Acute Change in Perceived Cognitive Performance Across Different Age Groups Following First Chemotherapy Infusion in Female Patients With Breast Cancer

BACKGROUND: Cancer-related cognitive impairment (CRCI) is frequently reported by women with breast cancer after chemotherapy. Yet, the acute effects of a single infusion on perceived cognition remain understudied, especially across different age groups.

AIMS: This study assessed acute changes in perceived cognition following the first chemotherapy infusion in young (< 40 years), middle-aged (40-64 years), and older adults (≥ 65 years) with breast cancer and identified baseline risk factors associated with worsened CRCI in these age groups.

METHODS: Chemotherapy-naïve women with breast cancer scheduled for intravenous chemotherapy completed PROMIS Cognitive Abilities 4a and Cognitive Function 8a assessments before and 5 days post-infusion. Clinically significant CRCI was defined as T-scores ≤ 45. Paired t-tests, chi-square tests, and residualized regression models (univariate and multivariable) were used to evaluate changes in cognition and associated risk factors.

RESULTS: Among all participants (N = 528; 85 young, 329 middle-aged, 114 older), perceived cognitive performance significantly declined, and the prevalence of CRCI increased across all three age groups (FDR adjusted p-values < 0.05). Among middle-aged patients, the White race (p = 0.011) and a college degree (p = 0.001) were associated with worsened cognitive function, while a college degree (p = 0.009) and sleep disturbance (p = 0.012) were linked to worsened cognitive ability. In older adults, depressive symptoms were associated with worsened cognitive function (p = 0.017) and cognitive ability (p = 0.011).

CONCLUSIONS: Cognitive impairment develops acutely after the first chemotherapy infusion across all age groups, with risk factors varying by age. Age-specific interventions are needed to address early cognitive decline in breast cancer patients.