OLDER BREAST CANCER PATIENTS: RISK FOR COGNITIVE DECLINE

描述(申请人提供)：65岁及以上的妇女(“老年妇女”)占所有乳腺癌新病例的近一半。随着美国的老龄化，到2030年，确诊和接受乳腺癌治疗的老年妇女的绝对数量将几乎翻一番。这些老年患者的治疗指南包括系统治疗，老年妇女对化疗感兴趣，即使在延长生存方面回报很小。但系统治疗并不是没有副作用，许多研究证明，在接受这些药物后，认知能力会下降。成像和动物研究证实，癌症化疗会影响大脑结构和功能。然而，人们实际上对老年患者的认知能力下降知之甚少，因为几乎所有现有的研究都是在年轻患者身上进行的。由于衰老本身与认知能力下降有关，老年患者很可能特别容易受到系统治疗的不利认知影响。我们的初步工作表明情况就是这样，但这一点从未经过实证检验。这项研究将是评估老年癌症患者认知变化的第一次大规模、前瞻性、对照研究。我们使用癌症生存的易损性模型来描述12个月期间系统治疗对认知的影响，测试认知与生活质量之间的关联，并评估载脂蛋白E基因多态是否影响认知结果。我们组建了一个由肿瘤学家、老年病学家、神经学家、神经、认知和行为心理学家和消费者组成的团队，他们来自隆巴迪综合癌症中心、纪念斯隆-凯特琳癌症中心、波士顿大学和Y-Me(一个全国性的消费者权益倡导组织)。我们将招募325名新诊断的老年乳腺癌患者和同等数量的非癌症朋友对照。参与者将接受基线(系统前治疗)神经心理测试和电话采访；临床数据将从记录中提取。参与者将在基线后12个月重复认知测试和生活质量测量。主要结果是注意力、工作记忆和精神运动速度领域测试的总分发生了变化。另外四个领域作为次要结果被包括在内，以评估更广泛的认知功能并检查不同的影响：语言；执行功能；学习和记忆；视觉空间。这项研究的结果将有助于为老年妇女设计适当的治疗方案，开发预防干预措施，为临床治疗决策提供信息，并指导第二代研究。总体而言，考虑到老年人口的预计增长、发病率随着年龄的增加而上升、老年患者更多地使用系统治疗的趋势、使用更激进的给药方案、高存活率以及预期寿命的增加，这一主题具有很高的研究、临床和公共卫生重要性。

DESCRIPTION (provided by applicant): Women 65 and older ("older women") account for nearly half of all new cases of breast cancer. With the "graying of America" the absolute number of older women diagnosed and undergoing breast cancer treatment will almost double by the year 2030. Treatment guidelines for these older patients include systemic therapy and older women are interested in chemotherapy for even small returns in survival extension. But systemic therapy is not without side effects, and numerous studies have documented cognitive decline after receipt of these agents. Imaging and animal studies confirm that cancer chemotherapy affects brain structure and function. However, very little is actually known about cognitive decline in older patients, because virtually all of the existing research has been conducted in younger patients. Since aging itself is associated with cognitive decline, older patients are likely to be particularly vulnerable to the adverse cognitive effects of systemic therapy. Our preliminary work suggests that this is the case, but this has never been empirically tested. This study will be the first large scale, prospective, controlled investigation to evaluate cognitive changes in older cancer patients. We use the vulnerability model of cancer survivorship to describe systemic therapy effects on cognition over a 12 month period, test associations between cognition and quality of life and to evaluate whether APOE polymorphisms moderate cognitive outcomes. We have assembled a team of oncologists, geriatricians, neurologists, neuro-, cognitive and behavioral psychologists and consumers from Lombardi Comprehensive Cancer Center, Memorial Sloan-Kettering Cancer Center, Boston University and Y- Me (a national consumer advocacy organization). We will enroll 325 newly diagnosed older breast cancer patients and an equal number of non-cancer friend controls. Participants will undergo baseline (pre-systemic therapy) neuropsychological testing and telephone interviews; clinical data will be abstracted from records. Participants will repeat cognitive testing and QOL measures 12 months after baseline. The primary outcome is change in the summary score on tests in the Attention, Working Memory, and Psychomotor Speed Domain. Four additional domains are included as secondary outcomes to assess broader cognitive function and examine differential impact: Language; Executive Functioning; Learning and Memory; Visuospatial. The results of this study will contribute to designing appropriate regimens for older women, developing preventive interventions, informing clinical decision-making about treatment, and guiding second generation studies. Overall, this topic has high research, clinical and public health importance, given the projected growth in the older population, rising incidence with advancing age, trends towards increasing use of systemic therapy in older patients, use of more aggressive dosing regimens, high survival rates, and increasing life expectancy.