Cognitive function and discontinuation of adjuvant hormonal therapy in older breast cancer survivors

CALGB 369901 (Alliance)

Shirley Bluethmann, Catherine M. Alfano, Jonathan D. Clapp, George Luta, Brent J. Small, Arti Hurria, Harvey J. Cohen, Steven Sugarman, Hyman B. Muss, Claudine Isaacs, Jeanne S. Mandelblatt

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Purpose: To investigate the effects of cognitive function on discontinuation of hormonal therapy in breast cancer survivors ages 65+ (“older”). Methods: Older breast cancer survivors with invasive, non-metastatic disease, and no reported cognitive difficulties were recruited from 78 Alliance sites between 2004 and 2011. Eligible survivors (n = 1280) completed baseline interviews; follow-up was conducted annually for up to 7 years. Survivors with estrogen-receptor-positive (ER+) cancers who initiated hormonal therapy (n = 990) were included. Self-reported cognitive function was measured using the EORTC-QLQ30 scale; a difference of eight points on the 0–100 scale was considered clinically significant. Based on varying rates of discontinuation over time, discontinuation was evaluated separately for three time periods: early (<1 year); midpoint (1–3 years); and late discontinuation (>3–5 years). Cox models for each time period were used to evaluate the effects of cognition immediately preceding discontinuation, controlling for age, chemotherapy, and other covariates. Results: Survivors were 65–91 years old (mean 72.6 years), and 79% had stages 1 or 2A disease. Overall, 43% discontinued hormonal therapy before 5 years. Survivors who reported lower cognitive function in the period before discontinuation had greater hazards of discontinuing therapy at the treatment midpoint (HR 1.22 per 8-point difference, CI 1.09–1.40, p < 0.001), considering covariates, but cognition was not related to discontinuation in the other periods. Conclusions: Self-reported cognitive problems were a significant risk factor for discontinuation of hormonal therapy 1–3 years post-initiation. Additional research is needed on the temporality of cognitive effects and hormonal therapy to support survivorship care needs of older survivors.

Original languageEnglish (US)
Pages (from-to)677-686
Number of pages10
JournalBreast Cancer Research and Treatment
Volume165
Issue number3
DOIs
StatePublished - Oct 1 2017

Fingerprint

Cognition
Breast Neoplasms
Therapeutics
Proportional Hazards Models
Estrogen Receptors
Interviews
Drug Therapy
Research
Neoplasms

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Bluethmann, Shirley ; Alfano, Catherine M. ; Clapp, Jonathan D. ; Luta, George ; Small, Brent J. ; Hurria, Arti ; Cohen, Harvey J. ; Sugarman, Steven ; B. Muss, Hyman ; Isaacs, Claudine ; Mandelblatt, Jeanne S. / Cognitive function and discontinuation of adjuvant hormonal therapy in older breast cancer survivors : CALGB 369901 (Alliance). In: Breast Cancer Research and Treatment. 2017 ; Vol. 165, No. 3. pp. 677-686.
@article{823db949f3ae46c094c924cf845acde2,
title = "Cognitive function and discontinuation of adjuvant hormonal therapy in older breast cancer survivors: CALGB 369901 (Alliance)",
abstract = "Purpose: To investigate the effects of cognitive function on discontinuation of hormonal therapy in breast cancer survivors ages 65+ (“older”). Methods: Older breast cancer survivors with invasive, non-metastatic disease, and no reported cognitive difficulties were recruited from 78 Alliance sites between 2004 and 2011. Eligible survivors (n = 1280) completed baseline interviews; follow-up was conducted annually for up to 7 years. Survivors with estrogen-receptor-positive (ER+) cancers who initiated hormonal therapy (n = 990) were included. Self-reported cognitive function was measured using the EORTC-QLQ30 scale; a difference of eight points on the 0–100 scale was considered clinically significant. Based on varying rates of discontinuation over time, discontinuation was evaluated separately for three time periods: early (<1 year); midpoint (1–3 years); and late discontinuation (>3–5 years). Cox models for each time period were used to evaluate the effects of cognition immediately preceding discontinuation, controlling for age, chemotherapy, and other covariates. Results: Survivors were 65–91 years old (mean 72.6 years), and 79{\%} had stages 1 or 2A disease. Overall, 43{\%} discontinued hormonal therapy before 5 years. Survivors who reported lower cognitive function in the period before discontinuation had greater hazards of discontinuing therapy at the treatment midpoint (HR 1.22 per 8-point difference, CI 1.09–1.40, p < 0.001), considering covariates, but cognition was not related to discontinuation in the other periods. Conclusions: Self-reported cognitive problems were a significant risk factor for discontinuation of hormonal therapy 1–3 years post-initiation. Additional research is needed on the temporality of cognitive effects and hormonal therapy to support survivorship care needs of older survivors.",
author = "Shirley Bluethmann and Alfano, {Catherine M.} and Clapp, {Jonathan D.} and George Luta and Small, {Brent J.} and Arti Hurria and Cohen, {Harvey J.} and Steven Sugarman and {B. Muss}, Hyman and Claudine Isaacs and Mandelblatt, {Jeanne S.}",
year = "2017",
month = "10",
day = "1",
doi = "10.1007/s10549-017-4353-y",
language = "English (US)",
volume = "165",
pages = "677--686",
journal = "Breast Cancer Research and Treatment",
issn = "0167-6806",
publisher = "Springer New York",
number = "3",

