Elevated C-reactive protein and subsequent patient-reported cognitive problems in older breast cancer survivors: The Thinking and Living with Cancer study Journal Article
| Authors: | Carroll, J. E.; Nakamura, Z. M.; Small, B. J.; Zhou, X.; Cohen, H. J.; Ahles, T. A.; Ahn, J.; Bethea, T. N.; Extermann, M.; Graham, D.; Isaacs, C.; Jim, H. S. L.; Jacobsen, P. B.; McDonald, B. C.; Patel, S. K.; Rentscher, K.; Root, J.; Saykin, A. J.; Tometich, D. B.; Van Dyk, K.; Zhai, W.; Breen, E. C.; Mandelblatt, J. S. |
| Article Title: | Elevated C-reactive protein and subsequent patient-reported cognitive problems in older breast cancer survivors: The Thinking and Living with Cancer study |
| Abstract: | PURPOSETo examine longitudinal relationships between levels of C-reactive protein (CRP) and cognition in older breast cancer survivors and noncancer controls.METHODSEnglish-speaking women age ≥ 60 years, newly diagnosed with primary breast cancer (stage 0-III), and frequency-matched controls were enrolled from September 2010 to March 2020; women with dementia, neurologic disorders, and other cancers were excluded. Assessments occurred presystemic therapy/enrollment and at annual visits up to 60 months. Cognition was measured using the Functional Assessment of Cancer Therapy-Cognitive Function and neuropsychological testing. Mixed linear effect models tested for survivor-control differences in natural log (ln)-transformed CRP at each visit. Random effect-lagged fluctuation models tested directional effects of ln-CRP on subsequent cognition. All models controlled for age, race, study site, cognitive reserve, obesity, and comorbidities; secondary analyses evaluated if depression or anxiety affected results.RESULTSThere were 400 survivors and 329 controls with CRP specimens and follow-up data (average age of 67.7 years; range, 60-90 years). The majority of survivors had stage I (60.9%), estrogen receptor-positive (87.6%) tumors. Survivors had significantly higher adjusted mean ln-CRP than controls at baseline and 12-, 24-, and 60-month visits (all P <.05). Higher adjusted ln-CRP predicted lower participant-reported cognition on subsequent visits among survivors, but not controls (P interaction =.008); effects were unchanged by depression or anxiety. Overall, survivors had adjusted Functional Assessment of Cancer Therapy-Cognitive Function scores that were 9.5 and 14.2 points lower than controls at CRP levels of 3.0 and 10.0 mg/L. Survivors had poorer neuropsychological test performance (v controls), with significant interactions with CRP only for the Trails B test.CONCLUSIONLongitudinal relationships between CRP and cognition in older breast cancer survivors suggest that chronic inflammation may play a role in development of cognitive problems. CRP testing could be clinically useful in survivorship care. © American Society of Clinical Oncology. |
| Keywords: | aged; middle aged; c reactive protein; psychology; c-reactive protein; breast neoplasms; cancer survivor; breast tumor; cognition; patient reported outcome measures; cancer survivors; complication; patient-reported outcome; humans; human; female |
| Journal Title: | Journal of Clinical Oncology |
| Volume: | 41 |
| Issue: | 2 |
| ISSN: | 0732-183X |
| Publisher: | American Society of Clinical Oncology |
| Date Published: | 2023-01-10 |
| Start Page: | 295 |
| End Page: | 306 |
| Language: | English |
| DOI: | 10.1200/jco.22.00406 |
| PUBMED: | 36179271 |
| PROVIDER: | scopus |
| PMCID: | PMC9839283 |
| DOI/URL: | |
| Notes: | Article -- MSK Cancer Center Support Grant (P30 CA008748) acknowledged in PDF -- Export Date: 1 February 2023 -- Source: Scopus |
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