Primary Care Research Unit, Department of Family and Community Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Suite E349, Toronto, ON, Canada.
Sunnybrook Research Institute, Toronto, ON, Canada.
Support Care Cancer. 2019 Aug;27(8):3035-3043. doi: 10.1007/s00520-018-4603-5. Epub 2019 Jan 4.
Evidence suggests endocrine therapy (ET) for breast cancer (BC) has adverse cognitive effects, but its specific effects on older women are unknown. This is despite the fact that older women are at increased risk of both breast cancer (BC) and cognitive decline relative to younger women. This study prospectively examined the cognitive effects of ET in a cohort of older BC patients. Our primary outcome measure was change in verbal memory, the cognitive domain most consistently affected by estrogen deprivation.
Forty-two chemotherapy-naïve women age 60+, without dementia and recently diagnosed with hormone receptor-positive BC, completed neuropsychological tests at the time of ET initiation and after 1 year of treatment. Change in age-standardized verbal memory performance was examined using paired t tests. To assess a broader range of potential cognitive effects, we also examined changes in visual memory, processing speed, frontal executive function, and perceptual reasoning.
Participants exhibited significant decline from baseline to 1 year in verbal memory (p = 0.01). This decline was small to moderate in effect size (d = - 0.40). Performance on other domains did not change significantly over the year (all p > 0.05).
Our findings suggest potentially detrimental effects of ET on verbal memory in older women after just 1 year of treatment. Given that ET is prescribed for courses of 5 to 10 years, additional studies examining longer-term effects of treatment in older women are critical.
有证据表明，乳腺癌（BC）的内分泌治疗（ET）有不良的认知影响，但它对老年女性的具体影响尚不清楚。尽管事实上，与年轻女性相比，老年女性患乳腺癌（BC）和认知能力下降的风险都更高。本研究前瞻性地检查了 ET 在一组老年 BC 患者中的认知影响。我们的主要结果衡量标准是言语记忆的变化，这是受雌激素剥夺影响最一致的认知领域。
42 名年龄在 60 岁以上、无痴呆且最近被诊断为激素受体阳性 BC 的化疗初治妇女，在开始 ET 时和治疗 1 年后完成了神经心理学测试。使用配对 t 检验检查年龄标准化言语记忆表现的变化。为了评估更广泛的潜在认知影响，我们还检查了视觉记忆、处理速度、额叶执行功能和知觉推理的变化。
参与者在言语记忆方面从基线到 1 年显著下降（p = 0.01）。这种下降在效应大小上属于小到中等程度（d = - 0.40）。在这一年中，其他领域的表现没有明显变化（所有 p > 0.05）。
我们的研究结果表明，ET 在仅仅 1 年的治疗后对老年女性的言语记忆可能有不利影响。鉴于 ET 被规定为 5 至 10 年的疗程，因此研究老年女性治疗的长期影响至关重要。
