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Rocha ECLD, Sousa KHJF, Lucchesi PADO, Faria MGDA, Balbinotti MAA, Rebustini F, Ferretti-Rebustini REDL, Gallasch CH. Content validity evidence of the Brazilian version of the Cognitive Symptom Checklist-Work-21. Rev Bras Enferm 2023; 76:e20220453. [PMID: 37672463 PMCID: PMC10476516 DOI: 10.1590/0034-7167-2022-0453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 02/15/2023] [Indexed: 09/08/2023] Open
Abstract
OBJECTIVE to cross-culturally adapt and assess the content validity evidence of the Cognitive Symptom Checklist-Work-21 for the Brazilian context. METHOD a psychometric study of cross-cultural adaptation, covering the stages of translation, reconciliation, back-translation, intercultural equivalence assessment and content validity evidence analysis, considering Content Validity Ratio parameters in breast cancer survivors. RESULTS the translations were equivalent to the original version. Colloquial expressions were modified, tense, verbal adjusted, and two items containing multiple commands were separated. The final version now contains 22 items, presenting semantic, conceptual, idiomatic and experimental equivalences. The pre-test indicated good understanding and ease in the response process. CONCLUSION the final version was defined as "Lista de verificação de sintomas cognitivos relacionados ao trabalho - 22 itens", showing good linguistic equivalence and strong evidence of content validity in the Brazilian context.
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2
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Klann IP, Fulco BCW, Nogueira CW. Subchronic exposure to Tamoxifen modulates the hippocampal BDNF/ERK/Akt/CREB pathway and impairs memory in intact female rats. Chem Biol Interact 2023; 382:110615. [PMID: 37392961 DOI: 10.1016/j.cbi.2023.110615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/13/2023] [Accepted: 06/27/2023] [Indexed: 07/03/2023]
Abstract
Tamoxifen (TAM), a Selective Estrogen Receptor Modulator (SERM), is commonly used to treat and prevent breast cancer. Memory impairment has been noticed in patients who experience hormone therapy in the case of TAM and other SERMs. Animal studies that mimic the TAM longer exposure effects are needed to better elucidate the adverse effects of continuous treatment in humans. This study evaluated the effects of TAM subchronic administration on the memory performance and hippocampal neural plasticity of intact female Wistar rats. Animals were treated intragastrically with TAM (0.25 and 2.5 mg/kg) for 59 days. The rats were subjected to the Object Location Test (OLT) and Object Recognition Test (ORT) to evaluate memory performance. After euthanasia, the hippocampus samples were excised and the protein levels of the BDNF/ERK/Akt/CREB pathway were evaluated. The rat's locomotor activity and hippocampal TrkB levels were similar among the experimental groups. TAM at both doses reduced the memory performance of female rats in the OLT and short-term memory of ORT, and impaired hippocampal levels of mBDNF, proBDNF, and pCREB/CREB. TAM only at the dose of 2.5 mg/kg reduced the memory performance of rats in the long-term memory of ORT and hippocampal pERK/ERK and pAkt/Akt ratios. TAM subchronic administration induced amnesic effects and modulated the hippocampal BDNF/ERK/Akt/CREB pathway in intact young adult female Wistar rats.
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Affiliation(s)
- Isabella P Klann
- Laboratório de Síntese, Reatividade e Avaliação Farmacológica e Toxicológica de Organocalcogênios, CCNE, Universidade Federal de Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
| | - Bruna C W Fulco
- Laboratório de Síntese, Reatividade e Avaliação Farmacológica e Toxicológica de Organocalcogênios, CCNE, Universidade Federal de Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
| | - Cristina W Nogueira
- Laboratório de Síntese, Reatividade e Avaliação Farmacológica e Toxicológica de Organocalcogênios, CCNE, Universidade Federal de Santa Maria, Santa Maria, Rio Grande do Sul, Brazil.
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Giustiniani A, Danesin L, Pezzetta R, Masina F, Oliva G, Arcara G, Burgio F, Conte P. Use of Telemedicine to Improve Cognitive Functions and Psychological Well-Being in Patients with Breast Cancer: A Systematic Review of the Current Literature. Cancers (Basel) 2023; 15:cancers15041353. [PMID: 36831693 PMCID: PMC9954456 DOI: 10.3390/cancers15041353] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/13/2023] [Accepted: 02/17/2023] [Indexed: 02/25/2023] Open
Abstract
The diagnosis and side effects of breast cancer (BC) treatments greatly affect the everyday lives of women suffering from this disease, with relevant psychological and cognitive consequences. Several studies have reported the psychological effects of receiving a diagnosis of BC. Moreover, women undergoing anticancer therapies may exhibit cognitive impairment as a side effect of the treatments. The access to cognitive rehabilitation and psychological treatment for these patients is often limited by resources; women of childbearing age often encounter difficulties in completing rehabilitation programs requiring access to care institutions. Telemedicine, which provides health services using information and communication technologies, is a useful tool to overcome these limitations. In particular, telemedicine may represent an optimal way to guarantee cognitive rehabilitation, psychological support, and recovery to BC patients. Previous studies have reviewed the use of telemedicine to improve psychological well-being in BC patients, and a few have investigated the effect of telerehabilitation on cognitive deficits. This study systematically reviewed the evidence on the cognitive and psychological effects of telemedicine in BC patients. Current evidence suggests that telemedicine may represent a promising tool for the management of some psychological problems experienced by breast cancer patients, but more controlled studies are needed to clarify its effectiveness, especially for cognitive deficits. The results are also discussed in light of the intervening and modulating factors that may mediate both side effect occurrence and the success of the interventions.
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4
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Atkins SLP, Zimmer AS. Neurologic complications of breast cancer. Cancer 2023; 129:505-520. [PMID: 36537474 DOI: 10.1002/cncr.34518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/14/2022] [Accepted: 08/22/2022] [Indexed: 12/24/2022]
Abstract
Breast cancer is a heterogeneous disease with unique neurologic complications that can arise from central nervous system (CNS) involvement or secondary to treatments themselves. As progress is made, with more targeted therapies and combinations available, particularly in the realm of human epidermal growth factor receptor 2 (HER2)-positive disease, the role of these new agents in patients with CNS disease is gradually evolving, although intracranial efficacy itself is lagging. At the same time, both systemic and local standard therapies pose clinical challenges regarding neurologic complications, such as peripheral neuropathy and cognitive changes. The development of new agents, such as immunotherapy, and new strategies, such as incorporating systemic therapies into local therapy, unveil new presentations of neurological complications.
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Affiliation(s)
- Sarah L P Atkins
- Women's Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Alexandra S Zimmer
- Hematology and Medical Oncology Division, Oregon Health and Science University, Knight Cancer Institute, Portland, Oregon, USA
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5
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Galvano E, Pandit H, Sepulveda J, Ng CAS, Becher MK, Mandelblatt JS, Van Dyk K, Rebeck GW. Behavioral and transcriptomic effects of the cancer treatment tamoxifen in mice. Front Neurosci 2023; 17:1068334. [PMID: 36845433 PMCID: PMC9951777 DOI: 10.3389/fnins.2023.1068334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/24/2023] [Indexed: 02/12/2023] Open
Abstract
Introduction Tamoxifen is a common treatment for estrogen receptor-positive breast cancer. While tamoxifen treatment is generally accepted as safe, there are concerns about adverse effects on cognition. Methods We used a mouse model of chronic tamoxifen exposure to examine the effects of tamoxifen on the brain. Female C57/BL6 mice were exposed to tamoxifen or vehicle control for six weeks; brains of 15 mice were analyzed for tamoxifen levels and transcriptomic changes, and an additional 32 mice were analyzed through a battery of behavioral tests. Results Tamoxifen and its metabolite 4-OH-tamoxifen were found at higher levels in the brain than in the plasma, demonstrating the facile entry of tamoxifen into the CNS. Behaviorally, tamoxifen-exposed mice showed no impairment in assays related to general health, exploration, motor function, sensorimotor gating, and spatial learning. Tamoxifen-treated mice showed a significantly increased freezing response in a fear conditioning paradigm, but no effects on anxiety measures in the absence of stressors. RNA sequencing analysis of whole hippocampi showed tamoxifen-induced reductions in gene pathways related to microtubule function, synapse regulation, and neurogenesis. Discussion These findings of the effects of tamoxifen exposure on fear conditioning and on gene expression related to neuronal connectivity suggest that there may be CNS side effects of this common breast cancer treatment.
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Affiliation(s)
- Elena Galvano
- Department of Neuroscience, Georgetown University Medical Center, Washington, DC, United States
| | - Harshul Pandit
- Department of Neuroscience, Georgetown University Medical Center, Washington, DC, United States
| | - Jordy Sepulveda
- Department of Pharmacology and Physiology, Georgetown University Medical Center, Washington, DC, United States
| | - Christi Anne S. Ng
- Department of Neuroscience, Georgetown University Medical Center, Washington, DC, United States
| | - Melanie K. Becher
- Department of Neuroscience, Georgetown University Medical Center, Washington, DC, United States
| | - Jeanne S. Mandelblatt
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, United States
| | - Kathleen Van Dyk
- Department of Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, United States
| | - G. William Rebeck
- Department of Neuroscience, Georgetown University Medical Center, Washington, DC, United States,*Correspondence: G. William Rebeck,
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6
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Quality of Life Issues Following Breast Cancer Treatment. Surg Clin North Am 2023; 103:155-167. [DOI: 10.1016/j.suc.2022.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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7
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A novel oncogenic enhancer of estrogen receptor-positive breast cancer. MOLECULAR THERAPY - NUCLEIC ACIDS 2022; 29:836-851. [PMID: 36159594 PMCID: PMC9463563 DOI: 10.1016/j.omtn.2022.08.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 08/17/2022] [Indexed: 11/22/2022]
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McDonald BC, Van Dyk K, Deardorff RL, Bailey JN, Zhai W, Carroll JE, Root JC, Ahles TA, Mandelblatt JS, Saykin AJ. Multimodal MRI examination of structural and functional brain changes in older women with breast cancer in the first year of antiestrogen hormonal therapy. Breast Cancer Res Treat 2022; 194:113-126. [PMID: 35476252 PMCID: PMC9255382 DOI: 10.1007/s10549-022-06597-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/05/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Cancer patients are concerned about treatment-related cognitive problems. We examined effects of antiestrogen hormonal therapy on brain imaging metrics in older women with breast cancer. METHODS Women aged 60 + treated with hormonal therapy only and matched non-cancer controls (n = 29/group) completed MRI and objective and self-reported cognitive assessment at pre-treatment/enrollment and 12 months later. Gray matter was examined using voxel-based morphometry (VBM), FreeSurfer, and brain age calculations. Functional MRI (fMRI) assessed working memory-related activation. Analyses examined cross-sectional and longitudinal differences and tested associations between brain metrics, cognition, and days on hormonal therapy. RESULTS The cancer group showed regional reductions over 12 months in frontal, temporal, and parietal gray matter on VBM, reduced FreeSurfer cortical thickness in prefrontal, parietal, and insular regions, and increased working memory-related fMRI activation in frontal, cingulate, and visual association cortex. Controls showed only reductions in fusiform gyrus on VBM and FreeSurfer temporal and parietal cortex thickness. Women with breast cancer showed higher estimated brain age and lower regional gray matter volume than controls at both time points. The cancer group showed a trend toward lower performance in attention, processing speed, and executive function at follow-up. There were no significant associations between brain imaging metrics and cognition or days on hormonal therapy. CONCLUSION Older women with breast cancer showed brain changes in the first year of hormonal therapy. Increased brain activation during working memory processing may be a sign of functional compensation for treatment-related structural changes. This hypothesis should be tested in larger samples over longer time periods. CLINICALTRIALS GOV IDENTIFIER NCT03451383.
