Collins Barbara, Mackenzie Joyce, Stewart Angela, Bielajew Catherine, Verma Shailendra
The Ottawa Hospital-Civic Campus, Ottawa, Ont., Canada K1Y 4E9.
Psychooncology. 2009 Aug;18(8):811-21. doi: 10.1002/pon.1453.
The primary purpose of this study was to evaluate the cognitive effects of adjuvant hormonal therapies in breast cancer patients.
Post-menopausal breast cancer patients scheduled to receive tamoxifen (n=31) or anastrozole (n=14) completed neuropsychological testing around the time of commencement of treatment (T1), and again 5-6 months later (T2). A sample of healthy female volunteers (n=28) was tested at comparable intervals. A standardized regression-based approach was used to assess cognitive change. This method uses test/retest scores of the healthy control group to generate an equation that predicts T2 scores from T1 scores. The difference between the predicted and obtained T2 scores divided by the standard error of the estimate produces a deviation score that reflects the discrepancy from the T1-T2 difference scores that would be expected on the basis of practice and error alone.
Analysis of individual deviation scores revealed that both the patients taking tamoxifen and those taking anastrozole were more likely than healthy controls to show reliable cognitive decline from T1 to T2 (39, 64, and 7%, respectively). Processing speed and verbal memory were the cognitive domains most affected.
These data suggest that hormonal therapies exert a subtle negative influence on cognition in breast cancer patients. Further analyses indicated that this effect was not fully accounted for by demographic factors or fatigue. Methodological limitations of the current study are addressed, along with recommendations for future studies in this area.
本研究的主要目的是评估辅助激素疗法对乳腺癌患者认知功能的影响。
计划接受他莫昔芬治疗的绝经后乳腺癌患者（n = 31）或阿那曲唑治疗的患者（n = 14）在治疗开始时（T1）及5 - 6个月后（T2）完成神经心理学测试。选取健康女性志愿者样本（n = 28）在相同间隔时间进行测试。采用基于标准化回归的方法评估认知变化。该方法利用健康对照组的重测分数生成一个方程，根据T1分数预测T2分数。预测的T2分数与实际获得的T2分数之差除以估计标准误差得出偏差分数，该分数反映了与仅基于练习和误差预期的T1 - T2差异分数的偏差。
对个体偏差分数的分析显示，服用他莫昔芬的患者和服用阿那曲唑的患者相比健康对照组，从T1到T2出现可靠认知下降的可能性更大（分别为39%、64%和7%）。加工速度和言语记忆是受影响最大的认知领域。
这些数据表明激素疗法对乳腺癌患者的认知有细微的负面影响。进一步分析表明，人口统计学因素或疲劳并不能完全解释这种影响。文中讨论了本研究的方法学局限性以及该领域未来研究的建议。
