Cognitive impairment in breast cancer patients before surgery: results from a CANTO cohort subgroup

Background:20-30% of breast cancer patients have cognitive impairment after surgery and before adjuvant treatment, but very few studies have focused on cognition before any treatment. The present study used a subgroup of women with newly diagnosed breast cancer patients from the French cancer and toxicities (CANTO) cohort to describe cognition before any treatment in comparison to a group of healthy controls (HC). Methods:Cognitive assessment was performed before any breast cancer treatment (surgery or neoadjuvant treatment) on women with newly diagnosed invasive stage I-III breast cancer and HC. Objective cognitive performance, cognitive complaints, anxiety, depression, and fatigue were assessed. Objective cognitive impairment was defined according to International Cognition and Cancer Task Force recommendations. Results:Of the 264 included breast cancer patients (54±11 years) and 132 age-matched HC (53±9 years), overall objective cognitive impairment was observed in 28% of breast cancer patients and 8% of HC (p<0.001). Cognitive complaints were reported by 24% of patients vs. 12% of HC (p<0.01). Patients reported significantly more anxiety, emotional and cognitive fatigue than HC (p<0.01). After adjustment, significantly more breast cancer patients had overall objective cognitive impairment than HC (OR=3.01, 95% CI: 1.31-6.88) without significant difference between groups for cognitive complaints (OR=1.38, 95% CI: 0.65-2.92). Cognitive complaints were positively associated with fatigue (OR=1.03, 95% CI: 1.02-1.05). Conclusions:In this prospective study, compared to HC, localized breast cancer patients had more objective cognitive impairment before any treatment. Cognitive complaints were mostly related to fatigue. Impact:Baseline assessment before treatment is important to assess the impact of each cancer treatment on cognition.