Cancer-related cognitive outcomes among older breast cancer survivors in the thinking and living with cancer study

Jeanne S. Mandelblatt, Brent J. Small, Gheorghe Luta, Arti Hurria, Heather Jim, Brenna McDonald, Deena Graham, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Elizabeth Breen, Judith E. Carroll, Neelima Denduluri, Asma Dilawari, Martine Extermann, Claudine Isaacs, Paul B. Jacobsen, Lindsay C. Kobayashi, Kelly Holohan Nudelman, James RootRobert A. Stern, Danielle Tometich, Raymond Turner, John W. VanMeter, Andrew Saykin, Tim Ahles

Research output: Contribution to journalArticle

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Abstract

Purpose To determine treatment and aging-related effects on longitudinal cognitive function in older breast cancer survivors. Methods Newly diagnosed nonmetastatic breast cancer survivors (n = 344) and matched controls without cancer (n = 347) 60 years of age and older without dementia or neurologic disease were recruited between August 2010 and December 2015. Data collection occurred during presystemic treatment/ control enrollment and at 12 and 24 months through biospecimens; surveys; self-reported Functional Assessment of Cancer Therapy-Cognitive Function; and neuropsychological tests that measured attention, processing speed, and executive function (APE) and learning and memory (LM). Linear mixed-effects models tested two-way interactions of treatment group (control, chemotherapy with or without hormonal therapy, and hormonal therapy) and time and explored three-way interactions of ApoE (e4+ v not) by group by time; covariates included baseline age, frailty, race, and cognitive reserve. Results Survivors and controls were 60 to 98 years of age, were well educated, and had similar baseline cognitive scores. Treatment was related to longitudinal cognition scores, with survivors who received chemotherapy having increasingly worse APE scores (P = .05) and those initiating hormonal therapy having lower LM scores at 12 months (P = .03) than other groups. These group-by-time differences varied by ApoE genotype, where only e4+ survivors receiving hormone therapy had short-term decreases in adjusted LM scores (three-way interaction P = .03). For APE, the three-way interaction was not significant (P = .14), but scores were significantly lower for e4+ survivors exposed to chemotherapy (20.40; 95% CI, 20.79 to 20.01) at 24 months than e4+ controls (0.01; 95% CI, 0.16 to 0.18; P, .05). Increasing age was associated with lower baseline scores on all cognitive measures (P, .001); frailty was associated with baseline APE and self-reported decline (P, .001). Conclusion Breast cancer systemic treatment and aging-related phenotypes and genotypes are associated with longitudinal decreases in cognitive function scores in older survivors. These data could inform treatment decision making and survivorship care planning.

Original languageEnglish (US)
Pages (from-to)3211-3222
Number of pages12
JournalJournal of Clinical Oncology
Volume36
Issue number32
DOIs
StatePublished - Nov 10 2018

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Survivors
Breast Neoplasms
Neoplasms
Cognition
Therapeutics
Learning
Apolipoproteins E
Drug Therapy
Thinking
Cognitive Reserve
Genotype
Neuropsychological Tests
Executive Function
Nervous System Diseases
Dementia
Decision Making
Survival Rate
Hormones
Phenotype
Control Groups

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Cancer-related cognitive outcomes among older breast cancer survivors in the thinking and living with cancer study. / Mandelblatt, Jeanne S.; Small, Brent J.; Luta, Gheorghe; Hurria, Arti; Jim, Heather; McDonald, Brenna; Graham, Deena; Zhou, Xingtao; Clapp, Jonathan; Zhai, Wanting; Breen, Elizabeth; Carroll, Judith E.; Denduluri, Neelima; Dilawari, Asma; Extermann, Martine; Isaacs, Claudine; Jacobsen, Paul B.; Kobayashi, Lindsay C.; Holohan Nudelman, Kelly; Root, James; Stern, Robert A.; Tometich, Danielle; Turner, Raymond; VanMeter, John W.; Saykin, Andrew; Ahles, Tim.

In: Journal of Clinical Oncology, Vol. 36, No. 32, 10.11.2018, p. 3211-3222.