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Affiliation(s)
- Brenna C McDonald
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine and Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN, USA.
| | - Kathleen Van Dyk
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and UCLA Jonnson Comprehensive Cancer Center, University of California at Los Angeles, Los Angeles, CA, USA
| | - Rachael L Deardorff
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine and Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN, USA
| | - Jessica N Bailey
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine and Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN, USA
| | - Wanting Zhai
- Georgetown University and Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Judith E Carroll
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and UCLA Jonnson Comprehensive Cancer Center, University of California at Los Angeles, Los Angeles, CA, USA
| | - James C Root
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tim A Ahles
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jeanne S Mandelblatt
- Georgetown University and Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Andrew J Saykin
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine and Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN, USA
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9
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Eroğlu İ, Eroğlu BÇ. Potential role of tryptophan catabolism in cancer-related cognitive impairment. Nutrition 2022; 103-104:111765. [PMID: 35908496 DOI: 10.1016/j.nut.2022.111765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 05/31/2022] [Indexed: 12/24/2022]
Abstract
Oncology may be the most rapidly expanding field in medicine, with several innovative diagnostic and therapeutic procedures appearing daily. Advances in oncology have improved the survival rate for patients with cancer and promoting quality of life is now one of the goals in the care of these patients. Patients face a variety of disease- and treatment-related side effects, including anorexia, nausea, vomiting, recurring infections, and sleep difficulties. Cancer-related cognitive impairment (CRCI) is an overlooked clinical condition found in oncologic practice, particularly in patients with breast cancer. Although several potential mechanisms for CRCI have been hypothesized, to our knowledge, the exact mechanism is still unknown. Alterations in the tryptophan kynurenine pathway have been shown to impair cognitive skills in several mental illnesses. However, its possible function in CRCI has yet to be investigated. The aim of this was to examine the possible interactions between tryptophan catabolism and CRCI.
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Affiliation(s)
- İmdat Eroğlu
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Ankara, Turkey.
| | - Burcu Çelik Eroğlu
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Ankara, Turkey
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10
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Jett S, Malviya N, Schelbaum E, Jang G, Jahan E, Clancy K, Hristov H, Pahlajani S, Niotis K, Loeb-Zeitlin S, Havryliuk Y, Isaacson R, Brinton RD, Mosconi L. Endogenous and Exogenous Estrogen Exposures: How Women's Reproductive Health Can Drive Brain Aging and Inform Alzheimer's Prevention. Front Aging Neurosci 2022; 14:831807. [PMID: 35356299 PMCID: PMC8959926 DOI: 10.3389/fnagi.2022.831807] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/07/2022] [Indexed: 01/14/2023] Open
Abstract
After advanced age, female sex is the major risk factor for late-onset Alzheimer's disease (AD), the most common cause of dementia affecting over 24 million people worldwide. The prevalence of AD is higher in women than in men, with postmenopausal women accounting for over 60% of all those affected. While most research has focused on gender-combined risk, emerging data indicate sex and gender differences in AD pathophysiology, onset, and progression, which may help account for the higher prevalence in women. Notably, AD-related brain changes develop during a 10-20 year prodromal phase originating in midlife, thus proximate with the hormonal transitions of endocrine aging characteristic of the menopause transition in women. Preclinical evidence for neuroprotective effects of gonadal sex steroid hormones, especially 17β-estradiol, strongly argue for associations between female fertility, reproductive history, and AD risk. The level of gonadal hormones to which the female brain is exposed changes considerably across the lifespan, with relevance to AD risk. However, the neurobiological consequences of hormonal fluctuations, as well as that of hormone therapies, are yet to be fully understood. Epidemiological studies have yielded contrasting results of protective, deleterious and null effects of estrogen exposure on dementia risk. In contrast, brain imaging studies provide encouraging evidence for positive associations between greater cumulative lifetime estrogen exposure and lower AD risk in women, whereas estrogen deprivation is associated with negative consequences on brain structure, function, and biochemistry. Herein, we review the existing literature and evaluate the strength of observed associations between female-specific reproductive health factors and AD risk in women, with a focus on the role of endogenous and exogenous estrogen exposures as a key underlying mechanism. Chief among these variables are reproductive lifespan, menopause status, type of menopause (spontaneous vs. induced), number of pregnancies, and exposure to hormonal therapy, including hormonal contraceptives, hormonal therapy for menopause, and anti-estrogen treatment. As aging is the greatest risk factor for AD followed by female sex, understanding sex-specific biological pathways through which reproductive history modulates brain aging is crucial to inform preventative and therapeutic strategies for AD.
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Affiliation(s)
- Steven Jett
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Niharika Malviya
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Eva Schelbaum
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Grace Jang
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Eva Jahan
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Katherine Clancy
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Hollie Hristov
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Silky Pahlajani
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
- Department of Radiology, Weill Cornell Medical College, New York, NY, United States
| | - Kellyann Niotis
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Susan Loeb-Zeitlin
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, United States
| | - Yelena Havryliuk
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, United States
| | - Richard Isaacson
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Roberta Diaz Brinton
- Department of Pharmacology, University of Arizona, Tucson, AZ, United States
- Department of Neurology, University of Arizona, Tucson, AZ, United States
| | - Lisa Mosconi
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
- Department of Radiology, Weill Cornell Medical College, New York, NY, United States
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11
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Ning S, Qiao K, Pan L. Physical Activity Patterns and Cognitive Function in Patients With Breast Cancer. J Clin Oncol 2022; 40:915-916. [PMID: 35061503 DOI: 10.1200/jco.21.02073] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Shipeng Ning
- Shipeng Ning, MD, Department of Breast Surgery, Guangxi Medical University Cancer Hospital, Nanning, China; Kun Qiao, MD, Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin, China; and Linghui Pan, MD, Department of Anesthesia, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Kun Qiao
- Shipeng Ning, MD, Department of Breast Surgery, Guangxi Medical University Cancer Hospital, Nanning, China; Kun Qiao, MD, Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin, China; and Linghui Pan, MD, Department of Anesthesia, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Linghui Pan
- Shipeng Ning, MD, Department of Breast Surgery, Guangxi Medical University Cancer Hospital, Nanning, China; Kun Qiao, MD, Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin, China; and Linghui Pan, MD, Department of Anesthesia, Guangxi Medical University Cancer Hospital, Nanning, China
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12
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Van Dyk K, Crespi CM, Bower JE, Carroll JE, Petersen L, Ganz PA. Association of APOE4 genotype and treatment with cognitive outcomes in breast cancer survivors over time. NPJ Breast Cancer 2021; 7:112. [PMID: 34480030 PMCID: PMC8417038 DOI: 10.1038/s41523-021-00327-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/26/2021] [Indexed: 11/09/2022] Open
Abstract
This prospective longitudinal study of breast cancer survivors (n = 167) examined the association of apolipoprotein ε4 (APOE ε4) genotype with cognition and interactions with chemotherapy or endocrine therapy up to 6 years after treatment. In general, we found no effects of ε4 across timepoints and treatment exposures; post hoc analysis at 3-6 years suggested a trend towards worse cognition in the domains of attention and learning among ε4 carriers exposed to endocrine therapy. Further study is needed.
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Affiliation(s)
- Kathleen Van Dyk
- Semel Institute and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, CA, USA
| | - Catherine M Crespi
- Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, CA, USA
- Department of Biostatistics, Fielding School of Public Health, UCLA, Los Angeles, CA, USA
| | - Julienne E Bower
- Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, CA, USA
- Department of Psychology, UCLA, Los Angeles, CA, USA
- Cousins Center for Psychoneuroimmunology, UCLA, Los Angeles, CA, USA
| | - Judith E Carroll
- Semel Institute and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Cousins Center for Psychoneuroimmunology, UCLA, Los Angeles, CA, USA
| | - Laura Petersen
- Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, CA, USA
| | - Patricia A Ganz
- Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, CA, USA.
- Department of Medicine (Hematology-Oncology), David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
- Department of Health Policy and Management, Fielding School of Public Health, UCLA, Los Angeles, CA, USA.
