marquette university college of nursing perceived cognitive changes during breast cancer...

MARQUETTE UNIVERSITY COLLEGE OF NURSING

Perceived Cognitive Changes During Breast Cancer Chemotherapy

Linda Piacentine, PhD, ACNP

Jiannan Zhang, BSN, RN Alan Bloom, PhD

Judith F. Miller, PhD, RN, FAAN


Chemobrain

• Cognitive deficits associated with chemotherapy– Reported by 15-50%– unknown severity and duration of decreased cognition – Cause of the phenomenon not understood

• Most common– Verbal and visual memory– Attention/concentration– Processing speed


Study Aim

To compare perceived cognitive ability (concentration/attention, fatigue, memory and

language/word finding)

among women who receive chemotherapy following surgery for breast cancer and healthy women


Study Design/Methods

• Descriptive, longitudinal• Four self-report instruments, administered

prior to and after 4 cycles of chemotherapy• Data analysis

– Descriptive analysis of demographics– Repeated Measures Anova


InstrumentsFunctional Assessment of Cancer Therapy•Cognitive Version (FACT-Cog)

– 50 items

•General well-being with Breast Module (FACT-B)– 23 items

•Fatigue (FACIT-F)

– 13 items

Beck Depression Inventory (BDI-II)– 21 items


Sample Description

• 11 women starting on chemotherapy- No metastasis- No previous chemo- No psych disorders or history of substance abuse- No previous traumatic brain injury

• 7 healthy women matched for age and education


Variables Chemo Healthy

Age (years)Age range (years)

46.2(32-58)

48.3(38-58)

Percent Percent

Race-WhiteEthnicity-Hispanic

91 9

100 0

Education (mean years) 17.1 16.4

Sample Description


Chemotherapy Regimen

Adriamycin Cytoxan 5-FU Taxotere Carboplatin Taxol Herceptin1 AC DD Y Y Y 2 TC Y Y 3 AC DD Y Y Y 4 FAC Y Y Y Y 5 AC Y Y Allergic 6 AC DD Y Y 7 AC DD Y Y Y Y8 TC Y Y 9 AC DD Y Y Y 10 TCH Y Y Y11 TC Y Y


Results FACT-Cog

Chemo HealthyT1 T2 T1 T2

Mental Acuity 14.6 (1.44) 11.9 (3.26) * 14.14 (1.77) 15.6 (0.79)

Concentration 14.0 (1.55) 13.2 (1.99) 13.6 (2.64) 15.7 (0.49) *

Memory # 25.8 (1.89) 22.7 (4.32) * 22.7 (4.63) 24.3 (3.62)

Verbal Fluency # 23.6 (2.25) 19.1 (5.72) 24.5 (2.59) 24.8 (2.64)

Functional 23.7 (1.74) 20.4 (5.52) * 24.7 (2.58) 25.8 (2.40)

Others comments 15.6 (0.92) 11.8 (4.40) * 15.6 (0.54) 15.6 (0.54)

Change 31.6 (2.91) 22.0 (12.51)* 31.3 (5.22) 34.71 (1.70)

FACT-Cog 148.8 (8.15) 121.0 (33.42)* 147.8 (12.30) 156.8 (7.44)

COGQ 28.8 (2.82) 25.9 (5.81 0) 29.14±2.91 31.3 (0.76)

& Indicates chemo group n=10 # indicates healthy group n=6* Indicates a within group change over timeShading indicates a group difference at a specific time point


ResultsFACT-B

Chemo Healthy

T1 T2 T1 T2

PWB 20.6 (1.91) 18.6 (3.17)* 23.4 (0.79) 23.00 (1.00 )

SWB 17.9 (2.66) 17.6 (2.42) 15.4 (4.04) 16.00(3.16)

EWB 19.8 (4.22) 21.0 (3.03) 22.4 (1.72) 22.6 (1.27)

FWB 21.2 (4.67) 20.3 (5.42) 24.7 (3.77) 26.00 (2.08)

BCS & 17.9 (4.20) 17.1 (3.78) 19.3 (2.69) 20.14 (2.61)

FACT-B 114.3 (20.74) 112.8 (14.5) xxx xxx

FACT-B rev 96.0 (16.38) 95.0 (11.5) 105.3 (10.90) 107.7 (7.32)

& Indicates number of participants in chemo group is 10* Indicates a within group change over timeShading indicates a group difference at a specific time point


ResultsFACIT-F

Chemo Healthy

T1 T2 T1 T2

Fatigue 42.3 (4.37) 36.5 (8.87)* 47.4 (5.32) 48.1 (2.73)

* Indicates a within group change over timeShading indicates a between group difference at a specific time point


ResultsBDI-II

Chemo Healthy

T1 T2 T1 T2

Becks 7.8 (5.38) 10.8 (6.74) 1.2 (0.75) 0.83 (1.60)


Conclusions

• Pre-chemotherapy compared to after 4 cycles:– Cognitive impairment increases– Physical well-being decreases – Fatigue symptoms increase

• Healthy persons report less fatigue at both timepoints

• Healthy persons report less cognitive impairment compared to those who have had 4 cycles of chemotherapy


Limitations

• Pilot study with small sample size• Lack of control group with cancer but no

chemotherapy• Unable to assess prior to cancer diagnosis and

surgery• Highly educated women• Incomplete data• Cognitive tool in development


Future Directions

• Compare data to imaging and qualitative data• Larger sample size• Cancer control group

Supported in part by DOD grant BC086890, State of Wisconsin Breast Cancer Check-off Funds and Greater Milwaukee Foundation and MCW Cancer Center

marquette university college of nursing perceived cognitive changes during breast cancer...

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