Annals of Oncology 13:1387-1397, 2002
© 2002 European Society for Medical Oncology
Original Paper |
Late effects of adjuvant chemotherapy on cognitive function: a follow-up study in breast cancer patients
1 Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam; 2 Department of Neurology and Clinical Neurophysiology, Municipal Hospital Slotervaart, Amsterdam; Departments of 3 Neuro-Oncology and 4 Medical Oncology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam; 5 Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
Received 4 January 2002; revised 25 February 2002; accepted 27 March 2002
Background:
Neuropsychological examinations have shown an elevated risk for cognitive impairment 2 years after therapy in breast cancer patients randomized to receive adjuvant high-dose cyclophosphamide, thiotepa, carboplatin (CTC) chemotherapy compared with a non-treated control group of stage I breast cancer patients. Patients randomized to receive standard-dose fluorouracil, epirubicin, cyclophosphamide (FEC) chemotherapy showed no elevated risk compared with controls. However, breast cancer patients treated with conventional cyclophosphamide, methotrexate, 5-fluorouracil (CMF) chemotherapy showed a higher risk of cognitive impairment. The present study was designed to obtain a greater insight into these long-term neuropsychological sequelae following chemotherapy and their course in time.
Patients and methods:
At 4 years post-therapy, 22 of the original 34 CTC patients, 23 of 36 FEC patients, 31 of 39 CMF patients and 27 of 34 control patients were re-examined with neuropsychological tests.
Results:
Improvement in performance was observed in all chemotherapy groups, whereas in the control group there was a slight deterioration in test results. A differential attrition was observed among the groups, with a relatively high percentage of initially cognitively impaired patients from the CTC group dropping out due to factors related to disease progression.
Conclusions:
The results suggest that cognitive dysfunction following adjuvant chemotherapy in breast cancer patients may be transient. Additional studies are needed to investigate the differential attrition of patients with cognitive impairment.
Key words: breast cancer, chemotherapy, cognitive deficits, late effects, neurotoxicity
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