1. MARQUETTE UNIVERSITY COLLEGE OF NURSING Perceived Cognitive Changes During Breast Cancer Chemotherapy Linda Piacentine, PhD, ACNP Jiannan Zhang, BSN, RN Alan Bloom, PhD Judith F. Miller, PhD, RN, FAAN

2. MARQUETTE UNIVERSITY COLLEGE OF NURSING Chemobrain Cognitive deficits associated with chemotherapy –Reported by 15-50% –unknown severity and duration of decreased cognition –Cause of the phenomenon not understood Most common –Verbal and visual memory –Attention/concentration –Processing speed

3. MARQUETTE UNIVERSITY COLLEGE OF NURSING Study Aim To compare perceived cognitive ability (concentration/attention, fatigue, memory and language/word finding) among women who receive chemotherapy following surgery for breast cancer and healthy women

4. MARQUETTE UNIVERSITY COLLEGE OF NURSING Study Design/Methods Descriptive, longitudinal Four self-report instruments, administered prior to and after 4 cycles of chemotherapy Data analysis –Descriptive analysis of demographics –Repeated Measures Anova

5. MARQUETTE UNIVERSITY COLLEGE OF NURSING Instruments Functional Assessment of Cancer Therapy Cognitive Version (FACT-Cog) –50 items General well-being with Breast Module (FACT-B) –23 items Fatigue (FACIT-F) –13 items Beck Depression Inventory (BDI-II) –21 items

6. MARQUETTE UNIVERSITY COLLEGE OF NURSING Sample Description 11 women starting on chemotherapy -No metastasis -No previous chemo -No psych disorders or history of substance abuse -No previous traumatic brain injury 7 healthy women matched for age and education

7. MARQUETTE UNIVERSITY COLLEGE OF NURSING VariablesChemoHealthy Age (years) Age range (years) 46.2 (32-58) 48.3 (38-58) Percent Race-White Ethnicity-Hispanic 91 9 100 0 Education (mean years)17.116.4 Sample Description

8. MARQUETTE UNIVERSITY COLLEGE OF NURSING Chemotherapy Regimen AdriamycinCytoxan5-FUTaxotereCarboplatinTaxolHerceptin 1 AC DDYY Y 2 TC Y Y 3 AC DDYY Y 4 FACYYY Y 5 ACYY Allergic 6 AC DDYY 7 YY YY 8 TC Y Y 9 AC DDYY Y 10 TCH YY Y 11 TC Y Y

9. MARQUETTE UNIVERSITY COLLEGE OF NURSING Results FACT-Cog ChemoHealthy T1T2T1T2 Mental Acuity 14.6 (1.44) 11.9 (3.26) * 14.14 (1.77) 15.6 (0.79) Concentration 14.0 (1.55) 13.2 (1.99) 13.6 (2.64) 15.7 (0.49) * Memory # 25.8 (1.89) 22.7 (4.32) * 22.7 (4.63) 24.3 (3.62) Verbal Fluency # 23.6 (2.25) 19.1 (5.72) 24.5 (2.59) 24.8 (2.64) Functional 23.7 (1.74) 20.4 (5.52) *24.7 (2.58) 25.8 (2.40) Others comments 15.6 (0.92) 11.8 (4.40) *15.6 (0.54) Change 31.6 (2.91) 22.0 (12.51)*31.3 (5.22) 34.71 (1.70) FACT-Cog148.8 (8.15)121.0 (33.42)*147.8 (12.30)156.8 (7.44) COGQ 28.8 (2.82)25.9 (5.81 0)29.14±2.91 31.3 (0.76) & Indicates chemo group n=10 # indicates healthy group n=6 * Indicates a within group change over time Shading indicates a group difference at a specific time point

10. MARQUETTE UNIVERSITY COLLEGE OF NURSING Results FACT-B ChemoHealthy T1T2T1T2 PWB20.6 (1.91)18.6 (3.17)*23.4 (0.79)23.00 (1.00 ) SWB17.9 (2.66)17.6 (2.42)15.4 (4.04)16.00(3.16) EWB19.8 (4.22)21.0 (3.03)22.4 (1.72)22.6 (1.27) FWB21.2 (4.67)20.3 (5.42)24.7 (3.77)26.00 (2.08) BCS & 17.9 (4.20)17.1 (3.78)19.3 (2.69)20.14 (2.61) FACT-B 114.3 (20.74)112.8 (14.5) xxx FACT-B rev96.0 (16.38)95.0 (11.5)105.3 (10.90)107.7 (7.32) & Indicates number of participants in chemo group is 10 * Indicates a within group change over time Shading indicates a group difference at a specific time point

11. MARQUETTE UNIVERSITY COLLEGE OF NURSING Results FACIT-F ChemoHealthy T1T2T1T2 Fatigue42.3 (4.37)36.5 (8.87)*47.4 (5.32)48.1 (2.73) * Indicates a within group change over time Shading indicates a between group difference at a specific time point

12. MARQUETTE UNIVERSITY COLLEGE OF NURSING Results BDI-II ChemoHealthy T1T2T1T2 Becks7.8 (5.38)10.8 (6.74)1.2 (0.75)0.83 (1.60)

13. MARQUETTE UNIVERSITY COLLEGE OF NURSING Conclusions Pre-chemotherapy compared to after 4 cycles: –Cognitive impairment increases –Physical well-being decreases –Fatigue symptoms increase Healthy persons report less fatigue at both timepoints Healthy persons report less cognitive impairment compared to those who have had 4 cycles of chemotherapy

14. MARQUETTE UNIVERSITY COLLEGE OF NURSING Limitations Pilot study with small sample size Lack of control group with cancer but no chemotherapy Unable to assess prior to cancer diagnosis and surgery Highly educated women Incomplete data Cognitive tool in development

15. MARQUETTE UNIVERSITY COLLEGE OF NURSING Future Directions Compare data to imaging and qualitative data Larger sample size Cancer control group Supported in part by DOD grant BC086890, State of Wisconsin Breast Cancer Check-off Funds and Greater Milwaukee Foundation and MCW Cancer Center