Older survivors of breast cancer may be more vulnerable to cognitive decline compared with other patient groups, according to a recent report published in the Journal of Clinical Oncology.

The prospective Thinking and Living With Cancer (TLC) study compared cognition in patients who survived breast cancer (n=344 enrolled) vs cognition in matched participants without breast cancer (n=347 enrolled). Survivors of breast cancer had had nonmetastatic disease and were treated with hormonal therapy only or chemotherapy with or without hormonal treatment. Participants were at least 60 years old and without a history of neurologic disease or dementia.

Participants were evaluated at baseline and at 12 and 24 months through numerous tests related to cognitive function, such as self-reports and neuropsychological assessments; the latter of these emphasized learning and memory (LM), as well as attention, processing speed, and executive function (APE). ApoE genotyping was also performed.

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At 12 months, participants who were treated with hormonal therapy had lower LM values than the other cohorts (P =.03). Those who were treated with chemotherapy had worse APE values than did other groups at 12 and 24 months (P =.05).

Participants with an ε4+ ApoE genotype who received hormonal therapy showed relatively lower LM scores at 12 months (P =.03). APE scores were lower at 24 months among those with the ε4+ genotype from the chemotherapy group compared with those from ε4+ controls (P <.05).

The researchers noted that the rate at which chemotherapy-related cognitive effects may happen in this population of patients appears low, in case chemotherapy is required, but that these results could alert health care providers to possible risks.


Mandelblatt JS, Small BJ, Luta G, et al. Cancer-related cognitive outcomes among older breast cancer survivors in the Thinking and Living With Cancer study [published online October 3, 2018]. J Clin Oncol. doi: 10.1200/JCO.18.00140