeared after chemotherapy — in others (13.7%), cognitive problems were reported only up to a year after chemotherapy.
Researchers noted that this delayed decline might be due to the lifestyle changes that survivors experience after resuming their lives, “which might contribute to a more pronounced awareness of previously unapparent cognitive deficits, leading to more cognitive complaints.”
The results strengthen the importance of raising awareness about cognitive dysfunction among breast cancer patients, so they can be better prepared for the changes they may experience during treatment and survivorship.
Also, patients who experienced no, or temporary, cognitive impairment were found to have higher self-perceived cognitive function even before chemotherapy, when compared with those who reported cognitive problems during survivorship.
This suggests that “a poor subjective baseline cognitive function may be indicative of a diminished cognitive reserve which could predispose patients towards undesirable cognitive outcomes during survivorship,” the team wrote.
“A well-rounded holistic survivorship programme will be very useful for cancer patients and survivors. More importantly, we should actively screen and manage patients at risk of cognitive impairment,” Chan added.
The researchers now are studying the mechanisms behind post-chemotherapy cognitive decline, and they also will assess the effectiveness of various interventions for managing chemotherapy-associated cognitive decline.