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Chemotherapy and Post-traumatic Stress in the Causation of Cognitive Dysfunction in Breast Cancer Patients.

Abstract

Background

Cancer-related cognitive dysfunction has mostly been attributed to chemotherapy; this explanation, however, fails to account for cognitive dysfunction observed in chemotherapy-naïve patients. In a controlled, longitudinal, multisite study, we tested the hypothesis that cognitive function in breast cancer patients is affected by cancer-related post-traumatic stress.

Methods

Newly diagnosed breast cancer patients and healthy control subjects, age 65 or younger, underwent three assessments within one year, including paper-and-pencil and computerized neuropsychological tests, clinical diagnostics of post-traumatic stress disorder (PTSD), and self-reported cognitive function. Analysis of variance was used to compare three groups of participants-patients who did or did not receive chemotherapy and healthy control subjects-on age- and education-corrected cognitive performance and cognitive change. Differences that were statistically significant after correction for false discovery rate were investigated with linear mixed-effects models and mediation models. All statistical tests were two-sided.

Results

Of 226 participants (166 patients and 60 control subjects), 206 completed all assessment sessions (attrition: 8.8%). Patients demonstrated overall cognitive decline (group*time effect on composite z -score: -0.13, P = .04) and scored consistently worse on Go/Nogo errors. The latter effect was mediated by PTSD symptoms (mediation effect: B = 0.15, 95% confidence interval = 0.02 to 0.38). Only chemotherapy patients showed declined reaction time on a computerized alertness test. Overall cognitive performance correlated with self-reported cognitive problems at one year ( T = -0.11, P = .02).

Conclusions

Largely irrespective of chemotherapy, breast cancer patients may encounter very subtle cognitive dysfunction, part of which is mediated by cancer-related post-traumatic stress. Further factors other than treatment side effects remain to be investigated.

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    Affiliations of authors: Breast Center, Department of Gynecology and Obstetrics (KHer, FN, JK, VV, RW, ND, KHä, SH, SM, NH), and Institute for Clinical Radiology (KHel, DRD), CCCLMU University Hospital of Munich, Munich, Germany; Department of Psychology, Division of Psychological Methods and Assessment, Ludwig Maximilian University of Munich, Munich, Germany (MBü, PS); Department of Psychology, Division of Neuropsychology, Ludwig Maximilian University of Munich, Munich, Germany (KM); Breast Center, Department of Gynecology, Red Cross Hospital, Munich, Germany (MBr); Breast Center, Department of Gynecology and Obstetrics, Dritter Orden Hospital, Munich, Germany (FEvK); Hochschule Fresenius, University of Applied Sciences, Psychology School, Munich, Germany (KHä); Breast Center, Department of Gynecology and Obstetrics, District Hospital of Ebersberg, Ebersberg, Germany (SH); Breast Center, Department of Gynecology and Obstetrics, Hospital of Landshut, Landshut, Germany (IB); Breast Center, Department of Gynecology and Obstetrics, Helios Amper Hospital Dachau, Dachau, Germany (GD); Department of Psychosomatic Medicine and Psychotherapy, Division of Psychosocial Oncology, Roman Herzog Comprehensive Cancer Center, Technical University of Munich, Munich, Germany (PH).

    ,

    Affiliations of authors: Breast Center, Department of Gynecology and Obstetrics (KHer, FN, JK, VV, RW, ND, KHä, SH, SM, NH), and Institute for Clinical Radiology (KHel, DRD), CCCLMU University Hospital of Munich, Munich, Germany; Department of Psychology, Division of Psychological Methods and Assessment, Ludwig Maximilian University of Munich, Munich, Germany (MBü, PS); Department of Psychology, Division of Neuropsychology, Ludwig Maximilian University of Munich, Munich, Germany (KM); Breast Center, Department of Gynecology, Red Cross Hospital, Munich, Germany (MBr); Breast Center, Department of Gynecology and Obstetrics, Dritter Orden Hospital, Munich, Germany (FEvK); Hochschule Fresenius, University of Applied Sciences, Psychology School, Munich, Germany (KHä); Breast Center, Department of Gynecology and Obstetrics, District Hospital of Ebersberg, Ebersberg, Germany (SH); Breast Center, Department of Gynecology and Obstetrics, Hospital of Landshut, Landshut, Germany (IB); Breast Center, Department of Gynecology and Obstetrics, Helios Amper Hospital Dachau, Dachau, Germany (GD); Department of Psychosomatic Medicine and Psychotherapy, Division of Psychosocial Oncology, Roman Herzog Comprehensive Cancer Center, Technical University of Munich, Munich, Germany (PH).

