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Annals of Oncology Advance Access published online on December 15, 2005
Annals of Oncology, doi:10.1093/annonc/mdj108
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© 2005 European Society for Medical Oncology
Received March 9, 2005
Revised October 25, 2005
Accepted November 11, 2005

original article

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. Scherwath 1 *, A. Mehnert 1, B. Schleimer 1, L. Schirmer 1, F. Fehlauer 2, R. Kreienberg 3, B. Metzner 4, E. Thiel 5, A. R. Zander 6, F. Schulz-Kindermann 6, and U. Koch 1

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

* To whom correspondence should be addressed.
A. Scherwath, E-mail: a.scherwath{at}uke.uni-hamburg.de


  Abstract

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.

Keywords: breast cancer; cognitive function; high-dose chemotherapy; long-term treatment effects; neuropsychological outcome.
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