Research output: Contribution to journalArticle

Mandelblatt, JS, Small, BJ, Luta, G, Hurria, A, Jim, H, McDonald, B, Graham, D, Zhou, X, Clapp, J, Zhai, W, Breen, E, Carroll, JE, Denduluri, N, Dilawari, A, Extermann, M, Isaacs, C, Jacobsen, PB, Kobayashi, LC, Holohan Nudelman, K, Root, J, Stern, RA, Tometich, D, Turner, R, VanMeter, JW, Saykin, A & Ahles, T 2018, 'Cancer-related cognitive outcomes among older breast cancer survivors in the thinking and living with cancer study', Journal of Clinical Oncology, vol. 36, no. 32, pp. 3211-3222. https://doi.org/10.1200/JCO.18.00140
Mandelblatt, Jeanne S. ; Small, Brent J. ; Luta, Gheorghe ; Hurria, Arti ; Jim, Heather ; McDonald, Brenna ; Graham, Deena ; Zhou, Xingtao ; Clapp, Jonathan ; Zhai, Wanting ; Breen, Elizabeth ; Carroll, Judith E. ; Denduluri, Neelima ; Dilawari, Asma ; Extermann, Martine ; Isaacs, Claudine ; Jacobsen, Paul B. ; Kobayashi, Lindsay C. ; Holohan Nudelman, Kelly ; Root, James ; Stern, Robert A. ; Tometich, Danielle ; Turner, Raymond ; VanMeter, John W. ; Saykin, Andrew ; Ahles, Tim. / Cancer-related cognitive outcomes among older breast cancer survivors in the thinking and living with cancer study. In: Journal of Clinical Oncology. 2018 ; Vol. 36, No. 32. pp. 3211-3222.
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title = "Cancer-related cognitive outcomes among older breast cancer survivors in the thinking and living with cancer study",
abstract = "Purpose To determine treatment and aging-related effects on longitudinal cognitive function in older breast cancer survivors. Methods Newly diagnosed nonmetastatic breast cancer survivors (n = 344) and matched controls without cancer (n = 347) 60 years of age and older without dementia or neurologic disease were recruited between August 2010 and December 2015. Data collection occurred during presystemic treatment/ control enrollment and at 12 and 24 months through biospecimens; surveys; self-reported Functional Assessment of Cancer Therapy-Cognitive Function; and neuropsychological tests that measured attention, processing speed, and executive function (APE) and learning and memory (LM). Linear mixed-effects models tested two-way interactions of treatment group (control, chemotherapy with or without hormonal therapy, and hormonal therapy) and time and explored three-way interactions of ApoE (e4+ v not) by group by time; covariates included baseline age, frailty, race, and cognitive reserve. Results Survivors and controls were 60 to 98 years of age, were well educated, and had similar baseline cognitive scores. Treatment was related to longitudinal cognition scores, with survivors who received chemotherapy having increasingly worse APE scores (P = .05) and those initiating hormonal therapy having lower LM scores at 12 months (P = .03) than other groups. These group-by-time differences varied by ApoE genotype, where only e4+ survivors receiving hormone therapy had short-term decreases in adjusted LM scores (three-way interaction P = .03). For APE, the three-way interaction was not significant (P = .14), but scores were significantly lower for e4+ survivors exposed to chemotherapy (20.40; 95{\%} CI, 20.79 to 20.01) at 24 months than e4+ controls (0.01; 95{\%} CI, 0.16 to 0.18; P, .05). Increasing age was associated with lower baseline scores on all cognitive measures (P, .001); frailty was associated with baseline APE and self-reported decline (P, .001). Conclusion Breast cancer systemic treatment and aging-related phenotypes and genotypes are associated with longitudinal decreases in cognitive function scores in older survivors. These data could inform treatment decision making and survivorship care planning.",
author = "Mandelblatt, {Jeanne S.} and Small, {Brent J.} and Gheorghe Luta and Arti Hurria and Heather Jim and Brenna McDonald and Deena Graham and Xingtao Zhou and Jonathan Clapp and Wanting Zhai and Elizabeth Breen and Carroll, {Judith E.} and Neelima Denduluri and Asma Dilawari and Martine Extermann and Claudine Isaacs and Jacobsen, {Paul B.} and Kobayashi, {Lindsay C.} and {Holohan Nudelman}, Kelly and James Root and Stern, {Robert A.} and Danielle Tometich and Raymond Turner and VanMeter, {John W.} and Andrew Saykin and Tim Ahles",
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T1 - Cancer-related cognitive outcomes among older breast cancer survivors in the thinking and living with cancer study

AU - Mandelblatt, Jeanne S.

AU - Small, Brent J.

AU - Luta, Gheorghe

AU - Hurria, Arti

AU - Jim, Heather

AU - McDonald, Brenna

AU - Graham, Deena

AU - Zhou, Xingtao

AU - Clapp, Jonathan

AU - Zhai, Wanting

AU - Breen, Elizabeth

AU - Carroll, Judith E.

