Lange Marie, Giffard Bénédicte, Noal Sabine, Rigal Olivier, Kurtz Jean-Emmanuel, Heutte Natacha, Lévy Christelle, Allouache Djelila, Rieux Chantal, Le Fel Johan, Daireaux Aurélie, Clarisse Bénédicte, Veyret Corinne, Barthélémy Philippe, Longato Nadine, Eustache Francis, Joly Florence
INSERM, U1077, Caen, France; Normandie Université, UMR-S1077, Caen, France; Ecole Pratique des Hautes Etudes, UMR-S1077, Caen, France; CHU de Caen, U1077, Caen, France; INSERM, U1086, Caen, France; Unité de Recherche Clinique, Centre François Baclesse, Caen, France.
INSERM, U1077, Caen, France; Normandie Université, UMR-S1077, Caen, France; Ecole Pratique des Hautes Etudes, UMR-S1077, Caen, France; CHU de Caen, U1077, Caen, France.
Eur J Cancer. 2014 Sep;50(13):2181-9. doi: 10.1016/j.ejca.2014.05.026. Epub 2014 Jun 20.
Cognitive deficits (CD) are reported among cancer patients receiving chemotherapy, but may also be observed before treatment. Though elderly patients are expected to be more prone to present age-related CD, poor information is available regarding the impact of cancer and chemotherapy on this population. This study assessed baseline cognitive functions (before adjuvant treatment) in elderly early stage breast cancer (EBC) patients.
Women >65years-old with newly diagnosed EBC were included in this prospective study. Episodic memory, working memory, executive functions and information processing speed were assessed by neuropsychological tests. Questionnaires were used to assess subjective CD, anxiety, depression, fatigue, quality of life and geriatric profile. Objective CD were defined using International Cognition and Cancer Task Force criteria. A group of elderly women without cancer coupled with published data related to healthy women were used for comparison (respectively to subjective and objective CD).
Among the 123 elderly EBC patients (70±4years) included, 41% presented objective CD, which is greater than expected in healthy population norms (binomial test P<.0001). Verbal episodic memory was mainly impaired (21% of patients). No correlation was observed between objective CD and cancer stage or geriatric assessment. Subjective CD only correlated with verbal episodic memory (P=.01).
This is the first large series assessing baseline cognitive functions in elderly EBC patients. More than 40% presented objective CD before any adjuvant therapy, which is higher than what is reported among younger patients. Our results reinforce the hypothesis that age is a risk factor for CD in EBC patients.
据报道，接受化疗的癌症患者存在认知缺陷（CD），但在治疗前也可能观察到。尽管老年患者预计更容易出现与年龄相关的认知缺陷，但关于癌症和化疗对该人群影响的信息却很少。本研究评估了老年早期乳腺癌（EBC）患者的基线认知功能（辅助治疗前）。
本前瞻性研究纳入了年龄大于65岁的新诊断EBC女性患者。通过神经心理学测试评估情景记忆、工作记忆、执行功能和信息处理速度。使用问卷评估主观认知缺陷、焦虑、抑郁、疲劳、生活质量和老年概况。客观认知缺陷根据国际认知与癌症特别工作组的标准定义。一组无癌症的老年女性以及已发表的与健康女性相关的数据用于比较（分别用于主观和客观认知缺陷）。
在纳入的123例老年EBC患者（70±4岁）中，41%存在客观认知缺陷，这高于健康人群的预期水平（二项式检验P<.0001）。言语情景记忆主要受损（21%的患者）。客观认知缺陷与癌症分期或老年评估之间未观察到相关性。主观认知缺陷仅与言语情景记忆相关（P=.01）。
这是首个评估老年EBC患者基线认知功能的大型系列研究。超过40%的患者在任何辅助治疗前就存在客观认知缺陷，这高于年轻患者的报道水平。我们的结果强化了年龄是EBC患者认知缺陷危险因素的假设。
