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Chemotherapy and Post-traumatic Stress in the Causation of Cognitive Dysfunction in Breast Cancer Patients.
- Source :
-
JNCI: Journal of the National Cancer Institute . Oct2017, Vol. 109 Issue 10, p1-15. 15p. 2 Diagrams, 5 Charts, 1 Graph. - Publication Year :
- 2017
-
Abstract
- <bold>Background: </bold>Cancer-related cognitive dysfunction has mostly been attributed to chemotherapy; this explanation, however, fails to account for cognitive dysfunction observed in chemotherapy-naïve patients. In a controlled, longitudinal, multisite study, we tested the hypothesis that cognitive function in breast cancer patients is affected by cancer-related post-traumatic stress.<bold>Methods: </bold>Newly diagnosed breast cancer patients and healthy control subjects, age 65 or younger, underwent three assessments within one year, including paper-and-pencil and computerized neuropsychological tests, clinical diagnostics of post-traumatic stress disorder (PTSD), and self-reported cognitive function. Analysis of variance was used to compare three groups of participants-patients who did or did not receive chemotherapy and healthy control subjects-on age- and education-corrected cognitive performance and cognitive change. Differences that were statistically significant after correction for false discovery rate were investigated with linear mixed-effects models and mediation models. All statistical tests were two-sided.<bold>Results: </bold>Of 226 participants (166 patients and 60 control subjects), 206 completed all assessment sessions (attrition: 8.8%). Patients demonstrated overall cognitive decline (group*time effect on composite z -score: -0.13, P = .04) and scored consistently worse on Go/Nogo errors. The latter effect was mediated by PTSD symptoms (mediation effect: B = 0.15, 95% confidence interval = 0.02 to 0.38). Only chemotherapy patients showed declined reaction time on a computerized alertness test. Overall cognitive performance correlated with self-reported cognitive problems at one year ( T = -0.11, P = .02).<bold>Conclusions: </bold>Largely irrespective of chemotherapy, breast cancer patients may encounter very subtle cognitive dysfunction, part of which is mediated by cancer-related post-traumatic stress. Further factors other than treatment side effects remain to be investigated. [ABSTRACT FROM AUTHOR]
- Subjects :
- *BREAST cancer treatment
*COGNITION disorders
*CANCER chemotherapy
*POST-traumatic stress
*NEUROPSYCHOLOGICAL tests
*CANCER patients
*ANTINEOPLASTIC agents
*BREAST tumors
*CLINICAL trials
*COGNITION
*COMPARATIVE studies
*LONGITUDINAL method
*RESEARCH methodology
*MEDICAL cooperation
*POST-traumatic stress disorder
*RESEARCH
*EVALUATION research
*CASE-control method
*DISEASE complications
*CANCER & psychology
Subjects
Details
- Language :
- English
- ISSN :
- 00278874
- Volume :
- 109
- Issue :
- 10
- Database :
- Academic Search Index
- Journal :
- JNCI: Journal of the National Cancer Institute
- Publication Type :
- Academic Journal
- Accession number :
- 123323460
- Full Text :
- https://doi.org/10.1093/jnci/djx057