Trajectories of self-reported cognitive function in postmenopausal women during adjuvant systemic therapy for breast cancer.
Trajectories of self-reported cognitive function in postmenopausal women during adjuvant systemic therapy for breast cancer.
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DOI：
10.1002/pon.4009
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发表时间：
2017-01
期刊：
影响因子：
3.6
通讯作者：
Bender CM
中科院分区：
文献类型：
--
作者：
Merriman JD;Sereika SM;Brufsky AM;McAuliffe PF;McGuire KP;Myers JS;Phillips ML;Ryan CM;Gentry AL;Jones LD;Bender CM
在368名绝经后妇女的样本中，我们(1)确定了乳腺癌辅助全身治疗与治疗前18个月自我报告的认知功能之间的队列内和队列间关系；(2)评估共现症状、神经心理功能和其他协变量对关系的影响。我们评估了158名单独接受芳香酶抑制剂（AI）治疗的女性、104名接受化疗后再接受AI治疗的女性和106名非癌症对照的女性的自我报告的认知功能，使用患者自身功能量表（PAOFI）和潜在的协变量（例如，共发生症状评分、神经心理功能z评分）。患者在全身治疗前进行评估，然后每六个月进行一次评估，在18个月内总共进行了四次评估。对照组在匹配的时间点进行评估。混合效应模型用于确定纵向关系。在控制协变量的情况下，化疗前入组的患者报告化疗后整体认知功能（p<0.001）、记忆（p<0.001）、语言和交流（p<0.001）和感觉运动功能（p=0.002）较差。从化疗前到AI治疗开始后12个月，这些患者报告较差的高级认知和智力功能（p<0.001）。入组时较高水平的抑郁症状（p<0.001）、焦虑（p<0.001）和疲劳（p=0.040）是随着时间推移认知功能较差的预测因素。在控制协变量的情况下，PAOFI总分是执行功能（p=0.048）和视觉工作记忆（p=0.005） z分数的预测因子。研究结果提供了进一步的证据，证明化疗后自我报告的认知功能较差，以及共存症状与认知改变之间的关系。人工智能治疗本身不会对自我报告的认知功能产生影响。
In a sample of 368 postmenopausal women, we (1) determined within-cohort and between-cohort relationships between adjuvant systemic therapy for breast cancer and self-reported cognitive function during the first 18 months of therapy; and (2) evaluated the influence of co-occurring symptoms, neuropsychological function, and other covariates on relationships. We evaluated self-reported cognitive function, using the Patient Assessment of Own Functioning Inventory (PAOFI), and potential covariates (e.g., co-occurring symptom scores, neuropsychological function z-scores) in 158 women receiving aromatase inhibitor (AI) therapy alone, 104 women receiving chemotherapy followed by AI therapy, and 106 non-cancer controls. Patients were assessed before systemic therapy and then every six months, for a total of four assessments over 18 months. Controls were assessed at matched time points. Mixed effects modeling was used to determine longitudinal relationships. Controlling for covariates, patients enrolled before chemotherapy reported poorer global cognitive function (p<0.001), memory (p<0.001), language and communication (p<0.001), and sensorimotor function (p=0.002) after chemotherapy. These patients reported poorer higher-level cognitive and intellectual functions from before chemotherapy to 12 months after initiation of AI therapy (p<0.001). Higher levels of depressive symptoms (p<0.001), anxiety (p<0.001), and fatigue (p=0.040) at enrollment were predictors of poorer cognitive function over time. PAOFI total score was a predictor of executive function (p=0.048) and visual working memory (p=0.005) z-scores, controlling for covariates. Findings provide further evidence of poorer self-reported cognitive function after chemotherapy and of relationships between co-occurring symptoms and cognitive changes. AI therapy alone does not have an impact on self-reported cognitive function.