Conferences > OncoLink Scientific Meetings Coverage > OncoLink at ASCO 2004 > Sunday, June 6, 2004

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
Posting Date: June 6, 2004

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

Background

• 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

Results

• 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

Oncolink's ASCO Coverage made possible by an unrestricted Educational Grant from Bristol-Myers Squibb Oncology.