• Cognitive Disorders
• Magnetic Resonance Imaging
• Oncology Clinical Trials
• Breast Cancer
• Radiology

Women diagnosed with and treated for breast cancer often experience problems with memory, concentration, and other cognitive abilities that affect their quality of life [Reuter-Lorenz PA, Cimprich B. Breast Cancer Res Treat 2013]. Although patients frequently attribute this to chemotherapy, cognitive complaints and deficits have been found before patients undergo any adjuvant treatment [Cimprich B et al. J Clin Exp Neuropsychol 2010]. Women treated for breast cancer often report fatigue, but an association between fatigue and neurocognitive function has not been systematically examined. Bernadine Cimprich, PhD, RN, University of Michigan, Ann Arbor, Michigan, USA, presented data from a prospective functional MRI (fMRI) study on the neurocognitive impact of breast cancer-linked fatigue.

Women enrolled in the study were patients with localized breast cancer stages I to IIIa. Twenty-eight patients received adjuvant chemotherapy (anthracycline-based regimen), 37 received radiotherapy alone without chemotherapy, and 32 age-matched healthy controls were enrolled. At 2 time points coinciding with pre- and 1-month postchemotherapy assessments, participants performed a verbal working memory task with varying levels of demand for cognitive control while undergoing fMRI scanning. Participants provided self-reports using the Attentional Function Index and the Functional Assessment of Cancer Therapy-Fatigue during these assessments.

Cognitive domains that may be affected in cancer patients include attention, working memory, processing speed, and executive function [Wefel JS, Schagen SB. Curr Neurol Neurosci Rep 2012]. Error rates on a verbal working memory task were significantly higher (p<0.05) before treatment in the chemotherapy and radiation groups compared with the healthy group.

In addition, fMRI scanning revealed that inferior frontal gyrus functioning differed between patients and controls over time (F=3.88, p=0.05). Left inferior frontal gyrus activation at the pretreatment evaluation was related to an increase in fatigue over time.

The group receiving chemotherapy had significantly higher fatigue levels both before and after treatment (p<0.01). However, higher levels of fatigue across all groups were associated with reduced cognitive function over time. In addition, preadjuvant treatment brain alterations during the working memory task were able to predict severity of post-treatment fatigue. Thus, fatigue and pretreatment neural vulnerability are contributors to cognitive problems in patients with breast cancer and may further compound any cognitive effects of chemotherapy.

Dr. Cimprich said, “‘Chemo brain’ is not an appropriate label for cancer-related cognitive dysfunction [and]… early interventions to reduce psychological distress may improve cognitive function over the course of treatment.”

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