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13
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Mzayek Y, de Ruiter MB, Oldenburg HSA, Reneman L, Schagen SB. Measuring decline in white matter integrity after systemic treatment for breast cancer: omitting skeletonization enhances sensitivity. Brain Imaging Behav 2021; 15:1191-1200. [PMID: 32705463 PMCID: PMC8286227 DOI: 10.1007/s11682-020-00319-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Chemotherapy for non-central nervous system cancers is associated with abnormalities in brain structure and function. Diffusion tensor imaging (DTI) allows for studying in vivo microstructural changes in brain white matter. Tract-based spatial statistics (TBSS) is a widely used processing pipeline in which DTI data are typically normalized to a generic DTI template and then 'skeletonized' to compensate for misregistration effects. However, this approach greatly reduces the overall white matter volume that is subjected to statistical analysis, leading to information loss. Here, we present a re-analysis of longitudinal data previously analyzed with standard TBSS (Menning et al., BIB 2018, 324-334). For our current approach, we constructed a pipeline with an optimized registration method in Advanced Normalization Tools (ANTs) where DTI data are registered to a study-specific, high-resolution T1 template and the skeletonization step is omitted. In a head to head comparison, we show that with our novel approach breast cancer survivors who had received chemotherapy plus or minus endocrine therapy (BC + SYST, n = 26) showed a global decline in overall FA that was not present in breast cancer survivors who did not receive systemic therapy (BC-SYST, n = 23) or women without a cancer diagnosis (no cancer controls, NC, n = 30). With the standard TBSS approach we did not find any group differences. Moreover, voxel-based analysis for our novel pipeline showed a widespread decline in FA in the BC + SYST compared to the NC group. Interestingly, the BC-SYST group also showed a decline in FA compared to the NC group, although in much less voxels. These results were not found with the standard TBSS approach. We demonstrate that a modified processing pipeline makes DTI data more sensitive to detecting changes in white matter integrity in non-CNS cancer patients after treatment, particularly chemotherapy.
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Affiliation(s)
- Yasmin Mzayek
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Brain and Cognition, Department of Psychology, University of Amsterdam, Nieuwe Achtergracht 129 B, Amsterdam, The Netherlands
| | - Michiel B de Ruiter
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Hester S A Oldenburg
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Liesbeth Reneman
- Department of Radiology, Location AMC, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Sanne B Schagen
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
- Brain and Cognition, Department of Psychology, University of Amsterdam, Nieuwe Achtergracht 129 B, Amsterdam, The Netherlands.
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14
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van Heesewijk JO, Dreijerink KMA, Wiepjes CM, Kok AAL, van Schoor NM, Huisman M, den Heijer M, Kreukels BPC. Long-Term Gender-Affirming Hormone Therapy and Cognitive Functioning in Older Transgender Women Compared With Cisgender Women and Men. J Sex Med 2021; 18:1434-1443. [PMID: 37057450 DOI: 10.1016/j.jsxm.2021.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 05/10/2021] [Accepted: 05/15/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Long-term gender-affirming hormone therapy (GHT) in older transgender individuals could have beneficial effects on cognitive functioning. Cardiovascular risk factors and psychological factors are known determinants of cognition. Despite the rising number of older transgender individuals, only few studies have examined cognitive functioning in this population. AIM We aimed to assess differences in cognitive functioning between transgender women, and non-transgender (cisgender) women and men, and investigated the contribution of cardiovascular risk factors and psychological factors on these differences. METHODS In this study, 37 transgender women (age range 55 to 69) receiving GHT for at least ten years (range 10.2 to 41.6) were examined, and their cognitive functioning was compared to an age and education level matched cohort consisting of 222 cisgender women and men from the Longitudinal Aging Study Amsterdam. Linear regression analyses were performed. OUTCOMES Cognitive functioning was assessed by neuropsychological tests including Mini-Mental State Examination (MMSE), Category Fluency animals, Letter Fluency D, 15-Word test (15WT) immediate and delayed recall. Additionally, cardiovascular risk factors and psychological factors such as cardiovascular disease, hypertension, antihypertensive use, statin use, diabetes mellitus, overweight, smoking, alcohol consumption, psychopharmaceutical use, anxiety and depression symptoms were collected. RESULTS Transgender women had higher MMSE scores compared with cisgender women (+0.9, 95% CI 0.4 to 1.5), and cisgender men (+1.1, 95% CI 0.4 to 1.8). On all other tests transgender women performed similar to cisgender men. Transgender women performed at a lower level than cisgender women on 15WT immediate recall, -5.5, 95% CI -7.6 to -3.4, and 15WT delayed recall, -2.7, 95% CI -3.7 to -1.7, and equal to cisgender women on Fluency animals and Fluency D. Cardiovascular and psychological factors (i.e., cardiovascular disease and depression symptoms) partly explained differences on MMSE score between transgender women and cisgender-control groups. CLINICAL IMPLICATIONS The results of this study do not indicate a need for tailored hormone treatment strategies for older transgender women, based on cognitive aspects after long-term GHT. STRENGTHS & LIMITATIONS As one of the first studies, this study compared older transgender women to a large cohort of cisgender men and women regarding cognitive functioning and took into account numerous potential influencing factors. Limitations include difference in test procedures and the cross-sectional design of the study. CONCLUSION Cognitive differences between transgender women and cisgender women and men were small, albeit significant. This may suggest that long-term GHT effects on cognitive functioning in older transgender women are minimal. van Heesewijk JO, Dreijerink KMA, Wiepjes CM, et al. Long-Term Gender-Affirming Hormone Therapy and Cognitive Functioning in Older Transgender Women Compared With Cisgender Women and Men. J Sex Med 2021;18:1434-1443.
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Affiliation(s)
- Jason O van Heesewijk
- Amsterdam University Medical Centers, location VUmc, Department of Endocrinology, , Amsterdam, the Netherlands
- Amsterdam University Medical Centers, location VUmc, Center of Expertise on Gender Dysphoria, , Amsterdam, the Netherlands
| | - Koen M A Dreijerink
- Amsterdam University Medical Centers, location VUmc, Department of Endocrinology, , Amsterdam, the Netherlands
- Amsterdam University Medical Centers, location VUmc, Center of Expertise on Gender Dysphoria, , Amsterdam, the Netherlands
| | - Chantal M Wiepjes
- Amsterdam University Medical Centers, location VUmc, Department of Endocrinology, , Amsterdam, the Netherlands
- Amsterdam University Medical Centers, location VUmc, Center of Expertise on Gender Dysphoria, , Amsterdam, the Netherlands
| | - Almar A L Kok
- Amsterdam University Medical Centers, location VUmc, Department of Epidemiology and Data Science, , Amsterdam, the Netherlands
| | - Natasja M van Schoor
- Amsterdam University Medical Centers, location VUmc, Department of Epidemiology and Data Science, , Amsterdam, the Netherlands
| | - Martijn Huisman
- Amsterdam University Medical Centers, location VUmc, Department of Epidemiology and Data Science, , Amsterdam, the Netherlands
| | - Martin den Heijer
- Amsterdam University Medical Centers, location VUmc, Department of Endocrinology, , Amsterdam, the Netherlands
- Amsterdam University Medical Centers, location VUmc, Center of Expertise on Gender Dysphoria, , Amsterdam, the Netherlands
| | - Baudewijntje P C Kreukels
- Amsterdam University Medical Centers, location VUmc, Department of Medical Psychology, , Amsterdam, the Netherlands
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15
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Novick AM, Scott AT, Neill Epperson C, Schneck CD. Neuropsychiatric effects of tamoxifen: Challenges and opportunities. Front Neuroendocrinol 2020; 59:100869. [PMID: 32822707 PMCID: PMC7669724 DOI: 10.1016/j.yfrne.2020.100869] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 08/12/2020] [Accepted: 08/16/2020] [Indexed: 02/08/2023]
Abstract
Epidemiological, clinical, and basic research over the past thirty years have described the benefits of estrogen on cognition, mood, and brain health. Less is known about tamoxifen, a selective estrogen receptor modifier (SERM) commonly used in breast cancer which is able to cross the blood-brain barrier. In this article, we review the basic pharmacology of tamoxifenas well as its effects on cognition and mood. The literature reveals an overall impairing effect of tamoxifen on cognition in breast cancer patients, hinting at central antiestrogen activity. On the other hand, tamoxifen demonstrates promising effects in psychiatric disorders, like bipolar disorder, where its therapeutic action may be independent of interaction with estrogen receptors. Understanding the neuropsychiatric properties of SERMs like tamoxifen can guide future research to ameliorate unwanted side-effects and provide novel options for difficult to treat disorders.
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Affiliation(s)
- Andrew M Novick
- Department of Psychiatry, University of Colorado School of Medicine, 13001 E 17th Place, Campus Box F546, Aurora, CO 80045, United States.
| | - Anthony T Scott
- Department of Psychiatry, University of Colorado School of Medicine, 13001 E 17th Place, Campus Box F546, Aurora, CO 80045, United States
| | - C Neill Epperson
- Department of Psychiatry, University of Colorado School of Medicine, 13001 E 17th Place, Campus Box F546, Aurora, CO 80045, United States
| | - Christopher D Schneck
- Department of Psychiatry, University of Colorado School of Medicine, 13001 E 17th Place, Campus Box F546, Aurora, CO 80045, United States
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16
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The association between endocrine therapy use and dementia among post-menopausal women treated for early-stage breast cancer in Ontario, Canada. J Geriatr Oncol 2020; 11:1132-1137. [DOI: 10.1016/j.jgo.2020.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/19/2020] [Accepted: 05/23/2020] [Indexed: 01/17/2023]
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17
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Mitobe Y, Ikeda K, Sato W, Kodama Y, Naito M, Gotoh N, Miyata K, Kataoka K, Sasaki H, Horie-Inoue K, Inoue S. Proliferation-associated long noncoding RNA, TMPO-AS1, is a potential therapeutic target for triple-negative breast cancer. Cancer Sci 2020; 111:2440-2450. [PMID: 32437068 PMCID: PMC7385350 DOI: 10.1111/cas.14498] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/21/2020] [Accepted: 05/15/2020] [Indexed: 01/31/2023] Open
Abstract
Triple‐negative breast cancer (TNBC) is an aggressive subtype of breast cancer compared with luminal or epidermal growth factor receptor 2 subtypes, thus effective therapeutic options for TNBC are yet to be developed. Nowadays, oncogenic long noncoding RNAs (lncRNAs) are applied to cancer management as a new class of therapeutic targets. We previously showed that thymopoietin antisense transcript 1 (TMPO‐AS1) is a proliferation‐associated lncRNA that contributes to hormone‐dependent breast cancer progression by stabilizing estrogen receptor‐α mRNA. We here showed that TMPO‐AS1 is abundantly expressed in basal‐like breast cancer subtype based on the transcriptomic data in The Cancer Genome Atlas as well as in TNBC cell lines and patient‐derived cells. Small interfering RNA‐based loss‐of‐function analyses showed that TMPO‐AS1 knockdown substantially represses the proliferation and migration of TNBC cells. Expression microarray analysis showed that TMPO‐AS1 alters gene signatures related to transforming growth factor‐β signaling in addition to proliferative E2F signaling pathways. TMPO‐AS1‐targeted siRNA treatment through engineered drug delivery systems using cancer‐targeted polyion complex micelle or nanoball technology significantly impaired the in vivo growth of primary and metastatic TNBC xenograft tumors. Our findings suggest that TMPO‐AS1 plays a key role in TNBC pathophysiology and could be a potential therapeutic target for TNBC.
