Abstract 292P
Background
Adjuvant systemic therapies are associated with subjective cognitive impairment in > 50% of breast cancer (BC) survivors. Adverse childhood experiences (ACEs) increase the risk of depression and anxiety, but data on the association of ACEs with cognitive impairment in BC patients is lacking. Sense of coherence (SOC) is a positive disposition towards life, reflecting a feeling that life is predictable and manageable, and is linked to better quality of life in BC patients.
Methods
We are conducting a prospective study designed to test whether ACEs increase chronic adverse events in patients with localized BC, and to identify potential mechanisms mediating this effect. Patients are recruited before starting (neo)adjuvant oncological treatment and assessed periodically by validated questionnaires including ACEs, SOC, sense of danger, FACT-COG, FACT-ES and brief pain inventory. BMI and blood pressure are measured, and blood samples for inflammatory biomarkers are stored. In this sub study, we tested whether ACE’s were associated with baseline cognitive function and examined the mediating role of SOC.
Results
Of 107 participants, 77 had complete questionnaires and clinical data. Median age was 49 (range 23-75), 28%, 62% and 10% had stage 1, 2 and 3 BC, respectively. Planned treatment included chemotherapy in 76%. The number of ACEs significantly correlated with baseline cognitive impairment, measured by the FACT-COG, and with lower SOC (p’s < .032). Living alone was also associated with cognitive impairment, t (20.73) = 2.21, p = .039, but planned chemotherapy, age, and level of education were not (p’s > .163). Controlling for living alone, we found that lower SOC mediated the link between ACEs and cognitive impairment (95% percentile CI [0.001, 0.086]).
Conclusions
The results indicate that exposure to a higher number of ACE’s increases the risk of subjective cognitive impairment in BC patients before treatment, and that decreased SOC mediates this association. The results highlight the importance of adressing childhood trauma and SOC in patients with localized BC to improve cognitive function. Further study will explore whether ACE’s and SOC are associated with cognitive decline during and after adjuvant therapy.
Legal entity responsible for the study
A. Shai.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.