Depressive Symptoms Are the Dominant Independent Correlate of Patient-Reported Cognitive Function in Older Women with Locally Advanced Breast Cancer: A Cross-Sectional Geriatric Assessment Study.

Background/

Objectives

Older women with breast cancer carry a high burden of frailty, depressive symptoms and cognitive complaints, yet how these domains relate to one another in routine clinical practice remains incompletely understood. We examined the prevalence of positive frailty screening and its association with patient-reported cognitive function and asked whether depressive symptoms account for the apparent link between the two.

Methods

We analyzed 314 women aged 65 years or older with stage IIB-IIIC breast cancer who underwent a standardized geriatric assessment. Measures included the G8 screening tool, Vulnerable Elders Survey-13 (VES-13), Geriatric Depression Scale (GDS), Instrumental Activities of Daily Living (IADL), cognition and quality of life (FACT-Cog, FACT-G, and EORTC QLQ-C30). Associations were examined using correlation analyses, group comparisons, and multivariable linear regression.

Results

Mean age was 72.9 years. A positive frailty screen (G8 ≤ 14) was present in 295 patients (93.9%), and 102 patients (32.5%) screened positive for depressive symptoms (GDS ≥ 5). G8 screening score correlated strongly with patient-reported cognitive function (Pearson r = 0.80, p < 0.001), and patients with a positive frailty screen reported lower FACT-Cog scores than those with a negative screen (113.0 vs. 129.0, p < 0.001). In multivariable analysis adjusted for age and G8 score, depressive symptoms emerged as the strongest independent correlate of FACT-Cog (β = -0.89, p < 0.001; model R2 = 0.90), whereas G8 screening score was no longer independently associated (p = 0.16). Patients with depressive symptoms had more than double the VES-13 vulnerability score of those without (7.8 vs. 3.6, p < 0.001). Overall geriatric assessment profiles were generally comparable across the three exploratory treatment-era cohorts.

Conclusions

In this cross-sectional analysis of older women with locally advanced breast cancer, depressive symptoms were the strongest independent correlate of patient-reported cognitive function. Incorporating a brief depression screen into routine geriatric assessment may represent a clinically actionable target that deserves further evaluation.