Title |
Cognitive function and discontinuation of adjuvant hormonal therapy in older breast cancer survivors: CALGB 369901 (Alliance)
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Published in |
Breast Cancer Research and Treatment, June 2017
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DOI | 10.1007/s10549-017-4353-y |
Pubmed ID | |
Authors |
Shirley M. Bluethmann, Catherine M. Alfano, Jonathan D. Clapp, George Luta, Brent J. Small, Arti Hurria, Harvey J. Cohen, Steven Sugarman, Hyman B. Muss, Claudine Isaacs, Jeanne S. Mandelblatt |
Abstract |
To investigate the effects of cognitive function on discontinuation of hormonal therapy in breast cancer survivors ages 65+ ("older"). Older breast cancer survivors with invasive, non-metastatic disease, and no reported cognitive difficulties were recruited from 78 Alliance sites between 2004 and 2011. Eligible survivors (n = 1280) completed baseline interviews; follow-up was conducted annually for up to 7 years. Survivors with estrogen-receptor-positive (ER+) cancers who initiated hormonal therapy (n = 990) were included. Self-reported cognitive function was measured using the EORTC-QLQ30 scale; a difference of eight points on the 0-100 scale was considered clinically significant. Based on varying rates of discontinuation over time, discontinuation was evaluated separately for three time periods: early (<1 year); midpoint (1-3 years); and late discontinuation (>3-5 years). Cox models for each time period were used to evaluate the effects of cognition immediately preceding discontinuation, controlling for age, chemotherapy, and other covariates. Survivors were 65-91 years old (mean 72.6 years), and 79% had stages 1 or 2A disease. Overall, 43% discontinued hormonal therapy before 5 years. Survivors who reported lower cognitive function in the period before discontinuation had greater hazards of discontinuing therapy at the treatment midpoint (HR 1.22 per 8-point difference, CI 1.09-1.40, p < 0.001), considering covariates, but cognition was not related to discontinuation in the other periods. Self-reported cognitive problems were a significant risk factor for discontinuation of hormonal therapy 1-3 years post-initiation. Additional research is needed on the temporality of cognitive effects and hormonal therapy to support survivorship care needs of older survivors. |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
Unknown | 52 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Other | 7 | 13% |
Student > Master | 7 | 13% |
Researcher | 6 | 12% |
Student > Ph. D. Student | 6 | 12% |
Student > Bachelor | 4 | 8% |
Other | 11 | 21% |
Unknown | 11 | 21% |
Readers by discipline | Count | As % |
---|---|---|
Medicine and Dentistry | 9 | 17% |
Psychology | 8 | 15% |
Neuroscience | 5 | 10% |
Nursing and Health Professions | 4 | 8% |
Pharmacology, Toxicology and Pharmaceutical Science | 4 | 8% |
Other | 10 | 19% |
Unknown | 12 | 23% |