Introduction

Studies investigating the long-term effects of breast cancer treatment on cognition in older women with breast cancer are lacking, even though preserving cognition is highly valued by the older population. Specifically, concerns have been raised regarding the detrimental effects of endocrine therapy (ET) on cognition. Therefore, we investigated cognitive functioning over time and predictors for cognitive decline in older women treated for early breast cancer.

Methods

We prospectively enrolled Dutch women aged ≥70 years with stage I-III breast cancer in the observational CLIMB study. The Mini-Mental State Examination (MMSE) was performed before ET initiation and after 9, 15 and 27 months. Longitudinal MMSE scores were analysed and stratified for ET. Linear mixed models were used to identify possible predictors of cognitive decline.

Results

Among the 273 participants, the mean age was 76 years (standard deviation 5), and 48% received ET. The mean baseline MMSE score was 28.2 (standard deviation 1.9). Cognition did not decline to clinically meaningful differences, irrespective of ET. MMSE scores of women with pre-treatment cognitive impairments slightly improved over time (significant interaction terms) in the entire cohort and in women receiving ET. High age, low educational level and impaired mobility were independently associated with declining MMSE scores over time, although the declines were not clinically meaningful.

Conclusion

Cognition of older women with early breast cancer did not decline in the first two years after treatment initiation, irrespective of ET. Our findings suggest that the fear of declining cognition does not justify the de-escalation of breast cancer treatment in older women.

Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.

Overview publication

TitleAssociation between endocrine therapy and cognitive decline in older women with early breast cancer: Findings from the prospective CLIMB study.
DateMay 1st, 2023
Issue nameEuropean journal of cancer (Oxford, England : 1990)
Issue numberv185:1-10
DOI10.1016/j.ejca.2023.02.008
AuthorsBaltussen JC, Derks MGM, Lemij AA, de Glas NA, Fiocco M, Linthorst-Niers EMH, Vulink AJE, van Gerven L, Guicherit OR, van Dalen T, Merkus JWS, Lans TE, van der Pol CC, Mooijaart SP, Portielje JEA & Liefers GJ
KeywordsBreast cancer, Cognition, Endocrine therapy, Longitudinal, MMSE, Older women
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