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A longitudinal study of the relationship between changes in pro-inflammatory cytokines to changes in fatigue and prospective memory functioning in chemotherapy treated early breast cancer patients

Marc Bedard

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Canadian Institutes of Health Research (CIHR)
The lifetime probability of women in Canada developing cancer is currently estimated to be about 41%, of which the most prevalent diagnosis is breast cancer (Canadian Cancer Society, 2013). Due to advancements in cancer treatment, there is a growing survivorship, as the overall 5-year survival rate in breast cancer patients now approaches 90 percent (Canadian Cancer Society, 2013). However, many women complain of persistent disturbances, particularly poor memory after breast cancer treatment, which can interfere with daily activities, relationships, occupational tasks, and which results in diminished quality of life. The burgeoning number of studies that have assessed memory impairments in breast cancer have typically used conventional neuropsychological tests that have measured retrospective memory which comprises the ability to remember facts from the past when explicitly requested to do so, often revealing subtle deficits. However, there has been limited attention devoted to analyses of prospective memory, a form of memory used in daily activities when we need to do something at a time in the future without explicit reminders. For instance, remembering to attend a scheduled doctors appointment or to take prescribed medication at the appropriate time would be an example of a prospective memory task. We recently reported that survivors treated with chemotherapy within the past year were significantly more impaired in prospective memory functioning than a group of healthy controls (Paquet et al., 2013). Furthermore, fatigue seemed to be a major contributor, mediating the prospective memory deficit as part of a symptom cluster, which is suggestive of a possible common underlying mechanism. In this regard, elevations of pro-inflammatory cytokines have previously been suggested to play a role in both fatigue and memory functioning and might be a candidate that accounts for the persistent effects of chemotherapy. In the proposed research I will be assessing early breast cancer patients before chemotherapy treatment and again three months after the completion of chemotherapy to determine the incidence of pro-inflammatory cytokines as a possible underlying mechanism for prospective memory disturbances and fatigue symptomology. It is hypothesized that from the baseline assessment to the final assessment post-chemotherapy, there will be a decrease prospective memory functioning, an increase in fatigue symptomology, and these will also be correlated with increased levels of pro-inflammatory cytokines, with cytokines mediating this relationship. The Research Ethics Boards at both Carleton University and The Ottawa Hospital have approved a preliminary study involving 20 breast cancer patients from The Ottawa Hospital Cancer Centre recruited at their first appointment to discuss chemotherapy treatment. Once enrolled, participants will receive a questionnaire that will include a measure of fatigue and they will undergo PM assessment at Carleton University. A nurse will be present to collect a blood sample, which will be analyzed for cytokine levels. This study procedure will be repeated again with the same breast cancer patients three months after their chemotherapy treatment. Funding for this project has been generously supplied by the Canadian Breast Cancer Foundation. As no other studies have evaluated pro-inflammatory cytokine changes in prospective memory and fatigue in breast cancer patients, this study will, I hope, provide tremendous insights to the field of psychosocial oncology concerning the persistent effects of chemotherapy, and may allow for the design and development of interventions to increase quality of life.

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