Distinct and heterogeneous trajectories of self-perceived cognitive impairment among Asian breast cancer survivors

作者：Ng Terence; Dorajoo Sreemanee Raaj; Cheung Yin Ting; Lam Yick Ching; Yeo Hui Ling; Shwe Maung; Gan Yan Xiang; Foo Koon Mian; Loh Wei Jen Kiley; Koo Si Lin; Jain Amit; Lee Guek Eng; Dent Rebecca; Yap Yoon Sim; Ng Raymond; Chan Alexandre^*

来源：Psycho-Oncology, 2018, 27(4): 1185-1192.

DOI：10.1002/pon.4635

• breast cancer
• chemotherapy
• cognition
• oncology
• cancer

Objectives: Currently, there are no studies that have established the self-perceived cognitive trajectories experienced by breast cancer patients (BCPs) post-chemotherapy. Therefore, we characterized the long-term trajectory of self-perceived cognitive function among Asian early-stage BCPs using the minimal clinically important difference of a subjective measure of cognitive function.
Methods: Early-stage BCPs who received chemotherapy were recruited and assessed at 4 time points: Before chemotherapy initiation (T1), 6 weeks post-chemotherapy initiation (T2), 12 weeks post-chemotherapy initiation (T3), and 15-months post-chemotherapy initiation (T4). All assessments were performed approximately within 2 weeks post-chemotherapy. Subjective and objective cognitive function were assessed using Functional Assessment of Cancer Therapy-Cognitive (version 3) and Headminder (TM).
Results: A total of 166 BCPs were recruited, of whom 131 completed assessment at all time points. Using the minimal clinically important difference of Functional Assessment of Cancer Therapy-Cognitive, 5 distinct cognitive trajectories were established. Of the 131 patients, 70 (53.4%) did not report any clinically significant cognitive impairment. Twenty-one (16.0%) patients reported acute cognitive changes during chemotherapy (T2 and/or T3) but not at T4. Forty patients (30.5%) reported clinically significant cognitive impairment at T4, of whom 18 did not report any cognitive impairment at earlier time points. Fifteen (11.5%) patients reported persistent cognitive impairment throughout all time points, while 7 (5.3%) patients reported intermittent cognitive impairment at T2 and T4 but not at T3.
Conclusion: This is the first study to establish the existence of heterogeneous cognitive trajectories based on clinically significant thresholds of self-perceived cognitive impairment. The findings have important implications on the window for screening and management of post-chemotherapy cognitive impairment.

• 出版日期2018-4