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Affiliation(s)
- Yuichi Mitobe
- Division of Gene Regulation and Signal Transduction, Research Center for Genomic Medicine, Saitama Medical University, Saitama, Japan
| | - Kazuhiro Ikeda
- Division of Gene Regulation and Signal Transduction, Research Center for Genomic Medicine, Saitama Medical University, Saitama, Japan
| | - Wataru Sato
- Division of Gene Regulation and Signal Transduction, Research Center for Genomic Medicine, Saitama Medical University, Saitama, Japan
| | - Yukinobu Kodama
- Department of Hospital Pharmacy, Nagasaki University Hospital, Nagasaki, Japan
| | - Mitsuru Naito
- Center for Disease Biology and Integrative Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Noriko Gotoh
- Division of Cancer Cell Biology, Cancer Research Institute, Kanazawa University, Ishikawa, Japan
| | - Kanjiro Miyata
- Department of Materials Engineering, Graduate School of Engineering, The University of Tokyo, Tokyo, Japan
| | - Kazunori Kataoka
- Institute for Future Initiatives, The University of Tokyo, Tokyo, Japan.,Innovation Center of Nanomedicine, Kawasaki Institute of Industrial Promotion, Kawasaki, Japan
| | - Hitoshi Sasaki
- Department of Hospital Pharmacy, Nagasaki University Hospital, Nagasaki, Japan
| | - Kuniko Horie-Inoue
- Division of Gene Regulation and Signal Transduction, Research Center for Genomic Medicine, Saitama Medical University, Saitama, Japan
| | - Satoshi Inoue
- Division of Gene Regulation and Signal Transduction, Research Center for Genomic Medicine, Saitama Medical University, Saitama, Japan.,Department of Systems Aging Science and Medicine, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
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18
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Ganz PA, Van Dyk K. Cognitive Impairment in Patients With Breast Cancer: Understanding the Impact of Chemotherapy and Endocrine Therapy. J Clin Oncol 2020; 38:1871-1874. [PMID: 32142394 DOI: 10.1200/jco.20.00336] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Affiliation(s)
- Patricia A Ganz
- University of California Los Angeles Jonsson Comprehensive Cancer Center, and David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA.,University of California Los Angeles, Fielding School of Public Health, Los Angeles, CA
| | - Kathleen Van Dyk
- University of California Los Angeles Jonsson Comprehensive Cancer Center, and David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA.,University of California Los Angeles, Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
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19
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Kohler C, Chang M, Allemann-Su YY, Vetter M, Jung M, Jung M, Conley Y, Paul S, Kober KM, Cooper BA, Smoot B, Levine JD, Miaskowski C, Katapodi MC. Changes in Attentional Function in Patients From Before Through 12 Months After Breast Cancer Surgery. J Pain Symptom Manage 2020; 59:1172-1185. [PMID: 31953207 PMCID: PMC7239765 DOI: 10.1016/j.jpainsymman.2020.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/03/2020] [Accepted: 01/06/2020] [Indexed: 02/07/2023]
Abstract
CONTEXT Although approximately 75% of patients with breast cancer report changes in attentional function, little is known about how demographic, clinical, symptom, and psychosocial adjustment (e.g., coping) characteristics influence changes in the trajectories of attentional function over time. OBJECTIVES This study evaluated interindividual variability in the trajectories of self-reported attentional function and determined which demographic, clinical, symptom, and psychosocial adjustment characteristics were associated with initial levels and with changes in attentional function from before through 12 months after breast cancer surgery. METHODS Before surgery, 396 women were enrolled. Attentional Function Index (AFI) was completed before and nine times within the first 12 months after surgery. Hierarchical linear modeling was used to determine which characteristics were associated with initial levels and trajectories of attentional function. RESULTS Given an estimated preoperative AFI score of 6.53, for each additional month, the estimated linear rate of change in AFI score was an increase of 0.054 (P < 0.001). Higher levels of comorbidity, receipt of adjuvant chemotherapy, higher levels of trait anxiety, fatigue, and sleep disturbance, and lower levels of energy and less sense of control were associated with lower levels of attentional function before surgery. Patients who had less improvements in attentional function over time were nonwhite, did not have a lymph node biopsy, had received hormonal therapy, and had less difficulty coping with their disease. CONCLUSION Findings can be used to identify patients with breast cancer at higher risk for impaired self-reported cognitive function and to guide the prescription of more personalized interventions.
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Affiliation(s)
- Carmen Kohler
- Medical Oncology, University Hospital Basel, Basel, Switzerland
| | - Ming Chang
- Department of Clinical Research, Nursing Science, University of Basel, Basel, Switzerland
| | - Yu-Yin Allemann-Su
- Department of Clinical Research, Nursing Science, University of Basel, Basel, Switzerland
| | - Marcus Vetter
- Medical Oncology, University Hospital Basel, Basel, Switzerland
| | - Miyeon Jung
- College of Nursing, Chungnam National University, Daejeon, South Korea
| | - Misook Jung
- School of Nursing, Indiana University, Indianapolis, Indiana, USA
| | - Yvette Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Steven Paul
- School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Kord M Kober
- School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Bruce A Cooper
- School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Betty Smoot
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Jon D Levine
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Christine Miaskowski
- School of Nursing, University of California San Francisco, San Francisco, California, USA.
| | - Maria C Katapodi
- Department of Clinical Research, Nursing Science, University of Basel, Basel, Switzerland; School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
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20
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Wang H, Wu D, Cai L, Li X, Zhang Z, Chen S. Aberrant methylation of WD-repeat protein 41 contributes to tumour progression in triple-negative breast cancer. J Cell Mol Med 2020; 24:6869-6882. [PMID: 32394588 PMCID: PMC7299681 DOI: 10.1111/jcmm.15344] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 04/03/2020] [Accepted: 04/14/2020] [Indexed: 12/21/2022] Open
Abstract
WD‐repeat proteins are implicated in a variety of biological functions, most recently in oncogenesis. However, the underlying function of WD‐repeat protein 41 (WDR41) in tumorigenesis remains elusive. The present study was aimed to explore the role of WDR41 in breast cancer. Combined with Western blotting and immunohistochemistry, the results showed that WDR41 was expressed at low levels in breast cancer, especially in triple‐negative breast cancer (TNBC). Using methylation‐specific PCR (MSP), we observed that WDR41 presented hypermethylation in MDA‐MB‐231 cells. Methylation inhibitor 5‐aza‐2′‐deoxycytidine (5‐aza‐dC) management increased the expression of WDR41 in MDA‐MB‐231 cells, but not in MCF‐10A (normal mammary epithelial cells) or oestrogen receptor‐positive MCF‐7 breast cancer cells. WDR41‐down‐regulation promoted, while WDR41‐up‐regulation inhibited the tumour characteristics of TNBC cells including cell viability, cell cycle and migration. Further, WDR41‐up‐regulation dramatically suppressed tumour growth in vivo. Mechanistically, WDR41 protein ablation activated, while WDR41‐up‐regulation repressed the AKT/GSK‐3β pathway and the subsequent nuclear activation of β‐catenin in MDA‐MB‐231 cells, and 5‐aza‐dC treatment enhanced this effect. After treatment with the AKT inhibitor MK‐2206, WDR41‐down‐regulation‐mediated activation of the GSK‐3β/β‐catenin signalling was robustly abolished. Collectively, methylated WDR41 in MDA‐MB‐231 cells promotes tumorigenesis through positively regulating the AKT/GSK‐3β/β‐catenin pathway, thus providing an important foundation for treating TNBC.
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Affiliation(s)
- Han Wang
- Translational Medicine Research Center (TMRC), School of Pharmaceutical Science, Xiamen University, Xiamen, Fujian, China
| | - Dan Wu
- Department of oncology, Xiamen Fifth hospital, Xiamen, China
| | - Liangliang Cai
- Translational Medicine Research Center (TMRC), School of Pharmaceutical Science, Xiamen University, Xiamen, Fujian, China
| | - Xiaohong Li
- Department of Medical Oncology, Cancer Hospital, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Zhiming Zhang
- Department of Breast Surgery, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Shuai Chen
- Department of oncology, Xiamen Fifth hospital, Xiamen, China.,Translational Medicine Research Center (TMRC), School of Pharmaceutical Science, Xiamen University, Xiamen, Fujian, China.,Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Xiamen University, Xiamen, China.,Xiamen Key Laboratory of Otolaryngology-Head and Neck Surgery, Xiamen, China
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21
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Self-reported cognitive decline in Japanese patients with breast cancer treated with endocrine therapy. Breast Cancer 2020; 27:670-682. [PMID: 32114664 DOI: 10.1007/s12282-020-01062-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 02/10/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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22
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Abstract
PURPOSE OF REVIEW To delineate the current state of evidence on the impact of night shift work on age at natural menopause. RECENT FINDINGS The only direct evidence is from a single observational study, which indicates that women who work night shifts are at moderately higher risk for earlier menopause and that this risk is more pronounced among younger women. Underlying biological mechanisms have yet to be sufficiently substantiated. A long-held line of inquiry, most strongly propagated by the observed link between night shift work and female breast cancer, is the 'Light at Night' hypothesis, which suggests melatonin-mediated circadian disruption as a potential regulator of reproductive signaling in women. Supporting evidence is found from observations of changes in endogenous melatonin production among night working women or in response to light exposure, and corresponding changes in endogenous ovarian hormone levels and modulated menstrual patterns, among other indications of altered central ovulation-governing processes. Susceptibility to night shift work may be modified by chronotype. SUMMARY This review summarizes the literature related to night work and ovulatory regulation in humans, prioritizing population-based evidence to provide motivation for the study of circadian disruption and night shift work as a regulator of menopausal timing.