AU - Denduluri, Neelima

AU - Dilawari, Asma

AU - Extermann, Martine

AU - Isaacs, Claudine

AU - Jacobsen, Paul B.

AU - Kobayashi, Lindsay C.

AU - Holohan Nudelman, Kelly

AU - Root, James

AU - Stern, Robert A.

AU - Tometich, Danielle

AU - Turner, Raymond

AU - VanMeter, John W.

AU - Saykin, Andrew

AU - Ahles, Tim

PY - 2018/11/10

Y1 - 2018/11/10

N2 - Purpose To determine treatment and aging-related effects on longitudinal cognitive function in older breast cancer survivors. Methods Newly diagnosed nonmetastatic breast cancer survivors (n = 344) and matched controls without cancer (n = 347) 60 years of age and older without dementia or neurologic disease were recruited between August 2010 and December 2015. Data collection occurred during presystemic treatment/ control enrollment and at 12 and 24 months through biospecimens; surveys; self-reported Functional Assessment of Cancer Therapy-Cognitive Function; and neuropsychological tests that measured attention, processing speed, and executive function (APE) and learning and memory (LM). Linear mixed-effects models tested two-way interactions of treatment group (control, chemotherapy with or without hormonal therapy, and hormonal therapy) and time and explored three-way interactions of ApoE (e4+ v not) by group by time; covariates included baseline age, frailty, race, and cognitive reserve. Results Survivors and controls were 60 to 98 years of age, were well educated, and had similar baseline cognitive scores. Treatment was related to longitudinal cognition scores, with survivors who received chemotherapy having increasingly worse APE scores (P = .05) and those initiating hormonal therapy having lower LM scores at 12 months (P = .03) than other groups. These group-by-time differences varied by ApoE genotype, where only e4+ survivors receiving hormone therapy had short-term decreases in adjusted LM scores (three-way interaction P = .03). For APE, the three-way interaction was not significant (P = .14), but scores were significantly lower for e4+ survivors exposed to chemotherapy (20.40; 95% CI, 20.79 to 20.01) at 24 months than e4+ controls (0.01; 95% CI, 0.16 to 0.18; P, .05). Increasing age was associated with lower baseline scores on all cognitive measures (P, .001); frailty was associated with baseline APE and self-reported decline (P, .001). Conclusion Breast cancer systemic treatment and aging-related phenotypes and genotypes are associated with longitudinal decreases in cognitive function scores in older survivors. These data could inform treatment decision making and survivorship care planning.

AB - Purpose To determine treatment and aging-related effects on longitudinal cognitive function in older breast cancer survivors. Methods Newly diagnosed nonmetastatic breast cancer survivors (n = 344) and matched controls without cancer (n = 347) 60 years of age and older without dementia or neurologic disease were recruited between August 2010 and December 2015. Data collection occurred during presystemic treatment/ control enrollment and at 12 and 24 months through biospecimens; surveys; self-reported Functional Assessment of Cancer Therapy-Cognitive Function; and neuropsychological tests that measured attention, processing speed, and executive function (APE) and learning and memory (LM). Linear mixed-effects models tested two-way interactions of treatment group (control, chemotherapy with or without hormonal therapy, and hormonal therapy) and time and explored three-way interactions of ApoE (e4+ v not) by group by time; covariates included baseline age, frailty, race, and cognitive reserve. Results Survivors and controls were 60 to 98 years of age, were well educated, and had similar baseline cognitive scores. Treatment was related to longitudinal cognition scores, with survivors who received chemotherapy having increasingly worse APE scores (P = .05) and those initiating hormonal therapy having lower LM scores at 12 months (P = .03) than other groups. These group-by-time differences varied by ApoE genotype, where only e4+ survivors receiving hormone therapy had short-term decreases in adjusted LM scores (three-way interaction P = .03). For APE, the three-way interaction was not significant (P = .14), but scores were significantly lower for e4+ survivors exposed to chemotherapy (20.40; 95% CI, 20.79 to 20.01) at 24 months than e4+ controls (0.01; 95% CI, 0.16 to 0.18; P, .05). Increasing age was associated with lower baseline scores on all cognitive measures (P, .001); frailty was associated with baseline APE and self-reported decline (P, .001). Conclusion Breast cancer systemic treatment and aging-related phenotypes and genotypes are associated with longitudinal decreases in cognitive function scores in older survivors. These data could inform treatment decision making and survivorship care planning.

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