    ,

    Affiliations of authors: Breast Center, Department of Gynecology and Obstetrics (KHer, FN, JK, VV, RW, ND, KHä, SH, SM, NH), and Institute for Clinical Radiology (KHel, DRD), CCCLMU University Hospital of Munich, Munich, Germany; Department of Psychology, Division of Psychological Methods and Assessment, Ludwig Maximilian University of Munich, Munich, Germany (MBü, PS); Department of Psychology, Division of Neuropsychology, Ludwig Maximilian University of Munich, Munich, Germany (KM); Breast Center, Department of Gynecology, Red Cross Hospital, Munich, Germany (MBr); Breast Center, Department of Gynecology and Obstetrics, Dritter Orden Hospital, Munich, Germany (FEvK); Hochschule Fresenius, University of Applied Sciences, Psychology School, Munich, Germany (KHä); Breast Center, Department of Gynecology and Obstetrics, District Hospital of Ebersberg, Ebersberg, Germany (SH); Breast Center, Department of Gynecology and Obstetrics, Hospital of Landshut, Landshut, Germany (IB); Breast Center, Department of Gynecology and Obstetrics, Helios Amper Hospital Dachau, Dachau, Germany (GD); Department of Psychosomatic Medicine and Psychotherapy, Division of Psychosocial Oncology, Roman Herzog Comprehensive Cancer Center, Technical University of Munich, Munich, Germany (PH).

    ,

    Affiliations of authors: Breast Center, Department of Gynecology and Obstetrics (KHer, FN, JK, VV, RW, ND, KHä, SH, SM, NH), and Institute for Clinical Radiology (KHel, DRD), CCCLMU University Hospital of Munich, Munich, Germany; Department of Psychology, Division of Psychological Methods and Assessment, Ludwig Maximilian University of Munich, Munich, Germany (MBü, PS); Department of Psychology, Division of Neuropsychology, Ludwig Maximilian University of Munich, Munich, Germany (KM); Breast Center, Department of Gynecology, Red Cross Hospital, Munich, Germany (MBr); Breast Center, Department of Gynecology and Obstetrics, Dritter Orden Hospital, Munich, Germany (FEvK); Hochschule Fresenius, University of Applied Sciences, Psychology School, Munich, Germany (KHä); Breast Center, Department of Gynecology and Obstetrics, District Hospital of Ebersberg, Ebersberg, Germany (SH); Breast Center, Department of Gynecology and Obstetrics, Hospital of Landshut, Landshut, Germany (IB); Breast Center, Department of Gynecology and Obstetrics, Helios Amper Hospital Dachau, Dachau, Germany (GD); Department of Psychosomatic Medicine and Psychotherapy, Division of Psychosocial Oncology, Roman Herzog Comprehensive Cancer Center, Technical University of Munich, Munich, Germany (PH).

    ,

    Affiliations of authors: Breast Center, Department of Gynecology and Obstetrics (KHer, FN, JK, VV, RW, ND, KHä, SH, SM, NH), and Institute for Clinical Radiology (KHel, DRD), CCCLMU University Hospital of Munich, Munich, Germany; Department of Psychology, Division of Psychological Methods and Assessment, Ludwig Maximilian University of Munich, Munich, Germany (MBü, PS); Department of Psychology, Division of Neuropsychology, Ludwig Maximilian University of Munich, Munich, Germany (KM); Breast Center, Department of Gynecology, Red Cross Hospital, Munich, Germany (MBr); Breast Center, Department of Gynecology and Obstetrics, Dritter Orden Hospital, Munich, Germany (FEvK); Hochschule Fresenius, University of Applied Sciences, Psychology School, Munich, Germany (KHä); Breast Center, Department of Gynecology and Obstetrics, District Hospital of Ebersberg, Ebersberg, Germany (SH); Breast Center, Department of Gynecology and Obstetrics, Hospital of Landshut, Landshut, Germany (IB); Breast Center, Department of Gynecology and Obstetrics, Helios Amper Hospital Dachau, Dachau, Germany (GD); Department of Psychosomatic Medicine and Psychotherapy, Division of Psychosocial Oncology, Roman Herzog Comprehensive Cancer Center, Technical University of Munich, Munich, Germany (PH).

