UCLA researchers led by Dr. Patricia Ganz, director of cancer prevention and control research at the Jonsson Comprehensive Cancer Center, professor of health policy and management at the Fielding School of Public Health and professor of medicine at the David Geffen School of Medicine, have published a study showing a statistically significant association between neuropsychological (NP) test performance and memory complaints in post-treatment, early stage breast cancer patients.
Patient-reported memory difficulties were associated with having received chemotherapy and radiation (chemo + RT) as well as symptoms related to depression. This is one of the first studies to show that patient complaints of memory and thinking (cognitive) problems after breast cancer treatment, often called “chemo brain,” are associated with NP test performance. The study was published today online ahead of press in the Journal of the National Cancer Institute.
Ganz and colleagues conducted the study with 189 breast cancer patients who were enrolled about one month after completing initial treatments with surgery with or without radiation and/or chemotherapy and before the start of hormone (endocrine) therapy, if planned. A major goal of the study was to examine how much hormone therapy contributes to memory and thinking problems in breast cancer survivors, and this pre-hormone therapy assessment was able to separate the effects of initial treatments on these problems. Earlier post-treatment studies of breast cancer patients were difficult to interpret as they included women already taking hormone therapy.
Cognitive complaints are common after breast cancer treatments, and earlier research had not identified a consistent association with NP testing abnormalities. More often these complaints were associated with anxiety and depressive symptoms, limiting confidence that “chemo brain” reflected a cancer treatment toxicity. In this study, women with serious depressive symptoms were excluded, and the researchers also took careful account of the cancer treatments used and whether or not menopause and hormonal changes could be influencing the cognitive complaints. Even though these patients reported subtle changes in their memory and thinking, the NP testing showed detectable differences.
The researchers used a sample of age-matched healthy women as a comparison (control) group. They found that 23.3 percent of the breast cancer patients had higher memory complaints and 19 percent reported higher executive function complaints after breast cancer treatments using a self-report questionnaire.
“In the past, many researchers said that we can’t rely on patients’ self-reported complaints or that they are just depressed,” Ganz said. "Previous studies could not find this association between NP testing and cognitive complaints. In this study, we were able to look at specific components of the cognitive complaints and found they were associated with relevant NP function test abnormalities. As we provide additional reports on the follow-up testing in these women, we will track their recovery from treatment as well as determine whether hormone therapy contributes to worsening complaints over time.”
This research was supported by the National Cancer Institute, the Breast Cancer Research Foundation, and funding from the National Institutes of Health to the Cousins Center for Psychoneuroimmunology.
UCLA's Jonsson Comprehensive Cancer Center has more than 240 researchers and clinicians engaged in disease research, prevention, detection, control, treatment and education. One of the nation's largest comprehensive cancer centers, the Jonsson center is dedicated to promoting research and translating basic science into leading-edge clinical studies. In July 2012, the Jonsson Cancer Center was once again named among the nation’s top 10 cancer centers by U.S. News & World Report, a ranking it has held for 12 of the last 13 years. For more information on the Jonsson Cancer Center, visit our website at http://www.cancer.ucla.edu.