Elucidating pretreatment cognitive impairment in breast cancer patients: the impact of cancer-related post-traumatic stress

Kerstin Hermelink; Varinka Voigt; Judith Kaste; Franziska Neufeld; Rachel Wuerstlein; Markus Bühner; Karin Münzel; Dorothea Rjosk-Dendorfer; Susanne Grandl; Michael Braun; Franz Edler von Koch; Kristin Härtl; Stephan Hasmüller; Ingo Bauerfeind; Gerlinde Debus; Peter Herschbach; Nadia Harbeck

doi:10.1093/jnci/djv099

Elucidating pretreatment cognitive impairment in breast cancer patients: the impact of cancer-related post-traumatic stress

J Natl Cancer Inst. 2015 Apr 16;107(7):djv099. doi: 10.1093/jnci/djv099. Print 2015 Jul.

Authors

Kerstin Hermelink¹, Varinka Voigt², Judith Kaste², Franziska Neufeld², Rachel Wuerstlein², Markus Bühner², Karin Münzel², Dorothea Rjosk-Dendorfer², Susanne Grandl², Michael Braun², Franz Edler von Koch², Kristin Härtl², Stephan Hasmüller², Ingo Bauerfeind², Gerlinde Debus², Peter Herschbach², Nadia Harbeck²

Affiliations

¹ Breast Center, Department of Gynecology and Obstetrics (Campus Grosshadern), CCCLMU University Hospital of Munich, Munich, Germany (KHe, VV, JK, FN, SH, NH); Breast Center, Department of Gynecology and Obstetrics (Campus Innenstadt), CCCLMU University Hospital of Munich, Munich, Germany (RW, KHä); Department of Psychology, Division of Psychological Methods and Assessment, Ludwig Maximilian University of Munich, Munich, Germany (MBü); Department of Psychology, Division of Neuropsychology, Ludwig Maximilian University of Munich, Munich, Germany (KM); Institute for Clinical Radiology, CCCLMU University Hospital of Munich, Munich, Germany (DRD, SG); Breast Center, Department of Gynecology, Red Cross Hospital, Munich, Germany (MBr); Breast Center, Department of Gynecology and Obstetrics, Dritter Orden Hospital, Munich, Germany (FEvK); Breast Center, Department of Gynecology and Obstetrics, District Hospital of Ebersberg, Ebersberg, Germany (SH); Breast Center, Department of Gynecology and Obstetrics, Hospital of Landshut, Landshut, Germany (IB); Breast Center, Department of Gynecology and Obstetrics, Helios Amper Hospital Dachau, Dachau, Germany (GD); Department of Psychosomatic Medicine and Psychotherapy, Division of Psychosocial Oncology, Roman Herzog Comprehensive Cancer Center, Technical University of Munich, Munich, Germany (PH). kerstin.hermelink@med.uni-muenchen.de.
² Breast Center, Department of Gynecology and Obstetrics (Campus Grosshadern), CCCLMU University Hospital of Munich, Munich, Germany (KHe, VV, JK, FN, SH, NH); Breast Center, Department of Gynecology and Obstetrics (Campus Innenstadt), CCCLMU University Hospital of Munich, Munich, Germany (RW, KHä); Department of Psychology, Division of Psychological Methods and Assessment, Ludwig Maximilian University of Munich, Munich, Germany (MBü); Department of Psychology, Division of Neuropsychology, Ludwig Maximilian University of Munich, Munich, Germany (KM); Institute for Clinical Radiology, CCCLMU University Hospital of Munich, Munich, Germany (DRD, SG); Breast Center, Department of Gynecology, Red Cross Hospital, Munich, Germany (MBr); Breast Center, Department of Gynecology and Obstetrics, Dritter Orden Hospital, Munich, Germany (FEvK); Breast Center, Department of Gynecology and Obstetrics, District Hospital of Ebersberg, Ebersberg, Germany (SH); Breast Center, Department of Gynecology and Obstetrics, Hospital of Landshut, Landshut, Germany (IB); Breast Center, Department of Gynecology and Obstetrics, Helios Amper Hospital Dachau, Dachau, Germany (GD); Department of Psychosomatic Medicine and Psychotherapy, Division of Psychosocial Oncology, Roman Herzog Comprehensive Cancer Center, Technical University of Munich, Munich, Germany (PH).

PMID: 25882713
DOI: 10.1093/jnci/djv099

Abstract

Background: Pretreatment cognitive impairment in cancer patients is well established but unexplained. Similar cognitive compromise has been observed in post-traumatic stress disorder (PTSD) patients, and PTSD symptoms are a frequent concomitant of cancer diagnosis. We tested the hypothesis that pretreatment cognitive impairment is attributable to cancer-related post-traumatic stress.

Methods: Women aged 65 years or younger who were diagnosed with breast cancer (case patients) or had undergone negative routine breast imaging (control patients) at one of six participating breast centers underwent traditional and computerized neuropsychological testing, clinician-administered diagnostic assessment of stress disorders, and self-report assessments of cognitive function and depression. To minimize confounding, case patients were evaluated prior to any local or systemic treatment. Cognitive indices of case patients, control patients, and normative samples were compared. The patients' risk of overall cognitive impairment was determined. Linear regression and a mediation model were used to test the study hypothesis. All statistical tests were two-sided.

Results: The 166 case patients and 60 well-matched control patients showed near-identical deviations from population norms. Case patients scored worse than control patients on two of 20 cognitive indices (Go/Nogo commission errors, Go/Nogo omission errors). Self-reported cognitive problems were associated with Go/Nogo omission errors and more pronounced in case patients. Only PTSD symptoms (Beta = 0.27, P = .004) and age (Beta = 0.22, P = .04) statistically significantly predicted Go/Nogo errors. The effect of having cancer on Go/Nogo errors was mediated by PTSD symptoms. Case patients did not have an increased risk of overall cognitive impairment.

Conclusion: Prior to any treatment, breast cancer patients may show limited cognitive impairment that is apparently largely caused by cancer-related post-traumatic stress.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Breast Neoplasms / psychology*
Breast Neoplasms / therapy*
Case-Control Studies
Cognition*
Cognitive Dysfunction / diagnosis*
Cognitive Dysfunction / etiology*
Depression / etiology
Female
Humans
Linear Models
Middle Aged
Neuropsychological Tests
Prospective Studies
Risk Assessment
Risk Factors
Self Report
Stress Disorders, Post-Traumatic / etiology
Stress, Psychological / complications
Stress, Psychological / etiology*