Skip to main content Accessibility help

Predictors of Cognitive Decline After Chemotherapy in Breast Cancer Patients



The objective of this study is to identify whether decline in cognitive functioning after chemotherapy in women with breast cancer is associated with health/disease, treatment, and psychological variables. Neuropsychological performance, health/disease, and treatment-related information of 136 women with breast cancer (age M = 49.38; SD = 7.92; range = 25.25–67.92) was assessed pre-chemotherapy and 1-month post-chemotherapy. The Reliable Change Index corrected for practice (RCIp) identified women whose performance significantly declined, while Pearson correlations assessed the relationship between cognitive change and predictor variables. A total of 16.9% of women showed significant decline post-chemotherapy, with affected domains including verbal learning and memory, abstract reasoning, and motor coordination. Decline in hemoglobin levels and increased anxiety over the course of chemotherapy was found to significantly predict impairment in multiple cognitive measures. Change in specific cognitive measures was significantly associated with baseline fatigue, depression, and functional well-being (r = 0.23 to 0.33; p = .01 to < .001). Although the effects are small, there is evidence that psychological and health factors may increase vulnerability to cognitive dysfunction after chemotherapy for breast cancer. Significant associations reported in this study may be useful in the identification and treatment of at-risk individuals. (JINS, 2009, 15, 951–962.)


Corresponding author

*Correspondence and reprint requests to: Katharine J. Vearncombe, School of Psychology, University of Queensland, St Lucia Brisbane, Australia. E-mail:


