Cognitive Performance and Psychological Distress in Breast Cancer Patients at Disease Onset.

Christine Solbach,Isa Rüschel,Miena Amiri,Jörg Dietrich,Klaus Fliessbach,Christoph Bledowski,Jochen Kaiser,Hazal Akbaba,Bianca Senf,Nonda Hantke

doi:10.3389/fpsyg.2019.02584

Abstract

ObjectiveMany cancer patients complain about cognitive dysfunction. While cognitive deficits have been attributed to the side effects of chemotherapy, there is evidence for impairment at disease onset, prior to cancer-directed therapy. Further debated issues concern the relationship between self-reported complaints and objective test performance and the role of psychological distress.MethodWe assessed performance on neuropsychological tests of attention and memory and obtained estimates of subjective distress and quality of life in 27 breast cancer patients and 20 healthy controls. Testing in patients took place shortly after the initial diagnosis, but prior to subsequent therapy.ResultsWhile patients showed elevated distress, cognitive performance differed on a few subtests only. Patients showed slower processing speed and poorer verbal memory than controls. Objective and self-reported cognitive function were unrelated, and psychological distress correlated more strongly with subjective complaints than with neuropsychological test performance.ConclusionThis study provides further evidence of limited cognitive deficits in cancer patients prior to the onset of adjuvant therapy. Self-reported cognitive deficits seem more closely related to psychological distress than to objective test performance.

Highlights

Cancer survivors may experience cognitive decline characterized by impaired attention, processing speed, memory or executive functions (Wefel et al, 2004; Bender et al, 2006; Vardy et al, 2007; Dietrich et al, 2008; Lindner et al, 2014; Van Arsdale et al, 2016; Rick et al, 2018)
While there are contradictory findings concerning the associations between subjective and objective cognitive impairments, subjective complaints tended to be more strongly correlated with distress than with performance on neuropsychological tests. These results have given rise to the suggestion that psychological distress caused by the diagnosis of cancer may account for some of the effects previously attributed to chemotherapy. To contribute to this debate, the present study investigated attention and memory in newly diagnosed breast cancer patients and a healthy control group
We focused our investigation on breast cancer because cognitive impairment is of particular relevance to this group of patients due to their high survival rates

Summary

Introduction

Cancer survivors may experience cognitive decline characterized by impaired attention, processing speed, memory or executive functions (Wefel et al, 2004; Bender et al, 2006; Vardy et al, 2007; Dietrich et al, 2008; Lindner et al, 2014; Van Arsdale et al, 2016; Rick et al, 2018). Several studies have reported cognitive impairment before chemotherapy administration in a certain proportion of breast cancer patients (Hermelink et al, 2007). Several other studies found little or no overall cognitive impairment in cancer patients prior to systemic therapy (Jenkins et al, 2006; Schagen et al, 2006; Debess et al, 2010; Mandelblatt et al, 2014; Hermelink et al, 2015)

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Discussion

Conclusion