Department of Health Sciences, School of Health Professions, University of Missouri, Columbia, MO 65221-4290, USA.
Med Care. 2012 Oct;50(10):849-55. doi: 10.1097/MLR.0b013e31825a8bb0.
This study tested 2 hypotheses: (1) chemotherapy increases the rate of cognitive decline in breast and colorectal cancer patients beyond what is typical of normal aging and (2) chemotherapy results in systematic cognitive declines when compared with breast and colorectal cancer patients who did not receive chemotherapy.
Data came from personal interviews with a prospective cohort of patients with breast (n=141) or colorectal cancer (n=224) with incident disease drawn from the nationally representative Health and Retirement Study (1998-2006) with linked Medicare claims.
The 27-point modified Telephone Interview for Cognitive Status was used to assess cognitive functioning, focusing on memory and attention. We defined the smallest clinically significant change as 0.4 points per year.
We used Bayesian hierarchical linear models to test the hypotheses, adjusting for multiple possible confounders. Eighty-eight patients were treated with chemotherapy; 277 were not. The mean age at diagnosis was 75.5. Patients were followed for a median of 3.1 years after diagnosis, with a range of 0 to 8.3 years. We found no differences in the rates of cognitive decline before and after diagnosis for patients who received chemotherapy in adjusted models (P=0.86, one-sided 95% posterior intervals lower bound: 0.09 worse after chemotherapy), where patients served as their own controls. Moreover, the rate of cognitive decline after diagnosis did not differ between patients who had chemotherapy and those who did not (P=0.84, one-sided 95% posterior intervals lower bound: 0.11 worse for chemotherapy group in adjusted model).
There was no evidence of cognitive decline associated with chemotherapy in this sample of older adults with breast and colorectal cancer.
本研究检验了两个假设：（1）化疗会增加乳腺癌和结直肠癌患者认知能力下降的速度，超出正常衰老的典型速度；（2）与未接受化疗的乳腺癌和结直肠癌患者相比，化疗会导致系统性认知能力下降。
数据来自于一项前瞻性队列研究的个人访谈，该研究对象为来自全国代表性的健康与退休研究（1998-2006 年）的患有乳腺癌（n=141）或结直肠癌（n=224）的新发病例患者，这些患者的医疗保险索赔与研究相关联。
使用 27 点改良电话认知状态测试来评估认知功能，重点关注记忆和注意力。我们将最小临床显著变化定义为每年 0.4 分。
我们使用贝叶斯分层线性模型来检验假设，调整了多种可能的混杂因素。88 名患者接受了化疗；277 名患者未接受化疗。诊断时的平均年龄为 75.5 岁。患者在诊断后中位数为 3.1 年进行随访，范围为 0 至 8.3 年。在调整后的模型中，我们未发现接受化疗的患者在诊断前后认知能力下降的速度存在差异（P=0.86，单侧 95%后验区间下限：化疗后认知能力下降 0.09），患者自身作为对照组。此外，接受化疗和未接受化疗的患者在诊断后认知能力下降的速度没有差异（P=0.84，单侧 95%后验区间下限：化疗组在调整后的模型中认知能力下降 0.11）。
在这项针对老年乳腺癌和结直肠癌患者的样本中，没有证据表明化疗与认知能力下降有关。
