New findings show women treated for breast cancer who report trouble with memory and problem solving skills do perform worse on tests of cognitive function than women who were never diagnosed. Cognitive function refers to a person’s attention, memory, and ability to reason, learn and understand.
Through the use of highly-specific and sensitive self-report surveys of cognitive function compared with tests of brain function, this study’s findings suggest that women’s perceptions of cognitive problems may reflect actual cognitive deficits, or short falls in mental ability.
Many women report trouble with memory and problem solving after breast cancer treatment. Yet, researchers and clinicians have questioned whether complaints of worse cognitive function reflect actual cognitive problems rather than depression and anxiety.
Few studies have explored the relationship between reported cognitive problems and women’s abilities to perform on neuropsychological tests, which show whether a person’s memory and problem solving skills are below average, average, or above average when the test is taken. In this study, researchers assessed whether the problems women reported were reflected in the neuropsychological test results.
A total of 189 women were recruited from a group participating in the University of California, Los Angeles Mind Body Study (MBS). Those leading the MBS study researched the effects of hormonal therapy on cognitive function, and collected data on each woman’s past treatment with hormone therapy as well as changes in her menstrual status because of treatment.
Women selected for the present study were ages 21 to 65 and newly diagnosed with early-stage breast cancer. They completed adjuvant treatment up to 3 months before joining the study, and had not yet started hormonal therapy. None of the participants were diagnosed with clinical depression before enrollment.
As part of the MBS, women had their blood tested for markers of inflammation and their brains imaged. The current study investigators considered their complaints of cognitive issues and evaluated the results of their neuropsychological tests. Complaints were reported by each woman using the following standard survey forms:
- Patient’s Assessment of Own Functioning Inventory, a 33-question survey that asked about issues including memory, higher-level cognition, executive function, and language and communication
- Higher-level cognition is the ability to problem solve
- Executive function helps us plan, organize, remember details and pay attention
- Multidimensional Fatigue Symptom Inventory – Short Form, a 30-question survey that asked about general, physical, emotional and mental fatigue, as well as vigor
After completing the surveys, the women took a 120-minute neuropsychological test that measured their cognitive abilities. Positive scores represented better-than-average abilities; negative scores represented worse-than-average abilities.
The complaints and test results of these women were compared to those of 63 women without breast cancer, and with no reported cognitive issues, who were recruited from a study at the University of California, San Diego.
Researchers found that women in the MBS group had worse complaints of memory and problem-solving issues than the control group. Women who were treated with a combination of chemotherapy and radiation were more likely to have worse cognitive complaints than others. In addition:
- Women who performed worse on verbal memory tests reported more memory issues
- Verbal memory is our ability to remember words and phrases
- Age, ethnicity, and marital status were not significantly associated with cognitive complaints
This study did not include women over 65, with chronic inflammatory conditions, or with clinical depression. Because of this, the findings cannot be broadly applied to these populations.
What This Means for You
These results show that the memory and problem-solving issues reported by many women treated for breast cancer are real and may be side effects of specific types of treatment, not only symptoms of depression. If you are experiencing these kinds of cognitive problems, you may find comfort in knowing that research is helping to explain them.
Cognitive problems related to breast cancer treatment, often called “chemobrain,” can be frustrating. Past research has shown that these issues are mild for most patients. If you have concerns, talk with your doctors about how your treatments may impact your memory, as well as ways to improve your function.
Ganz, P, Lorna, K, Castellon, S, et al. Cognitive complaints after breast cancer treatments: Examining the relationship with neuropsychological test performance. Journal of the National Cancer Institute. 2013; 105 (11):791-801.