    ,

    Affiliations of authors: Breast Center, Department of Gynecology and Obstetrics (KHer, FN, JK, VV, RW, ND, KHä, SH, SM, NH), and Institute for Clinical Radiology (KHel, DRD), CCCLMU University Hospital of Munich, Munich, Germany; Department of Psychology, Division of Psychological Methods and Assessment, Ludwig Maximilian University of Munich, Munich, Germany (MBü, PS); Department of Psychology, Division of Neuropsychology, Ludwig Maximilian University of Munich, Munich, Germany (KM); Breast Center, Department of Gynecology, Red Cross Hospital, Munich, Germany (MBr); Breast Center, Department of Gynecology and Obstetrics, Dritter Orden Hospital, Munich, Germany (FEvK); Hochschule Fresenius, University of Applied Sciences, Psychology School, Munich, Germany (KHä); Breast Center, Department of Gynecology and Obstetrics, District Hospital of Ebersberg, Ebersberg, Germany (SH); Breast Center, Department of Gynecology and Obstetrics, Hospital of Landshut, Landshut, Germany (IB); Breast Center, Department of Gynecology and Obstetrics, Helios Amper Hospital Dachau, Dachau, Germany (GD); Department of Psychosomatic Medicine and Psychotherapy, Division of Psychosocial Oncology, Roman Herzog Comprehensive Cancer Center, Technical University of Munich, Munich, Germany (PH).

    ,

    Affiliations of authors: Breast Center, Department of Gynecology and Obstetrics (KHer, FN, JK, VV, RW, ND, KHä, SH, SM, NH), and Institute for Clinical Radiology (KHel, DRD), CCCLMU University Hospital of Munich, Munich, Germany; Department of Psychology, Division of Psychological Methods and Assessment, Ludwig Maximilian University of Munich, Munich, Germany (MBü, PS); Department of Psychology, Division of Neuropsychology, Ludwig Maximilian University of Munich, Munich, Germany (KM); Breast Center, Department of Gynecology, Red Cross Hospital, Munich, Germany (MBr); Breast Center, Department of Gynecology and Obstetrics, Dritter Orden Hospital, Munich, Germany (FEvK); Hochschule Fresenius, University of Applied Sciences, Psychology School, Munich, Germany (KHä); Breast Center, Department of Gynecology and Obstetrics, District Hospital of Ebersberg, Ebersberg, Germany (SH); Breast Center, Department of Gynecology and Obstetrics, Hospital of Landshut, Landshut, Germany (IB); Breast Center, Department of Gynecology and Obstetrics, Helios Amper Hospital Dachau, Dachau, Germany (GD); Department of Psychosomatic Medicine and Psychotherapy, Division of Psychosocial Oncology, Roman Herzog Comprehensive Cancer Center, Technical University of Munich, Munich, Germany (PH).

    ,

    Affiliations of authors: Breast Center, Department of Gynecology and Obstetrics (KHer, FN, JK, VV, RW, ND, KHä, SH, SM, NH), and Institute for Clinical Radiology (KHel, DRD), CCCLMU University Hospital of Munich, Munich, Germany; Department of Psychology, Division of Psychological Methods and Assessment, Ludwig Maximilian University of Munich, Munich, Germany (MBü, PS); Department of Psychology, Division of Neuropsychology, Ludwig Maximilian University of Munich, Munich, Germany (KM); Breast Center, Department of Gynecology, Red Cross Hospital, Munich, Germany (MBr); Breast Center, Department of Gynecology and Obstetrics, Dritter Orden Hospital, Munich, Germany (FEvK); Hochschule Fresenius, University of Applied Sciences, Psychology School, Munich, Germany (KHä); Breast Center, Department of Gynecology and Obstetrics, District Hospital of Ebersberg, Ebersberg, Germany (SH); Breast Center, Department of Gynecology and Obstetrics, Hospital of Landshut, Landshut, Germany (IB); Breast Center, Department of Gynecology and Obstetrics, Helios Amper Hospital Dachau, Dachau, Germany (GD); Department of Psychosomatic Medicine and Psychotherapy, Division of Psychosocial Oncology, Roman Herzog Comprehensive Cancer Center, Technical University of Munich, Munich, Germany (PH).

