Evaluating the effects of chemotherapy on cognitive function and quality of life in pre-menopausal women with breast cancer

Abstract

A number of studies have documented significant reductions in quality of life (QOL) and cognitive function in women with breast cancer (BrCa) receiving adjuvant chemotherapy. These decrements can be identified in some women even several years following treatment. However, the majority of relevant research has been based on retrospective data in women with BrCa. Moreover, current estimates suggest that 25% of BrCa will be diagnosed in women under age 50, and little data are available regarding younger women's cognitive function and QOL during chemotherapy. This study examined the change in cognitive function and QOL in 20 pre-menopausal women with BrCa receiving chemotherapy.

Measures of cognitive functioning and QOL, along with serum hormone values (i.e., estradiol), were analyzed prior to, during, and post-treatment. Objective measures of cognitive functioning on the High Sensitivity Cognitive Screen (HSCS) did not change over the course of treatment, except for a significant improvement in memory performance. Subjective cognitive difficulties, as assessed with the Breast Cancer Prevention Trial (BCPT) Cognitive Problems subscale and clinical interview, increased significantly over the study period. The HSCS Total score and Memory subscales were not significantly associated with BCPT Cognitive Problems. Chemotherapy-relevant measures of QOL, including menopausal symptoms, fatigue, and depressive symptoms, all significantly worsened over the course of treatment.

Higher levels of blood hemoglobin at baseline, but no QOL measures, predicted an increase in BCPT Cognitive Problems over the course of treatment. Higher baseline hemoglobin, as well as older age and lower hot flashes, predicted an increase in fatigue, and lower baseline hot flashes predicted an increase in depressive symptoms. Lower baseline levels of serum estradiol and higher depressive symptoms predicted an increase in hot flashes. This in-depth study of pre-menopausal women with BrCa suggests that deficits in cognition, at least in young and highly educated sample such as in the current study, might have been overestimated in previous studies. Continued research with longitudinal study designs and larger samples is necessary to further understand the impact of diagnosis and treatment of young women with BrCa.