Cognitive Impairment in Patients with Early-Stage Breast Cancer

Cancer-related cognitive impairment has long been described in association with breast cancer therapy, and patients often express feeling “less sharp and more forgetful” than before the breast cancer diagnosis. Investigators in France report neurocognitive findings for 276 patients with stage I–III breast cancer who were evaluated before treatment and 1 and 2 years after the diagnosis of breast cancer. A group of 135 age-matched healthy controls underwent the same evaluations.

A battery of neuropsychological tests were used to assess five cognitive domains, including episodic memory, working memory, information processing speed, attention, and executive function. Participants also self-reported cognitive difficulties and were evaluated for anxiety, depression, and fatigue.

Most patients underwent at least one neuropsychological assessment after baseline, and 85% underwent cognitive assessment after surgery. Mean patient age was 54 years. Sixty-two percent of patients received chemotherapy, mostly an anthracycline and taxane in the adjuvant setting. Median follow-up was 24 months.

Cognitive impairment was present in 33% of patients at year 1 and 29% at 2, compared with 11% and 10%, respectively, of controls. Similarly, cognitive difficulties were reported by significantly more patients than controls at years 1 and 2. Executive function decreased significantly in patients compared with controls at year 1 but not at year 2. Compared with patients not taking chemotherapy, those receiving chemotherapy reported more cognitive difficulties and cognitive fatigue at year 1 but not at year 2. Factors associated with cognitive difficulties included use of psychotropic medications, cognitive fatigue, and anxiety.