John Theurer Cancer Center researcher contributes to report on role of chronic inflammation in development of cognitive problems in breast cancer survivors

Dr. Deena Graham is co-author of a Journal of Clinical Oncology paper demonstrating the relationship between C-reactive protein (CRP) levels and cognition in older breast cancer survivors

Deena Graham, M.D., a member of the breast and gynecologic divisions at Hackensack University Medical Center’s  John Theurer Cancer Center, a part of Georgetown Lombardi Comprehensive Cancer Center, is co-author of a recent paper focusing on the role of chronic information in development of cognitive problems in breast cancer survivors. The paper, published in the Journal of Clinical Oncology, demonstrates that high levels of C-reactive protein (CRP), a marker of inflammation, are associated with long-term cognitive problems in older survivors of breast cancer.

Dr. Graham contributed to the conception, design, and manuscript development of a study examining the longitudinal relationships between CRP levels and cognition in older breast cancer survivors and noncancer controls. The study found that survivors with high CRP levels were significantly more likely to report clinically meaningful levels of cognitive problems at later points in time, but the investigators did not observe this relationship in controls.

“Our findings suggest that chronic inflammation, as measured by CRP, plays a mechanistic role in development of cognitive problems in older breast cancer survivors,” said Dr. Graham, who is medical co-director at Palisades Medical Center, assistant professor in the Department of Oncology at Hackensack Meridian School of Medicine, and an associate member of the Breast Cancer Program at Georgetown Lombardi Cancer Center. “The study also suggests that the clinical utility of CRP testing, which is a well-established method of measuring inflammation in cardiovascular disease and other disorders, may extend to cancer survivorship care, in that CRP levels may identify survivors needing intervention to prevent and/or monitor for cognitive decline. The validation and availability of such a useful tool in the oncology setting would be a tremendous benefit in the ongoing care of older survivors of breast cancer.”

Dr. Graham and colleagues evaluated CRP specimens and cognitive assessment data from 400 survivors and 329 controls (average age: 67.7 years, range: 60-90 years). The majority of survivors had stage I (60.9%), estrogen receptor-positive (87.6%) tumors. CRP levels were significantly higher in survivors than in controls at baseline and at 12-, 24- and 60-month visits (all P < 0.05). Higher CRP levels predicted lower participant-reported cognition on subsequent visits among survivors, but not controls (P interaction = 0.008); these effects were unchanged by the presence of depression or anxiety. Overall, survivors had adjusted Functional Assessment of Cancer Therapy-Cognitive Function scores that were 9.5 and 14.2 points lower than controls at CRP levels of 3.0 and 10.0 mg/L. Additionally, survivors had poorer neuropsychological test performance, compared to controls, with significant interactions with CRP only for the Trails Making Test Part B, a measure of cognitive function.

“We hope the noteworthy findings from this study, which demonstrate an apparently robust relationship between high CRP levels and cognitive decline in breast cancer survivors, lead to widespread use of CRP testing as a means to identify and manage cognitive issues in patients with cancer,” commented Andre H. Goy, M.D., chairman and chief physician officer at John Theurer Cancer Center. “The study also highlights the productive collaborative relationship between John Theurer Cancer Center and Georgetown Lombardi Cancer Center, two leading institutions at the forefront of oncology research and care.”