Cognitive limitations associated with tamoxifen and aromatase inhibitors in employed breast cancer survivors

Objectives: Previous research has suggested that endocrine therapy is associated with cognitive limitations in breast cancer survivors (BCS); this study examined the relationship in employed BCS, an average of three years post-primary treatment. Methods: 77 BCS with past or current exposure to tamoxifen or aromatase inhibitors and 56 BCS with no history of endocrine therapy completed self- report measures of cognitive function, anxiety, depression, and fatigue as well as an online neurocognitive battery. Results: Exposure to endocrine therapy was not related to scores on the objective measures, but moderately related to perceived attentional problems at work (beta = 0.20; CI0.95 = 2.75, - 0.25) and perceived cognitive functioning in overall life (beta = 0.17; CI0.95 = 0.33, 11.47) in excess of what could be explained by symptom burden measures. No differences were reported between groups on symptom burden measures. Symptoms of physical fatigue, depression, and anxiety were positively associated with self- report of general cognitive limitations (R-2 change range: 0.28-0.37), and symptoms of depression and anxiety were positively associated with perceived cognitive limitations at work (R-2 change range: 0.21-0.28). Discussion: Symptoms of depression, anxiety, and fatigue should be screened for and treated in BCS, as an approach to mitigating perceived cognitive limitations. However, healthcare providers should be aware that cognitive limitations exist in excess of what can be associated with symptom burden, and may be related to endocrine therapy and other cancer treatments. Copyright (C) 2010 John Wiley & Sons, Ltd.