Hide All
Ahles, T.A., & Saykin, A.J. (2007). Candidate mechanisms for chemotherapy induced cognitive changes. Nature Reviews, 7, 192201.
Ahles, T.A., Saykin, A.J., McDonald, B.C., Furstenberg, C.T., Cole, B.F., Hanscom, B.S., et al. (2008). Cognitive function in breast cancer patients prior to adjuvant treatment. Breast Cancer Research and Treatment, 110, 143152.
Bender, C.M., Sereika, S.M., Berga, S.L., Vogel, V.G., Brufsky, A.M., Paraska, K.K., et al. (2006). Cognitive impairment associated with adjuvant therapy in breast cancer. Psychooncology, 15, 422430.
Brady, M.J., Cella, D.F., Bonomi, A.E., Tulsky, D.S., Lloyd, S.R., Deasy, S., et al. (1997). Reliability and validity of the functional assessment of cancer – breast quality-of-life instrument. Journal of Clinical Oncology, 15, 974986.
Castellon, S.A., Ganz, P.A., Bower, J.E., Petersen, L., Abraham, L., & Greendale, G.A. (2004). Neurocognitive performance in breast cancer survivors exposed to adjuvant chemotherapy and Tamoxifen. Journal of Clinical and Experimental Neuropsychology, 26, 955969.
Chelune, G.J., Naugle, R.I., Luders, H., Sedlack, J., & Awad, I.A. (1993). Individual change after epilepsy surgery: Practice effects and base rate information. Neuropsychology, 7, 4152.
Cimprich, B. (1992). Attentional fatigue following breast cancer surgery. Research in Nursing and Health, 15, 199207.
Cimprich, B. (1993). Development of an intervention to restore attention in cancer patients. Cancer Nursing, 16, 8392.
Collins, B., Mackenzie, J., Stewart, A., Bielajew, C., & Verma, S. (2009). Cognitive effects of chemotherapy in post-menopausal breast cancer patients 1 year after treatment. Psychooncology, 18, 134143.
Delis, D.C., Kaplan, E., & Kramer, J.H. (2001). D-KEFS: Delis-Kaplan Executive Function System: Examiners Manual. San Antonio: The Psychological Corporation, Harcourt Assessment.
Donovan, K., Small, B.J., Andrykowski, M.A., Schmitt, F.A., Munster, P., & Jacobsen, P.B. (2005). Cognitive functioning after adjuvant chemotherapy and/or radiotherapy for early stage breast carcinoma. Cancer, 104, 24992507.
Falleti, M.G., Sanfilippo, A., Maruff, P., Weih, L., & Phillips, K. (2005). The nature and severity of cognitive impairment associated with adjuvant chemotherapy in women with breast cancer: A meta-analysis of the current literature. Brain and Cognition, 59, 6070.
Geffen, G.M., Butterworth, P., & Geffen, L.B. (1994). Test-retest reliability of a new form of the Auditory Verbal Learning Test (AVLT). Archives of Clinical Neuropsychology, 9, 303316.
Geffen, G., & Geffen, L. (2000). Auditory Verbal Learning Test: Australian Manual: Computerized Scoring Program and Population Norms. Melbourne: ACER Press.
Golden, C., & Freshwater, S. (2002). Stroop Color and Word Test: Revised Examiners Manual. Wood Dale, Illinois; Stroelting.
Hermelink, K., Henschel, V., Untch, M., Bauerfeind, I., Lux, M.P., & Munzel, K. (2008). Short-term effects of treatment-induced hormonal changes on cognitive function in breast cancer patients: Results of a multicenter, prospective, longitudinal study. Cancer, 113, 24312439.
Hermelink, K., Untch, M., Lux, M.P., Kreienberg, R., Beck, T., Bauerfeind, I., et al. (2007). Cognitive function during neoadjuvant chemotherapy for breast cancer. Results of a prospective, multicenter, longitudinal study. Cancer, 109, 19051913.
Hurria, A., Somlo, G., & Ahles, T. (2007). Renaming “Chemobrain”. Cancer Investigations, 25, 373377.
Jansen, C.E., Miaskowski, C., Dodd, M., Dowling, G., & Kramer, J. (2005). A metaanalysis of studies of the effects of cancer chemotherapy on various domains of cognitive function. Cancer, 104, 22222233.
Jacobson, P.B., Garland, L.L., Booth-Jones, M., Donovan, K.A., Thors, C.L., Winters, E., et al. (2004). Relationship of hemoglobin levels to fatigue and cognitive functioning among cancer patients receiving chemotherapy. Journal of Pain and Symptom Management, 28, 718.
Lezak, M.D. (1995). Neuropsychological Assessment (3rd ed.). New York: Oxford University Press.
McSweeny, A.J., Naugle, R.I., Chelune, G.J., & Luders, H. (1993). “T scores for Change”: An illustration of a regression approach to depicting change in clinical neuropsychology. The Clinical Neuropsychologist, 7, 300312.
Mehlsen, M., Pedersen, A.D., Jensen, A.B., & Zachariae, R. (2009). No indications of cognitive side-effects in a prospective study of breast cancer patients receiving adjuvant chemotherapy. Psychooncology, 18, 248257.
Mehnert, A., Scherwath, A., Schirmer, L., Schleimer, B, Petersen, C., Schulz-Kindermann, F., et al. (2007). The association between neuropsychological impairment, self-perceived cognitive deficits, fatigue and health related quality of life in breast cancer survivors following standard adjuvant versus high-dose chemotherapy. Patient Education and Counseling, 66, 108118.
Nelson, H.E., & Willison, J. (1991). National Adult Reading Test (NART) Manual. NFER-NELSON.
