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Cognitive impairment in older patients with breast cancer before systemic therapy: is there an interaction between cancer and comorbidity?
Mandelblatt JS, Stern RA, Luta G, Luta G, McGuckin M, Clapp JD, Hurria A, Jacobsen PB et al.. Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2014-05-19
Topic: Risk, prevention and care in population studies
Purpose To determine if older patients with breast cancer have cognitive impairment before systemic therapy. Patients and methods Participants were patients with newly diagnosed nonmetastatic breast cancer and matched friend or community controls age > 60 years without prior systemic treatment, dementia, or neurologic disease. Participants completed surveys and a 55-minute battery of 17 neuropsychological tests. Biospecimens were obtained for APOE genotyping, and clinical data were abstracted. Neuropsychological test scores were standardized using control means and standard deviations (SDs) and grouped into five domain z scores. Cognitive impairment was defined as any domain z score two SDs below or ≥ two z scores 1.5 SDs below the control mean. Multivariable analyses evaluated pretreatment differences considering age, race, education, and site; comparisons between patient cases also controlled for surgery. Results The 164 patient cases and 182 controls had similar neuropsychological domain scores. However, among patient cases, those with stage II to III cancers had lower executive function compared with those with stage 0 to I disease, after adjustment (P = .05). The odds of impairment were significantly higher among older, nonwhite, less educated women and those with greater comorbidity, after adjustment. Patient case or control status, anxiety, depression, fatigue, and surgery were not associated with impairment. However, there was an interaction between comorbidity and patient case or control status; comorbidity was strongly associated with impairment among patient cases (adjusted odds ratio, 8.77; 95% CI, 2.06 to 37.4; P = .003) but not among controls (P = .97). Only diabetes and cardiovascular disease were associated with impairment among patient cases. Conclusion There were no overall differences between patients with breast cancer and controls before systemic treatment, but there may be pretreatment cognitive impairment within subgroups of patient cases with greater tumor or comorbidity burden.
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APA 7th
Mandelblatt, J. S., Stern, R. A., Luta, G., McGuckin, M., Clapp, J. D., Hurria, A., et al. (2014). Cognitive impairment in older patients with breast cancer before systemic therapy: is there an interaction between cancer and comorbidity? Journal of clinical oncology : official journal of the American Society of Clinical Oncology. https://doi.org/10.1200/jco.2013.54.2050
Vancouver
Mandelblatt JS, Stern RA, Luta G, McGuckin M, Clapp JD, Hurria A, et al. Cognitive impairment in older patients with breast cancer before systemic therapy: is there an interaction between cancer and comorbidity? Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2014. doi:10.1200/jco.2013.54.2050. PMID: 24841981.
BibTeX
@article{mandelblatt2014-24841981,
author = {Mandelblatt, J. S. and Stern, R. A. and Luta, G. and McGuckin, M. and Clapp, J. D. and Hurria, A. and Jacobsen, P. B. and others},
title = {{Cognitive impairment in older patients with breast cancer before systemic therapy: is there an interaction between cancer and comorbidity?}},
journal = {Journal of clinical oncology : official journal of the American Society of Clinical Oncology},
year = {2014},
doi = {10.1200/jco.2013.54.2050},
pmid = {24841981},
url = {https://doi.org/10.1200/jco.2013.54.2050}
}
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Key findings
- Results The 164 patient cases and 182 controls had similar neuropsychological domain scores.
- However, among patient cases, those with stage II to III cancers had lower executive function compared with those with stage 0 to I disease, after adjustment (P = .05).
- The odds of impairment were significantly higher among older, nonwhite, less educated women and those with greater comorbidity, after adjustment.
- Patient case or control status, anxiety, depression, fatigue, and surgery were not associated with impairment.
- However, there was an interaction between comorbidity and patient case or control status; comorbidity was strongly associated with impairment among patient cases (adjusted odds ratio, 8.77; 95% CI, 2.06 to 37.4; P = .003) but not among controls (P = .97).
Why it matters
This study found that older patients with breast cancer had similar neuropsychological domain scores to controls before systemic therapy. However, among patients, those with more advanced cancer had lower executive function, and greater comorbidity was associated with higher odds of impairment.
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Study details
- Evidence strengthLow
How this study scored 47/100
Published in a peer-reviewed journal. Scored zero for study design, sample size, effect reported, studied in people and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Journal of clinical oncology : official journal of the American Society of Clinical Oncology) |
| Journal's citation record | 4 / 4 | Journal of Clinical Oncology: journal h-index 737 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 2014 — within 20 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 5 / 7 | Cited 178 times (OpenAlex, 2026-10-10) |
| Citations per year | 3 / 5 | 12.7 citations a year over 14 year(s) since 2014 |
| Impact for its field and year | 4 / 6 | Cited 9.7× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 1 / 6 | Cited by 1 other studies in this library |
| Still being cited | 2 / 4 | Cited 33 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author Tim A. Ahles: h-index 79 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | Cornell University: institution h-index 1,649 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 6 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 24841981) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 47 / 100 | — |
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