Department of Internal Medicine, Sealy Center on Aging, University of Texas Medical Branch, 301 University Blvd., Rt. 0460, Galveston, TX 77555-0460, USA.
Med Oncol. 2009 Dec;26(4):452-9. doi: 10.1007/s12032-008-9145-0. Epub 2008 Dec 9.
Little is known about long-term cognitive side effects of adjuvant chemotherapy for breast cancer. We thus examined incidence of dementia diagnoses in older women diagnosed with breast cancer, stratified by types of chemotherapy regimen.
We identified patients with incident dementia diagnoses through Medicare claims linked to the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) tumor registry data. The study population (n = 6,932) consisted of women at least 68 years of age, who were diagnosed with early-stage breast cancer from 1994 through 2002 in one of the SEER areas and received chemotherapy as part of their cancer treatment. Excluded were women with a diagnosis of dementia within the 3 years prior to their cancer diagnosis.
Our sample comprised mostly white women. The mean age was 74. Fifty-seven percent were estrogen receptor positive. Over 70% had no comorbidity. The use of taxol and anthracycline-based treatments increased from mid-1990s to early 2000. Increasing age at cancer diagnosis, Black ethnicity, living in a census tract with lower level of education, and increasing number of comorbidities were associated with new claims of dementia diagnoses after chemotherapy. There was no significant association between types of chemotherapy agents and risk of subsequent dementia diagnoses.
No association was found between types of adjuvant chemotherapy agents for breast cancer and risk of new dementia diagnoses. Our findings suggest that concerns about post-chemotherapy dementia should not be a major factor in determining type of adjuvant chemotherapy regimen to prescribe for older women with breast cancer.
对于乳腺癌辅助化疗的长期认知副作用知之甚少。因此，我们研究了接受不同化疗方案的老年乳腺癌患者的痴呆诊断发生率。
我们通过与美国国家癌症研究所的监测、流行病学和最终结果（SEER）肿瘤登记数据相关联的医疗保险索赔来确定痴呆诊断的新发病例。研究人群（n=6932）由至少 68 岁的女性组成，她们在 SEER 区域之一中被诊断患有早期乳腺癌，并且在癌症治疗中接受了化疗。排除了在癌症诊断前 3 年内被诊断为痴呆的女性。
我们的样本主要由白人女性组成。平均年龄为 74 岁。57%为雌激素受体阳性。超过 70%的患者没有合并症。1990 年代中期至 2000 年初，紫杉醇和蒽环类药物治疗的使用率增加。癌症诊断时年龄越大、黑人种族、居住在教育水平较低的普查地段以及合并症数量增加与化疗后新的痴呆诊断有关。化疗药物类型与随后发生痴呆的风险之间没有显著关联。
乳腺癌辅助化疗药物类型与新发痴呆诊断风险之间没有关联。我们的研究结果表明，在为老年乳腺癌患者确定辅助化疗方案时，不应将化疗后痴呆的担忧作为主要因素。
