Vasomotor Symptoms and Cognition Among Women Receiving Estrogen Therapy for Breast Cancer

Increases in vasomotor symptoms (VMS) and decreases in cognitive performance have been demonstrated among women with a history of breast cancer. There is considerable interest in lowering the burden of both VMS and cognitive difficulties among breast cancer survivors, as each contributes to decreased quality of life. The presents study had two central aims. First, this investigation aimed to evaluate the relationship between VMS and verbal memory performance in midlife women with breast cancer experiencing moderate-to-severe VMS. Second, this study examined the effects of a Stellate Ganglion Blockade (SGB) intervention for VMS on verbal memory performance in a subsample of women participating in an ongoing, sham-controlled, clinical trial. Results showed that increased frequency of physiological, but not subjective, VMS were associated with worse performance on CVLT outcome measures at baseline. This effect was not attenuated after controlling for sleep quality or length as measured by actigraphy. Additionally, in an analysis of a subsample of women studied before and after SGB-intervention versus sham-intervention, there was no significant reduction in physiologically recorded or subjectively reported VMS over a 24-hour timeframe. Despite this lack of improvement in VMS frequency, the magnitude of improvement in verbal memory was higher among those who received the SGB-intervention compared to those who received the sham-intervention. Of note, the study is ongoing and one of the primary subjective VMS outcomes (two weeks of daily diary reporting) has not been assessed. However, if replicated in the final sample from this ongoing clinical trial, these findings would suggest a direct impact of the SGB intervention on memory independent of VMS. Broadly, this work replicates prior findings in healthy women showing a relationship between memory and physiologic VMS, not subjective VMS, and replicates this pattern in women with a history of breast cancer. These findings suggest that VMS, independent of sleep, may be a modifiable risk factor for memory problems in midlife women.