Cancer-Related Cognitive Outcomes Among Older Breast Cancer Survivors in the Thinking and Living With Cancer Study

dc.contributor.authorMandelblatt, Jeanne S.
dc.contributor.authorSmall, Brent J.
dc.contributor.authorLuta, Gheorghe
dc.contributor.authorHurria, Arti
dc.contributor.authorJim, Heather
dc.contributor.authorMcDonald, Brenna C.
dc.contributor.authorGraham, Deena
dc.contributor.authorZhou, Xingtao
dc.contributor.authorClapp, Jonathan
dc.contributor.authorZhai, Wanting
dc.contributor.authorBreen, Elizabeth
dc.contributor.authorCarroll, Judith E.
dc.contributor.authorDenduluri, Neelima
dc.contributor.authorDilawari, Asma
dc.contributor.authorExtermann, Martine
dc.contributor.authorIsaacs, Claudine
dc.contributor.authorJacobsen, Paul B.
dc.contributor.authorKobayashi, Lindsay C.
dc.contributor.authorHolohan Nudelman, Kelly
dc.contributor.authorRoot, James
dc.contributor.authorStern, Robert A.
dc.contributor.authorTometich, Danielle
dc.contributor.authorTurner, Raymond
dc.contributor.authorVanMeter, John W.
dc.contributor.authorSaykin, Andrew J.
dc.contributor.authorAhles, Tim
dc.contributor.departmentRadiology and Imaging Sciences, School of Medicineen_US
dc.date.accessioned2019-05-24T19:01:23Z
dc.date.available2019-05-24T19:01:23Z
dc.date.issued2018-11
dc.description.abstractPurpose To determine treatment and aging-related effects on longitudinal cognitive function in older breast cancer survivors. Methods Newly diagnosed nonmetastatic breast cancer survivors (n = 344) and matched controls without cancer (n = 347) 60 years of age and older without dementia or neurologic disease were recruited between August 2010 and December 2015. Data collection occurred during presystemic treatment/control enrollment and at 12 and 24 months through biospecimens; surveys; self-reported Functional Assessment of Cancer Therapy-Cognitive Function; and neuropsychological tests that measured attention, processing speed, and executive function (APE) and learning and memory (LM). Linear mixed-effects models tested two-way interactions of treatment group (control, chemotherapy with or without hormonal therapy, and hormonal therapy) and time and explored three-way interactions of ApoE (ε4+ v not) by group by time; covariates included baseline age, frailty, race, and cognitive reserve. Results Survivors and controls were 60 to 98 years of age, were well educated, and had similar baseline cognitive scores. Treatment was related to longitudinal cognition scores, with survivors who received chemotherapy having increasingly worse APE scores (P = .05) and those initiating hormonal therapy having lower LM scores at 12 months (P = .03) than other groups. These group-by-time differences varied by ApoE genotype, where only ε4+ survivors receiving hormone therapy had short-term decreases in adjusted LM scores (three-way interaction P = .03). For APE, the three-way interaction was not significant (P = .14), but scores were significantly lower for ε4+ survivors exposed to chemotherapy (−0.40; 95% CI, −0.79 to −0.01) at 24 months than ε4+ controls (0.01; 95% CI, 0.16 to 0.18; P < .05). Increasing age was associated with lower baseline scores on all cognitive measures (P < .001); frailty was associated with baseline APE and self-reported decline (P < .001). Conclusion Breast cancer systemic treatment and aging-related phenotypes and genotypes are associated with longitudinal decreases in cognitive function scores in older survivors. These data could inform treatment decision making and survivorship care planning.en_US
dc.eprint.versionFinal published versionen_US
dc.identifier.citationMandelblatt, J. S., Small, B. J., Luta, G., Hurria, A., Jim, H., McDonald, B. C., … Ahles, T. (2018). Cancer-Related Cognitive Outcomes Among Older Breast Cancer Survivors in the Thinking and Living With Cancer Study. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology, JCO1800140. https://doi.org/10.1200/JCO.18.00140en_US
dc.identifier.urihttps://hdl.handle.net/1805/19471
dc.language.isoenen_US
dc.publisherASCOen_US
dc.relation.isversionof10.1200/JCO.18.00140en_US
dc.relation.journalJournal of Clinical Oncologyen_US
dc.rightsPublisher Policyen_US
dc.sourcePublisheren_US
dc.subjectbreast canceren_US
dc.subjectcognitive outcomesen_US
dc.subjectaging-related effectsen_US
dc.titleCancer-Related Cognitive Outcomes Among Older Breast Cancer Survivors in the Thinking and Living With Cancer Studyen_US
dc.typeArticleen_US
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