Sukendro Sendjaja(1*), Ibnu Purwanto(2), Johan Kurnianda(3)

(*) Corresponding Author



Objective. The objective of this study was to determine the changes cognitive function of anthracycline-based adjuvant chemotherapy in women with breast carcinoma.

Method. The study design was prospective longitudinal study. The breast cancer patients who received anthracycline-based adjuvant chemotherapy were recruited from internal medicine wards and TULIP outpatient department Dr. Sardjito General Hospital Yogyakarta. Subjects eligible with inclusion and exclusion criteria were examined for cognitive function by mini-mental state examination (MMSE) before chemotherapy (T0), 3 weeks after 2nd adjuvant chemotherapy (T1), 3 weeks after 4th adjuvant chemotherapy (T2), and 3 months after 4th adjuvant chemotherapy (T3). The mean difference of MMSE scores were analyzed with Wilcoxon-signed rank test and P<0.05 was considered statistically significant.

Result. There were 47 subjects eligible to study criteria in October 1st 2008 – October 31st 2009. Forty subjects finished this study and were analyzed. The mean age was 47.08±6.65 with age ranged from 27 to 61 years old. The mean MMSE scores before chemotherapy (T0), 3 weeks after 2nd adjuvant chemotherapy (T1), 3 weeks after 4th adjuvant chemotherapy (T2), and 3 months after 4th adjuvant chemotherapy (T3) were 29.28±1.20, 28.60±1.69, 28.18±1.89, and 27.85±2.03, respectively. The mean MMSE score changes (ΔT0-T1), (ΔT0-T2), and (ΔT0-T3) were 0.68±0.80, 1.10±1.06, and 1.43±1.36, respectively and P<0,001. The incidence of cognitive impairment with MMSE scores < 24 was 2.5% and P=1.0.

Conclusion. There was a significant decline of MMSE score in women with breast carcinoma who received anthracycline-based adjuvant chemotherapy at 3 weeks after 2nd adjuvant chemotherapy, 3 weeks after 4th adjuvant chemotherapy, and 3 months after 4th adjuvant chemotherapy compared with before chemotherapy.


Key Words: Cognitive Function, Breast Cancer, Adjuvant Chemotherapy, Anthracycline


Full Text:



Ahles T.A., Saykin A.J., Furstenberg, C.T. 2002. Neuropsychologic impact of standard-dose systemic chemotherapy in long-term survivors of breast cancer and lymphoma. J Clin Oncol, 20(2): 485 – 93.

Ahles, T.A. & Saykin, A.J. 2007. Candidate mechanisms for chemotherapy-induced cognitive changes. Nature Reviews Cancer, 7: 192 – 201.

Aryandono T. 2008. Kemajuan dalam Penelitian, Penanganan, dan Deteksi Dini Penderita Kanker Payudara dengan Perhatian Khusus pada Kualitas Hidup. Pidato Pengukuhan Guru Besar Fakultas Kedokteran UGM.

Bender, C.M., Paraska, K.K., Sereika, S.M., Ryan, C.M., Berga, S.L. 2001. Cognitive Function and Reproductive Hormones in Adjuvant Therapy for Breast Cancer: A Critical Review. J Pain Symptom Manage 21(5): 407 – 24

Brezden, C.B., Phillips, K.A., Abdolell, M., Bunston, T., Tannock, I.F. 2000. Cognitive Function in Breast Cancer Patients Receiving Adjuvant Chemotherapy. J Clin Oncol, 18: 2695 – 701.

Colozza, M., Azambuja, E.D., Cardoso, F., Bernard, C., Piccart, M.J. 2006. Breast Cancer: Achievements in Adjuvant Systemic Therapies in the Pre-Genomic Era. The Oncologist, 11: 111 – 25.

Dahlan, P. 1999. Pemeriksaan Neuropsikologi Pada Demensia. B NeuroSains, 1(1): 17 – 23.

