TY - JOUR
T1 - Cognitive impairment in older patients with breast cancer before systemic therapy
T2 - Is there an interaction between cancer and comorbidity?
AU - Mandelblatt, Jeanne S.
AU - Stern, Robert A.
AU - Luta, Gheorghe
AU - McGuckin, Meghan
AU - Clapp, Jonathan D.
AU - Hurria, Arti
AU - Jacobsen, Paul B.
AU - Faul, Leigh Anne
AU - Isaacs, Claudine
AU - Denduluri, Neelima
AU - Gavett, Brandon
AU - Traina, Tiffany A.
AU - Johnson, Patricia
AU - Silliman, Rebecca A.
AU - Turner, R. Scott
AU - Howard, Darlene
AU - Van Meter, John W.
AU - Saykin, Andrew
AU - Ahles, Tim
PY - 2014/6/20
Y1 - 2014/6/20
N2 - Purpose: To determine if older patients with breast cancer have cognitive impairment before systemic therapy. Patients and Methods: Participants were patients with newly diagnosed nonmetastatic breast cancer and matched friend or community controls age > 60 years without prior systemic treatment, dementia, or neurologic disease. Participants completed surveys and a 55-minute battery of 17 neuropsychological tests. Biospecimens were obtained for APOE genotyping, and clinical data were abstracted. Neuropsychological test scores were standardized using control means and standard deviations (SDs) and grouped into five domain z scores. Cognitive impairment was defined as any domain z score two SDs below or ≥ two z scores 1.5 SDs below the control mean. Multivariable analyses evaluated pretreatment differences considering age, race, education, and site; comparisons between patient cases also controlled for surgery. Results: The 164 patient cases and 182 controls had similar neuropsychological domain scores. However, among patient cases, those with stage II to III cancers had lower executive function compared with those with stage 0 to I disease, after adjustment (P = .05). The odds of impairment were significantly higher among older, nonwhite, less educated women and those with greater comorbidity, after adjustment. Patient case or control status, anxiety, depression, fatigue, and surgery were not associated with impairment. However, there was an interaction between comorbidity and patient case or control status; comorbidity was strongly associated with impairment among patient cases (adjusted odds ratio, 8.77; 95% CI, 2.06 to 37.4; P = .003) but not among controls (P = .97). Only diabetes and cardiovascular disease were associated with impairment among patient cases. Conclusion: There were no overall differences between patients with breast cancer and controls before systemic treatment, but there may be pretreatment cognitive impairment within subgroups of patient cases with greater tumor or comorbidity burden.
AB - Purpose: To determine if older patients with breast cancer have cognitive impairment before systemic therapy. Patients and Methods: Participants were patients with newly diagnosed nonmetastatic breast cancer and matched friend or community controls age > 60 years without prior systemic treatment, dementia, or neurologic disease. Participants completed surveys and a 55-minute battery of 17 neuropsychological tests. Biospecimens were obtained for APOE genotyping, and clinical data were abstracted. Neuropsychological test scores were standardized using control means and standard deviations (SDs) and grouped into five domain z scores. Cognitive impairment was defined as any domain z score two SDs below or ≥ two z scores 1.5 SDs below the control mean. Multivariable analyses evaluated pretreatment differences considering age, race, education, and site; comparisons between patient cases also controlled for surgery. Results: The 164 patient cases and 182 controls had similar neuropsychological domain scores. However, among patient cases, those with stage II to III cancers had lower executive function compared with those with stage 0 to I disease, after adjustment (P = .05). The odds of impairment were significantly higher among older, nonwhite, less educated women and those with greater comorbidity, after adjustment. Patient case or control status, anxiety, depression, fatigue, and surgery were not associated with impairment. However, there was an interaction between comorbidity and patient case or control status; comorbidity was strongly associated with impairment among patient cases (adjusted odds ratio, 8.77; 95% CI, 2.06 to 37.4; P = .003) but not among controls (P = .97). Only diabetes and cardiovascular disease were associated with impairment among patient cases. Conclusion: There were no overall differences between patients with breast cancer and controls before systemic treatment, but there may be pretreatment cognitive impairment within subgroups of patient cases with greater tumor or comorbidity burden.
KW - Aged
KW - Aged, 80 and over
KW - Breast Neoplasms/ethnology
KW - Cognition
KW - Cognitive Dysfunction/diagnosis
KW - Comorbidity
KW - Educational Status
KW - Executive Function
KW - Female
KW - Humans
KW - Neoplasm Staging
KW - Neuropsychological Tests
KW - Odds Ratio
KW - Surveys and Questionnaires
KW - United States/epidemiology
UR - http://www.scopus.com/inward/record.url?scp=84905455466&partnerID=8YFLogxK
U2 - 10.1200/JCO.2013.54.2050
DO - 10.1200/JCO.2013.54.2050
M3 - Article
C2 - 24841981
SN - 0732-183X
VL - 32
SP - 1909
EP - 1918
JO - Journal of clinical oncology : official journal of the American Society of Clinical Oncology
JF - Journal of clinical oncology : official journal of the American Society of Clinical Oncology
IS - 18
ER -