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Affiliation(s)
- David Stock
- Community Health and Epidemiology, Dalhousie University
- Maritime SPOR SUPPORT Unit, Halifax, Nova Scotia, Canada
| | - Eva Schernhammer
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria
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23
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Bromley SE, Matthews A, Smeeth L, Stanway S, Bhaskaran K. Risk of dementia among postmenopausal breast cancer survivors treated with aromatase inhibitors versus tamoxifen: a cohort study using primary care data from the UK. J Cancer Surviv 2019; 13:632-640. [PMID: 31321612 PMCID: PMC6776493 DOI: 10.1007/s11764-019-00782-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 06/28/2019] [Indexed: 11/04/2022]
Abstract
Purpose Among a cohort of postmenopausal breast cancer survivors, we aimed to compare the risk of dementia associated with aromatase inhibitor (AI) therapy versus tamoxifen. Methods Using UK primary care electronic health records, we identified 14,214 postmenopausal breast cancer survivors (aged ≥ 54 years) with a first AI or tamoxifen prescription between January 2002 and December 2015 and no previous dementia diagnosis. Women were followed-up to identify incident cases of dementia. Cox regression was used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) to quantify the association between AI exposure (vs. tamoxifen) and dementia, adjusted for confounders. Results A total of 368 incident dementia cases was identified over 57,102 person-years of follow-up. The crude incidence rate of dementia was 7.46 per 1000 person-years (95% CI 6.43–8.65) among women starting endocrine treatment on an AI, and 6.32 per 1000 person-years (95% CI 5.34–7.47) among women starting on tamoxifen. After accounting for age differences and assessing other potential confounders, there was no evidence of a difference in dementia risk between exposure groups (HR for AI vs tamoxifen 1.04, 95% CI 0.83–1.03). There was no evidence of effect modification by age. Conclusion There was no evidence for a difference in dementia risk between AI and tamoxifen users among postmenopausal breast cancer survivors. Implications for Cancer Survivors Our findings suggest that there is no reason for concern about a difference in dementia risk with AI vs. tamoxifen, which is relevant to postmenopausal breast cancer patients recommended these treatments. Electronic supplementary material The online version of this article (10.1007/s11764-019-00782-w) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Susan E Bromley
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK. .,EpiMed Communications Ltd, Abingdon, UK.
| | - Anthony Matthews
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Liam Smeeth
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Krishnan Bhaskaran
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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24
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Barrientos RM, Brunton PJ, Lenz KM, Pyter L, Spencer SJ. Neuroimmunology of the female brain across the lifespan: Plasticity to psychopathology. Brain Behav Immun 2019; 79:39-55. [PMID: 30872093 PMCID: PMC6591071 DOI: 10.1016/j.bbi.2019.03.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/25/2019] [Accepted: 03/09/2019] [Indexed: 02/06/2023] Open
Abstract
The female brain is highly dynamic and can fundamentally remodel throughout the normal ovarian cycle as well as in critical life stages including perinatal development, pregnancy and old-age. As such, females are particularly vulnerable to infections, psychological disorders, certain cancers, and cognitive impairments. We will present the latest evidence on the female brain; how it develops through the neonatal period; how it changes through the ovarian cycle in normal individuals; how it adapts to pregnancy and postpartum; how it responds to illness and disease, particularly cancer; and, finally, how it is shaped by old age. Throughout, we will highlight female vulnerability to and resilience against disease and dysfunction in the face of environmental challenges.
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Affiliation(s)
- R M Barrientos
- Institute for Behavioral Medicine Research, Wexner Medical Centre, The Ohio State University, Columbus, OH 43210, United States; Department of Psychiatry and Behavioral Health, Wexner Medical Centre, The Ohio State University, Columbus, OH 43210, United States; Chronic Brain Injury Program, Discovery Themes Initiative, The Ohio State University, Columbus, OH 43210, United States
| | - P J Brunton
- Centre for Discovery Brain Sciences, University of Edinburgh, Hugh Robson Building, George Square, Edinburgh EH8 9XD, Scotland, UK; Zhejiang University-University of Edinburgh Joint Institute, Zhejiang University School of Medicine, International Campus, Haining, Zhejiang 314400, PR China
| | - K M Lenz
- Institute for Behavioral Medicine Research, Wexner Medical Centre, The Ohio State University, Columbus, OH 43210, United States; Department of Psychology, Department of Neuroscience, The Ohio State University, Columbus, OH 43210, United States
| | - L Pyter
- Institute for Behavioral Medicine Research, Wexner Medical Centre, The Ohio State University, Columbus, OH 43210, United States; Department of Psychiatry and Behavioral Health, Wexner Medical Centre, The Ohio State University, Columbus, OH 43210, United States
| | - S J Spencer
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Vic. 3083, Australia.
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25
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Menning S, de Ruiter MB, Veltman DJ, Boogerd W, Oldenburg HSA, Reneman L, Schagen SB. Changes in brain white matter integrity after systemic treatment for breast cancer: a prospective longitudinal study. Brain Imaging Behav 2019; 12:324-334. [PMID: 28290072 DOI: 10.1007/s11682-017-9695-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
An increasing number of studies suggest chemotherapy for breast cancer may be neurotoxic. Cross-sectional MRI diffusion tensor imaging (DTI) studies suggest a vulnerability of brain white matter to various chemotherapeutic regimens. Up till now, this was confirmed in one prospective DTI study: Deprez et al. (2012) showed a widespread decline in fractional anisotropy (FA) of breast cancer patients after chemotherapy consisting of 5-fluorouracil (5-FU), epirubicin and cyclophosphamide (FEC) +/- taxanes +/- endocrine treatment. Our aim was to evaluate whether similar detrimental effects on white matter integrity would be observed with the currently widely prescribed anthracycline-based chemotherapy for breast cancer (predominantly doxorubicin and cyclophosphamide +/- taxanes +/- endocrine treatment (=BC + SYST; n = 26) compared to no systemic treatment (BC; n = 23) and no-cancer controls (NC; n = 30). Assessment took place before and six months after chemotherapy, and matched intervals for the unexposed groups. DTI data were analyzed using voxel-based tract-based spatial statistics and region of interest (ROI) analysis. Voxel-based analysis did not show an effect of chemotherapy +/- endocrine treatment on white matter integrity. ROI analysis however indicated subtle detrimental effects of chemotherapy +/- endocrine treatment by showing a larger decline in WM integrity in the superior longitudinal fasciculus and corticospinal tract in BC + SYST than BC. Indications for relatively mild neurotoxicity in our study might be explained by patient characteristics and specific aspects of data analysis. The omission of 5-FU in current treatment regimens or the administration of doxorubicin instead of epirubicin is also discussed as an explanation for the observed effects.
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Affiliation(s)
- Sanne Menning
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Plesmanlaan 121, 1066, CX, Amsterdam, The Netherlands.,Department of Radiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Michiel B de Ruiter
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Plesmanlaan 121, 1066, CX, Amsterdam, The Netherlands.,Department of Radiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Dick J Veltman
- Department of Psychiatry, VU University Medical Center, Van der Boechorststraat 7, 1081, BT, Amsterdam, The Netherlands
| | - Willem Boogerd
- Department of Neuro-Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066, CX, Amsterdam, The Netherlands
| | - Hester S A Oldenburg
- Department of Surgical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066, CX, Amsterdam, The Netherlands
| | - Liesbeth Reneman
- Department of Radiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Sanne B Schagen
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Plesmanlaan 121, 1066, CX, Amsterdam, The Netherlands.
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26
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Van Dyk K, Crespi CM, Bower JE, Castellon SA, Petersen L, Ganz PA. The cognitive effects of endocrine therapy in survivors of breast cancer: A prospective longitudinal study up to 6 years after treatment. Cancer 2018; 125:681-689. [PMID: 30485399 DOI: 10.1002/cncr.31858] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 09/10/2018] [Accepted: 10/22/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND After treatment of primary breast cancer, endocrine therapy (ET) is prescribed for patients with hormone receptor-positive cancers. Despite ET recommendations of 5 to 10 years of treatment, to the authors' knowledge there is little prospective study of its impact on cognitive function over an extended period of time. ET has known pharmacologic effects on the brain. Cognitive side effects are a concern for many women, with mixed findings reported in various studies. The current prospective longitudinal study examined the neuropsychological effects of ET over time, up to 6 years after treatment. METHODS A total of 189 survivors of early-stage breast cancer enrolled in the study prior to initiating ET if prescribed, and were followed at 6 months (175 patients), 12 months (173 patients), and for 3 to 6 years (102 patients) with self-report and neuropsychological assessments. Using linear mixed models, the authors examined whether neuropsychological performance or impairment rates differed over time based on whether or not ET was received. RESULTS The authors did not find any effect of ET on neuropsychological performance or impairment at any time point among survivors who received it compared with women who did not. However, those who participated in the 3-year to 6-year year visit demonstrated better executive function at baseline. CONCLUSIONS In the current observational cohort study, no detrimental effect of ET on cognitive function was identified in survivors of early-stage breast cancer receiving treatment with ET compared with those who were not.