DeSantis, C., Siegel, R., Jemal, A. 2007. Breast Cancer Facts & Figures 2007-2008. Am Cancer Society, 1 – 32.

Fan, H.G.M., Tchen, N.H., Yi, Q.L., Chemerynsky, I., Downie, F.P., Sabate, K., Tannock, I.F. 2005. Fatigue, Menopausal Symptoms, and Cognitive Function in Women After Adjuvant Chemotherapy for Breast Cancer: 1- and 2-Year Follow-Up of a Prospective Controlled Study. J Clin Oncol, 23: 8025 – 32.

Goldhirsch, A., Glick, J.H., Gelber, R.D., Coates, A.S., Thurlimann, B., Senn, H.J., & Panel Members. 2005. Meeting Highlights: International Expert Consensus on the Primary Therapy of Early Breast Cancer 2005. Ann Oncol, 16: 1569 – 83.

Harbeck, N. & Jakesz, R. 2007. St Gallen 2007: Breast Cancer Treatment Consensus Report. Breast Care, 2: 130 – 4.

Hayes, D.F. 2007. Adjuvant systemic therapy for early breast cancer: Rationale, assessing the need for and benefit from therapy, and treatment guidelines. Up To Date® 15.3.

Iconomou, G., Mega, V., Koutras, A., Iconomou, A.V., Kalofonos, H.P. 2004. Prospective Assesment of Emosional Distress, Cognitive Function, and Quality of Life in Patients with Cancer Treated with Chemotherapy. Cancer, 101: 404 – 11.

Jenkins, V., Shilling, V., Deutsch, G., Bloomfield, D., Morris, R., Allan, S., Bishop, H., Hodson, N., Mitra, S., Sadler, G., Shah, E., Stein, R., Whitehead, S., Winstanley, J. 2006. A 3-year prospective study of the effects of adjuvant treatments on cognition in women with early stage breast cancer. Br J Cancer, 94: 828 – 34.

Lwanga, S.K. & Lemeshow, S. 1991. Two sample situations. In: S.K. Lwanga & S. Lemeshow. Sample size determination in health studies. A practical manual: 6 – 8. Geneva: WHO.

Matsuda, T., Takayama, T., Tashiro, M., Nakamura, Y., Ohashi, Y., Shimozuma, K. 2005. Mild Cognitive Impairment after Adjuvant Chemotherapy in Breast Cancer Patients – Evaluation of Appropriate Research Design and Methodology to Measure Symptoms. Breast Cancer, 12: 279 – 87.

Minotti, G., Menna, P., Salvatorelli, E., Cairo G., Gianni, L. 2004. Anthracyclines: Molecular Advances and Pharmacologic Developments in Antitumor Activity and Cardiotoxicity. Pharmacol Rev, 56(2): 186 – 229.

National Cancer Institute (NCI). 2003. Appendix 4 NCI Common Toxicity Criteria (CTC) Version 3.0.

Orrell, M. & Sahakian, B. 1995. Education and dementia. Br Med J, 310: 951 – 2.

O’Shaughnessy, J. 2003. Chemotherapy-Related Cognitive Dysfunction in Breast Cancer. Semin Oncol Nurs, 19(4): 17 – 24.

Pasaribu, B.O. 2005. Parameter Biokimia Untuk Mild Cognitive Impairment (MCI) dan Alzheimer. Forum Diagnosticum, 2: 1 – 7.

Perneczky, R., Wagenpfeil, Kornossa, K., Grimmer, T., Diehl, J., Kurz, A. 2006. Mapping Scores Onto Stages : MMSE and Clinical Dementia Rating (abstract). Am J Geriatr Psychiatry, 14(2): 139 – 44.

Petersen, R.C., Stevens, J.C., Ganguli, M., Tangalos, Cummings & DeKosky. 2001. Practice Parameter : Early Detection of Dementia: Mild Cognitive Impairment (An Evidence Based Review). Report of the Quality Standards Subcommittee of the America Academy of Neurology. Neur, 56: 1133 – 42.

