Cognitive Decline With Breast Ca May Be Rooted in Depression


MONTREAL — Cognitive complaints in long-term breast cancer survivors might be better managed if issues of depression and fatigue are addressed, according to Heather McGinty, a doctoral student at the University South Florida in Tampa.

In a study that she presented at the annual meeting of the Society of Behavioral Medicine, Ms. McGinty showed that at 3 years after the end of breast cancer treatment, depression and fatigue were the strongest factors related to women's perceived cognitive decline.

“Perhaps women with these psychosocial issues are more vulnerable to cognitive problems,” she suggested.

The principal investigator on this study was Paul B. Jacobsen, Ph.D., of the H. Lee Moffitt Cancer Center in Tampa and the department of psychology at the University of South Florida.

The study included 216 women, with a mean age of 54 years, who had completed breast cancer treatment at least 3 years previously.

Roughly 90% of the women were postmenopausal, and all of them had received surgery: 55% for stage I disease; 35% for stage II; and 10% for stage 0.

In addition, half had received chemotherapy, either alone or in combination with radiotherapy.

Depression, fatigue, and perceived health were measured using the CES-D (Center for Epidemiologic Studies-Depression scale), the FSI (Fatigue Symptom Inventory), and the fatigue and general health subscales of the SF-36 (Medical Outcomes Study 36-Item Short Form Health Survey).

The participants also completed the MASQ (Multiple Abilities Self-Report Questionnaire) that measures perceived cognitive functioning across five cognitive domains, compared with that of same-age peers.

Sample statements about perceived cognitive functioning included: “After putting something away for safekeeping, I may not recall its location” (visual memory); “I can follow telephone conversations” (attention); “I can easily fit the pieces of a jigsaw puzzle together” (visual-perceptual ability); “I am able to recall the details of the evening news report several hours later” (verbal memory); and “I find myself calling a familiar object by the wrong name” (language), Ms. McGinty explained.

Overall, mean perceived cognitive function scores indicated that “these women were functioning quite well, reported rarely experiencing problems, and were frequently able to perform most tasks that were listed,” she said.

A particular combination of demographic, clinical, and psychosocial characteristics was associated with poorer cognitive functioning, however.

“Age, stage of diagnosis, surgery type, and tamoxifen use did not significantly correlate, but postmenopausal status, chemotherapy, depression, and fatigue were associated with worse cognition,” Ms. McGinty said.

“Interventions for fatigue and depression may have beneficial effects on perceived cognitive functioning in this patient population,” she noted.

“Neuropsychological testing may not always be sensitive to cancer-related changes, and lab-based measures may not correspond to people's experiences at home or at work,” Ms. McGinty said.

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