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Affiliation(s)
- Kathleen Van Dyk
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, California.,Jonsson Comprehensive Cancer Center, University of California at Los Angeles, Los Angeles, California
| | - Catherine M Crespi
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, California.,Jonsson Comprehensive Cancer Center, University of California at Los Angeles, Los Angeles, California.,Department of Biostatistics, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, California
| | - Julienne E Bower
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, California.,Jonsson Comprehensive Cancer Center, University of California at Los Angeles, Los Angeles, California.,Department of Psychology, University of California at Los Angeles, Los Angeles, California
| | - Steven A Castellon
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, California.,VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Laura Petersen
- Jonsson Comprehensive Cancer Center, University of California at Los Angeles, Los Angeles, California
| | - Patricia A Ganz
- Jonsson Comprehensive Cancer Center, University of California at Los Angeles, Los Angeles, California.,David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.,Department of Health Policy and Management, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, California
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27
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Mandelblatt JS, Small BJ, Luta G, Hurria A, Jim H, McDonald BC, 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 AJ, Ahles T. Cancer-Related Cognitive Outcomes Among Older Breast Cancer Survivors in the Thinking and Living With Cancer Study. J Clin Oncol 2018; 36:JCO1800140. [PMID: 30281396 PMCID: PMC7237199 DOI: 10.1200/jco.18.00140] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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 (ε4+ 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 ε4+ 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 ε4+ survivors exposed to chemotherapy (-0.40; 95% CI, -0.79 to -0.01) at 24 months than ε4+ 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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Affiliation(s)
- Jeanne S. Mandelblatt
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Brent J. Small
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Gheorghe Luta
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Arti Hurria
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Heather Jim
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Brenna C. McDonald
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Deena Graham
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Xingtao Zhou
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Jonathan Clapp
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Wanting Zhai
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Elizabeth Breen
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Judith E. Carroll
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Neelima Denduluri
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Asma Dilawari
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Martine Extermann
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Claudine Isaacs
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Paul B. Jacobsen
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Lindsay C. Kobayashi
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Kelly Holohan Nudelman
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - James Root
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Robert A. Stern
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Danielle Tometich
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Raymond Turner
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - John W. VanMeter
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Andrew J. Saykin
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Tim Ahles
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
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28
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Krul IM, Opstal-van Winden AWJ, Zijlstra JM, Appelman Y, Schagen SB, Meijboom LJ, Serné E, Lambalk CB, Lips P, van Dulmen-den Broeder E, Hauptmann M, Daniëls LA, Aleman BMP, van Leeuwen FE. Rationale and design of a cohort study on primary ovarian insufficiency in female survivors of Hodgkin's lymphoma: influence on long-term adverse effects (SOPHIA). BMJ Open 2018; 8:e018120. [PMID: 30206072 PMCID: PMC6144325 DOI: 10.1136/bmjopen-2017-018120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Hodgkin's lymphoma (HL) has become the prototype of a curable disease. However, many young survivors suffer from late adverse effects of treatment. Both chemotherapy (CT) and radiotherapy (RT) may induce primary ovarian insufficiency (POI), which has been associated with reduced bone mineral density (BMD), neurocognitive dysfunction and possibly cardiovascular disease (CVD). While the general assumption is that POI increases CVD risk, other hypotheses postulate reverse causality, suggesting that cardiovascular risk factors determine menopausal age or that biological ageing underlies both POI and CVD risk. None of these hypotheses are supported by convincing evidence. Furthermore, most studies on POI-associated conditions have been conducted in women with early natural or surgery-induced menopause with short follow-up times. In this study, we will examine the long-term effects of CT-induced and/or RT-induced POI on BMD, cardiovascular status, neurocognitive function and quality of life in female HL survivors. METHODS AND ANALYSIS This study will be performed within an existing Dutch cohort of HL survivors. Eligible women were treated for HL at ages 15-39 years in three large hospitals since 1965 and survived for ≥8 years after their diagnosis. Women visiting a survivorship care outpatient clinic will be invited for a neurocognitive, cardiovascular and BMD assessment, and asked to complete several questionnaires and to provide a blood sample. Using multivariable regression analyses, we will compare the outcomes of HL survivors who developed POI with those who did not. Cardiovascular status will also be compared with women with natural POI. ETHICS AND DISSEMINATION This study has been approved by the Institutional Review Board of the Netherlands Cancer Institute and has been registered at 'Toetsingonline' from the Dutch Central Committee on Research involving Human Subjects (file no. NL44714.031.13). Results will be disseminated through peer-reviewed publications and will be incorporated in follow-up guidelines for HL survivors.
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Affiliation(s)
- Inge M Krul
- Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Josée M Zijlstra
- Department of Haemato-oncology, VU University Medical Center, Amsterdam, Netherlands
| | - Yolande Appelman
- Department of Cardiology, VU University Medical Center, Amsterdam, Netherlands
| | - Sanne B Schagen
- Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Lilian J Meijboom
- Department of Radiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Erik Serné
- Department of Vascular Medicine, VU University Medical Center, Amsterdam, Netherlands
| | - Cornelis B Lambalk
- Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands
| | - Paul Lips
- Department of Internal Medicine, Endocrine Section, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Michael Hauptmann
- Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Laurien A Daniëls
- Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Berthe M P Aleman
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Flora E van Leeuwen
- Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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29
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Hardy SJ, Krull KR, Wefel JS, Janelsins M. Cognitive Changes in Cancer Survivors. Am Soc Clin Oncol Educ Book 2018; 38:795-806. [PMID: 30231372 DOI: 10.1200/edbk_201179] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Advances in cancer treatments have led to substantially improved survival for patients with cancer. However, many patients experience changes in cognition as a side effect of both cancer and cancer treatment. This occurs with both central nervous system (CNS) tumors and non-CNS tumors and in both children and adults. Studies of patients with non-CNS cancer have shown that cancer-related cognitive impairment (CRCI), which can include changes in memory, executive function, attention, and processing speed, occurs in up to 30% of patients prior to any treatment and in up to 75% of patients during treatment. A subset of patients with non-CNS and CNS cancer appear to be at higher risk for CRCI, so much research has gone into identifying who is vulnerable. Risk factors for CRCI in adults include cognitive reserve, age, genetic factors, and ethnicity; risk factors for children include genetic factors, female sex, younger age at diagnosis, chemotherapy dose, and both dose and field size for radiation. Although the field has made substantial strides in understanding and treating CRCI, more research is still needed to improve outcomes for both pediatric and adult cancer survivors.
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Affiliation(s)
- Sara J Hardy
- From the University of Rochester Medical Center, Rochester, NY; St. Jude Children's Research Hospital, Memphis, TN; The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kevin R Krull
- From the University of Rochester Medical Center, Rochester, NY; St. Jude Children's Research Hospital, Memphis, TN; The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jeffrey S Wefel
- From the University of Rochester Medical Center, Rochester, NY; St. Jude Children's Research Hospital, Memphis, TN; The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michelle Janelsins
- From the University of Rochester Medical Center, Rochester, NY; St. Jude Children's Research Hospital, Memphis, TN; The University of Texas MD Anderson Cancer Center, Houston, TX
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30
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Salehi ASM, Yang SO, Earl CC, Shakalli Tang MJ, Porter Hunt J, Smith MT, Wood DW, Bundy BC. Biosensing estrogenic endocrine disruptors in human blood and urine: A RAPID cell-free protein synthesis approach. Toxicol Appl Pharmacol 2018; 345:19-25. [PMID: 29499249 DOI: 10.1016/j.taap.2018.02.016] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 01/26/2018] [Accepted: 02/23/2018] [Indexed: 11/30/2022]
Abstract
Many diseases and disorders are linked to exposure to endocrine disrupting chemicals (EDCs) that mimic the function of natural estrogen hormones. Here we present a Rapid Adaptable Portable In-vitro Detection biosensor platform (RAPID) for detecting chemicals that interact with the human estrogen receptor β (hERβ). This biosensor consists of an allosteric fusion protein, which is expressed using cell-free protein synthesis technology and is directly assayed by a colorimetric response. The resultant biosensor successfully detected known EDCs of hERβ (BPA, E2, and DPN) at similar or better detection range than an analogous cell-based biosensor, but in a fraction of time. We also engineered cell-free protein synthesis reactions with RNAse inhibitors to increase production yields in the presence of human blood and urine. The RAPID biosensor successfully detects EDCs in these human samples in the presence of RNAse inhibitors. Engineered cell-free protein synthesis facilitates the use of protein biosensors in complex sample matrices without cumbersome protein purification.
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Affiliation(s)
- Amin S M Salehi
- Department of Chemical Engineering, Brigham Young University, Provo, UT, USA
| | - Seung Ook Yang
- Department of Chemical Engineering, Brigham Young University, Provo, UT, USA
| | - Conner C Earl
- Department of Chemical Engineering, Brigham Young University, Provo, UT, USA
| | - Miriam J Shakalli Tang
- Department of Chemical and Biomolecular Engineering, Ohio State University, Columbus, OH, USA
| | - J Porter Hunt
- Department of Chemical Engineering, Brigham Young University, Provo, UT, USA
| | - Mark T Smith
- Department of Chemical Engineering, Brigham Young University, Provo, UT, USA
| | - David W Wood
- Department of Chemical and Biomolecular Engineering, Ohio State University, Columbus, OH, USA.
| | - Bradley C Bundy
- Department of Chemical Engineering, Brigham Young University, Provo, UT, USA.
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31
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Wang K, Li J, Xiong YF, Zeng Z, Zhang X, Li HY. A Potential Prognostic Long Noncoding RNA Signature to Predict Recurrence among ER-positive Breast Cancer Patients Treated with Tamoxifen. Sci Rep 2018; 8:3179. [PMID: 29453409 PMCID: PMC5816619 DOI: 10.1038/s41598-018-21581-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 02/02/2018] [Indexed: 12/14/2022] Open
Abstract
Limited predictable long noncoding RNA (lncRNA) signature was reported in tamoxifen resistance among estrogen receptor (ER)-positive breast cancer (BC) patients. The aim of this study was to identify and assess prognostic lncRNA signature to predict recurrence among ER-positive BC patients treated with tamoxifen. Cohorts from Gene Expression Omnibus (GEO) (n = 298) and The Cancer Genome Atlas (TCGA) (n = 160) were defined as training and validation cohort, respectively. BC relapse associated lnRNAs was identify within training cohort, and the predictable value of recurrence was assessed in both cohorts. A total of 11lncRNAs were recognized to be associated with relapse free survival (RFS) of ER-positive BC patients receiving tamoxifen, who were divided into low-risk and high-risk group on basis of relapse risk scores (RRS). Multivariate cox regression analyses revealed that the RRS is an independent prognostic biomarker in the prediction of ER-positive BC patients' survival. GSEA indicated that high-risk group was associated with several signaling pathways in processing of BC recurrence and metastasis such as PI3K-Akt and Wnt signaling. Our 11-lncRNA based classifier is a reliable prognostic and predictive tool for disease relapse in BC patients receiving tamoxifen.
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Affiliation(s)
- Kang Wang
- Department of the Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, 400016, China
| | - Jie Li
- Department of the Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, 400016, China
| | - Yong-Fu Xiong
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, 400016, China
| | - Zhen Zeng
- Department of the Breast and Thyroid Surgery, The Traditional Chinese Medicine Hospital, Chongqing, 400021, China
| | - Xiang Zhang
- Department of the Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, 400016, China.
| | - Hong-Yuan Li
- Department of the Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, 400016, China.
