Abstract
PurposeSubsequent to chemotherapy treatment, breast cancer patients often report a decline in cognitive functioning that can adversely impact many aspects of their lives. Evidence has mounted in recent years indicating that a portion of breast cancer survivors who have undergone chemotherapy display reduced performance on objective measures of cognitive functioning relative to comparison groups. Neurophysiological support for chemotherapy-related cognitive impairment has been accumulating due to an increase in neuroimaging studies in this field; however, longitudinal studies are limited and have not examined the relationship between structural grey matter alterations and neuropsychological performance. The aim of this study was to extend the cancer-cognition literature by investigating the association between grey matter attenuation and objectively measured cognitive functioning in chemotherapy-treated breast cancer patients.MethodsFemale breast cancer patients (n = 19) underwent magnetic resonance imaging after surgery but before commencing chemotherapy, one month following treatment, and one year after treatment completion. Individually matched controls (n = 19) underwent imaging at similar intervals. All participants underwent a comprehensive neuropsychological battery comprising four cognitive domains at these same time points. Longitudinal grey matter changes were investigated using voxel-based morphometry.ResultsOne month following chemotherapy, patients had distributed grey matter volume reductions. One year after treatment, a partial recovery was observed with alterations persisting predominantly in frontal and temporal regions. This course was not observed in the healthy comparison group. Processing speed followed a similar trajectory within the patient group, with poorest scores obtained one month following treatment and some improvement evident one year post-treatment.ConclusionThis study provides further credence to patient claims of altered cognitive functioning subsequent to chemotherapy treatment.
Highlights
Patient reports of cognitive changes subsequent to chemotherapy exposure abound in the breast cancer population
Neuroimaging studies of chemotherapy-exposed breast cancer patients have started to elucidate the neural underpinnings of CRCI (for reviews, see (McDonald and Saykin 2013; Scherling and Smith 2013))
Some studies have found grey matter abnormalities in breast cancer patients at approximately 9.5 years after treatment (De Ruiter et al 2011a) and 21 years after chemotherapy (Koppelmans et al 2011), suggesting that a subset of breast cancer patients exposed to chemotherapy are vulnerable to long-term grey matter deficits after chemotherapy exposure
Summary
Patient reports of cognitive changes subsequent to chemotherapy exposure abound in the breast cancer population. Research into the neuroanatomical correlates of CRCI has employed voxel-based morphometry (VBM) to explore grey matter compromise in the breast cancer population (Inagaki et al 2007; Hakamata et al 2007; Yoshikawa et al 2005a; Yoshikawa et al 2005b; McDonald et al 2010; McDonald et al 2012a; Conroy et al 2012; Scherling et al 2012a; Hosseini et al 2012; De Ruiter et al 2011a; Koppelmans et al 2011). Some studies have found grey matter abnormalities in breast cancer patients at approximately 9.5 years after treatment (De Ruiter et al 2011a) and 21 years after chemotherapy (Koppelmans et al 2011), suggesting that a subset of breast cancer patients exposed to chemotherapy are vulnerable to long-term grey matter deficits after chemotherapy exposure. The chemotherapy-exposed group displayed distributed grey matter attenuation that partially recovered one year subsequent to treatment. That was the first study to demonstrate a pattern of grey matter attenuation consistent with the course of cognitive impairment reported in neuropsychological studies, warranting a replication and extension study examining the link between neuropsychological functioning and grey matter disruption in chemotherapy treated breast cancer patients
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