Association of markers of tumor aggressivity and cognition in women with breast cancer before adjuvant treatment: The Thinking and Living with Cancer Study

Purpose Tumor features associated with aggressive cancers may affect cognition prior to systemic therapy. We evaluated associations of cognition prior to adjuvant therapy and tumor aggressivity in older breast cancer patients. Methods Women diagnosed with non-metastatic breast cancer ( n  = 705) age...

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Published inBreast cancer research and treatment Vol. 194; no. 2; pp. 413 - 422
Main Authors Root, James C., Zhou, Xingtao, Ahn, Jaeil, Small, Brent J., Zhai, Wanting, Bethea, Traci, Carroll, Judith E., Cohen, Harvey Jay, Dilawari, Asma, Extermann, Martine, Graham, Deena, Isaacs, Claudine, Jacobsen, Paul B., Jim, Heather, McDonald, Brenna C., Nakamura, Zev M., Patel, Sunita K., Rentscher, Kelly, Saykin, Andrew J., Van Dyk, Kathleen, Mandelblatt, Jeanne S., Ahles, Tim A.
Format Journal Article
LanguageEnglish
Published New York Springer US 01.07.2022
Springer Nature B.V
Subjects
Adjuvant therapy
Aged
Aged, 80 and over
Breast cancer
Breast Neoplasms - drug therapy
Breast Neoplasms - therapy
Cancer research
Cancer therapies
Cognition
Cognition & reasoning
Cognitive ability
Cognitive Dysfunction - diagnosis
Cognitive Dysfunction - etiology
Epidemiology
ErbB-2 protein
Executive function
Female
Humans
Medicine
Medicine & Public Health
Metastases
Middle Aged
Neuropsychological Tests
Oncology
Percutaneous Coronary Intervention
Tumors
Breast cancer
Cognition
Clinicopathological tumor features
Older adults
Elderly
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Summary:Purpose Tumor features associated with aggressive cancers may affect cognition prior to systemic therapy. We evaluated associations of cognition prior to adjuvant therapy and tumor aggressivity in older breast cancer patients. Methods Women diagnosed with non-metastatic breast cancer ( n  = 705) ages 60–98 were enrolled from August 2010-March 2020. Cognition was measured post-surgery, pre-systemic therapy using self-reported (FACT-Cog Perceived Cognitive Impairment [PCI]) and objective tests of attention, processing speed, and executive function (APE domain) and learning and memory [LM domain]. Linear regression tested associations of pre-treatment tumor features and cognition, adjusting for age, race, and study site. HER2 positivity and higher stage (II/III vs. 0/I) were a priori predictors of cognition; in secondary analyses we explored associations of other tumor features and cognitive impairment (i.e., PCI score < 54 or having 2 tests < 1.5 SD or 1 test < 2 SD from the mean APE or LM domain score). Results HER2 positivity and the hormone receptor negative/HER2 + molecular subtype were associated with lower adjusted mean self-reported cognition scores and higher impairment rates ( p values < .05). Higher stage of disease was associated with lower objective performance in APE. Other tumor features were associated with cognition in unadjusted and adjusted models, including larger tumor size and lower PCI scores ( p  = 0.02). Tumor features were not related to LM. Conclusions Pre-adjuvant therapy cognition was associated with HER2 positivity and higher stage of disease and other features of aggressive tumors. Additional research is needed to confirm these results and assess potential mechanisms and clinical management strategies.
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Mandelblatt and Ahles have contributed equally as senior authors.
Author contributions JCR was responsible for investigation, supervision, and writing. XZ was responsible for formal analysis, data curation, and writing. JA was responsible for supervision, methodology, formal analysis, data curation, and writing. BJ Small was responsible for supervision, methodology, formal analysis, data curation, and writing. WZ was responsible for formal analysis, data curation, and writing. TB was responsible for conceptualization and writing. JC was responsible for conceptualization and writing. HJC was responsible for conceptualization and writing and editing. AD was responsible for conceptualization and writing. ME was responsible for conceptualization and writing. DG was responsible for investigation, resources, and writing. PBJ was responsible for investigation and writing. Heather Jim was responsible for investigation, resources, writing, project administration, and funding acquisition. CI was responsible for conceptualization and writing. BCM was responsible for investigation and writing. ZN was responsible for conceptualization and writing. SKP was responsible for investigation, resources, writing, and project administration. KR was responsible for conceptualization and writing. AJS was responsible for investigation, resources, writing, project administration, and funding acquisition. KvD was responsible for conceptualization and writing. JSM was responsible for conceptualization, investigation, resources, writing and editing, supervision, project administration, and funding acquisition. TA was responsible for conceptualization, investigation, resources, writing, project administration, and funding acquisition.
ISSN:0167-6806
1573-7217
DOI:10.1007/s10549-022-06623-2