Cognitive Dysfunction in Older Breast Cancer Survivors: An Integrative Review.
Adele Crouch, Victoria Champion, Diane Von Ah
PMID 34870942WHAT IT FOUND
Older breast cancer survivors often report cognitive problems and show decline on tests, with up to 49% showing decline after treatment and up to 64% reporting problems before adjuvant therapy.
Age, comorbidities, chemotherapy, sleep, frailty and symptom clusters were associated.
Key findings
01Objective neuropsychological testing found cognitive dysfunction before treatment in 11% to 41% of older breast cancer survivors, and after treatment up to 49% showed cognitive decline.
02Self-report measures showed higher prevalence, with up to 64% reporting cognitive dysfunction before adjuvant treatment and up to 51% reporting significant memory decline after treatment.
03In one included study of 118 older early-stage breast cancer survivors, all participants experienced objective cognitive decline from pre-treatment to post-treatment at different rates, and none improved.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The review included only observational studies, so it cannot show that any factor caused cognitive dysfunction or that treating it would help. No intervention trials, randomized control trials or systematic reviews were available in this area. Cognitive dysfunction was measured differently across studies, so direct comparison was difficult. Several studies had small samples, and two had fewer than 30 breast cancer survivors. Ten of the 12 studies came from three research teams, and some may have used overlapping samples. Most studies did not follow participants long enough to describe cognitive dysfunction many years after treatment. The review excluded survivors with metastatic disease and studies focused on dementia, so findings may not apply to those groups. The search was limited to English-language studies published from 2006 to 2019.
Declared interests
The authors reported no conflicts of interest.
The easy way to misread this
Do not treat the linked factors as proven causes or as targets that will improve cognition. The review found associations in observational studies, and no intervention trials were included, so it cannot show that addressing age, comorbidities, chemotherapy effects, sleep, frailty or symptoms reverses cognitive dysfunction.