Cognitive function, fatigue and menopausal symptoms in women following adjuvant chemotherapy for breast cancer: One and two year follow-up of a prospective controlled study

Reviewer: S. Jack Wei, MD
Abramson Cancer Center of the University of Pennsylvania
Last Modified: June 6, 2004

Presenter: N. Tchen
Presenter's Affiliation: Princess Margaret Hospital, Toronto, CA
Type of Session: Scientific


  • Adjuvant chemotherapy is given to many beast cancer patients; however, it can result in significant toxicity
  • A previous report from this group showed significantly increased fatigue and menopausal symptoms for women receiving adjuvant chemotherapy compared to matched untreated women immediately following completion of chemotherapy
  • Treated women were also found to have significantly increased rates of moderate-severe cognitive dysfunction (16% vs. 4%, p<0.008)
  • This report provides the one- and two-year updates of this trial

Materials and Methods

  • 100 women receiving adjuvant chemotherapy for breast cancer nominated an age-matched (+/- 5 yrs) female acquaintance who did not have breast cancer
  • All subjects were assessed using with multiple assessment tools including High-Sensitivity Cognitive Screening (HSCG), the Mini-Mental Status exam, Trail Making Test, Conner's Continuous Performance Test, and the FACT-G quality of life (QOL) scale with subscales for menopausal symptoms (FACT-ES) and fatigue (FACT-F)
  • These assessments were initially administered immediately following CT and then repeated one and two years later
  • The role of adjuvant tamoxifen therapy in long-term toxicity and QOL was also assessed


  • Patients were well matched between groups for age, educational status, marital status, and menopausal status
  • At one year, 85 treated patients and 79 control patients completed the assessment; at two years, 81 treated patients and 80 control patients completed the assessment.
  • Tamoxifen was taken by 45/89 treated patiejnts
  • FACT-F scores revealed significant fatigue in untreated vs treated patients with the following results: 31% vs. 46% (baseline), 43% vs. 47% (year one), and 45% vs. 48% (year two) 
  • At year 2, fatigue was related to tamoxifen therapy.  48% of patients on hormone therapy were found to have significant fatigue compared to 42% of patients not taking hormone therapy (p=0.02)
  • Cessation of menses was seen in untreated vs treated patients with the following results: 62% vs. 64% (baseline), 15% vs. 53% (year one), and 11% vs. 46% (year two) 
  • FACT-ES showed significant menopausal symptoms in untreated vs treated patients with the following results: 58% vs. 64% (baseline), 59% vs. 65% (year one), and 61% vs. 65% (year two) (p<0.0001).  There was no influence with the use of tamoxifen for these symptoms
  • Significant cognitive dysfunction was noted in untreated vs treated patients with the following results: 4% vs. 16% (baseline), 2% vs. 4% (year one), and 0% vs. 3% (year two, p=ns)
  • Good quality of life as assessed by FACT-G was found in untreated vs treated patients with the following results 93% vs. 77% (baseline, p<0.001), 91% vs. 89% (year one), and 90% vs. 91% (year two) 
  • A significant correlation between fatigue and QOL, menopausal symptoms and QOL, and fatigue and menopausal symptoms was seen

Author's Conclusions

  • Cognitive dysfunction is temporary in most patients
  • Menopausal symptoms and fatigue are important toxicities immediately following treatment with adjuvant chemotherapy.  These symptoms improve in most treated patients; however, they remain worse than in control subjects even two years after treatment
  • Hormonal treatment has minimal impact on  these symptoms

Clinical/Scientific Implications

This report updates the results of a previous study that showed significant toxicities immediately following the use of adjuvant chemotherapy in breast cancer patients.  This update shows that although cognitive function improves, other side effects such as fatigue and menopausal symptoms can remain more than two years after treatment.  Ample clinical evidence shows that certain breast cancer patients benefit from the addition of adjuvant chemotherapy.  This benefit, however, comes with some cost which may not resolve for several years.  The use of chemotherapy in these patients should be used judiciously as long-term toxicities can result from these treatments.

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