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Elevated C-Reactive Protein and Subsequent Patient-Reported Cognitive Problems in Older Breast Cancer Survivors: The Thinking and Living With Cancer Study.

Publication ,  Journal Article
Carroll, JE; Nakamura, ZM; Small, BJ; Zhou, X; Cohen, HJ; Ahles, TA; Ahn, J; Bethea, TN; Extermann, M; Graham, D; Isaacs, C; Jim, HSL ...
Published in: J Clin Oncol
January 10, 2023

PURPOSE: To examine longitudinal relationships between levels of C-reactive protein (CRP) and cognition in older breast cancer survivors and noncancer controls. METHODS: English-speaking women age ≥ 60 years, newly diagnosed with primary breast cancer (stage 0-III), and frequency-matched controls were enrolled from September 2010 to March 2020; women with dementia, neurologic disorders, and other cancers were excluded. Assessments occurred presystemic therapy/enrollment and at annual visits up to 60 months. Cognition was measured using the Functional Assessment of Cancer Therapy-Cognitive Function and neuropsychological testing. Mixed linear effect models tested for survivor-control differences in natural log (ln)-transformed CRP at each visit. Random effect-lagged fluctuation models tested directional effects of ln-CRP on subsequent cognition. All models controlled for age, race, study site, cognitive reserve, obesity, and comorbidities; secondary analyses evaluated if depression or anxiety affected results. RESULTS: There were 400 survivors and 329 controls with CRP specimens and follow-up data (average age of 67.7 years; range, 60-90 years). The majority of survivors had stage I (60.9%), estrogen receptor-positive (87.6%) tumors. Survivors had significantly higher adjusted mean ln-CRP than controls at baseline and 12-, 24-, and 60-month visits (all P < .05). Higher adjusted ln-CRP predicted lower participant-reported cognition on subsequent visits among survivors, but not controls (P interaction = .008); effects were unchanged by depression or anxiety. Overall, survivors had adjusted Functional Assessment of Cancer Therapy-Cognitive Function scores that were 9.5 and 14.2 points lower than controls at CRP levels of 3.0 and 10.0 mg/L. Survivors had poorer neuropsychological test performance (v controls), with significant interactions with CRP only for the Trails B test. CONCLUSION: Longitudinal relationships between CRP and cognition in older breast cancer survivors suggest that chronic inflammation may play a role in development of cognitive problems. CRP testing could be clinically useful in survivorship care.

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Published In

J Clin Oncol

DOI

EISSN

1527-7755

Publication Date

January 10, 2023

Volume

41

Issue

2

Start / End Page

295 / 306

Location

United States

Related Subject Headings

  • Patient Reported Outcome Measures
  • Oncology & Carcinogenesis
  • Middle Aged
  • Humans
  • Female
  • Cognition
  • Cancer Survivors
  • C-Reactive Protein
  • Breast Neoplasms
  • Aged
 

Citation

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Carroll, J. E., Nakamura, Z. M., Small, B. J., Zhou, X., Cohen, H. J., Ahles, T. A., … Mandelblatt, J. S. (2023). Elevated C-Reactive Protein and Subsequent Patient-Reported Cognitive Problems in Older Breast Cancer Survivors: The Thinking and Living With Cancer Study. J Clin Oncol, 41(2), 295–306. https://doi.org/10.1200/JCO.22.00406
Carroll, Judith E., Zev M. Nakamura, Brent J. Small, Xingtao Zhou, Harvey J. Cohen, Tim A. Ahles, Jaeil Ahn, et al. “Elevated C-Reactive Protein and Subsequent Patient-Reported Cognitive Problems in Older Breast Cancer Survivors: The Thinking and Living With Cancer Study.J Clin Oncol 41, no. 2 (January 10, 2023): 295–306. https://doi.org/10.1200/JCO.22.00406.
Carroll JE, Nakamura ZM, Small BJ, Zhou X, Cohen HJ, Ahles TA, et al. Elevated C-Reactive Protein and Subsequent Patient-Reported Cognitive Problems in Older Breast Cancer Survivors: The Thinking and Living With Cancer Study. J Clin Oncol. 2023 Jan 10;41(2):295–306.
Carroll, Judith E., et al. “Elevated C-Reactive Protein and Subsequent Patient-Reported Cognitive Problems in Older Breast Cancer Survivors: The Thinking and Living With Cancer Study.J Clin Oncol, vol. 41, no. 2, Jan. 2023, pp. 295–306. Pubmed, doi:10.1200/JCO.22.00406.
Carroll JE, Nakamura ZM, Small BJ, Zhou X, Cohen HJ, Ahles TA, Ahn J, Bethea TN, Extermann M, Graham D, Isaacs C, Jim HSL, Jacobsen PB, McDonald BC, Patel SK, Rentscher K, Root J, Saykin AJ, Tometich DB, Van Dyk K, Zhai W, Breen EC, Mandelblatt JS. Elevated C-Reactive Protein and Subsequent Patient-Reported Cognitive Problems in Older Breast Cancer Survivors: The Thinking and Living With Cancer Study. J Clin Oncol. 2023 Jan 10;41(2):295–306.

Published In

J Clin Oncol

DOI

EISSN

1527-7755

Publication Date

January 10, 2023

Volume

41

Issue

2

Start / End Page

295 / 306

Location

United States

Related Subject Headings

  • Patient Reported Outcome Measures
  • Oncology & Carcinogenesis
  • Middle Aged
  • Humans
  • Female
  • Cognition
  • Cancer Survivors
  • C-Reactive Protein
  • Breast Neoplasms
  • Aged