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32
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Underwood EA, Rochon PA, Moineddin R, Lee PE, Wu W, Pritchard KI, Tierney MC. Cognitive sequelae of endocrine therapy in women treated for breast cancer: a meta-analysis. Breast Cancer Res Treat 2017; 168:299-310. [PMID: 29264751 DOI: 10.1007/s10549-017-4627-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 12/11/2017] [Indexed: 12/29/2022]
Abstract
PURPOSE Evidence suggests anti-estrogen endocrine therapy (ET) is associated with adverse cognitive effects; however, findings are based on small samples and vary in the cognitive abilities affected. We conducted a meta-analysis to quantitatively synthesize the evidence. METHODS Electronic databases were searched in November 2016. Fourteen studies totaling 911 BC patients on aromatase inhibitors (AIs) or tamoxifen (TAM) and 911 controls (i.e., non-cancer controls and BC controls not using ET) were included. Neuropsychological tests were categorized into six domains. Effect sizes were computed to compare (1) ET patients versus controls and (2) TAM patients versus AI patients. RESULTS In cross-sectional comparisons, ET patients performed worse than control groups on verbal learning/memory, visual learning/memory, frontal executive function, and processing speed, but did not differ on psychomotor efficiency or visuospatial function. Subgroup analyses revealed that verbal learning/memory was the only domain where ET patients performed worse than both non-cancer and BC controls. In other domains, ET patients and BC controls performed equivalently. Regarding change from pre-treatment performance, ET patients did not differ from controls on any domain. TAM and AI patients did not from one another differ overall; however, subgroup analyses indicated that TAM patients performed better than non-steroidal AI patients on several domains, but showed few performance differences relative to steroidal AI patients. CONCLUSIONS Verbal learning/memory was the only domain where ET patients performed worse than both non-cancer and BC controls, suggesting specific adverse effects on this domain. Additional studies assessing change from pre-treatment performance and differences between steroidal and non-steroidal AIs are warranted.
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Affiliation(s)
- E A Underwood
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Primary Care Research Unit, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Suite E349, Toronto, ON, M4N 3M5, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - P A Rochon
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - R Moineddin
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - P E Lee
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - W Wu
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - K I Pritchard
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - M C Tierney
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada. .,Institute of Medical Science, University of Toronto, Toronto, ON, Canada. .,Primary Care Research Unit, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Suite E349, Toronto, ON, M4N 3M5, Canada. .,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
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33
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Abstract
A growing population of cancer survivors is at risk for acute and long-term consequences resulting from cancer and its treatment. Cancer-related cognitive impairment (CRCI) typically manifests as modest deficits in attention, processing speed, executive functioning, and memory, which may persist for decades after treatment. Although some risk factors for CRCI are largely immutable (eg, genetics and demographic factors), there are many other contributors to CRCI that when appropriately addressed can result in improved cognitive functioning and quality of life. Neuropsychological assessment can help identify patient cognitive strengths and weaknesses, target psychological and behavioral contributors to CRCI, and guide treatment interventions.
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Affiliation(s)
- Tracy D Vannorsdall
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 218, Baltimore, MD 21287, USA; Department of Neurology, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 218, Baltimore, MD 21287, USA.
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34
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Borbélyová V, Domonkos E, Csongová M, Kačmárová M, Ostatníková D, Celec P, Hodosy J. Sex-dependent effects of letrozole on anxiety in middle-aged rats. Clin Exp Pharmacol Physiol 2017; 44 Suppl 1:93-98. [DOI: 10.1111/1440-1681.12731] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 01/04/2017] [Accepted: 01/07/2017] [Indexed: 12/24/2022]
Affiliation(s)
- Veronika Borbélyová
- Institute of Molecular Biomedicine; Faculty of Medicine; Comenius University; Bratislava Slovakia
| | - Emese Domonkos
- Institute of Molecular Biomedicine; Faculty of Medicine; Comenius University; Bratislava Slovakia
| | - Melinda Csongová
- Institute of Molecular Biomedicine; Faculty of Medicine; Comenius University; Bratislava Slovakia
| | - Mária Kačmárová
- Department of Animal Physiology and Ethology; Faculty of Natural Sciences; Comenius University; Bratislava Slovakia
| | - Daniela Ostatníková
- Institute of Physiology; Faculty of Medicine; Comenius University; Bratislava Slovakia
| | - Peter Celec
- Institute of Molecular Biomedicine; Faculty of Medicine; Comenius University; Bratislava Slovakia
- Institute of Pathophysiology; Faculty of Medicine; Comenius University; Bratislava Slovakia
- Department of Molecular Biology; Faculty of Natural Sciences; Comenius University; Bratislava Slovakia
| | - Július Hodosy
- Institute of Molecular Biomedicine; Faculty of Medicine; Comenius University; Bratislava Slovakia
- Institute of Physiology; Faculty of Medicine; Comenius University; Bratislava Slovakia
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35
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Bluethmann SM, Alfano CM, Clapp JD, Luta G, Small BJ, Hurria A, Cohen HJ, Sugarman S, B Muss H, Isaacs C, Mandelblatt JS. Cognitive function and discontinuation of adjuvant hormonal therapy in older breast cancer survivors: CALGB 369901 (Alliance). Breast Cancer Res Treat 2017; 165:677-686. [PMID: 28653250 DOI: 10.1007/s10549-017-4353-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 06/20/2017] [Indexed: 01/10/2023]
Abstract
PURPOSE To investigate the effects of cognitive function on discontinuation of hormonal therapy in breast cancer survivors ages 65+ ("older"). METHODS Older breast cancer survivors with invasive, non-metastatic disease, and no reported cognitive difficulties were recruited from 78 Alliance sites between 2004 and 2011. Eligible survivors (n = 1280) completed baseline interviews; follow-up was conducted annually for up to 7 years. Survivors with estrogen-receptor-positive (ER+) cancers who initiated hormonal therapy (n = 990) were included. Self-reported cognitive function was measured using the EORTC-QLQ30 scale; a difference of eight points on the 0-100 scale was considered clinically significant. Based on varying rates of discontinuation over time, discontinuation was evaluated separately for three time periods: early (<1 year); midpoint (1-3 years); and late discontinuation (>3-5 years). Cox models for each time period were used to evaluate the effects of cognition immediately preceding discontinuation, controlling for age, chemotherapy, and other covariates. RESULTS Survivors were 65-91 years old (mean 72.6 years), and 79% had stages 1 or 2A disease. Overall, 43% discontinued hormonal therapy before 5 years. Survivors who reported lower cognitive function in the period before discontinuation had greater hazards of discontinuing therapy at the treatment midpoint (HR 1.22 per 8-point difference, CI 1.09-1.40, p < 0.001), considering covariates, but cognition was not related to discontinuation in the other periods. CONCLUSIONS Self-reported cognitive problems were a significant risk factor for discontinuation of hormonal therapy 1-3 years post-initiation. Additional research is needed on the temporality of cognitive effects and hormonal therapy to support survivorship care needs of older survivors.
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Affiliation(s)
- Shirley M Bluethmann
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, 500 University Drive, Hershey, PA, 17033, USA.
| | - Catherine M Alfano
- American Cancer Society, Inc., 1875 Connecticut Ave NW, Washington, DC, 20009, USA
| | - Jonathan D Clapp
- Department of Oncology, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, 3300 Whitehaven Street NW, suite 4100, Washington, DC, 20007, USA
| | - George Luta
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, 3300 Whitehaven Street NW, suite 4100, Washington, DC, 20007, USA
| | - Brent J Small
- School of Aging Studies, University of South Florida, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Arti Hurria
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, 1500 Duarte Rd, Duarte, CA, 91010, USA
| | - Harvey J Cohen
- Department of Medicine and Center for the Study of Aging and Human Development, Duke University, DUMC, Room 3502 Busse Building, Blue Zone, Duke South, Box 3003, Durham, NC, 27710, USA
| | - Steven Sugarman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Hyman B Muss
- Department of Medicine, UNC-Chapel Hill School of Medicine, University of North Carolina, 321 South Columbia Street, Chapel Hill, NC, 27514, USA
| | - Claudine Isaacs
- Department of Medicine, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, 3300 Whitehaven Street NW, suite 4100, Washington, DC, 20007, USA
| | - Jeanne S Mandelblatt
- Department of Oncology, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, 3300 Whitehaven Street NW, suite 4100, Washington, DC, 20007, USA.,Department of Medicine, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, 3300 Whitehaven Street NW, suite 4100, Washington, DC, 20007, USA
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36
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Menning S, de Ruiter MB, Veltman DJ, Boogerd W, Oldenburg HSA, Reneman L, Schagen SB. Changes in brain activation in breast cancer patients depend on cognitive domain and treatment type. PLoS One 2017; 12:e0171724. [PMID: 28267750 PMCID: PMC5340346 DOI: 10.1371/journal.pone.0171724] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 01/23/2017] [Indexed: 11/18/2022] Open
Abstract
Background Cognitive problems in breast cancer patients are common after systemic treatment, particularly chemotherapy. An increasing number of fMRI studies show altered brain activation in breast cancer patients after treatment, suggestive of neurotoxicity. Previous prospective fMRI studies administered a single cognitive task. The current study employed two task paradigms to evaluate whether treatment-induced changes depend on the probed cognitive domain. Methods Participants were breast cancer patients scheduled to receive systemic treatment (anthracycline-based chemotherapy +/- endocrine treatment, n = 28), or no systemic treatment (n = 24) and no-cancer controls (n = 31). Assessment took place before adjuvant treatment and six months after chemotherapy, or at similar intervals. Blood oxygen level dependent (BOLD) activation and performance were measured during an executive functioning task and an episodic memory task. Group-by-time interactions were analyzed using a flexible factorial design. Results Task performance did not differ between patient groups and did not change over time. Breast cancer patients who received systemic treatment, however, showed increased parietal activation compared to baseline with increasing executive functioning task load compared to breast cancer patients who did not receive systemic treatment. This hyperactivation was accompanied by worse physical functioning, higher levels of fatigue and more cognitive complaints. In contrast, in breast cancer patients who did not receive systemic treatment, parietal activation normalized over time compared to the other two groups. Conclusions Parietal hyperactivation after systemic treatment in the context of stable levels of executive task performance is compatible with a compensatory processing account of hyperactivation or maintain adequate performance levels. This over-recruitment of brain regions depends on the probed cognitive domain and may represent a response to decreased neural integrity after systemic treatment. Overall these results suggest different neurobehavioral trajectories in breast cancer patients depending on treatment type.
