Astudy by the Instituto de Saúde Pública da Universidade do Porto (ISPUP) analysed the evolution of the cognitive performance of a group of women diagnosed with breast cancer over the course of five years through the administration of a cognitive evaluation test known as the Montreal Cognitive Assessment.
The patients, followed at the Instituto Português de Oncologia do Porto (IPO Porto), are part of the ISPUP NEON-BC cohort.
It is known that cancer treatments, namely for breast cancer, have been pointed out as causing cognitive alterations in patients. Memory problems, difficulties in concentration and in decision making are some of the difficulties reported.
Most of the studies published on the subject do not follow the patients for a considerable period of time so as to understand whether the cognitive decline observed is persistent or reversible.
For this reason, the ISPUP researchers carried out the research present in Trajectories of cognitive performance over five years in a prospective cohort of patients with breast cancer (NEON-BC), where, over a period of five years, they analysed the variation in the cognitive trajectories of a group of women.
“The aim was to understand to what extent the cognitive problems persisted in time and see how frequent these problems were in the long term,” says Natália Araújo, first author of the study, coordinated by ISPUP researcher Nuno Lunet.
The study involved 464 women who were part of the ISPUP NEON-BC cohort (acronym that results from neuro-oncology and breast cancer), which, since 2012, has seeked to assess the neurological performance of women with breast cancer undergoing surgical intervention and other treatments in IPO Porto.
In order to assess their cognitive performance over time, the women were submitted to a test known as Montreal Cognitive Assessment. The test was administered before they started treatment, one year after their first treatment, as well as three and five years after.
The researchers found two groups of women with distinct cognitive trajectories. In one group, the cognitive performance trajectory consistently improved after one year and continued to improve over time.
However, in another group, comprising 26 per cent of the research participants, the opposite was true: women’s cognitive performance decreased after one year and worsened over multiple assessments. This group included older women with higher levels of anxiety and depression.
To understand how the cognitive trajectory of patients will evolve, Natália Araújo highlights the importance of evaluating cognitive performance one year after cancer diagnosis and subsequent beginning of treatments.
“It would be important, in clinical practice, to assess cognitive performance before the start of therapies and one year later, since, according to our study, the decline in cognitive performance during this time interval has been shown to be a predictor of poor cognitive performance in the long term,” she says.
Furthermore, “only assessing the cognitive performance of women before treatment is not a good predictor of the future cognitive performance of patients, since half of them eventually regain their abilities one year later,” she concludes.
According to the researchers, it is possible to screen patients’ cognitive performance in a more regular, simpler way using the Montreal Cognitive Assessment test.
“Through this test, which is free, quick, and most doctors know and can apply, it is possible to test women before treatments, a year or several years later,” she adds.
Psychological monitoring of patients is fundamental if the cognitive difficulties shown, especially in women with a trajectory of cognitive decline over time, are to be addressed.
The study was published in the scientific journal The Breast, and included the participation of researchers Milton Severo, Luísa Lopes-Conceição, Filipa Fontes, Teresa Dias, Mariana Branco, Samantha Morais, Vítor Tedim Cruz, Luís Ruano, Susana Pereira and Nuno Lunet.
The research received funding from FEDER, through the Competitiveness and Internationalisation Operational Programme, and from the Foundation for Science and Technology – FCT (Portuguese Ministry of Science, Technology and Higher Education), under the project “A five-year prospective cohort study on the neurological complications of breast cancer: frequency and impact in patient reported outcomes”.