早期乳腺癌女性认知表现与并发症状、癌症及癌症治疗相关变量的关系：一项为期2年的纵向研究。
The relationship of cognitive performance to concurrent symptoms, cancer- and cancer-treatment-related variables in women with early-stage breast cancer: a 2-year longitudinal study.
作者信息
Lyon Debra E, Cohen Ronald, Chen Huaihou, Kelly Debra L, Starkweather Angela, Ahn Hyo-Chol, Jackson-Cook Colleen K
机构信息
University of Florida, Gainesville, FL, USA.
University of Connecticut, Storrs Hall, Room 112B, 231 Glenbrook Road, Unit 4026, Storrs, CT, 06269, USA.
出版信息
J Cancer Res Clin Oncol. 2016 Jul;142(7):1461-74. doi: 10.1007/s00432-016-2163-y. Epub 2016 Apr 21.
PURPOSE
Cognitive dysfunction in women with breast cancer continues to be an area of intense research interest. The prevalence, severity, timing, and cognitive domains that are most affected, as well as the contribution of cancer and its treatments to cognition, remain unresolved. Thus, longitudinal studies are needed that examine cognitive function during different stages of breast cancer treatment and survivorship. This longitudinal trial followed women with early-stage breast cancer, prior to chemotherapy through 2 years survivorship.
METHODS
In women with early-stage breast cancer (N = -75), performance-based assessment of nine cognitive domains was performed at five time points beginning prior to chemotherapy and finishing 24 months after initial chemotherapy. Linear mixed effects models were used to examine the temporal changes in cognitive performance domains, while adjusting for cofactors, including those related to individuals, tumor attributes, chemotherapy (adjuvant or neoadjuvant), radiation, endocrine therapy, and concurrent symptoms.
RESULTS
At baseline, scores on reaction time, complex attention, cognitive flexibility, executive function, and visual memory were lower than 90. At 2 years, all domains improved except for the memory domains (verbal, visual, and composite). Scores on six domains (psychomotor speed, reaction time, complex attention, cognitive flexibility, and visual memory) remained lower than 100 at 2 years. Neoadjuvant chemotherapy and fatigue had strong inverse relationship with cognitive functioning at multiple time points.
CONCLUSION
The low performance-based cognitive scores at baseline and over time warrant further study. Although most scores improved over time, memory did not improve. In all, the level of cognitive function is lower than expected for a majority college-educated sample. Thus, future studies are warranted to replicate these findings and to develop methods for identifying women with cognitive dysfunction pretreatment and into survivorship.
目的
乳腺癌女性的认知功能障碍仍是一个备受关注的深入研究领域。其患病率、严重程度、发生时间、受影响最严重的认知领域，以及癌症及其治疗对认知的影响仍未得到解决。因此，需要进行纵向研究，以考察乳腺癌治疗和生存不同阶段的认知功能。这项纵向试验跟踪了早期乳腺癌女性，从化疗前到存活2年。
方法
在早期乳腺癌女性（N = 75）中，在化疗前开始并在初始化疗后24个月结束的五个时间点，对九个认知领域进行基于表现的评估。使用线性混合效应模型来检查认知表现领域的时间变化，同时调整包括与个体、肿瘤属性、化疗（辅助或新辅助）、放疗、内分泌治疗和并发症状相关的协变量。
结果
在基线时，反应时间、复杂注意力、认知灵活性、执行功能和视觉记忆的得分低于90。在2年时，除记忆领域（言语、视觉和综合）外，所有领域均有所改善。在2年时，六个领域（心理运动速度、反应时间、复杂注意力、认知灵活性和视觉记忆）的得分仍低于100。新辅助化疗和疲劳在多个时间点与认知功能呈强烈负相关。
结论
基于表现的认知得分在基线和随时间的较低水平值得进一步研究。尽管大多数得分随时间有所改善，但记忆并未改善。总体而言，对于大多数受过大学教育的样本，认知功能水平低于预期。因此，有必要进行未来研究以重复这些发现，并开发用于识别治疗前和进入存活期时存在认知功能障碍女性的方法。
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