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Anthracycline chemotherapy does not increase risk for long-term cognitive decline
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Anthracycline-based chemotherapy did not increase risk for long-term cognitive decline in survivors of breast cancer, according to an analysis of the Mind Body Study.
“A recent cross-sectional study in JAMA Oncology had suggested that patients who had received anthracyclines did worse. We had examined this in the past looking at the immediate post treatment period in the Mind Body Study study and did not see more cognitive difficulties with anthracyclines,” Patricia Ganz, MD, director of cancer prevention and control research at UCLA Jonsson Comprehensive Cancer Center, told HemOnc Today. “Stimulated by that recent report, we now did a very detailed prospective longitudinal evaluation and can see no evidence to suggest a worse outcome with anthracyclines.”
Patricia Ganz
Ganz and colleagues evaluated data from 190 patients (mean age, 51.8 years; 79% white) in the Mind Body Study to determine risk for lasting cognitive decline associated with anthracyclines. Eighty-two percent of patients (n = 156) reported some college or more.
Researchers conducted neuropsychological evaluations — which included measures of memory, processing speed and executive functions — of the breast cancer survivors at four time points following primary treatment: 3 months (n = 190), 6 months (n = 173), 1 year (n = 173) and at a mean of 4.8 years (n = 102).
Women were categorized as receiving no chemotherapy (n = 92), chemotherapy without an anthracycline (n = 74) or chemotherapy with an anthracycline (n = 24). Twenty women only received chemotherapy, 64 only received radiation, and 78 received chemotherapy and radiation. Also, 132 of the women had received endocrine therapy.
The mean baseline Wechsler score of adult reading intelligence quotient in the total cohort was 114.3 (range, 81-126) and did not significantly differ across chemotherapy treatment groups.
Researchers compared the neuropsychological test scores among treatment groups across all four assessment points while controlling for age, IQ and history of treatment with endocrine therapy.
Overall, there was no evidence that patients treated with an anthracycline-based chemotherapy had a higher risk for cognitive decline compared with other treatment groups in seven neuropsychological tests, which included verbal fluency, total and delayed visual memory, verbal learning and memory, processing speed and executive function.
“This is important as this class of drugs are very effective and necessary for treatment of some cancers. Doctors and patients should not be concerned about eliminating Anthracyclines in treatment if they are indicated,” Ganz said.
Kathleen Van Dyk
Researchers observed no significant group and time interactions in any of the seven tests (P > .05). This observation persisted up to 7 years after treatment.
“Experiencing cognitive dysfunction after cancer and its treatment can be extremely disruptive to the lives of breast cancer survivors and it is critical to better understand what factors, including treatment, might put someone at greater risk for these types of problems,” study researcher Kathleen Van Dyk, PhD, UCLA post-doctorate fellow, said in the release. “These results bring us an important step further toward uncovering the influence of treatment on cognitive problems in these women.” – by Nick Andrews
Disclosure : Ganz reports an advisory board role with the Breast Cancer Research Foundation. Van Dyk and the other researchers report no relevant financial disclosures.
Perspective
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Douglas Yee
For women with operable breast cancer, one of the greatest fears of therapy is the long-term effect of this treatment on cognitive function. “Chemo brain” is a term commonly used by patients and physicians to describe subjective changes in cognitive function during chemotherapy. Whether these effects are long lasting is poorly studied. Tests to measure neuropsychological function are difficult to administer in the clinic; thus, many of the reports of long-term changes were not done prospectively.
The letter from Van Dyk and colleagues provide longitudinal prospective data on neuropsychological function in women who have been followed over time for therapy of their early-stage breast cancer. Researchers studied a cohort of women who have been followed after breast cancer surgery, a significant number of whom were not receiving systemic therapy (previously described by Ganz and colleagues). In the previous report, there was a correlation between memory complaints and poorer performance on verbal memory performance and higher depressive symptoms. Similarly, complaints around executive functioning showed associations with better visual memory performance and higher depressive symptoms.
The current report occurred after longer follow-up of the same cohort. Researchers examined specific effects of chemotherapy — with or without anthracyclines — compared with no chemotherapy on cognitive function in 190 patients over four time points after treatment: 3 months, 6 months, 1 year and long term (mean, 4.8 years).
Researchers found no significant effects in seven neuropsychological tests administered to the cohort, and they specifically commented on the lack of an effect on anthracycline-containing regimens. Moreover, compared to the “no-chemotherapy” group, long-term effects on neuropsychological testing could not be discerned.
Although there are limitations to this study — including relatively small sample size and use of a nonrandomized population — this study shows that long-term cognitive function declines measured by formal neuropsychological testing are not associated with chemotherapy and do not seem to be affected by the type of chemotherapy (anthracycline vs. nonanthracycline). There are reasons to avoid anthracycline-based chemotherapy — such as heart failure and secondary malignancies — but it is reassuring that a decline in neuropsychiatric function is not one of them.
Reference:
Ganz P, et al. J Natl Cancer Inst. 2013;doi:10.1093/jnci/djt073.
Disclosure: Yee reports no relevant financial disclosures.
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