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Cognitive complaints during breast cancer endocrine therapy: aromatase inhibitors versus tamoxifen
  1. Ichrak Ben Abdallah,
  2. Haifa Rachdi,
  3. Nesrine Mejri,
  4. Yosra Berrazega,
  5. Soumaya Laabidi and
  6. Hamouda Boussen
  1. Medical oncology department, Abdurrahmane Mami Hospital, Ariana. University of Tunis El Manar. Faculty of Medicine of Tunis, Tunisia
  1. Correspondence to Dr Ichrak Ben Abdallah, Medical Oncology, University of Tunis El Manar Faculty of Medicine of Tunis, Tunis 2074, Tunisia; benabdallah.ichrak.1212{at}


Objective Previous data hypothesise that women receiving aromatase inhibitors (AIs) exhibit worse cognitive functioning than patients on tamoxifen (TAM) since their oestrogen levels are lower. We aimed to compare cognitive complaints in both groups.

Methods From September 2020 to January 2021, we conducted a cross-sectional study on patients with stage I–III breast cancer undergoing adjuvant endocrine therapy for at least 6 months. Cognitive complaints were assessed using the Functional Assessment of Cancer Therapy–Cognitive V.3 questionnaire with higher scores indicating better outcomes.

Results We included 108 female patients, 60 on AI and 48 on TAM. Mean age at diagnosis was 52 (44 in the TAM group vs 58 in the AI group, p<0.001). Assessment of ‘perceived cognitive impairment-20 subscale’ did not identify a significant difference between the two groups (mean score: patients on AI=63/80 vs patients on TAM=58/80, p=0.198). Patients on TAM scored significantly worse than patients on AI (p<0.001) on the concentration complaints, while for the verbal domain, memory, multitasking, speed and functional interference, no significant difference between the two groups was observed. The difference in concentration complaints was maintained after adjustment to age, educational level, physical activity, prior exposure to chemotherapy, and living alone or with others. Finally, a favourable impact of regular physical activity on concentration scores was observed in both groups (p<0.001).

Conclusion Despite age difference, patients on AI did not demonstrate worse complaints than patients on TAM. Patients on TAM exhibited significantly increased concentration complaints. Oncologists should carefully screen their patients for mental fog and educate them on the importance of regular exercise.

  • Breast
  • Quality of life
  • Supportive care
  • Survivorship

Data availability statement

Data are available upon reasonable request. NA.

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Data availability statement

Data are available upon reasonable request. NA.

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  • Contributors Study design, data collection: IBA and HR; writing: IBA, HR and NM; statistical analysis: IBA; review: YB, SL and HB. The author responsible for the overall content: IBA.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.