Symptoms affect quality of life (QOL), functional status, and cognitive function in
cancer survivors, but older survivors are understudied. To identify prototypical pre-systemic
therapy psychoneurological symptom clusters among older breast cancer survivors, and
determine whether these symptom clusters predicted cognition and QOL over time. Women
with newly diagnosed non-metastatic breast cancer (n=319) and matched non-cancer controls
(n=347) aged 60+ completed questionnaires and neuropsychological tests before systemic
therapy and 12- and 24-months later. Latent class analysis identified clusters of
survivors based upon their pre-therapy depression, anxiety, fatigue, sleep disturbance,
and pain. Linear mixed-effects models examined changes in objective cognition, perceived
cognition, and functional status (instrumental activities of daily living (IADL) disability,
functional well-being, and breast cancer-specific QOL) by group, controlling for covariates.
Nearly one-fifth of older survivors were classified as having a high pre-therapy symptoms
(n=51; 16%); the remainder had a low symptoms (n=268; 84%); both groups improved over
time on all outcomes. However, compared to the low symptom group and controls, survivors
with high symptoms had lower baseline objective cognition and lower perceived cognition
at baseline and 24-months, lower functional well-being at baseline and 12-months,
greater IADL disability at baseline, and lower breast cancer-specific QOL at all time
points (all p <0.05). Nearly one-fifth of older breast cancer survivors had high
psychoneurological symptoms at diagnosis, which, predict clinically meaningful decrements
in perceived cognition and function in the first 24 months post-diagnosis. Pre-treatment
psychoneurological symptom clusters could identify survivors for monitoring or intervention.