Advertisement

Treatment With Chemotherapy and Cognitive Functioning in Older Adult Cancer Survivors

      Abstract

      Objective

      To investigate whether treatment of cancer with chemotherapy, as compared with surgery and radiation, differentially affects cognitive functioning in older adults.

      Design

      Latent class growth analysis approach.

      Setting

      Health and Retirement Study.

      Participants

      Older adults (N=403) with a new diagnosis of cancer who were still alive 4 years after their diagnosis.

      Interventions

      Not applicable.

      Main Outcome Measures

      Cognition (degree of immediate recall and delayed recall of a word list).

      Results

      Findings indicated that 3 classes of cognitive functioning best fit the data, specifically high, middle, and low recall classes. Individuals treated with chemotherapy were significantly more likely to be in the high recall class, with no effect of receiving surgery or radiation. When interactions with demographic predictors were entered into the model, an Age × Treatment interaction was present such that individuals younger than 80 years were more likely to both receive chemotherapy and have high recall cognition.

      Conclusions

      Three distinct classes of cognitive functioning emerged in older adults with cancer. Treatment with chemotherapy predicted likely membership in the high recall class in this sample of cancer survivors; however, this was due to an Age × Treatment interaction. Implications for understanding cognitive sequelae of cancer in late life are discussed.

      Keywords

      List of abbreviations:

      BIC (Bayesian information criterion), HRS (Health and Retirement Study), LCGA (latent class growth analysis)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. Howlader N. Noone A.M. Krapcho M. SEER cancer statistics review, 1975-2008. National Cancer Institute, Bethesda2011 (Available at:) (Accessed September 1, 2016)
        • Argyriou A.A.
        • Assimakopoulos K.
        • Iconomou G.
        • Giannakopoulou F.
        • Kalofonos H.P.
        Either called “chemobrain” or “chemofog,” the long-term chemotherapy induced cognitive decline in cancer survivors is real.
        J Pain Symptom Manage. 2011; 41: 126-139
        • Ahles T.A.
        • Saykin A.J.
        • Furstenberg C.T.
        • et al.
        Neuropsychologic impact of standard-dose systemic chemotherapy in long-term survivors of breast cancer and lymphoma.
        J Clin Oncol. 2002; 20: 485-493
        • Vardy J.
        • Tannock I.
        Cognitive function after chemotherapy in adults with solid tumours.
        Crit Rev Oncol Hematol. 2007; 63: 183-202
        • Silberfarb P.M.
        Chemotherapy and cognitive defects in cancer patients.
        Annu Rev Med. 1983; 34: 35-46
        • Ahles T.A.
        • Saykin A.J.
        Candidate mechanisms for chemotherapy-induced cognitive changes.
        Nat Rev Cancer. 2007; 7: 192-201
        • Donovan K.A.
        • Small B.J.
        • Andrykowski M.A.
        • Schmitt F.A.
        • Munster P.
        • Jacobsen P.B.
        Cognitive functioning after adjuvant chemotherapy and/or radiotherapy for early stage breast carcinoma.
        Cancer. 2005; 104: 2499-2507
        • Shaffer V.A.
        • Merkle E.C.
        • Fagerlin A.
        • Griggs J.J.
        • Langa K.M.
        • Iwashyna T.J.
        Chemotherapy was not associated with cognitive decline in older adults with breast and colorectal cancer: findings from a prospective cohort study.
        Med Care. 2012; 50: 849
        • Porter K.E.
        “Chemo brain”—is cancer survivorship related to later-life cognition? Findings from the Health and Retirement Study.
        J Aging Health. 2013; 25: 960-981
        • Reitan R.M.
        • Wolfson D.
        The Halstead-Reitan neuropsychological test battery: theory and clinical interpretation.
        Neuropsychology Pr, Tucson1993
        • Anderson N.D.
        • Iidaka T.
        • Cabeza R.
        • Kapur S.
        • McIntosh A.R.
        • Craik F.I.
        The effects of divided attention on encoding- and retrieval-related brain activity: a PET study of younger and older adults.
        J Cogn Neurosci. 2000; 12: 775-792
        • Butters N.
        • Grant I.
        • Haxyb J.
        • et al.
        Assessment of AIDS-related cognitive changes: recommendations of the NIMH Workshop on Neuropsychological Assessment Approaches.
        J Clin Exp Neuropsychol. 1990; 12: 963-978
        • Whittington C.J.
        • Podd J.
        • Kan M.M.
        Recognition memory impairment in Parkinson's disease: power and meta-analyses.
        Neuropsychology. 2000; 14: 233
        • Craik F.I.M.
        Memory changes in normal aging.
        Curr Dir Psychol Sci. 1994; 3: 155-158
        • Anderson-Hanley C.Y.
        • Sherman M.L.
        • Riggs R.
        • Agocha V.
        • Compas B.E.
        Neuropsychological effects of treatments for adults with cancer: a meta-analysis and review of the literature.
        J Int Neuropsychol Soc. 2003; 9: 967-982
        • Wefel J.S.
        • Schagen S.B.
        Chemotherapy-related cognitive dysfunction.
        Curr Neurol Neurosci. 2012; 12: 267-275
        • Peake M.D.
        • Thompson S.
        • Lowe D.
        • Pearson M.G.
        Ageism in the management of lung cancer.
        Age Ageing. 2003; 32: 171-177
        • Bond M.
        • Bowling A.
        • McKee D.
        • et al.
        Does ageism affect the management of ischaemic heart disease?.
        J Health Serv Res Policy. 2003; 8: 40-47
        • Heflin L.H.
        • Meyerowitz B.E.
        • Hall P.
        • et al.
        Cancer as a risk factor for long-term cognitive deficits and dementia.
        J Natl Cancer Inst. 2005; 97: 854-856
        • Schroyen S.
        • Adam S.
        • Jerusalem G.
        • Missotten P.
        Ageism and its clinical impact in oncogeriatry: state of knowledge and therapeutic leads.
        Clin Interv Aging. 2014; 10: 117-125
        • Schagen S.B.
        • Muller M.J.
        • Boogerd W.
        • et al.
        Late effects of adjuvant chemotherapy on cognitive function: a follow-up study in breast cancer patients.
        Ann Oncol. 2002; 13: 1387-1397
      2. RAND HRS Data, Version M. Produced by the RAND Center for the Study of Aging, with funding from the National Institute on Aging and the Social Security Administration. Santa Monica, CA; September 2014.