Quesnel, C., Savard, J., & Ivers, H. (2009). Cognitive impairments associated with breast cancer treatments: Results from a longitudinal study. Breast Cancer Research and Treatment, 116, 113123.
Robertson, I.H., Ward, T., Ridgeway, V., & Nimmo-Smith, I. (1994). The Test of Everyday Attention: Manual. Bury St Edmunds, UK: Thames Valley Test Company.
Schagen, S.B., Muller, M.J., Boogerd, W., Mellenbergh, G.J., & van Dam, F.S.A.M. (2006). Change in cognitive function after chemotherapy: A prospective longitudinal study in breast cancer patients. Journal of the National Cancer Institute, 98, 17421745.
Schagen, S.B., Muller, M.J., Boogerd, W., Rosenbrand, R.M., van Rhijn, D., Rodenhuis, S., et al. (2002). Late effects of adjuvant chemotherapy on cognitive function: A follow-up study in breast cancer patients. Annals of Oncology, 13, 13871397.
Schagen, S.B., van Dam, F.S.A.M., Muller, M.J., Boorgerd, W., Lindeboom, J., & Bruning, P.F. (1999). Cognitive deficits after postoperative adjuvant chemotherapy for breast carcinoma. Cancer, 85, 640650.
Scherwath, A., Mehnert, A., Schleimer, B., Schirmer, L., Fehlauer, F., Kreienberg, R., et al. (2006). Neuropsychological function in high-risk breast cancer survivors after stem-cell supported high-dose therapy verses standard-dose chemotherapy: Evaluation of long-term treatment effects. Annals of Oncology, 17, 415423.
Silverman, D.H.S., Dy, C.J., Castellon, S.A., Lai, J., Pio, B.S., Abraham, L., et al. (2007). Altered frontocortical, cerebellar, and basal ganglia activity in adjuvant-treated breast cancer survivors 5-10 years after chemotherapy. Breast Cancer Research and Treatment. 103, 303311.
Smith, A. (1982). Symbol Digit Modalities Test: Manual Revised. Los Angeles: Western Psychological Services.
Stewart, A., Bielajew, C., Collins, B., Parkinson, M., & Tomiak, E. (2006). A meta-analysis of the neuropsychological effects of adjuvant chemotherapy treatment in women treated for breast cancer. Clinical Neuropsychology, 20, 7689.
Stewart, A., Collins, B., Mackenzie, J., Tomiak, E., Verma, S., & Bielajew, C. (2008). The cognitive effects of adjuvant chemotherapy in early stage breast cancer: A prospective study. Psychooncology, 17, 122130.
Strauss, E., Sherman, E.M.S., & Spreen, O. (2006). A Compendium of Neuropsychological Tests: Administration, Norms and Commentary. New York: Oxford University Press.
Tchen, N., Juffs, H.G., Downie, F.P., Yi, Q., Hu, H., Chemerynsky, I., et al. (2003). Cognitive function, fatigue, and menopausal symptoms in women receiving adjuvant chemotherapy for breast cancer. Journal of Clinical Oncology, 21, 41754183.
Temkin, N.R., Heaton, R.K., Grant, I., & Dikmen, S.S. (1999). Detecting significant change in neuropsychological test performance: A comparison of four models. Journal of the International Neuropsychological Society, 5, 357369.
Tiffin, J. (1968). Purdue Pegboard: Examiner Manual. Chicago: Science Research Associates.
van Dam, F.S.A.M., Schagen, S., Muller, M.J., Boogerd, W., Wall, E., Fortuym, D., et al. (1998). Impairment of cognitive function in women receiving adjuvant treatment for high-risk breast cancer: High dose versus standard-dose chemotherapy. Journal of the National Cancer Institute, 90, 210218.
Vardy, J., & Tannock, I. (2007). Cognitive function after chemotherapy in adults with solid tumours. Critical Reviews in Oncology/Hematology, 63, 183202.
Verstappen, C.C.P., Heimans, J.J., Hoekman, K., & Postma, T.J. (2003). Neurotoxic complications of chemotherapy in patients with cancer. Clinical signs and optimal management. Drugs, 63, 15491563.
Waters, G.S., & Caplan, D. (2003). The reliability and stability of verbal working memory measures. Behavior Research Methods, Instruments and Computers, 35, 550564.
Wechsler, D. (1997a). Wechsler Memory Scale: Administration and Scoring Manual (3rd ed.). San Antonio: The Psychological Corporation
Wechsler, D. (1997b) Wechsler Adult Intelligence Scale: Administration and Scoring Manual (3rd ed.). New York: The Psychological Corporation.
Wefel, J.S., Lenzi, R., Theriault, R., Buzdar, A.U., Cruickshank, S., & Meyers, C.A. (2004a). ‘Chemobrain’ in breast carcinoma? A prologue. Cancer, 101, 466475.
Wefel, J.S., Lenzi, R., Theriault, R.L., Davis, R.N., & Meyers, C.A. (2004b). The cognitive sequelae of standard-dose adjuvant chemotherapy in women with breast carcinoma: Results of a prospective, randomized, longitudinal trial. Cancer, 100, 22922299.
Wieneke, M.H., & Dienst, E.R. (1995). Neuropsychological assessment of cognitive functioning following chemotherapy for breast cancer. Psychooncology, 4, 6166.
Yellen, S.B., Cella, D.F., Webster, K., Blendowski, C., & Kaplan, E. (1997). Measuring fatigue and other anemia-related symptoms with the Functional Assessment of Cancer Therapy (FACT) measurement system. Journal of Pain and Symptom Management, 13, 6374.
Zigmond, A.S, & Snaith, R.P. (1983). The hospital anxiety and depression scale. Acta Psychiatricia Scandinavica, 67, 361370.



Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed