Association of cognitive impairment and breast cancer survivorship on quality of life in younger breast cancer survivors

Diane Von Ah,Andrea A Cohee,Frederick W Unverzagt,Timothy E Stump,Adele D Crouch,Victoria L Champion,Susan Storey,Patrick O Monahan,David Cella

doi:10.1007/s11764-021-01075-x

Abstract

PurposeYounger breast cancer survivors (BCS) often report cognitive impairment and poor quality of life (QoL), which could be interrelated. The purpose of this study was to examine the association of cognitive impairment and breast cancer status (BCS versus healthy control (HC)), with QoL, which included psychological (depressive symptoms, well-being, perceived stress, and personal growth) and physical well-being (physical functioning and fatigue).MethodsFour hundred ninety-eight BCS (≤45 years at diagnosis) who were 3 to 8 years post-chemotherapy treatment and 394 HC completed subjective questionnaires and a one-time neuropsychological assessment, including tests of attention, memory, processing speed, and verbal fluency. For each test, cognitive impairment was defined as scoring 1.5 and 2.0 standard deviations below the mean of the HC group. Separate linear regression models for each outcome were ran controlling for known covariates.ResultsBCS reported significantly more memory problems than HC (p < 0.0001), with up to 23% having significant impairment. Cognitive performance did not differ significantly between BCS and HCs. BCS vs. HCs had greater depression and fatigue, yet more personal growth. Objective and subjective cognitive impairment were significantly related to greater depressive symptoms and perceived stress and lower well-being and physical functioning; whereas, objective impairment was related to less personal growth and subjective impairment was related to greater fatigue.ConclusionsYounger BCS report significant cognitive impairment years after treatment which may relate to greater decrements in QoL.Implications to Cancer SurvivorsAssessment and interventions to address cognitive concerns may also influence QoL outcomes in younger BCS.

Highlights

Breast cancer survivors (BCS) make up the largest population in the cancer survivor community
The purpose of this study was to examine the association of cognitive impairment and breast cancer status (BCS versus healthy control (HC)), with quality of life, which for this study included psychological and physical well-being
Data used for this study were part of a larger cross-sectional, descriptive quality of life study comparing younger BCS, older BCS, and healthy age-matched controls (HC), collected through an Eastern Cooperative Oncology Group (ECOG) 97site database [8]

Summary

Introduction

Breast cancer survivors (BCS) make up the largest population in the cancer survivor community. Commonly reported by BCS, include deficits in memory, speed of processing, attention, concentration and working memory, and language and executive functioning [13, 14] These impairments in cognition may persist for many years post-treatment [15, 16] and have been associated with decrements in quality of life [17,18,19]. The purpose of this study was to examine the association of cognitive impairment and breast cancer status (BCS versus healthy control (HC)), with quality of life, which for this study included psychological (depressive symptoms, well-being, perceived stress, and personal growth) and physical well-being (physical functioning and fatigue). Research questions tested included: (1) Are there differences in cognitive impairment and quality of life between BCS and HC? and (2) Is cognitive impairment and breast cancer status (BCS vs. HC) associated with quality of life variables, including psychological and physical well-being?

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