Elham Hedayati

Effects of adjuvant treatment on cognitive function in women with early breast cancer.

PURPOSE Whether adjuvant therapy impairs cognitive function in women with breast cancer (BC) is unclear. We determined the effects of adjuvant therapy on cognitive function in women with early BC. METHODS We consecutively and prospectively enrolled women aged 40-69 years who had a positive radiographic finding from the mammography screening program at Stockholm South General Hospital. All women completed the Headminder Web-based neuropsychological battery Cognitive Stability Index (CSI) for response speed, processing speed, memory, and attention before diagnosis (T1), after surgery and before adjuvant treatment (T2), 6 months after start of adjuvant treatment (T3), and after another 3 months of follow-up (T4). Women with BC were divided into those receiving chemotherapy, hormone therapy, or no adjuvant medical therapy. Women without a diagnosis of BC served as healthy controls. RESULTS Of the 146 women enrolled, 77 had BC of whom 18 received chemotherapy; 45, hormone therapy, and 14, no adjuvant medical therapy; 69 were healthy controls. Memory scores for women with BC were significantly lower than those for controls over time, even after controlling for age and education. Memory and response speed scores were lower after chemotherapy than before (P<0.01 for both). Processing speed and attention improved significantly over time in all groups, a result consistent with a practice effect. CONCLUSION Our results indicate subtle changes related to time course and treatment. Especially, that chemotherapy may impair memory and response speed in women with BC, consistent with those reported by BC survivors after adjuvant medical treatment.

The effects of breast cancer diagnosis and surgery on cognitive functions

Abstract Background. Women with breast cancer (BC) report cognitive impairment. Receiving a BC diagnosis may have a negative psychological impact. We sought to determine whether a diagnosis of BC and subsequent surgical treatment reduced cognitive function. Material and methods. We recruited women, who had a positive radiographic finding, consecutively from the mammography screening program at Stockholm South General Hospital. All subjects completed the Headminder Web-based neuropsychological battery Cognitive Stability Index (CSI) for response speed, processing speed, memory, and attention at enrolment (T1, Baseline). CSI was administered again, after BC was ruled out, or after sector resection or mastectomy, if BC was confirmed by cytology or biopsy (T2, Retest). Results and conclusion. Of the 148 women approached, 146 were enrolled; 69 were healthy and 77 had BC. Comparison between groups at baseline, according to independent t-test, showed significant differences in response speed and processing speed. Cognitive abilities did not decline in either group on any of the measured domains. Our results suggest that a diagnosis of BC and subsequent surgery is not associated with substantial cognitive decline at retest. However, the lack of improvement in attention at retest among BC patients may be suggestive of a decline.

Cognitive, psychosocial, somatic and treatment factors predicting return to work after breast cancer treatment.

BACKGROUND Breast cancer (BC) may affect the ability to work. In this study, we want to identify any associations between cognitive, psychosocial, somatic and treatment factors with time to return to work (RTW) among women treated for BC. METHODS AND PARTICIPANTS At eight (baseline) and 11(follow-up) months after BC diagnosis, women who had received adjuvant treatment for early BC at Stockholm South General Hospital completed the Headminder neuropsychological tests to obtain the Cognitive Stability Index (CSI), the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire and its Breast Cancer Module. At both time points, we compared the scores from women who had returned to work with those who had not. We also reviewed the medical certificates of women still on sick leave at 8, 11 and 18 months after diagnosis to determine why they had not returned to work. RESULTS At baseline, 29 of 45 enroled women were working and 15 were not (one dropped out after baseline testing). The 14 women still not working 11 months after BC diagnosis had more advanced BC (OR = 3.64, 95% CI 2.01-7.31), lymph-node involvement (OR = 18.80, 95% CI 5.32-90.69) and Her 2-positive tumours (OR = 10.42,95% CI 2.19-65.32) than did working women. None of the scores for the four cognitive domains changed significantly at follow-up in either group. Comments on the medical certificates generally supported these findings. Independently of any adjuvant cancer therapy, overall quality of life improved and most women did RTW 18 months after BC diagnosis. CONCLUSIONS Chemotherapy is associated with longer periods of sick leave. Cognitive functions do not predict RTW. Independently of any adjuvant therapy, most women eventually RTW in a few months. The ability to predict RTW after BC treatment should help prepare higher-risk patients for delayed RTW and allow earlier interventions to restore their social relations and quality of life.

Gene expression profiling of sequential metastatic biopsies for biomarker discovery in breast cancer

The feasibility of longitudinal metastatic biopsies for gene expression profiling in breast cancer is unexplored. Dynamic changes in gene expression can potentially predict efficacy of targeted cancer drugs.

Young woman with breast cancer and cardiotoxicity with severe heart failure treated with a HeartMate IITM for nearly 6 years before heart transplantation.

Cardiotoxicity is a multifactorial problem, which has emerged with the improvement of cancer therapies and survival. Heart transplantation is relatively contraindicated in patients with breast cancer, until at least 5 years after complete remission. We present a case where a young woman who in 2001, at the age of 31, was diagnosed with breast cancer. She was considered cured, but 4 years later she suffered a relapse. During her second treatment, in 2006, she suffered from severe heart failure. She received a HeartMate II, as a long-term bridge to transplantation and 6 years later she was successfully transplanted. In this case report we discuss the use of mechanical circulatory support in cancer patients with drug-induced heart failure.

