demographics, PROs and fMRI task data

BackgroundCognitive problems in breast cancer patients are common after systemic treatment, particularly chemotherapy. An increasing number of fMRI studies show altered brain activation in breast cancer patients after treatment, suggestive of neurotoxicity. Previous prospective fMRI studies administered a single cognitive task. The current study employed two task paradigms to evaluate whether treatment-induced changes depend on the probed cognitive domain.MethodsParticipants were breast cancer patients scheduled to receive systemic treatment (anthracycline-based chemotherapy +/- endocrine treatment, n=28), or no systemic treatment (n=24) and no-cancer controls (n=31). Assessment took place before adjuvant treatment and six months after chemotherapy, or at similar intervals. Blood oxygen level dependent (BOLD) activation and performance were measured during an executive functioning task and an episodic memory task. Group-by-time interactions were analyzed using a flexible factorial design.ResultsTask performance did not differ between patient groups and did not change over time. Breast cancer patients who received systemic treatment, however, showed increased parietal activation compared to baseline with increasing executive functioning task load compared to breast cancer patients who did not receive systemic treatment. This hyperactivation was accompanied by worse physical functioning, higher levels of fatigue and more cognitive complaints. In contrast, in breast cancer patients who did not receive systemic treatment, parietal activation normalized over time compared to the other two groups.ConclusionsParietal hyperactivation after systemic treatment in the context of stable levels of executive task performance is compatible with a compensatory processing account of hyperactivation or maintain adequate performance levels. This over-recruitment of brain regions depends on the probed cognitive domain and may represent a response to decreased neural integrity after systemic treatment. Overall these results suggest different neurobehavioral trajectories in breast cancer patients depending on treatment type.

背景：乳腺癌患者在系统性治疗，尤其是化疗之后，常出现认知问题。越来越多的功能性磁共振成像（fMRI）研究表明，乳腺癌患者在治疗后大脑激活模式发生改变，提示存在神经毒性。先前前瞻性的fMRI研究仅实施了单一的认知任务。本研究采用了两种任务范式，以评估治疗诱导的变化是否依赖于被探测的认知领域。方法：参与者为计划接受系统性治疗（以蒽环类药物为基础的化疗±内分泌治疗，n=28）或未接受系统性治疗（n=24）以及无癌对照组（n=31）的乳腺癌患者。评估在辅助治疗之前以及化疗后六个月或相似的时间间隔进行。在执行功能任务和情景记忆任务期间，测量血氧水平依赖性（BOLD）激活和表现。使用灵活的方差设计分析组间时间交互作用。结果：任务表现在不同患者组之间没有差异，且随时间推移没有变化。然而，接受系统性治疗的乳腺癌患者与未接受系统性治疗的乳腺癌患者相比，在执行功能任务负荷增加时，顶叶激活较基线水平增加。这种过度激活伴随着更差的生理功能、更高的疲劳水平和更多的认知抱怨。相反，在未接受系统性治疗的乳腺癌患者中，与另外两组相比，顶叶激活随时间正常化。结论：在执行任务表现稳定的情况下，系统性治疗后的顶叶过度激活与补偿性处理账户的过度激活或维持适当的性能水平相一致。这种大脑区域的过度招募依赖于被探测的认知领域，可能代表了对系统性治疗后神经完整性下降的反应。总体而言，这些结果表明，根据治疗类型，乳腺癌患者的神经行为轨迹不同。