        • Burton C.L.
        • Galatzer-Levy I.R.
        • Bonanno G.A.
        Treatment type and demographic characteristics as predictors for cancer adjustment: prospective trajectories of depressive symptoms in a population sample.
        Health Psychol. 2014; 34: 602
        • Lubke G.H.
        • Muthén B.
        Investigating population heterogeneity with factor mixture models.
        Psychol Methods. 2005; 10: 21
      3. Muthén BO, Muthén LK. Mplus user's guide. 6th ed. Los Angeles: Muthén & Muthén; 1998-2010.

        • Jung T.
        • Wickrama K.A.S.
        An introduction to latent class growth analysis and growth mixture modeling.
        Soc Pers Psychol Compass. 2008; 2: 302-317
        • Ram N.
        • Grimm K.J.
        Methods and measures: growth mixture modeling: a method for identifying differences in longitudinal change among unobserved groups.
        Int J Behav Dev. 2009; 33: 565-576
        • Li S.C.
        • Lindenberger U.
        • Sikström S.
        Aging cognition: from neuromodulation to representation.
        Trends Cogn Sci. 2001; 5: 479-486
        • Siegel R.
        • DeSantis C.
        • Virgo K.
        • et al.
        Cancer treatment and survivorship statistics, 2012.
        CA Cancer J Clin. 2012; 62: 220-241
        • Yellen S.B.
        • Cella D.F.
        • Leslie W.T.
        Age and clinical decision making in oncology patients.
        J Natl Cancer Inst. 1994; 86: 1766-1770
        • Puts M.T.
        • Papoutsis A.
        • Springall E.
        • Tourangeau A.E.
        A systematic review of unmet needs of newly diagnosed older cancer patients undergoing active cancer treatment.
        Support Care Cancer. 2012; 20: 1377-1394
        • Stout N.L.
        • Silver J.K.
        • Raj V.S.
        • et al.
        Towards a national initiative in cancer rehabilitation: recommendations from a subject matter expert group.
        Arch Phys Med Rehabil. 2016; 97: 2006-2015