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Self-reported cognitive decline in Japanese patients with breast cancer treated with endocrine therapy

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Abstract

Background

Despite contributing to the control of hormone receptor-positive breast cancer, a highly prevalent cancer type, endocrine therapy affects patients’ cognitive function. We aimed to identify cognitive decline following the start of endocrine therapy using patient-reported measures and investigate factors associated with cognitive difficulties.

Methods

This cross-sectional survey used a self-administered, anonymous questionnaire. The participants were 876 patients with breast cancer who experienced subjective cognitive difficulties after starting endocrine therapy. Our sample was recruited from 11 patient advocacy groups, 5 clinics, and 2 hospitals in Japan. The questionnaire assessed subjective cognitive difficulties (30 items), psychological well-being, demographic and clinical information, and other subjective symptoms.

Results

Of 510 (58.2%) responses, we analyzed 405 (46.2%) questionnaires. Exploratory factor analysis identified three factors of cognitive difficulties: Factor 1, “difficulties in manipulating memory and language;” Factor 2, “difficulties in processing multiple pieces of information;” and Factor 3, “difficulties in maintaining attention and concentration.” Factor 1 was the most common type, and it was significantly related to the treatment characteristics of endocrine therapy. Multivariate logistic regression analysis revealed that fewer household members, a history of breast surgery, more severe menopausal symptoms, and greater psychological distress were significantly associated with cognitive difficulties. As cognitive difficulties increased, the proportion of participants suspected to have psychological disorders increased significantly.

Conclusions

Patients treated with endocrine therapy for breast cancer experience intricately intertwined impairments in several domains of cognitive function. They have an increased risk of psychological disorders corresponding to the degree of subjective cognitive function.

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Acknowledgements

We are grateful to our collaborators, Dr. Yoshio Tanji and Ms. Namiki Kitada. We wish to thank Dr. Naotoshi Nakamura for his supervision on statistical analysis. We sincerely thank the patient advocacy groups, the clinics, and the hospitals for participant recruitment. We also thank the patients and the experts for their grateful support in the development of the SCRS-HT instrument. This study was supported by a grant from the JSPS KAKENHI (Grant number: 25670946).

Funding

This study was funded by the JSPS KAKENHI (Grant number: 25670946).

Author information

Authors and Affiliations

  1. Department of Nursing, Hakuaikai Sagara Hospital, 3-31 Matsubara-cho, Kagoshima City, Kagoshima, 892-0833, Japan

    Sena Yamamoto

  2. Former Osaka University Graduate School of Medicine, Cancer Education and Research Center, 1-7 Yamadaoka, Suita City, Osaka, 565-0871, Japan

    Eiko Masutani

  3. Division of Health Sciences, Osaka University Graduate School of Medicine, 1-7 Yamadaoka, Suita City, Osaka, 565-0871, Japan

    Harue Arao

Authors
  1. Sena Yamamoto
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  3. Harue Arao
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Contributions

All authors contributed to the study conception and design, development of the questionnaire, and data analysis. Data collection was performed mainly by EM. The first draft of the manuscript was written by SY and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Harue Arao.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Yamamoto, S., Masutani, E. & Arao, H. Self-reported cognitive decline in Japanese patients with breast cancer treated with endocrine therapy. Breast Cancer 27, 670–682 (2020). https://doi.org/10.1007/s12282-020-01062-7

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