Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands.
Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands; Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands.
Eur J Cancer. 2023 May;185:1-10. doi: 10.1016/j.ejca.2023.02.008. Epub 2023 Feb 17.
Studies investigating the long-term effects of breast cancer treatment on cognition in older women with breast cancer are lacking, even though preserving cognition is highly valued by the older population. Specifically, concerns have been raised regarding the detrimental effects of endocrine therapy (ET) on cognition. Therefore, we investigated cognitive functioning over time and predictors for cognitive decline in older women treated for early breast cancer.
We prospectively enrolled Dutch women aged ≥70 years with stage I-III breast cancer in the observational CLIMB study. The Mini-Mental State Examination (MMSE) was performed before ET initiation and after 9, 15 and 27 months. Longitudinal MMSE scores were analysed and stratified for ET. Linear mixed models were used to identify possible predictors of cognitive decline.
Among the 273 participants, the mean age was 76 years (standard deviation 5), and 48% received ET. The mean baseline MMSE score was 28.2 (standard deviation 1.9). Cognition did not decline to clinically meaningful differences, irrespective of ET. MMSE scores of women with pre-treatment cognitive impairments slightly improved over time (significant interaction terms) in the entire cohort and in women receiving ET. High age, low educational level and impaired mobility were independently associated with declining MMSE scores over time, although the declines were not clinically meaningful.
Cognition of older women with early breast cancer did not decline in the first two years after treatment initiation, irrespective of ET. Our findings suggest that the fear of declining cognition does not justify the de-escalation of breast cancer treatment in older women.
尽管保护认知能力受到老年人群的高度重视，但针对乳腺癌治疗对老年乳腺癌女性认知功能的长期影响的研究仍然缺乏，尤其是对内分泌治疗（endocrine therapy，ET）对认知功能的潜在有害影响的关注。因此，我们研究了老年早期乳腺癌女性患者认知功能随时间的变化以及认知能力下降的预测因素。
我们前瞻性地纳入了荷兰年龄≥70 岁的 I-III 期乳腺癌女性患者参与 CLIMB 观察性研究。在开始 ET 治疗之前以及 9、15 和 27 个月时进行了简易精神状态检查（Mini-Mental State Examination，MMSE）。分析了纵向 MMSE 评分并根据 ET 进行分层。使用线性混合模型确定认知下降的可能预测因素。
在 273 名参与者中，平均年龄为 76 岁（标准差 5），48%的患者接受了 ET。基线 MMSE 评分的平均值为 28.2（标准差 1.9）。无论是否接受 ET，认知功能均未下降到具有临床意义的差异。在整个队列和接受 ET 的女性中，有治疗前认知障碍的女性的 MMSE 评分随时间略有改善（显著的交互项）。高年龄、低教育水平和行动不便与随时间推移 MMSE 评分下降独立相关，尽管下降无临床意义。
在治疗开始后的前两年，早期乳腺癌老年女性的认知功能并未下降，无论是否接受 ET。我们的研究结果表明，对认知能力下降的担忧并不能证明在老年女性中降低乳腺癌治疗的强度是合理的。
