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Cognitive Function, Fatigue, and Menopausal Symptoms in Women Receiving Adjuvant Chemotherapy for Breast Cancer

Nadine Tchen, Helen G. Juffs, Fiona P. Downie, Qi-Long Yi, Hanxian Hu, Irene Chemerynsky, Mark Clemons, Michael Crump, Paul E. Goss, David Warr, Mary E. Tweedale, Ian F. Tannock

From the Princess Margaret Hospital and University of Toronto, Toronto; Toronto-Sunnybrook Regional Cancer Centre, and North York General Hospital, North York, Ontario, Canada; and Institut Bergonié, Bordeaux, France.

Address reprint requests to Ian F. Tannock, MD, PhD, Department of Medical Oncology and Hematology, Princess Margaret Hospital, 610 University Ave, Toronto, ON M5G 2M9, Canada; e-mail: ian.tannock{at}uhn.on.ca.

Purpose: There is evidence that cognitive dysfunction, fatigue, and menopausal symptoms may occur in women receiving adjuvant chemotherapy for breast cancer. Here, we determine their incidence and severity, and interrelationships between them and quality of life.

Patients and Methods: In this study, 110 women receiving adjuvant chemotherapy each nominated a female relative, friend, or neighbor (matched by age) as a control; 100 eligible matched pairs were evaluated. Patients and controls completed the following assessments: the High-Sensitivity Cognitive Screen, and the Functional Assessment of Cancer Therapy–General (FACT-G) quality of life scale with subscales for fatigue (FACT-F) and endocrine symptoms (FACT-ES). They also performed tests of attention and reaction time.

Results: Patients and controls were well matched for age and level of education. There was a higher incidence of moderate or severe cognitive impairment in the patient group (16% v 4%; P = .008). Patients experienced much more fatigue than controls (median FACT-F scores, 31 v 46; P < .0001) and more menopausal symptoms (median FACT-ES scores, 58 v 64; P < .0001). Self-reported quality of life of the patients was poorer than for controls, especially in physical and functional domains (median FACT-G scores, 77 v 93; P < .0001). There was strong correlation between fatigue, menopausal symptoms, and quality of life (P < .0001 for each pair), but none were significantly associated with the presence of cognitive dysfunction.

Conclusion: Adjuvant chemotherapy causes cognitive dysfunction, fatigue, and menopausal symptoms in women with breast cancer. Priority should be given to the study of strategies that might reduce these toxic effects.

This work was supported in part by the 2001 Professor of Survivorship awarded to Dr Tannock by the Susan G. Komen Breast Cancer Foundation. Dr Tchen was supported by a research fellowship from the Association pour la Recherche contre le Cancer.

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