    ,

    Affiliations of authors: Breast Center, Department of Gynecology and Obstetrics (KHer, FN, JK, VV, RW, ND, KHä, SH, SM, NH), and Institute for Clinical Radiology (KHel, DRD), CCCLMU University Hospital of Munich, Munich, Germany; Department of Psychology, Division of Psychological Methods and Assessment, Ludwig Maximilian University of Munich, Munich, Germany (MBü, PS); Department of Psychology, Division of Neuropsychology, Ludwig Maximilian University of Munich, Munich, Germany (KM); Breast Center, Department of Gynecology, Red Cross Hospital, Munich, Germany (MBr); Breast Center, Department of Gynecology and Obstetrics, Dritter Orden Hospital, Munich, Germany (FEvK); Hochschule Fresenius, University of Applied Sciences, Psychology School, Munich, Germany (KHä); Breast Center, Department of Gynecology and Obstetrics, District Hospital of Ebersberg, Ebersberg, Germany (SH); Breast Center, Department of Gynecology and Obstetrics, Hospital of Landshut, Landshut, Germany (IB); Breast Center, Department of Gynecology and Obstetrics, Helios Amper Hospital Dachau, Dachau, Germany (GD); Department of Psychosomatic Medicine and Psychotherapy, Division of Psychosocial Oncology, Roman Herzog Comprehensive Cancer Center, Technical University of Munich, Munich, Germany (PH).

    ,

    Affiliations of authors: Breast Center, Department of Gynecology and Obstetrics (KHer, FN, JK, VV, RW, ND, KHä, SH, SM, NH), and Institute for Clinical Radiology (KHel, DRD), CCCLMU University Hospital of Munich, Munich, Germany; Department of Psychology, Division of Psychological Methods and Assessment, Ludwig Maximilian University of Munich, Munich, Germany (MBü, PS); Department of Psychology, Division of Neuropsychology, Ludwig Maximilian University of Munich, Munich, Germany (KM); Breast Center, Department of Gynecology, Red Cross Hospital, Munich, Germany (MBr); Breast Center, Department of Gynecology and Obstetrics, Dritter Orden Hospital, Munich, Germany (FEvK); Hochschule Fresenius, University of Applied Sciences, Psychology School, Munich, Germany (KHä); Breast Center, Department of Gynecology and Obstetrics, District Hospital of Ebersberg, Ebersberg, Germany (SH); Breast Center, Department of Gynecology and Obstetrics, Hospital of Landshut, Landshut, Germany (IB); Breast Center, Department of Gynecology and Obstetrics, Helios Amper Hospital Dachau, Dachau, Germany (GD); Department of Psychosomatic Medicine and Psychotherapy, Division of Psychosocial Oncology, Roman Herzog Comprehensive Cancer Center, Technical University of Munich, Munich, Germany (PH).

    ,

    Affiliations of authors: Breast Center, Department of Gynecology and Obstetrics (KHer, FN, JK, VV, RW, ND, KHä, SH, SM, NH), and Institute for Clinical Radiology (KHel, DRD), CCCLMU University Hospital of Munich, Munich, Germany; Department of Psychology, Division of Psychological Methods and Assessment, Ludwig Maximilian University of Munich, Munich, Germany (MBü, PS); Department of Psychology, Division of Neuropsychology, Ludwig Maximilian University of Munich, Munich, Germany (KM); Breast Center, Department of Gynecology, Red Cross Hospital, Munich, Germany (MBr); Breast Center, Department of Gynecology and Obstetrics, Dritter Orden Hospital, Munich, Germany (FEvK); Hochschule Fresenius, University of Applied Sciences, Psychology School, Munich, Germany (KHä); Breast Center, Department of Gynecology and Obstetrics, District Hospital of Ebersberg, Ebersberg, Germany (SH); Breast Center, Department of Gynecology and Obstetrics, Hospital of Landshut, Landshut, Germany (IB); Breast Center, Department of Gynecology and Obstetrics, Helios Amper Hospital Dachau, Dachau, Germany (GD); Department of Psychosomatic Medicine and Psychotherapy, Division of Psychosocial Oncology, Roman Herzog Comprehensive Cancer Center, Technical University of Munich, Munich, Germany (PH).

