Effects of Chemotherapy and Psychosocial Distress on Perceived Cognitive Disturbances in Asian Breast Cancer Patients

Abstract

Background:

There is conflicting evidence on the effect of chemotherapy and psychosocial distress on perceived cognitive changes in cancer patients.

Objective:

To compare the severity of perceived cognitive disturbance in Asian breast cancer patients receiving chemotherapy and those not receiving chemotherapy, and identify clinical characteristics associated with perceived cognitive disturbances.

Methods:

A cross-sectional, observational study was conducted at the largest cancer center in Singapore. Breast cancer patients receiving chemotherapy and not receiving chemotherapy completed the Functional Assessment of Cancer Therapy–Cognitive Function (FACT-Cog), European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ-C30), and Beck Anxiety Inventory to assess their perceived cognitive functioning, health-related quality of life, and anxiety, respectively. Multiple regression was conducted to delineate the factors associated with perceived cognitive disturbances.

Results:

A total of 85 breast cancer patients receiving chemotherapy and 81 not receiving chemotherapy were recruited. Chemotherapy patients experienced more fatigue (QLQ-C30 fatigue scores: 33.3 vs 22.2 points; p = 0.005) and moderate-to-severe anxiety (21.9% vs 8.6%; p = 0.002) compared to non-chemotherapy patients. Non-chemotherapy patients reported better perceived cognitive functioning than those who received chemotherapy (FACT-Cog scores: 124 vs 110 points, respectively; p < 0.001). Chemotherapy and endocrine therapy were strongly associated with perceived cognitive disturbances (p < 0.001 and 0.021, respectively). The interacting effect between anxiety and fatigue was moderately associated with perceived cognitive disturbances (β = -0.29; p = 0.037).

Conclusions:

Chemotherapy and endocrine treatment were associated with significant cognitive disturbances among Asian breast cancer patients. Psychosocial factors could be used to identify cancer patients who are more susceptible to cognitive disturbances in the clinical setting.

Keywords

anxiety cancer chemobrain cognitive function psycho-oncology psychosocial distress quality of life

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References

Chen

, Miaskowski

, Liu

, Chen

. Changes in perceived attentional function in women following breast cancer surgery. Breast Cancer Res Treat 2012; 131:599–606.

Tel

, Dogan

. Fatigue, anxiety and depression in cancer patients. Neurology, Psychiatry and Brain Research 2011; 17:42–5.

Tchen

, Juffs

, Downie

. Cognitive function, fatigue, and menopausal symptoms in women receiving adjuvant chemotherapy for breast cancer. J Clin Oncol 2003; 21:4175–83.

Reid-Arndt

, Hsieh

, Perry

. Neuropsychological functioning and quality of life during the first year after completing chemotherapy for breast cancer. Psychooncology 2010; 19:535–44.

Redeker

, Lev

, Ruggiero

. Insomnia, fatigue, anxiety, depression, and quality of life of cancer patients undergoing chemotherapy. Sch Inq Nurs Pract 2000; 14:275–90; discussion 91.

Nguyen

, Cramarossa

, Bruner

. A literature review of symptom clusters in patients with breast cancer. Expert Rev Pharmacoecon Outcomes Res 2011; 11:533–9.

Cheung

, Shwe

, Tan

, Fan

, Ng

, Chan

. Cognitive changes in multiethnic Asian breast cancer patients: a focus group study. Ann Oncol 2012; 23:2547–52.

National Comprehensive Cancer Network. NCCN clinical practice guidelines in cancer-related fatigue version 1.2013. www.nccn.org/professionals/physician-gls/pdf/fatigue.pdf (accessed 2012 Nov 30).

Hurria

, Somlo

, Ahles

. Renaming “chemobrain”. Cancer Invest 2007; 25:373–7.

10.

Vardy

, Wefel

, Ahles

, Tannock

, Schagen

. Cancer and cancer-therapy related cognitive dysfunction: an international perspective from the Venice cognitive workshop. Ann Oncol 2008; 19:623–9.

11.

Schagen

, Vardy

. Cognitive dysfunction in people with cancer. Lancet Oncol 2007; 8:852–3.

12.

Vardy

. Cognitive function in breast cancer survivors. Cancer Treat Res 2009; 151:387–419.

13.

Pullens

MJJ

, De Vries

, Roukema

. Subjective cognitive dysfunction in breast cancer patients: a systematic review. Psychooncology 2010; 19:1127–38.

14.

Moon

, Kim

. Perceived cognitive function and related factors in Korean women with breast cancer. Asian Nurs Res 2011; 5:141–50.

15.

Vearncombe

, Rolfe

, Wright

, Pachana

, Andrew

, Beadle

. Predictors of cognitive decline after chemotherapy in breast cancer patients. J Int Neuropsychol Soc 2009; 15:951–62.

16.

Van Esch

, Roukema

, Ernst

, Nieuwenhuijzen

GAP

, De Vries

. Combined anxiety and depressive symptoms before diagnosis of breast cancer. J Affect Disord 2012; 136:895–901.

17.

Ahles

, Saykin

, McDonald

. Cognitive function in breast cancer patients prior to adjuvant treatment. Breast Cancer Res Treat 2008; 110:143–52.

18.

Wefel

, Vidrine

, Veramonti

. Cognitive impairment in men with testicular cancer prior to adjuvant therapy. Cancer 2011; 117:190–6.

19.

Garssen

. Psychological factors and cancer development: evidence after 30 years of research. Clin Psychol Rev 2004; 24:315–38.

20.

