Cognitive Dysfunction in Older Breast Cancer Survivors: An Integrative Review
Crouch, Adele PhD, RN; Champion, Victoria PhD, RN, FAAN; Von Ah, Diane PhD, RN, FAAN
"From my clinical and previous research experiences, I knew cognitive issues were a concern for many breast cancer survivors. Those concerns can range from increased forgetfulness, trouble paying attention, and/or difficulty thinking of words (word-finding). In addition, from my studies in my adult-gerontology clinical nurse specialist program, my doctoral minor studies in interdisciplinary gerontology, and my clinical experiences I knew cognitive issues were also a common concern among many older adults. These observations lead me to seek out studies from the literature regarding cognitive concerns among older breast cancer survivors specifically. From this search, I discovered most of the research regarding cognition and breast cancer thus far has focused on younger or all-age breast cancer survivors.
The studies and evidence we currently have in older breast cancer survivors are limited. As we found in this integrative review, most of the studies to date have been mostly focused on the more immediate cognitive concerns during and directly following diagnosis and treatment. However, due to our rapidly aging society and advances in prevention, diagnosis, and treatment of breast cancer the majority of breast cancer survivors are 60 years of age and older, and many breast cancer survivors are expected to live longer after diagnosis and treatment.
This review highlighted a gap in our currently limited evidence regarding the more long-term dysfunction of older breast cancer survivors. A main takeaway from this review is the necessity of a comprehensive geriatric assessment for older breast cancer survivors that includes questions regarding cognitive concerns. Healthcare providers, especially cancer nurses, play an important role in assessing, discussing, and identifying cognitive concerns in older breast cancer survivors."
--Corresponding author Dr Adele Crouch speaks on her paper, " Cognitive Dysfunction in Older Breast Cancer Survivors: An Integrative Review," published in CANCER NURSING Volume 45, Issue 1. The article may be viewed below without a subscription.
Approximately 60% of the more than 3.8 million breast cancer survivors (BCSs) living in the United States are 60 years or older. Breast cancer survivors experience many symptoms including cognitive dysfunction; however, little is known regarding how age affects these symptoms.
This integrative review was conducted to synthesize the literature on cognitive dysfunction in older BCSs. The purpose was to (1) describe the prevalence of objective and subjective cognitive dysfunctions and (2) examine factors associated with cognitive dysfunction in older BCSs.
Whittemore and Knafl's integrative review methodology was used to examine cognitive dysfunction in BCSs 60 years or older.
Twelve quantitative studies were included. Up to 41% of older BCSs experienced cognitive dysfunction on neuropsychological examination, and up to 64% reported cognitive dysfunction on subjective measures pretreatment. Approximately half of older BCSs experienced cognitive decline from pretreatment to posttreatment regardless of cognitive measure. The domains most impacted were memory, executive functioning, and processing speed. Objective and subjective cognitive dysfunctions were associated with age, comorbidities, chemotherapy receipt, sleep, neuropsychological symptom cluster, frailty, and quality of life.
Cognitive dysfunction among older BCSs was common both prior to and following treatment. Cognitive dysfunction was associated with multiple factors that are compounded in the aging population and could be detrimental to quality of life and independent living.
Implications to Practice
Early assessment and intervention by healthcare providers, including nurses, for cognitive dysfunction in older BCSs are essential. Future research should focus on evidence-based interventions for cognitive dysfunction incorporating the unique needs of older BCSs.