Yamamoto Sena, Masutani Eiko, Arao Harue
Department of Nursing, Hakuaikai Sagara Hospital, 3-31 Matsubara-cho, Kagoshima City, Kagoshima, 892-0833, Japan.
Former Osaka University Graduate School of Medicine, Cancer Education and Research Center, 1-7 Yamadaoka, Suita City, Osaka, 565-0871, Japan.
Breast Cancer. 2020 Jul;27(4):670-682. doi: 10.1007/s12282-020-01062-7. Epub 2020 Feb 29.
Despite contributing to the control of hormone receptor-positive breast cancer, a highly prevalent cancer type, endocrine therapy affects patients' cognitive function. We aimed to identify cognitive decline following the start of endocrine therapy using patient-reported measures and investigate factors associated with cognitive difficulties.
This cross-sectional survey used a self-administered, anonymous questionnaire. The participants were 876 patients with breast cancer who experienced subjective cognitive difficulties after starting endocrine therapy. Our sample was recruited from 11 patient advocacy groups, 5 clinics, and 2 hospitals in Japan. The questionnaire assessed subjective cognitive difficulties (30 items), psychological well-being, demographic and clinical information, and other subjective symptoms.
Of 510 (58.2%) responses, we analyzed 405 (46.2%) questionnaires. Exploratory factor analysis identified three factors of cognitive difficulties: Factor 1, "difficulties in manipulating memory and language;" Factor 2, "difficulties in processing multiple pieces of information;" and Factor 3, "difficulties in maintaining attention and concentration." Factor 1 was the most common type, and it was significantly related to the treatment characteristics of endocrine therapy. Multivariate logistic regression analysis revealed that fewer household members, a history of breast surgery, more severe menopausal symptoms, and greater psychological distress were significantly associated with cognitive difficulties. As cognitive difficulties increased, the proportion of participants suspected to have psychological disorders increased significantly.
Patients treated with endocrine therapy for breast cancer experience intricately intertwined impairments in several domains of cognitive function. They have an increased risk of psychological disorders corresponding to the degree of subjective cognitive function.
尽管内分泌治疗有助于控制激素受体阳性乳腺癌（一种高度常见的癌症类型），但它会影响患者的认知功能。我们旨在使用患者报告的测量方法来确定内分泌治疗开始后的认知衰退情况，并调查与认知困难相关的因素。
这项横断面调查使用了一份自行填写的匿名问卷。参与者为876例乳腺癌患者，她们在开始内分泌治疗后出现了主观认知困难。我们的样本来自日本的11个患者倡导团体、5个诊所和2家医院。该问卷评估了主观认知困难（30项）、心理健康、人口统计学和临床信息以及其他主观症状。
在510份（58.2%）回复中，我们分析了405份（46.2%）问卷。探索性因素分析确定了认知困难的三个因素：因素1，“记忆和语言操作困难”；因素2，“处理多条信息困难”；因素3，“维持注意力和专注力困难”。因素1是最常见的类型，并且它与内分泌治疗的治疗特征显著相关。多因素逻辑回归分析显示，家庭成员较少、有乳腺手术史、更年期症状更严重以及心理困扰更大与认知困难显著相关。随着认知困难的增加，疑似有心理障碍的参与者比例显著增加。
接受乳腺癌内分泌治疗的患者在认知功能的多个领域经历了错综复杂的损伤。他们出现心理障碍的风险随着主观认知功能程度的增加而增加。