    ,

    Affiliations of authors: Breast Center, Department of Gynecology and Obstetrics (KHer, FN, JK, VV, RW, ND, KHä, SH, SM, NH), and Institute for Clinical Radiology (KHel, DRD), CCCLMU University Hospital of Munich, Munich, Germany; Department of Psychology, Division of Psychological Methods and Assessment, Ludwig Maximilian University of Munich, Munich, Germany (MBü, PS); Department of Psychology, Division of Neuropsychology, Ludwig Maximilian University of Munich, Munich, Germany (KM); Breast Center, Department of Gynecology, Red Cross Hospital, Munich, Germany (MBr); Breast Center, Department of Gynecology and Obstetrics, Dritter Orden Hospital, Munich, Germany (FEvK); Hochschule Fresenius, University of Applied Sciences, Psychology School, Munich, Germany (KHä); Breast Center, Department of Gynecology and Obstetrics, District Hospital of Ebersberg, Ebersberg, Germany (SH); Breast Center, Department of Gynecology and Obstetrics, Hospital of Landshut, Landshut, Germany (IB); Breast Center, Department of Gynecology and Obstetrics, Helios Amper Hospital Dachau, Dachau, Germany (GD); Department of Psychosomatic Medicine and Psychotherapy, Division of Psychosocial Oncology, Roman Herzog Comprehensive Cancer Center, Technical University of Munich, Munich, Germany (PH).

    ,

    Affiliations of authors: Breast Center, Department of Gynecology and Obstetrics (KHer, FN, JK, VV, RW, ND, KHä, SH, SM, NH), and Institute for Clinical Radiology (KHel, DRD), CCCLMU University Hospital of Munich, Munich, Germany; Department of Psychology, Division of Psychological Methods and Assessment, Ludwig Maximilian University of Munich, Munich, Germany (MBü, PS); Department of Psychology, Division of Neuropsychology, Ludwig Maximilian University of Munich, Munich, Germany (KM); Breast Center, Department of Gynecology, Red Cross Hospital, Munich, Germany (MBr); Breast Center, Department of Gynecology and Obstetrics, Dritter Orden Hospital, Munich, Germany (FEvK); Hochschule Fresenius, University of Applied Sciences, Psychology School, Munich, Germany (KHä); Breast Center, Department of Gynecology and Obstetrics, District Hospital of Ebersberg, Ebersberg, Germany (SH); Breast Center, Department of Gynecology and Obstetrics, Hospital of Landshut, Landshut, Germany (IB); Breast Center, Department of Gynecology and Obstetrics, Helios Amper Hospital Dachau, Dachau, Germany (GD); Department of Psychosomatic Medicine and Psychotherapy, Division of Psychosocial Oncology, Roman Herzog Comprehensive Cancer Center, Technical University of Munich, Munich, Germany (PH).

    ,

    Affiliations of authors: Breast Center, Department of Gynecology and Obstetrics (KHer, FN, JK, VV, RW, ND, KHä, SH, SM, NH), and Institute for Clinical Radiology (KHel, DRD), CCCLMU University Hospital of Munich, Munich, Germany; Department of Psychology, Division of Psychological Methods and Assessment, Ludwig Maximilian University of Munich, Munich, Germany (MBü, PS); Department of Psychology, Division of Neuropsychology, Ludwig Maximilian University of Munich, Munich, Germany (KM); Breast Center, Department of Gynecology, Red Cross Hospital, Munich, Germany (MBr); Breast Center, Department of Gynecology and Obstetrics, Dritter Orden Hospital, Munich, Germany (FEvK); Hochschule Fresenius, University of Applied Sciences, Psychology School, Munich, Germany (KHä); Breast Center, Department of Gynecology and Obstetrics, District Hospital of Ebersberg, Ebersberg, Germany (SH); Breast Center, Department of Gynecology and Obstetrics, Hospital of Landshut, Landshut, Germany (IB); Breast Center, Department of Gynecology and Obstetrics, Helios Amper Hospital Dachau, Dachau, Germany (GD); Department of Psychosomatic Medicine and Psychotherapy, Division of Psychosocial Oncology, Roman Herzog Comprehensive Cancer Center, Technical University of Munich, Munich, Germany (PH).

    ,

    Affiliations of authors: Breast Center, Department of Gynecology and Obstetrics (KHer, FN, JK, VV, RW, ND, KHä, SH, SM, NH), and Institute for Clinical Radiology (KHel, DRD), CCCLMU University Hospital of Munich, Munich, Germany; Department of Psychology, Division of Psychological Methods and Assessment, Ludwig Maximilian University of Munich, Munich, Germany (MBü, PS); Department of Psychology, Division of Neuropsychology, Ludwig Maximilian University of Munich, Munich, Germany (KM); Breast Center, Department of Gynecology, Red Cross Hospital, Munich, Germany (MBr); Breast Center, Department of Gynecology and Obstetrics, Dritter Orden Hospital, Munich, Germany (FEvK); