Association between Endocrine Therapy and Cognitive Decline in Older Women with Early Breast Cancer: Findings from the Prospective CLIMB Study
Menée aux Pays-Bas à partir de données portant sur 273 patientes âgées atteintes d'un cancer du sein de stade précoce (âge moyen : 76 ans), cette étude prospective analyse l'effet d'une thérapie endocrinienne sur l'évolution de leurs capacités cognitives
Introduction: Studies investigating the long-term effects of breast cancer treatment on cognition in older women with breast cancer are lacking, even though preserving cognition is highly valued by the older population. Specifically, concerns have been raised regarding detrimental effects of endocrine therapy (ET) on cognition . Therefore, we investigated cognitive functioning over time and predictors for cognitive decline in older women treated for early breast cancer. Methods: We prospectively enrolled Dutch women aged ≥70 years with stage I-III breast cancer in the observational CLIMB study. The Mini-Mental State Examination (MMSE) was performed before ET initiation, and after 9, 15 and 27 months. Longitudinal MMSE scores were analyzed and stratified for ET. Linear mixed models were used to identify possible predictors of cognitive decline. Results: Among the 273 participants, mean age was 76 years (standard deviation (SD) 5) and 48% received ET. Mean baseline MMSE score was 28.2 (SD 1.9). Cognition did not decline to clinically meaningful differences, i rrespective of ET. MMSE scores of women with pretreatment cognitive impairments slightly improved over time (significant interaction terms) in the entire cohort and in women receiving ET. High age, low educational level and impaired mobility were independently associated with declining MMSE scores over time, although the declines were not clinically meaningful. Conclusion: Cognition of older women with early breast cancer did not decline in the first two years after treatment initiation, irrespective of ET. Our findings suggest that fear of declining cognition does not justify de-escalation of breast cancer treatment in older women.