Abstract P5-21-07: Unexpected low incidence of cardiovascular related events in women with primary breast cancer; population derived retrospective cohort

Background Many studies and even a meta-analysis of the EBCTCG found that, compared to methotrexate containing chemotherapy (non-ACT) or no chemotherapy (no-CT), anthracycline-containing chemotherapy (ACT) decreases overall mortality after breast cancer (BC). However, increased cardiac mortality was observed but did not outweigh improvement in BC survival. The incidence of cardiotoxicity after adjuvant BC treatment is reported with varying frequencies and still remains unknown. Methods Women younger than 60 years and diagnosed with lymph node positive BC between 1998 and 2002 were identified through the Cancer Registry of the Regional Cancer Centre in the southeast health region of Sweden. Data on patient, tumor and treatment characteristics were registered from the Cancer Registry and medical records. Information on cardiovascular toxicity (CVT) was collected from the National Patient Registry, the Cause of Death Registry and the Prescribed Drugs Registry. ICD diagnoses for cardiac diseases and hypertension were used. A predefined Kaplan Meier and Cox regression analysis and a post hoc multivariate analysis to investigate confounders were performed. CVT was registered as event only if it occurred prior to BC relapse. Results Of 524 eligible women, 329 were analyzed (mean age, 50 years; range, 28 to 60 years) and 195 were excluded due to missing medical records (n=153), primary metastatic disease (n=18), trastuzumab treatment (n=6) and known heart disease at BC diagnosis (n=13). Of those analyzed, 176 received ACT, 64 non-ACT and 89 no-CT. The cumulative CVT was 16 %. CVT was observed in 12 % of those that received ACT, 14 % of those that received non-ACT and 25 % of those that received no-CT. CVT was significantly higher among women that received no-CT (p=0.024) meanwhile BC relapse and BC mortality was significantly higher among women treated with ACT compared to no-CT (p=0.02). According to Kaplan Meier curve, the risk for CVT among women treated with ACT was higher than the rest the first 5 years after diagnosis. 13 out of 85 patients that received epirubicin 450 mg/m2 developed CVT (p=0.302). A multivariate analysis adjusted for age, treated side, obesity, smoking and received chemotherapy showed that age between 51 and 60 year was a significant risk factor for developing CVT (p=0.035). Conclusion Clinically overt CVT 10-14 years after adjuvant BC treatment was diagnosed in 16% of women, but the subclinical incidence remains unclear. Women that did not receive chemotherapy showed increased incidence of CVT, probably due to lower risk for BC relapse and better overall survival. Age seems to be an independent risk factor for CVT. The incidence of clinical ACT CVT was unexpected low, however, CVT was observed already in epirubicin Citation Format: Antroula Papakonstantinou, Laila Hubbert, Rasmus Mikiver, Jonas Bergh, Elham Hedayati. Unexpected low incidence of cardiovascular related events in women with primary breast cancer; population derived retrospective cohort [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P5-21-07.

The Effect of Breast Cancer Diagnose on Cognitive Function.

Background: Women with breast cancer treatment complain about cognitive impairment. Previous studies indicate separately that receiving a breast cancer diagnosis has negative psychological impact and adjuvant treatment impairs cognitive functions. To investigate the impact on cognitive function is of great importance, since breast cancer is the most common cancer among women at working age in Sweden. We have started a longitudinal study to investigate if the effects of receiving a breast cancer diagnosis may affect cognitive functions. Materials and methods: The study is dimensioned for 148 subjects. The subjects were recruited consecutively and prospectively from the mammography-screening program at South Hospital, Stockholm. Those women who were recalled for further triple diagnosis assessment were invited to participate in our study. According to the results of the diagnostic process the patients were grouped in to: healthy women (n=69) and women with breast cancer (n=79). All participants were examined by a web-based battery of neuropsychological tests at inclusion (T1) and after diagnosis and subsequent surgery (T2). We measured four cognitive domains (Response speed, Processing speed, Memory and Attention). Results: Our results show that neither the healthy women nor patients with a recent breast cancer diagnosis with its subsequent surgery demonstrate any tendency toward a cognitive decline in any measured domains. The result did not differ significantly with regard to age, educational level or other demographic variables. Conclusions: The results may be interpreted to suggest that receiving a breast cancer diagnosis and/or surgery may not be associated to a substantial cognitive decline. Cognitive functions are not related with secondary depression and anxiety due to cancer diagnosis. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4091.

The effects of breast cancer treatment on cognitive functions

11531 Background: We have started a longitudinal study to investigate if a) the effects of being given a breast cancer (bc) diagnosis may affect cognitive functions in women, b) if adjuvant therapy may have detrimental effects on cognition, c) if subjects with substantial cognitive impairment after therapy may benefit from a cognitive training program. Methods: The study is dimensioned for 140 subjects. The subjects are recruited consecutively and prospectively from the mammography-screening program at Sodersjukhuset, Stockholm. According to the results of the diagnostic process the patients are divided in two main groups by “biological” randomization; healthy subjects and women with bc (n=70 in each group). All participants are examined by a web-based battery of neuropsychological tests at four times: at inclusion and before diagnosis, after diagnosis (two months), after treatment (six months), and follow-up after an additional three months. Subjects who score one standard deviation below the mean compar...