IMPAIRMENT OF COGNITIVE FUNCTION IN WOMEN RECEIVING ADJUVANT TREATMENT FOR HIGH-RISK BREAST-CANCER - HIGH-DOSE VERSUS STANDARD-DOSE CHEMOTHERAPY

Background: Although high-dose chemotherapy is rapidly gaining accepta nce as a treatment option for a number of cancers, the long-term toxic effects of such therapy are a concern, Cognitive deficits (e,g,, prob lems with memory and concentration) are not uncommon after chemotherap y, but they have not been documented systematically, In this study, we assessed the prevalence of cognitive deficits in a group of patients with high-risk breast cancer who were randomly assigned to receive eit her high-dose or standard-dose adjuvant chemotherapy plus tamoxifen, a nd we investigated whether high-dose chemotherapy impaired cognitive f unctioning more than standard-dose chemotherapy, Methods: Cognitive fu nctioning was evaluated by use of a battery of neuropsychologic tests, In addition, patients were interviewed with regard to cognitive probl ems, health-related quality of life, anxiety, and depression, Results from patients who received adjuvant systemic therapy were compared wit h results from patients who had early stage breast cancer not treated with such therapy (control patients), Results: The study population co nsisted of 34 patients treated with high-dose chemotherapy plus tamoxi fen, 36 patients treated with standard-dose chemotherapy plus tamoxife n, and 34 control patients, For all patients, the average time since t he completion of last nonhormonal therapy was 2 years, Cognitive impai rment was found in 32% of the patients treated with high-dose chemothe rapy, in 17% of the patients treated with standard-dose chemotherapy, and in 9% of the control patients, In comparison with the control pati ents, patients treated with high-dose chemotherapy appeared to have an 8.2-times higher risk of cognitive impairment (odds ratio; 95% confid ence interval [CI] = 1.8-37.7); in comparison with the patients who re ceived standard-dose chemotherapy, this risk of impairment was 3.5-tim es higher (95% CI = 1.0-12.8), Conclusion: High-dose chemotherapy appe ars to impair cognitive functioning more than standard-dose chemothera py, Central nervous system toxicity may be a dose-limiting factor in h igh-dose chemotherapy regimens.