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Affiliation(s)
- Sanne Menning
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Michiel B. de Ruiter
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Dick J. Veltman
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - Willem Boogerd
- Department of Neuro-Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Hester S. A. Oldenburg
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Liesbeth Reneman
- Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Sanne B. Schagen
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- * E-mail:
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Wu LM, Amidi A. Cognitive impairment following hormone therapy: current opinion of research in breast and prostate cancer patients. Curr Opin Support Palliat Care 2017; 11:38-45. [PMID: 27926544 PMCID: PMC5297865 DOI: 10.1097/spc.0000000000000251] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW Hormone therapy is a common cancer treatment that may be associated with numerous side and late effects, and in recent years, has been linked to changes in cognition. Here, we present the most important recent findings from empirical studies and reviews that have focused on the effects of hormone therapy on cognitive functioning in breast and prostate cancer populations, underline some general shortcomings, and propose directions for future research. RECENT FINDINGS Recent research indicates that cognitive impairment may occur in breast and prostate cancer patients following onset of hormone therapy. However, because of methodological shortcomings and heterogeneity of current research, conclusions regarding the effects of hormone therapy on cognitive functions remain tentative. SUMMARY The review highlights the general findings while also describing the many methodological shortcomings that need to be addressed in future research. It is clear that larger scale neuropsychological studies that also evaluate the impact of impairments on daily life functioning will improve our understanding of the effects of hormone therapy on cognition and inform the development of appropriate interventions.
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Affiliation(s)
- Lisa M. Wu
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ali Amidi
- Unit for Psycho-oncology and Health Psychology, Department of Oncology, Aarhus University Hospital & Department of Psychology, Aarhus University, Aarhus, Denmark
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38
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Recovery from chemotherapy-induced white matter changes in young breast cancer survivors? Brain Imaging Behav 2017; 12:64-77. [DOI: 10.1007/s11682-016-9665-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Jerzak KJ, Desautels DN, Pritchard KI. An update on adjuvant systemic therapy for elderly patients with early breast cancer. Expert Opin Pharmacother 2016; 17:1881-8. [PMID: 27539883 DOI: 10.1080/14656566.2016.1219339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Elderly women with early breast cancer require an individualized approach to risk assessment and treatment. Unfortunately, there are limited data to inform optimal adjuvant therapy decisions in this population. Cytotoxic chemotherapy, biologic treatments and endocrine agents, while important in reducing breast cancer recurrence and mortality, are associated with the potential for adverse effects that may be of particular significance to elderly patients. AREAS COVERED In this review, we summarize the evidence for geriatric assessment in elderly patients with early breast cancer, outline special considerations for the use of chemotherapy and trastuzumab in older adults, and describe the age-specific risks of endocrine therapy in the adjuvant breast cancer setting. EXPERT OPINION The treatment of elderly women with early breast cancer should take into account cancer risk, life expectancy, comorbidities, functional status, physiologic changes, and patient values. Formal geriatric assessment may better inform treatment recommendations for individual patients. In general, there is no strong evidence to suggest that older women benefit less from standard adjuvant therapies than do their younger counterparts. When choosing between endocrine therapies, the differential risks associated with each agent should be considered and particular attention to the fracture risk on aromatase inhibitors (AIs) is warranted. Enrolment of women over 70 years of age into breast cancer clinical trials should be encouraged to better inform treatment guidelines.
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Poortmans PMP, Arenas M, Livi L. Over-irradiation. Breast 2016; 31:295-302. [PMID: 27522160 DOI: 10.1016/j.breast.2016.07.022] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 07/16/2016] [Accepted: 07/21/2016] [Indexed: 10/21/2022] Open
Abstract
Decreasing the burden of radiation therapy (RT) for breast cancer includes, next to complete omission, several ways to tailor the extent of RT. Possible options for this include lowering of the total dose, such as selective omission of the boost, hypofractionated RT to shorten the duration of treatment, the selective introduction of partial breast irradiation and anatomy based target volume contouring to decrease the size of the irradiated volumes. Elective regional nodal irradiation showed in several randomised trials and meta-analyses to significantly impact on local-regional control, disease-free survival, breast cancer mortality and overall survival. The generalisability of these results remains complex in the light of the decreasing use of axillary lymph node dissection, the use of more effective adjuvant systemic therapy, the increasing use of primary systemic therapy and continuously improving RT techniques. In general, the use of RT compensates for the decreasing extent of surgery to the breast and the axillary lymph nodes, eliminating residual tumour cells while maintaining better aesthetic and functional results. In some occasions, however, the indications for the extent of RT have to be based on limited pathological staging information. Research is ongoing to individualise RT more on the basis of biological factors including gene expression profiles. When considering age, treatment decisions should rather be based on biological instead of formal age. The aim of this review article is to put current evidence into the right perspective, and to search for an appropriate appreciation of the balance between efficacy and side effects of local-regional RT.
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Affiliation(s)
- Philip M P Poortmans
- Department of Radiation Oncology, Radboud university medical center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
| | - Meritxell Arenas
- Department of Radiation Oncology, University Hospital Sant Joan de Reus, Av. del Dr. Josep Laporte, 2, 43204 Reus, Spain.
| | - Lorenzo Livi
- Radiation Oncology Unit, Florence University Hospital, Largo G. A. Brambilla, 3, 50134 Florence, Italy.
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Droog M, Mensink M, Zwart W. The Estrogen Receptor α-Cistrome Beyond Breast Cancer. Mol Endocrinol 2016; 30:1046-1058. [PMID: 27489947 DOI: 10.1210/me.2016-1062] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Although many tissues express estrogen receptor (ER)α, most studies focus on breast cancer where ERα occupies just a small fraction of its total repertoire of potential DNA-binding sites, based on sequence. This raises the question: Can ERα occupy these other potential binding sites in a different context? Ligands, splice variants, posttranslational modifications, and acquired mutations of ERα affect its conformation, which may alter chromatin interactions. To date, literature describes the DNA-binding sites of ERα (the ERα cistrome) in breast, endometrium, liver, and bone, in which the receptor mainly binds to enhancers. Chromosomal boundaries provide distinct areas for dynamic gene regulation between tissues, where the usage of enhancers deviates. Interactions of ERα with enhancers and its transcriptional complex depend on the proteome, which differs per cell type. This review discusses the biological variables that influence ERα cistromics, using reports from human specimens, cell lines, and mouse tissues, to assess whether ERα genomics in breast cancer can be translated to other tissue types.
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Affiliation(s)
- Marjolein Droog
- Division of Molecular Pathology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
| | - Mark Mensink
- Division of Molecular Pathology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
| | - Wilbert Zwart
- Division of Molecular Pathology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
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Endocrine treatment-associated cognitive impairment in breast cancer survivors: evidence from published studies. Breast Cancer Res Treat 2016; 158:407-20. [DOI: 10.1007/s10549-016-3906-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 07/06/2016] [Indexed: 12/22/2022]
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Ganz PA. Understanding the impact of breast cancer adjuvant endocrine therapy on cognitive function: a work in progress. Br J Cancer 2016; 114:953-5. [PMID: 27115566 PMCID: PMC4984919 DOI: 10.1038/bjc.2016.89] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Patricia A Ganz
- Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
- Center for Cancer Prevention & Control Research, Jonsson Comprehensive Cancer Center at UCLA, Los Angeles, CA, USA
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Lyon DE, Cohen R, Chen H, Kelly DL, Starkweather A, Ahn HC, Jackson-Cook CK. The relationship of cognitive performance to concurrent symptoms, cancer- and cancer-treatment-related variables in women with early-stage breast cancer: a 2-year longitudinal study. J Cancer Res Clin Oncol 2016; 142:1461-74. [PMID: 27102492 DOI: 10.1007/s00432-016-2163-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 04/11/2016] [Indexed: 12/30/2022]
Abstract
PURPOSE Cognitive dysfunction in women with breast cancer continues to be an area of intense research interest. The prevalence, severity, timing, and cognitive domains that are most affected, as well as the contribution of cancer and its treatments to cognition, remain unresolved. Thus, longitudinal studies are needed that examine cognitive function during different stages of breast cancer treatment and survivorship. This longitudinal trial followed women with early-stage breast cancer, prior to chemotherapy through 2 years survivorship. METHODS In women with early-stage breast cancer (N = -75), performance-based assessment of nine cognitive domains was performed at five time points beginning prior to chemotherapy and finishing 24 months after initial chemotherapy. Linear mixed effects models were used to examine the temporal changes in cognitive performance domains, while adjusting for cofactors, including those related to individuals, tumor attributes, chemotherapy (adjuvant or neoadjuvant), radiation, endocrine therapy, and concurrent symptoms. RESULTS At baseline, scores on reaction time, complex attention, cognitive flexibility, executive function, and visual memory were lower than 90. At 2 years, all domains improved except for the memory domains (verbal, visual, and composite). Scores on six domains (psychomotor speed, reaction time, complex attention, cognitive flexibility, and visual memory) remained lower than 100 at 2 years. Neoadjuvant chemotherapy and fatigue had strong inverse relationship with cognitive functioning at multiple time points. CONCLUSION The low performance-based cognitive scores at baseline and over time warrant further study. Although most scores improved over time, memory did not improve. In all, the level of cognitive function is lower than expected for a majority college-educated sample. Thus, future studies are warranted to replicate these findings and to develop methods for identifying women with cognitive dysfunction pretreatment and into survivorship.
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Affiliation(s)
| | | | | | | | - Angela Starkweather
- University of Connecticut, Storrs Hall, Room 112B, 231 Glenbrook Road, Unit 4026, Storrs, CT, 06269, USA
| | | | - Colleen K Jackson-Cook
- School of Medicine, Virginia Commonwealth University, 1101 E. Marshall Street, Richmond, VA, 23298-0662, USA
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