Wagner

, Sweet

, Butt

, Lai

J-s

, Cella

. Measuring patient self-reported cognitive function: development of the Functional Assessment of Cancer Therapy–Cognitive Function instrument. J Support Oncol 2009; 7:W32–9.

21.

Bonomi

, Cella

, Hahn

. Multilingual translation of the functional assessment of cancer therapy (FACT) quality of life measurement system. Qual Life Res 1996; 5:309–20.

22.

Eremenco

, Arnold

, Cella

. A comprehensive method for the translation and cross-cultural validation of health status questionnaires. Eval Health Prof 2005; 28:212–32.

23.

Wild

, Grove

, Martin

. Principles of good practice for the translation and cultural adaptation process for patient-reported outcomes (PRO) measures: report of the ISPOR Task Force for Translation and Cultural Adaptation. Value Health 2005; 8:94–104.

24.

Aaronson

, Ahmedzai

, Bergman

. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 1993; 85:365–76.

25.

Luo

, Fones

CSL

, Lim

, Xie

, Thumboo

, Li

. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30): validation of English version in Singapore. Qual Life Res 2005; 14:1181–6.

26.

Cheung

, Thumboo

, Goh

, Khoo

, Che

, Wee

. The equivalence and difference between the English and Chinese versions of two major, cancer-specific, health-related quality-of-life questionnaires. Cancer 2004; 101:2874–80.

27.

Beck

, Epstein

, Brown

, Steer

. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol 1988; 56:893–7.

28.

Osoba

, Rodrigues

, Myles

, Zee

, Pater

. Interpreting the significance of changes in health-related quality-of-life scores. J Clin Oncol 1998; 16:139–44.

29.

Ahles

, Saykin

, McDonald

. Longitudinal assessment of cognitive changes associated with adjuvant treatment for breast cancer: impact of age and cognitive reserve. J Clin Oncol 2010; 28:4434–40.

30.

Fan

HGM

, Houédé-Tchen

, Yi

. Fatigue, menopausal symptoms, and cognitive function in women after adjuvant chemotherapy for breast cancer: 1- and 2-year follow-up of a prospective controlled study. J Clin Oncol 2005; 23:8025–32.

31.

Mehnert

, Scherwath

, Schirmer

. The association between neuropsychological impairment, self-perceived cognitive deficits, fatigue and health related quality of life in breast cancer survivors following standard adjuvant versus high-dose chemotherapy. Patient Educ Couns 2007; 66:108–18.

32.

Shilling

, Jenkins

, Fallowfield

, Howell

. The effects of hormone therapy on cognition in breast cancer. J Steroid Biochem Mol Biol 2003; 86:405–12.

33.

Schilder

, Seynaeve

, Beex

. Effects of tamoxifen and exemestane on cognitive functioning of postmenopausal patients with breast cancer: results from the neuropsychological side study of the tamoxifen and exemestane adjuvant multinational trial. J Clin Oncol 2010; 28:1294–300.

34.

Jacobsen

, Garland

, Booth-Jones

. Relationship of hemoglobin levels to fatigue and cognitive functioning among cancer patients receiving chemotherapy. J Pain Symptom Manage 2004; 28:7–18.

35.

Joly

, Rigal

, Noal

, Giffard

. Cognitive dysfunction and cancer: which consequences in terms of disease management? Psychooncology 2011; 20:1251–8.

36.

Schwartz

, Bode

, Repucci

, Becker

, Sprangers

MAG

, Fayers

. The clinical significance of adaptation to changing health: a metaanalysis of response shift. Qual Life Res 2006; 15:1533–50.

37.

NCCN clinical practice guidelines in cancer-related fatigue version 1. www.nccn.org/professionals/physician_gls/pdf/fatigue.pdf (accessed 2012 Jan 9).

38.

Breckenridge

, Bruns

, Todd

, Feuerstein

. Cognitive limitations associated with tamoxifen and aromatase inhibitors in employed breast cancer survivors. Psychooncology 2012; 21:43–53.

39.

Bender

, Sereika

, Brufsky

. Memory impairments with adjuvant anastrozole versus tamoxifen in women with early-stage breast cancer. Menopause 2007; 14:995–8.

40.

Cunningham

. Anemia in the oncology patient: cognitive function and cancer. Cancer Nurs 2003; 26:38S–42S.

41.

Jansen

, Miaskowski

, Dodd

, Dowling

, Kramer

. Potential mechanisms for chemotherapy-induced impairments in cognitive function. Oncol Nurs Forum 2005; 32:1151–63.

42.

Janelsins

, Mustian

, Palesh

. Differential expression of cytokines in breast cancer patients receiving different chemotherapies: implications for cognitive impairment research. Support Care Cancer 2011; 1–9.

43.

Myers

. The possible role of cytokines in chemotherapy-induced cognitive deficits. Adv Exp Med Biol 2010; 678:119–23.

44.

Meyers

, Albitar

, Estey

. Cognitive impairment, fatigue, and cytokine levels in patients with acute myelogenous leukemia or myelodysplastic syndrome. Cancer 2005; 104:788–93.

45.

Cheung

, Lim

, Chan

. The intermediary role of cytokines in chemotherapy-associated cognitive impairment: a systematic review. Support Care Cancer 2012; 20:S130.

46.

Seruga

, Zhang

, Bernstein

, Tannock

. Cytokines and their relationship to the symptoms and outcome of cancer. Nat Rev Cancer 2008; 8:887–99.

47.

Schagen

, Das

, van Dam

FSAM

. The influence of priming and preexisting knowledge of chemotherapy-associated cognitive complaints on the reporting of such complaints in breast cancer patients. Psychooncology 2009; 18:674–8.