Pretreatment Psychoneurological Symptoms and Their Association With Longitudinal Cognitive Function and Quality of Life in Older Breast Cancer Survivors

Danielle B Tometich, Brent J Small, Judith E Carroll, Wanting Zhai, George Luta, Xingtao Zhou, Lindsay C Kobayashi, Tim Ahles, Andrew J Saykin, Jonathan D Clapp, Heather S L Jim, Paul B Jacobsen, Arti Hurria, Deena Graham, Brenna C McDonald, Neelima Denduluri, Martine Extermann, Claudine Isaacs, Asma Dilawari, James Root, Christine Rini, Jeanne S Mandelblatt, Thinking and Living with Cancer (TLC) Study, Danielle B Tometich, Brent J Small, Judith E Carroll, Wanting Zhai, George Luta, Xingtao Zhou, Lindsay C Kobayashi, Tim Ahles, Andrew J Saykin, Jonathan D Clapp, Heather S L Jim, Paul B Jacobsen, Arti Hurria, Deena Graham, Brenna C McDonald, Neelima Denduluri, Martine Extermann, Claudine Isaacs, Asma Dilawari, James Root, Christine Rini, Jeanne S Mandelblatt, Thinking and Living with Cancer (TLC) Study

Abstract

Context: Symptoms affect quality of life (QOL), functional status, and cognitive function in cancer survivors, but older survivors are understudied.

Objectives: The objectives of this study were to identify prototypical presystemic therapy psychoneurological symptom clusters among older breast cancer survivors and determine whether these symptom clusters predicted cognition and QOL over time.

Methods: Women with newly diagnosed nonmetastatic breast cancer (n = 319) and matched noncancer controls (n = 347) aged 60+ years completed questionnaires and neuropsychological tests before systemic therapy and 12 and 24 months later. Latent class analysis identified clusters of survivors based on their pretherapy depression, anxiety, fatigue, sleep disturbance, and pain. Linear mixed-effects models examined changes in objective cognition, perceived cognition, and functional status (Instrumental Activities of Daily Living disability, functional well-being, and breast cancer-specific QOL) by group, controlling for covariates.

Results: Nearly one-fifth of older survivors were classified as having high pretherapy symptoms (n = 51; 16%); the remainder had low symptoms (n = 268; 84%); both groups improved over time on all outcomes. However, compared to the low symptom group and controls, survivors with high symptoms had lower baseline objective cognition and lower perceived cognition at baseline and 24 months, lower functional well-being at baseline and 12 months, greater Instrumental Activities of Daily Living disability at baseline, and lower breast cancer-specific QOL at all time points (all P < 0.05).

Conclusion: Nearly one-fifth of older breast cancer survivors had high psychoneurological symptoms at diagnosis, which predicted clinically meaningful decrements in perceived cognition and function in the first 24 months after diagnosis. Pretreatment psychoneurological symptom clusters could identify survivors for monitoring or intervention.

Trial registration: ClinicalTrials.gov NCT03451383.

Keywords: Symptoms; cognition; geriatric assessment; quality of life; symptom cluster.

Conflict of interest statement

Conflicts of Interest: A.D.: Cardinal Health (Advisory board). M.E.: GTx (research support). A.H.: Seattle Genetics, Amgen Pharmaceuticals, and Genentech (consultation); Glaxo Smith Kline, Abraxis Bioscience, and Celgene (research support). C.I.: Genentech, Pfizer, and AstraZeneca (consulting and speakers bureau); Novartis and Nanostring (consulting). HJ: RedHill Biopharma, Janssen Scientific Affairs (consulting). All remaining authors have declared no conflicts of interest.