Cognitive Impairment in Older Patients With Breast Cancer Before Systemic Therapy: Is There an Interaction Between Cancer and Comorbidity?
Cognitive Impairment in Older Patients With Breast Cancer Before Systemic Therapy: Is There an Interaction Between Cancer and Comorbidity?
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DOI：
10.1200/jco.2013.54.2050
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发表时间：
2014-06-20
影响因子：
45.3
通讯作者：
Ahles, Tim
中科院分区：
文献类型：
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作者：
Mandelblatt, Jeanne S.;Stern, Robert A.;Ahles, Tim
目的探讨老年乳腺癌患者在接受全身治疗前是否存在认知功能障碍。患者和方法参与者是新诊断的非转移性乳腺癌患者和匹配的朋友或社区对照，年龄在60岁至60岁之间，之前没有接受过全身治疗、痴呆或神经系统疾病。参与者完成了问卷调查和长达55分钟的17项神经心理测试。采集生物标本进行APOE基因分型，提取临床资料。采用对照均值和标准差（sd）对神经心理测试分数进行标准化，并将其分为5个z域分数。认知障碍定义为任何领域z得分低于对照平均值2个标准差或>=两个z得分低于对照平均值1.5个标准差。多变量分析评估了考虑年龄、种族、教育程度和地点的预处理差异；患者病例之间的比较也控制了手术。结果164例患者与182例对照组神经心理域评分相似。然而，在患者病例中，调整后，II期至III期癌症患者的执行功能低于0期至1期癌症患者（P = 0.05）。调整后，年龄较大、非白人、受教育程度较低的女性和有更多合并症的女性出现损伤的几率明显更高。患者病例或对照状态、焦虑、抑郁、疲劳和手术与损伤无关。然而，合并症与患者病例或对照状态之间存在相互作用；在患者中，共病与损伤密切相关（调整后的优势比为8.77；95% CI为2.06 ~ 37.4;P = 0.003），但在对照组中无相关（P = 0.97）。在患者病例中，只有糖尿病和心血管疾病与损伤有关。结论乳腺癌患者与对照组在接受系统治疗前认知功能无总体差异，但在肿瘤或合并症负担较大的患者亚组内可能存在预处理认知功能障碍。(C) 2014年由美国临床肿瘤学会出版。
Purpose To determine if older patients with breast cancer have cognitive impairment before systemic therapy.Patients and Methods Participants were patients with newly diagnosed nonmetastatic breast cancer and matched friend or community controls age > 60 years without prior systemic treatment, dementia, or neurologic disease. Participants completed surveys and a 55-minute battery of 17 neuropsychological tests. Biospecimens were obtained for APOE genotyping, and clinical data were abstracted. Neuropsychological test scores were standardized using control means and standard deviations (SDs) and grouped into five domain z scores. Cognitive impairment was defined as any domain z score two SDs below or >= two z scores 1.5 SDs below the control mean. Multivariable analyses evaluated pretreatment differences considering age, race, education, and site; comparisons between patient cases also controlled for surgery.Results The 164 patient cases and 182 controls had similar neuropsychological domain scores. However, among patient cases, those with stage II to III cancers had lower executive function compared with those with stage 0 to 1 disease, after adjustment (P = .05). The odds of impairment were significantly higher among older, nonwhite, less educated women and those with greater comorbidity, after adjustment. Patient case or control status, anxiety, depression, fatigue, and surgery were not associated with impairment. However, there was an interaction between comorbidity and patient case or control status; comorbidity was strongly associated with impairment among patient cases (adjusted odds ratio, 8.77; 95% CI, 2.06 to 37.4; P = .003) but not among controls (P = .97). Only diabetes and cardiovascular disease were associated with impairment among patient cases.Conclusion There were no overall differences between patients with breast cancer and controls before systemic treatment, but there may be pretreatment cognitive impairment within subgroups of patient cases with greater tumor or comorbidity burden. (C) 2014 by American Society of Clinical Oncology.