Prospective cohort data show: Nearly half of all women undergoing therapy for breast cancer experience neurological complications. Cognitive impairment is also common in this population. If one wants to reduce the disease burden of those affected, early detection and treatment of such problems is central.
A total of 506 Portuguese female patients with an average age of 55 years participated in the prospective cohort study. After an initial neurologic examination before starting cancer therapy, neoadjuvant chemotherapy followed in some, resection in all (breast-conserving in about 50%, with axillary lymph node dissection in a good third), and again adjuvant treatment, whether with hormone therapy, radiation, or chemotherapy, in most. After surgery, (if performed) after chemotherapy and after one year, further neurological tests followed. At baseline and after one year, we also tested cognitive function with the so-called Montreal Cognitive Assessment.
Neuropathic pain occurs most frequently
Overall, 6.9% of the 506 women received neoadjuvant chemotherapy, 83.9% completed adjuvant hormone therapy, 73.0% radio therapy, and 52.5% chemotherapy. This mostly consisted of three cycles of 5-fluorouracil, epirubicin, and cyclophosphamide, followed by three cycles of docetaxel. A taxane-based regimen was used in 71.6% of patients receiving chemotherapy overall. More than half of all women had stage 0 or I breast cancer.
In the first year, at least one associated neurologic complication occurred in a total of 48.4% of women (95% CI 44.1-52.8%). Neuropathic pain was the most common, occurring in 30.8%, mainly in the surgical area. Also common were chemotherapy-induced peripheral neuropathy (16.8%) and phantom breast pain (16.6%). Cognitive decline was observed in 8.1%. At baseline, neurologic examination was still largely unremarkable, with migraine being the most common finding.
Clinical relevance of the results
The authors emphasize that neurological problems in particular can be very distressing in the course of breast cancer disease and make a contribution to morbidity that should not be underestimated. Determining their frequency would be a first step, but it would be much more important to identify and address such complications at an early stage. The study showed that such a proactive approach was indicated in nearly 50% of patients.
Source: Pereira S, et al: Neurological complications of breast cancer: A prospective cohort study. Breast 2015, June 18. DOI: http://dx.doi.org/10.1016/j.breast.2015.05.006 (Epub ahead of print).
InFo ONCOLOGY & HEMATOLOGY 2015; 3(9-10): 4-5.
