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Annals of Oncology Advance Access originally published online on December 15, 2005
Annals of Oncology 2006 17(3):415-423; doi:10.1093/annonc/mdj108
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© 2005 European Society for Medical Oncology

Neuropsychological function in high-risk breast cancer survivors after stem-cell supported high-dose therapy versus standard-dose chemotherapy: evaluation of long-term treatment effects

A. Scherwath1,*, A. Mehnert1, B. Schleimer1, L. Schirmer1, F. Fehlauer3, R. Kreienberg4, B. Metzner5, E. Thiel6, A. R. Zander2, F. Schulz-Kindermann2 and U. Koch1

1 Institute of Medical Psychology, 2 Transplant Center and 3 Clinic and Policlinic for Radiotherapy and Radiooncology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany; 4 Department of Gynecology and Obstetrics, Ulm University Clinic, Ulm, Germany; 5 Department of Hematology and Oncology, Oldenburg Community Hospital, Oldenburg, Germany; 6 Department of Hematology, Oncology, and Transfusion Medicine, Berlin University Clinic Benjamin Franklin, Berlin, Germany

* Correspondence to: A. Scherwath, Center for Psychosocial Medicine, Institute of Medical Psychology, Hamburg-Eppendorf University Medical Center, Martinistrasse 52 (S35), 20246 Hamburg, Germany. Tel: +49-40-42803-7565; Fax: +49-40-42803-4940; E-mail: a.scherwath{at}uke.uni-hamburg.de

Background: Studies on cognitive functioning in breast cancer patients point out that a subset of women exhibit chemotherapy-related neuropsychological impairment. Thereby, high-dose therapy may elevate the risk of cognitive dysfunctions. The primary purpose of the study was to evaluate the impact of high-dose versus standard-dose chemotherapy on the late neuropsychological outcome in randomized assigned high-risk breast cancer survivors. Next to focusing prevalence, function specificity and extent of cognitive impairment, the question as to whether doses-dependant group differences occur was investigated.

Patients and methods: Twenty-four high-dose and 23 standard-dose patients 5 years, on average, after treatment underwent a comprehensive neuropsychological assessment. In addition, 29 early-stage breast cancer patients matched for age, education and time since treatment were recruited as a comparison group.

Results: Global cognitive impairment was observed in 8% of high-dose versus 13% of standard-dose compared with 3% of early-stage breast cancer patients. Compared with normative data, all patient groups performed worse on one attention subtest measuring the simple reaction time (P < 0.001 in each case). By contrast, no significant between-group differences on the late neuropsychological outcome were found.

Conclusions: Five years after treatment, standard-dose patients were slightly, but not significantly, more impaired in cognitive performance than high-dose patients.

Key words: breast cancer, cognitive function, high-dose chemotherapy, long-term treatment effects, neuropsychological outcome


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