Reductions in sleep quality and circadian activity rhythmicity predict longitudinal changes in objective and subjective cognitive functioning in women treated for breast cancer

Sonia Ancoli-Israel, Lianqi Liu, Loki Natarajan, Michelle Rissling, Ariel B. Neikrug, Shawn D. Youngstedt, Paul J. Mills, Georgia R. Sadler, Joel E. Dimsdale, Barbara A. Parker, Barton W. Palmer

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: To examine long-term cognitive effects of chemotherapy and identify predictors among women with breast cancer (WBC). Patients and methods: Sixty-nine WBC scheduled to receive chemotherapy, and 64 matched-controls with no cancer, participated. Objective and subjective cognition, total sleep time, nap time, circadian activity rhythms (CAR), sleep quality, fatigue, and depression were measured pre-chemotherapy (Baseline), end of cycle 4 (Cycle-4), and one-year post-chemotherapy (1-Year). Results: WBC showed no change in objective cognitive measures from Baseline to Cycle-4 but significantly improved from both time points to 1-Year. Matched-controls showed an increase in test performance at all time points. WBC had significantly higher self-reported cognitive dysfunction at Cycle-4 and 1-Year compared to baseline and compared to matched-controls. Worse neuropsychological functioning was predicted by less robust CARs (i.e., inconsistent 24 h pattern), worse sleep quality, longer naps, and worse cognitive complaints. Worse subjective cognition was predicted by lower sleep quality and higher fatigue and depressed mood. Conclusion: Objective testing showed increases in performance scores from pre- and post-chemotherapy to one year later in WBC, but matched-controls showed an increase in test performance from baseline to Cycle-4 and from Cycle-4 to 1-Year, likely due to a practice effect. The fact that WBC showed no practice effects may reflect a form of learning deficit. Compared with the matched-controls, WBC reported significant worsened cognitive function. In WBC, worse objective and subjective cognitive functioning were predicted by worse sleep and sleep-related behaviors (naps and CAR). Interventions that target sleep, circadian rhythms, and fatigue may benefit cognitive function in WBC.

Original languageEnglish (US)
JournalSupportive Care in Cancer
DOIs
StateAccepted/In press - 2021

Keywords

  • Breast cancer
  • Chemotherapy
  • Circadian activity rhythms
  • Cognitive function
  • Depression
  • Fatigue
  • Sleep quality

ASJC Scopus subject areas

  • Oncology

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