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[The effect of hormone therapy on cognitive function in patients with breast cancer]
C M T Schilder1, S C Linn, F S A M van Dam
1Nederlands Kanker Instituut-Antoni van Leeuwenhoek Ziekenhuis, Plesmanlaan 121, 1066 CX Amsterdam. c.schilder@nki.nl
Abstract:
Preclinical and clinical studies suggest that oestrogens have an important role in brain functioning and cognitive ability. Given that hormone therapies for breast cancer reduce oestrogen levels or block oestrogen receptors, it is conceivable that these agents also influence cognitive function. Several small studies have been conducted to address this issue, but many of them are methodologically insufficient. The negative effects of oophorectomy and luteinising hormone-releasing hormone (LHRH) analogues on verbal memory and working memory have been demonstrated the most consistently, albeit only in small studies. Anastrozole and tamoxifen also appear to exert some negative effect on cognition, but well-designed studies are lacking. No data are available on the influence of the aromatase inhibitors exemestane and letrozole on cognitive function. Raloxifene, a drug that has no obvious advantages over tamoxifen and will likely not be developed further for breast cancer treatment, has no negative influence on cognitive functioning. It remains unclear whether the observed effects are transient or permanent, and to what extent age, menopausal status and duration of therapy influence the severity of cognitive effects.
Insights
Breast cancer hormone therapies may impact cognitive function, particularly memory. Oophorectomy and LHRH analogues show consistent negative effects, while anastrozole and tamoxifen suggest potential cognitive decline, requiring further research.
Area of Science:
- Neuroendocrinology
- Oncology
- Cognitive Neuroscience
Context:
- Estrogens play a crucial role in brain function and cognition.
- Hormone therapies for breast cancer alter estrogen levels or block receptors.
- Potential cognitive side effects of these therapies warrant investigation.
Purpose:
- To review existing evidence on the impact of breast cancer hormone therapies on cognitive function.
- To identify specific therapies associated with cognitive changes and highlight research gaps.
Summary:
- Oophorectomy and luteinizing hormone-releasing hormone (LHRH) analogues consistently show negative effects on verbal and working memory in small studies.
- Anastrozole and tamoxifen may also negatively affect cognition, but robust studies are limited.
- Exemestane, letrozole, and raloxifene have no reported negative cognitive impact, though data for the former two is absent.
- The long-term and influencing factors (age, menopausal status, therapy duration) of these cognitive effects remain unclear.
Impact:
- Highlights the need for methodologically sound studies to confirm and quantify cognitive effects of breast cancer treatments.
- Informs clinicians and patients about potential cognitive risks associated with specific hormone therapies.
- Guides future research directions focusing on mechanisms and mitigating strategies for therapy-induced cognitive impairment.
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