Janelsins Michelle C, Heckler Charles E, Peppone Luke J, Ahles Tim A, Mohile Supriya G, Mustian Karen M, Palesh Oxana, O'Mara Ann M, Minasian Lori M, Williams Annalynn M, Magnuson Allison, Geer Jodi, Dakhil Shaker R, Hopkins Judith O, Morrow Gary R
Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Supriya G. Mohile, Karen M. Mustian, Annalynn M. Williams, Allison Magnuson, and Gary R. Morrow, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Oxana Palesh, Stanford Cancer Center, Stanford, CA; Ann M. O'Mara and Lori M. Minasian, National Cancer Institute (NCI), National Institutes of Health, Rockville, MD; Jodi Geer, Metro Minnesota NCI Community Oncology Research Program (NCORP), Saint Louis Park, MN; Shaker R. Dakhil, Wichita NCORP, Wichita, KS; and Judith O. Hopkins, Southeast Clinical Oncology Research Consortium NCORP, Winston-Salem, NC.
J Clin Oncol. 2018 Sep 21;36(32):JCO2018786624. doi: 10.1200/JCO.2018.78.6624.
Cancer-related cognitive impairment (CRCI) is an important clinical problem in patients with breast cancer receiving chemotherapy. Nationwide longitudinal studies are needed to understand the trajectory and severity of CRCI in specific cognitive domains.
The overall objective of this nationwide, prospective, observational study conducted within the National Cancer Institute Community Clinical Oncology Research Program was to assess trajectories in specific cognitive domains in patients with breast cancer (stage I-IIIC) receiving chemotherapy, from pre- (A1) to postchemotherapy (A2) and from prechemotherapy to 6 months postchemotherapy (A3); controls were assessed at the same time-equivalent points. The primary aim assessed visual memory using the Cambridge Neuropsychological Test Automated Battery Delayed Match to Sample test by longitudinal mixed models including A1, A2, and A3 and adjusting for age, education, race, cognitive reserve score, and baseline anxiety and depressive symptoms. We also assessed trajectories of CRCI in other aspects of memory as well as in attention and executive function with computerized, paper-based, and telephone-based cognitive tests.
In total, 580 patients with breast cancer (mean age, 53.4 years) and 363 controls (mean age, 52.6 years) were assessed. On the Delayed Match to Sample test, the longitudinal mixed model results revealed a significant group-by-time effect ( P < .005); patients declined over time from prechemotherapy (A1) to 6 months postchemotherapy (A3; P = .005), but controls did not change ( P = .426). The group difference between patients and controls was also significant, revealing declines in patients but not controls ( P = .017). Several other models of computerized, standard, and telephone tests indicated significantly worse performance by patients compared with controls from pre- to postchemotherapy and from prechemotherapy to 6 months postchemotherapy.
This nationwide study showed CRCI in patients with breast cancer affects multiple cognitive domains for at least 6 months postchemotherapy.
癌症相关认知障碍（CRCI）是接受化疗的乳腺癌患者的一个重要临床问题。需要进行全国性纵向研究以了解特定认知领域中CRCI的发展轨迹和严重程度。
在国家癌症研究所社区临床肿瘤学研究项目内开展的这项全国性、前瞻性、观察性研究的总体目标是评估接受化疗的乳腺癌（I-IIIC期）患者在特定认知领域从化疗前（A1）到化疗后（A2）以及从化疗前到化疗后6个月（A3）的发展轨迹；对照组在相同的时间点进行评估。主要目的是通过纵向混合模型（包括A1、A2和A3）并对年龄、教育程度、种族、认知储备评分以及基线焦虑和抑郁症状进行调整，使用剑桥神经心理测试自动成套系统延迟匹配样本测试来评估视觉记忆。我们还通过计算机化、纸质和电话认知测试评估了CRCI在记忆其他方面以及注意力和执行功能方面的发展轨迹。
总共评估了580例乳腺癌患者（平均年龄53.4岁）和363例对照组（平均年龄52.6岁）。在延迟匹配样本测试中，纵向混合模型结果显示出显著的组×时间效应（P <.005）；患者从化疗前（A1）到化疗后6个月（A3）随时间下降（P =.005），但对照组没有变化（P =.426）。患者与对照组之间的组间差异也很显著，显示患者下降而对照组未下降（P =.017）。其他几种计算机化、标准和电话测试模型表明，与对照组相比，患者在化疗前到化疗后以及化疗前到化疗后6个月的表现明显更差。
这项全国性研究表明，乳腺癌患者的CRCI在化疗后至少6个月会影响多个认知领域。
