Lani
07-06-2010, 01:54 PM
Cancer
CA: A Cancer Journal for Clinicians
Volume 116 Issue 14, Pages 3348 - 3356
Published Online: 28 Apr 2010
Copyright © 2010 American Cancer Society
Published on behalf of the American Cancer Society
Original Article
Acute and late onset cognitive dysfunction associated with chemotherapy in women with breast cancer
Jeffrey S. Wefel, PhD 1 *, Angele K. Saleeba, PhD 1, Aman U. Buzdar, MD 2, Christina A. Meyers, PhD 1
1The University of Texas M. D. Anderson Cancer Center, Section of Neuropsychology, Department of Neuro-Oncology, Houston, Texas
2The University of Texas M. D. Anderson Cancer Center, Department of Breast Medical Oncology, Houston, Texas
email: Jeffrey S. Wefel (jwefel@mdanderson.org)
*Correspondence to Jeffrey S. Wefel, Department of Neuro-Oncology, The University of Texas M. D. Anderson Cancer Center, P.O. Box 301402-Unit 431, Houston, TX 77230-1402
Fax: (713) 794-4999
KEYWORDS
cognition disorders • memory • neuropsychological tests • systemic chemotherapy • breast neoplasms
ABSTRACT
BACKGROUND:
Growing evidence supports cognitive dysfunction associated with standard dose chemotherapy in breast cancer survivors. We determined the incidence, nature, and chronicity of cognitive dysfunction in a prospective longitudinal randomized phase 3 treatment trial for patients with T1-3, N0-1, M0 breast cancer receiving 5-fluorouracil, doxorubicin, and cyclophosphamide with or without paclitaxel.
METHODS:
Forty-two patients underwent a neuropsychological evaluation including measures of cognition, mood, and quality of life. Patients were scheduled to be assessed before chemotherapy, during and shortly after chemotherapy, and 1 year after completion of chemotherapy.
RESULTS:
Before chemotherapy, 21% (9 of 42) evidenced cognitive dysfunction. In the acute interval, 65% (24 of 37) demonstrated cognitive decline. At the long-term evaluation, 61% (17 of 28) evidenced cognitive decline after cessation of treatment. Within this group of patients, 71% (12 of 17) evidenced continuous decline from the acute interval, and, notably, 29% (5 of 17) evidenced new delayed cognitive decline. Cognitive decline was most common in the domains of learning and memory, executive function, and processing speed. Cognitive decline was not associated with mood or other measured clinical or demographic characteristics, but late decline may be associated with baseline level of performance.
CONCLUSIONS:
Standard dose systemic chemotherapy is associated with decline in cognitive function during and shortly after completion of chemotherapy. In addition, delayed cognitive dysfunction occurred in a large proportion of patients. These findings are consistent with a developing body of translational animal research demonstrating both acute and delayed structural brain changes as well as functional changes associated with common chemotherapeutic agents such as 5-flouorouracil. Cancer 2010. © 2010 American Cancer Society.
CA: A Cancer Journal for Clinicians
Volume 116 Issue 14, Pages 3348 - 3356
Published Online: 28 Apr 2010
Copyright © 2010 American Cancer Society
Published on behalf of the American Cancer Society
Original Article
Acute and late onset cognitive dysfunction associated with chemotherapy in women with breast cancer
Jeffrey S. Wefel, PhD 1 *, Angele K. Saleeba, PhD 1, Aman U. Buzdar, MD 2, Christina A. Meyers, PhD 1
1The University of Texas M. D. Anderson Cancer Center, Section of Neuropsychology, Department of Neuro-Oncology, Houston, Texas
2The University of Texas M. D. Anderson Cancer Center, Department of Breast Medical Oncology, Houston, Texas
email: Jeffrey S. Wefel (jwefel@mdanderson.org)
*Correspondence to Jeffrey S. Wefel, Department of Neuro-Oncology, The University of Texas M. D. Anderson Cancer Center, P.O. Box 301402-Unit 431, Houston, TX 77230-1402
Fax: (713) 794-4999
KEYWORDS
cognition disorders • memory • neuropsychological tests • systemic chemotherapy • breast neoplasms
ABSTRACT
BACKGROUND:
Growing evidence supports cognitive dysfunction associated with standard dose chemotherapy in breast cancer survivors. We determined the incidence, nature, and chronicity of cognitive dysfunction in a prospective longitudinal randomized phase 3 treatment trial for patients with T1-3, N0-1, M0 breast cancer receiving 5-fluorouracil, doxorubicin, and cyclophosphamide with or without paclitaxel.
METHODS:
Forty-two patients underwent a neuropsychological evaluation including measures of cognition, mood, and quality of life. Patients were scheduled to be assessed before chemotherapy, during and shortly after chemotherapy, and 1 year after completion of chemotherapy.
RESULTS:
Before chemotherapy, 21% (9 of 42) evidenced cognitive dysfunction. In the acute interval, 65% (24 of 37) demonstrated cognitive decline. At the long-term evaluation, 61% (17 of 28) evidenced cognitive decline after cessation of treatment. Within this group of patients, 71% (12 of 17) evidenced continuous decline from the acute interval, and, notably, 29% (5 of 17) evidenced new delayed cognitive decline. Cognitive decline was most common in the domains of learning and memory, executive function, and processing speed. Cognitive decline was not associated with mood or other measured clinical or demographic characteristics, but late decline may be associated with baseline level of performance.
CONCLUSIONS:
Standard dose systemic chemotherapy is associated with decline in cognitive function during and shortly after completion of chemotherapy. In addition, delayed cognitive dysfunction occurred in a large proportion of patients. These findings are consistent with a developing body of translational animal research demonstrating both acute and delayed structural brain changes as well as functional changes associated with common chemotherapeutic agents such as 5-flouorouracil. Cancer 2010. © 2010 American Cancer Society.