Effects of Comorbid Disease on Pre-treatment Neurobehavioral Functioning. Sunita K. Patel, PhD

Effects of Comorbid Disease on Pre-treatment
Neurobehavioral Functioning.
Sunita K. Patel, PhD
Assistant Professor
City of Hope Medical Center
D arte California
D
u
arte
,
California
.

Pr
e
-
C
h
e
m
o
th
e
r
apy
Cog
niti
ve
F
u
n
c
ti
o
nin
g
e
Ce o eapyCog ve uco g
Neurocognitive dysfunction in survivors of breast cancer is primarily
attributed to the effects of chemotherapy and/or hormonal therapy.
However, more recent studies suggest these symptoms are present even prior
to adjuvant treatments.
Initially reported in the first prospective trial that assessed pts prior to chemo
rather than only after treatment (Wefel et al., Cancer, 2004).
In this study of breast cancer pts, 33% showed neurocognitive deficits prior to
starting chemo.
Th f l i b t 30% t
hhib
Th
e presence o
f
l
ow scores
i
n a
b
ou
t
30%
a
t
pre-c
h
emo
h
as s
i
nce
b
een
replicated with larger N = 101 (Hermelink et al., Cancer 2007).
The reasons for cognitive problems in cancer patients
prior
to treatment are not
The
reasons
for
cognitive
problems
in
cancer
patients
prior
to
treatment
are
not
known.
Possible mechanisms underlying effects for both prior treatment, and for the
dysfunction observed following treatment, have been postulated.

Proposed Mechanisms for Cognitive Changes
Proposed
Mechanisms
for
Cognitive
Changes
.
Blood
brain barrier
Blood
-
brain
barrier
integrity
Changes in
cognition, and
Genetic
susceptibility DNA damage and
telomere length
brain structure
and function
Oestrogen or
testosterone reduction
Cytokine
deregulation
testosterone
reduction
deregulation
Ahl d S ki
Nt R i C
7 2007
Ahl
es an
d
S
ay
ki
n,
N
a
t
ure
R
ev
i
ews
C
ancer,
7
,
2007

Study Objective and Background
Study
Objective
and
Background
We hypothesized that comorbid health status at cancer diagnosis is
associated with lowered neurocognitive and behavioral functioning
associated
with
lowered
neurocognitive
and
behavioral
functioning
prior to initiation of cancer treatment.
This was based on the literature linking cognitive and behavioral
This
was
based
on
the
literature
linking
cognitive
and
behavioral
dysfunction with various non-cancer health/disease conditions.
Type 1 and Type 2 diabetes have been associated with neurocognitive
Type
1
and
Type
2
diabetes
have
been
associated
with
neurocognitive
compromise (Review article: Kodl et al., 2008).
There is an increased incidence of dementia in pts with Type 2 (Cukierman
et al 2005)
et
al
.,
2005)
Elevated blood pressure is a risk factor for vascular dementia and
decline of cognitive function in middle age and older patients
decline
of
cognitive
function
in
middle
age
and
older
patients
(Papademetriou, 2005).
Treating HTN lessens the cognitive complications
“only 34% of hypertensive Americans have their hypertension
under control, despite widespread treatment”(Papademetriou, 2005).

Methods
Methods
Used data from an ongoing study tracking various outcomes in newly
Used
data
from
an
ongoing
study
tracking
various
outcomes
in
newly
diagnosed breast cancer pts. across two years.
In the larger study,
p
ost-menopausal women newly diagnosed with
breast cancer are seen for neurobehavioral assessment prior to any
treatment, includin
g
sur
g
er
y
.
ggy
We used the baseline assessment data to evaluate the impact of a co-
bid h lth diti b h i l f ti i i t
mor
bid
h
ea
lth
con
diti
on on neuro
b
e
h
av
i
ora
l
f
unc
ti
on
i
ng pr
i
or
t
o any
treatment.
Results are based on 176 post-menopausal breast cancer patients for
whom we have pre-treatment data.