}

Bluethmann, S, Alfano, CM, Clapp, JD, Luta, G, Small, BJ, Hurria, A, Cohen, HJ, Sugarman, S, B. Muss, H, Isaacs, C & Mandelblatt, JS 2017, 'Cognitive function and discontinuation of adjuvant hormonal therapy in older breast cancer survivors: CALGB 369901 (Alliance)', Breast Cancer Research and Treatment, vol. 165, no. 3, pp. 677-686. https://doi.org/10.1007/s10549-017-4353-y

Cognitive function and discontinuation of adjuvant hormonal therapy in older breast cancer survivors : CALGB 369901 (Alliance). / Bluethmann, Shirley; Alfano, Catherine M.; Clapp, Jonathan D.; Luta, George; Small, Brent J.; Hurria, Arti; Cohen, Harvey J.; Sugarman, Steven; B. Muss, Hyman; Isaacs, Claudine; Mandelblatt, Jeanne S.

In: Breast Cancer Research and Treatment, Vol. 165, No. 3, 01.10.2017, p. 677-686.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Cognitive function and discontinuation of adjuvant hormonal therapy in older breast cancer survivors

T2 - CALGB 369901 (Alliance)

AU - Bluethmann, Shirley

AU - Alfano, Catherine M.

AU - Clapp, Jonathan D.

AU - Luta, George

AU - Small, Brent J.

AU - Hurria, Arti

AU - Cohen, Harvey J.

AU - Sugarman, Steven

AU - B. Muss, Hyman

AU - Isaacs, Claudine

AU - Mandelblatt, Jeanne S.

PY - 2017/10/1

Y1 - 2017/10/1

N2 - Purpose: To investigate the effects of cognitive function on discontinuation of hormonal therapy in breast cancer survivors ages 65+ (“older”). Methods: Older breast cancer survivors with invasive, non-metastatic disease, and no reported cognitive difficulties were recruited from 78 Alliance sites between 2004 and 2011. Eligible survivors (n = 1280) completed baseline interviews; follow-up was conducted annually for up to 7 years. Survivors with estrogen-receptor-positive (ER+) cancers who initiated hormonal therapy (n = 990) were included. Self-reported cognitive function was measured using the EORTC-QLQ30 scale; a difference of eight points on the 0–100 scale was considered clinically significant. Based on varying rates of discontinuation over time, discontinuation was evaluated separately for three time periods: early (<1 year); midpoint (1–3 years); and late discontinuation (>3–5 years). Cox models for each time period were used to evaluate the effects of cognition immediately preceding discontinuation, controlling for age, chemotherapy, and other covariates. Results: Survivors were 65–91 years old (mean 72.6 years), and 79% had stages 1 or 2A disease. Overall, 43% discontinued hormonal therapy before 5 years. Survivors who reported lower cognitive function in the period before discontinuation had greater hazards of discontinuing therapy at the treatment midpoint (HR 1.22 per 8-point difference, CI 1.09–1.40, p < 0.001), considering covariates, but cognition was not related to discontinuation in the other periods. Conclusions: Self-reported cognitive problems were a significant risk factor for discontinuation of hormonal therapy 1–3 years post-initiation. Additional research is needed on the temporality of cognitive effects and hormonal therapy to support survivorship care needs of older survivors.

AB - Purpose: To investigate the effects of cognitive function on discontinuation of hormonal therapy in breast cancer survivors ages 65+ (“older”). Methods: Older breast cancer survivors with invasive, non-metastatic disease, and no reported cognitive difficulties were recruited from 78 Alliance sites between 2004 and 2011. Eligible survivors (n = 1280) completed baseline interviews; follow-up was conducted annually for up to 7 years. Survivors with estrogen-receptor-positive (ER+) cancers who initiated hormonal therapy (n = 990) were included. Self-reported cognitive function was measured using the EORTC-QLQ30 scale; a difference of eight points on the 0–100 scale was considered clinically significant. Based on varying rates of discontinuation over time, discontinuation was evaluated separately for three time periods: early (<1 year); midpoint (1–3 years); and late discontinuation (>3–5 years). Cox models for each time period were used to evaluate the effects of cognition immediately preceding discontinuation, controlling for age, chemotherapy, and other covariates. Results: Survivors were 65–91 years old (mean 72.6 years), and 79% had stages 1 or 2A disease. Overall, 43% discontinued hormonal therapy before 5 years. Survivors who reported lower cognitive function in the period before discontinuation had greater hazards of discontinuing therapy at the treatment midpoint (HR 1.22 per 8-point difference, CI 1.09–1.40, p < 0.001), considering covariates, but cognition was not related to discontinuation in the other periods. Conclusions: Self-reported cognitive problems were a significant risk factor for discontinuation of hormonal therapy 1–3 years post-initiation. Additional research is needed on the temporality of cognitive effects and hormonal therapy to support survivorship care needs of older survivors.

UR - http://www.scopus.com/inward/record.url?scp=85021289624&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85021289624&partnerID=8YFLogxK

U2 - 10.1007/s10549-017-4353-y

DO - 10.1007/s10549-017-4353-y

M3 - Article

VL - 165

SP - 677

EP - 686

JO - Breast Cancer Research and Treatment

JF - Breast Cancer Research and Treatment

SN - 0167-6806

IS - 3

ER -