Phillips, K.A. & Bernhard, J. 2003. Adjuvant Breast Cancer Treatment and Cognitive Function: Current Knowledge and Research Directions. J Natl Cancer Inst, 95: 190 – 7.

Rodgers, G.M., Becker, P.S., Bennett, C.L. 2008. Cancer- and chemotherapy-induced anemia. J Natl Compr Canc Netw, 6: 536.

Setyopranoto, I. & Lamsudin, R. 1999. Kesepakatan Penilaian Mini Mental State Examination (MMSE) Pada Penderita Stroke Iskemik Akut di RSUP Dr. Sardjito Yogyakarta. B NeuroSains, 1(1): 73 – 6.

Shapiro, C. 2007. Side effects of adjuvant chemotherapy for early stage breast cancer. Up To Date® 15.3.

Shadlen, M.F. & Larson, E.B. 2007. Evaluation of cognitive impairment and dementia. Up To Date® 15.3.

Singletary, S.E. & Connolly, J.L. 2006. Breast Cancer Staging: Working With the Sixth Edition of the AJCC Cancer Staging Manual. CA Cancer J Clin, 56: 37 – 47.

Soejono, C.H., Harimurti, K., Setiati, S., Damping, C.E. 2006. Pedoman Diagnosis dan Tatalaksana MCI dan VCI, dalam Konsensus Nasional-Peran Dokter Spesialis Penyakit Dalam Untuk Deteksi Dini, Diagnosis Dan Penatalaksanaan Gangguan Kognitif Ringan Pada Usia Lanjut. Perhimpunan Gerontologi Medik Indonesia. Jakarta: 1 – 28. 56

Tannock, I.F., Ahles, T.A., Ganz, P.A., van Dam, F.S. 2004. Cognitive Impairment Associated With Chemotherapy for Cancer: Report of a Workshop. J Clin Oncol, 22: 2233 – 39.

Tchen, N., Juffs, H.G., Downie, F.P. 2003. Cognitive function, fatigue, and menopausal symptoms in women receiving adjuvant chemotherapy for breast cancer. J Clin Oncol, 21: 4175 – 83.

Vardy, J. & Tannock, I. 2007. Cognitive function after chemotherapy in adults with solid tumours. Crit Rev Oncol/Hematol, 63: 183 – 202.

Vardy, J., Wefel, J.S., Ahles, T., Tannock, I.F., Schagen, S.B. 2008. Cancer and cancer-therapy related cognitive dysfunction: an international perspective from the Venice cognitive workshop. Ann Oncol, 19: 623 – 29.

Visser, P.J. 2006. Mild Cognitive Impairment. Dalam Pathy, M.S., Sinclair, J., & Morley, J.E. (Eds) Principles and Practice of Geriatric Medicine 4th (ed). John Wiley and Sons. Ltd: 1 – 7.

Wefel J.S., Lenzi R., Theriault R.L., Davis R.N., Meyers C.A. 2004. The cognitive sequelae of standard-dose adjuvant chemotherapy in women with breast carcinoma: results of a prospective, randomized, longitudinal trial. Cancer, 100(11): 2292 – 9.

World Health Organization. 2000. The Asia-Pacific perspective: redefining obesity and its treatment. World Health Organization. Melbourne.

Wright, J.D. 2007. Mild Cognitive Impairment. Up To Date® 15.3.


Article Metrics

Abstract views : 259 | views : 190


  • There are currently no refbacks.

Copyright (c) 2011 Acta Interna The Journal of Internal Medicine

Creative Commons License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

Acta Interna The Journal of Internal Medicine Indexed by:


 Indonesia Onesearch Google Scholar IPI Indonesian Publication Index

 website statistics View My Stats  



Creative Commons License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.