Purpose: Proton pump inhibitors (PPIs) are used in cancer patients to manage treatment-related gastrointestinal symptoms and to prevent damage to the gastric mucosal lining during treatment. However, PPI use may contribute to cognitive problems. To compare PPI-users and non-users, breast cancer survivors reported cognitive problems in three studies.
Methods: In Study 1, breast cancer survivors (N = 209; n = 173 non-users, n = 36 PPI-users; stages 0-IIIC) rated their cognitive function on the Kohli scale prior to cancer treatment, as well as one and two years later. In Study 2, women (N = 200; n = 169 non-users, n = 31 PPI-users, stages 0-IIIa, M = 11 months post-treatment) rated their cognitive function on the Kohli scale and BCPT checklist at three visits over a six-month period. In Study 3, participants (N = 142; n = 121 non-users, n = 21 PPI-users; stages I-IIIa, M = 4 years post-treatment) rated their cognitive function on the Kohli scale, BCPT checklist, and Functional Assessment of Cancer Therapy cognitive scale (FACT-cog).
Results: In Study 1, PPI-users reported more severe concentration problems (p = 0.039) but not memory problems (p = 0.17) than non-users. In Study 2, PPI-users reported more severe concentration problems (p = 0.022) than non-users, but not memory problems or symptoms on the BCPT (ps = 0.11). Study 3's PPI-users reported more severe memory problems (p = 0.002), poorer overall cognitive function (p = 0.006), lower quality of life related to cognitive problems (p = 0.005), greater perceived cognitive impairment (p = 0.013), and poorer cognitive abilities (p = 0.046), but not more severe concentration problems (p = 0.16), compared to non-users.
Conclusions/implications: PPI use may impair breast cancer survivors' memory, concentration, and quality of life.
Keywords: Breast cancer survivors; Cognitive symptoms, concentration, memory; Proton pump inhibitors.
Conflict of interest statement
Conflicts of Interest: The authors had no conflicts of interest.
Lack of Association Between Proton Pump Inhibitor Use and Cognitive Decline.Clin Gastroenterol Hepatol. 2018 May;16(5):681-689. doi: 10.1016/j.cgh.2018.01.034. Epub 2018 Jan 31. Clin Gastroenterol Hepatol. 2018. PMID: 29391266
Systematic reviews of the clinical effectiveness and cost-effectiveness of proton pump inhibitors in acute upper gastrointestinal bleeding.Health Technol Assess. 2007 Dec;11(51):iii-iv, 1-164. doi: 10.3310/hta11510. Health Technol Assess. 2007. PMID: 18021578 Review.
Proton-pump inhibitor utilization associated with the change to nonpreferred formulary status for esomeprazole in the TRICARE formulary.J Manag Care Pharm. 2009 Jan-Feb;15(1):42-54. doi: 10.18553/jmcp.2009.15.1.42. J Manag Care Pharm. 2009. PMID: 19125549
Cognitive problems among breast cancer survivors: loneliness enhances risk.Psychooncology. 2014 Dec;23(12):1356-64. doi: 10.1002/pon.3544. Epub 2014 Apr 11. Psychooncology. 2014. PMID: 24729533 Free PMC article.
Long-term proton pump inhibitor (PPI) use and the development of gastric pre-malignant lesions.Cochrane Database Syst Rev. 2014 Dec 2;(12):CD010623. doi: 10.1002/14651858.CD010623.pub2. Cochrane Database Syst Rev. 2014. PMID: 25464111 Review.