Boele Florien W, Schilder Christina M T, de Roode Mari-Lou, Deijen Jan Berend, Schagen Sanne B
From the 1Department of Medical Psychology, VU University Medical Center, Amsterdam, the Netherlands; 2Department of Medical Psychology, Medical Center Haaglanden, the Hague, the Netherlands; 3Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands; and 4Department of Clinical Neuropsychology, VU University, Amsterdam, the Netherlands.
Menopause. 2015 Jan;22(1):17-25. doi: 10.1097/GME.0000000000000271.
Endocrine therapy is widely used-often for many years-in women with breast cancer. Yet little is known about cognitive functioning after long-term use of tamoxifen. We examine cognitive sequelae, approximately 3 years after diagnosis, in postmenopausal women with breast cancer who were treated with adjuvant tamoxifen.
Data from participants who underwent surgical operation with or without radiotherapy, participants who received adjuvant tamoxifen, and healthy controls were collected. Neuropsychological tests were administered, and participants completed questionnaires on health-related quality of life (Quality of Life Questionnaire Core 30 and Breast Cancer-Specific Quality-of-Life Questionnaire), menopausal symptoms (Functional Assessment of Cancer Therapy-Breast endocrine symptom subscale), and anxiety and depression (Hopkins Symptom Checklist).
In total, 107 women participated (adjuvant tamoxifen group, n = 20; surgical operation/radiotherapy group, n = 43; healthy control group, n = 44). Women in the adjuvant tamoxifen group had received tamoxifen for a mean (SD) of 31.5 (18.6) months (range, 15-79 mo) and performed worse on verbal memory than the surgical operation/radiotherapy group (P < 0.05) and the healthy control group (P < 0.05). Participants in the adjuvant tamoxifen group performed worse on measures of fluency than healthy controls (P < 0.05). Furthermore, women in the adjuvant tamoxifen group reported worse cognitive functioning (P < 0.05) than women in the surgical operation/radiotherapy group or the healthy control group.
Our results provide insights into cognitive functioning in women who receive long-term adjuvant tamoxifen treatment. By adding the surgical operation/radiotherapy group, we could control for the mental and physical influences of the diagnosis and treatment of breast cancer. Cognitive domains that rely on verbal abilities (verbal memory and fluency) seem to be at risk for deterioration after treatment with tamoxifen.
内分泌治疗在乳腺癌女性患者中被广泛应用——通常长达数年。然而，对于长期使用他莫昔芬后的认知功能了解甚少。我们研究了接受辅助性他莫昔芬治疗的绝经后乳腺癌女性患者在诊断后约3年的认知后遗症。
收集了接受或未接受放疗的手术参与者、接受辅助性他莫昔芬治疗的参与者以及健康对照者的数据。进行了神经心理学测试，参与者完成了关于健康相关生活质量（生活质量问卷核心30项和乳腺癌特异性生活质量问卷）、更年期症状（癌症治疗功能评估-乳腺内分泌症状子量表）以及焦虑和抑郁（霍普金斯症状清单）的问卷调查。
共有107名女性参与（辅助性他莫昔芬组，n = 20；手术/放疗组，n = 43；健康对照组，n = 44）。辅助性他莫昔芬组的女性接受他莫昔芬的平均（标准差）时间为31.5（18.6）个月（范围为15 - 79个月），其言语记忆表现比手术/放疗组（P < 0.05）和健康对照组（P < 0.05）更差。辅助性他莫昔芬组的参与者在流畅性测试中的表现比健康对照组差（P < 0.05）。此外，辅助性他莫昔芬组的女性报告的认知功能比手术/放疗组或健康对照组的女性更差（P < 0.05）。
我们的研究结果为接受长期辅助性他莫昔芬治疗的女性的认知功能提供了见解。通过增加手术/放疗组，我们可以控制乳腺癌诊断和治疗对心理和身体的影响。依赖言语能力（言语记忆和流畅性）的认知领域在接受他莫昔芬治疗后似乎有恶化的风险。
