Pretreatment psychoneurological symptoms and their association with longitudinal cognitive function and quality of life in older breast cancer survivors Journal Article


Authors: Tometich, D. B.; Small, B. J.; Carroll, J. E.; Zhai, W.; Luta, G.; Zhou, X.; Kobayashi, L. C.; Ahles, T.; Saykin, A. J.; Clapp, J. D.; Jim, H. S. L.; Jacobsen, P. B.; Hurria, A.; Graham, D.; McDonald, B. C.; Denduluri, N.; Extermann, M.; Isaacs, C.; Dilawari, A.; Root, J.; Rini, C.; Mandelblatt, J. S.; Thinking; Living with Cancer, Study; for the Thinking and Living with Cancer(TLC) Study
Article Title: Pretreatment psychoneurological symptoms and their association with longitudinal cognitive function and quality of life in older breast cancer survivors
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. © 2018 American Academy of Hospice and Palliative Medicine
Keywords: quality of life; cognition; geriatric assessment; symptoms; symptom cluster
Journal Title: Journal of Pain and Symptom Management
Volume: 57
Issue: 3
ISSN: 0885-3924
Publisher: Elsevier Inc.  
Date Published: 2019-03-01
Start Page: 596
End Page: 606
Language: English
DOI: 10.1016/j.jpainsymman.2018.11.015
PUBMED: 30472317
PROVIDER: scopus
PMCID: PMC6382533
DOI/URL:
Notes: Article -- Export Date: 1 March 2019 -- Source: Scopus
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MSK Authors
  1. Tim A Ahles
    95 Ahles
  2. James Charles Root
    42 Root