INSERM, U1086, ANTICIPE, Caen, France.
Clinical Research Department, Caen, France.
Oncologist. 2019 Jan;24(1):62-68. doi: 10.1634/theoncologist.2017-0570. Epub 2018 Jun 22.
Group-based trajectory modeling is particularly important to identify subgroups of patients with pathological cognitive changes after cancer treatment. To date, only one study has explored cognitive trajectories in older patients with cancer. The present article describes objective cognitive changes before to after adjuvant treatment in older adults with early-stage breast cancer (EBC) after adjuvant treatment compared with healthy controls.
Participants were patients ≥65 years of age with newly diagnosed EBC and healthy controls (age-, sex-, and education-matched). The pretreatment assessment was conducted before adjuvant therapy, and the post-treatment assessment after the end of the first adjuvant treatment. Objective cognitive changes before to after treatment were evaluated based on the Reliable Change Index for cognitive decline accounting for cognitive impairment status.
The sample consisted of women newly diagnosed with EBC ( = 118) and healthy controls ( = 62). Five patterns of changes before to after treatment were identified based on the presence of cognitive decline and cognitive impairment. The distribution of these five change patterns was statistically significant ( = .0001). Thirty-six percent of patients had phase shift changes, 31% without initial objective cognitive impairment developed impairment, 15% had a normal aging, 12% had a nonpathological decline, and 6% experienced accelerated cognitive decline.
This study described for the first time objective cognitive changes before to after treatment of older adults with EBC immediately after the end of adjuvant treatment. A longer-term remote follow-up of adjuvant treatment is needed to better understand the cognitive trajectories of older patients with EBC.
After the end of adjuvant treatment, 31% of older adults with early-stage breast cancer without initial objective cognitive impairment developed impairment, and 6% experienced accelerated cognitive decline. Initial cognitive functioning should be included in the balance of benefits and harms of systemic therapy for patients who are likely to be at highest risk for cognitive decline after cancer treatments. Regular cognitive follow-up of patients who had cognitive impairment before cancer treatment should monitor symptoms suggestive of neurodegenerative disease and avert the effect of cognitive disorders on patients' autonomy.
基于群组的轨迹建模对于识别癌症治疗后出现病理性认知变化的患者亚组尤为重要。迄今为止，仅有一项研究探讨了老年癌症患者的认知轨迹。本文描述了与健康对照组相比，接受辅助治疗后的老年早期乳腺癌（EBC）患者在接受辅助治疗前后的客观认知变化。
参与者为新诊断为 EBC 的年龄在 65 岁以上的患者和健康对照组（年龄、性别和教育程度匹配）。治疗前评估在辅助治疗前进行，治疗后评估在第一辅助治疗结束后进行。基于认知下降的可靠变化指数评估治疗前后的客观认知变化，该指数考虑了认知障碍状况。
该样本包括新诊断为 EBC 的女性（ = 118）和健康对照组（ = 62）。根据治疗前后是否存在认知下降和认知障碍，确定了五种变化模式。这五种变化模式的分布具有统计学意义（ = .0001）。36%的患者发生了相位转变变化，31%无初始客观认知障碍的患者发生了认知障碍，15%出现了正常衰老，12%出现了非病理性下降，6%出现了加速认知下降。
本研究首次描述了 EBC 老年患者在辅助治疗结束后立即接受治疗前后的客观认知变化。需要对辅助治疗进行更长期的远程随访，以更好地了解 EBC 老年患者的认知轨迹。
辅助治疗结束后，31%的无初始客观认知障碍的 EBC 老年患者出现了认知障碍，6%的患者出现了加速认知下降。对于那些在癌症治疗后最有可能出现认知下降风险较高的患者，应在系统治疗的获益与危害平衡中纳入初始认知功能，定期对癌症治疗前存在认知障碍的患者进行认知随访，监测提示神经退行性疾病的症状，并避免认知障碍对患者自主性的影响。
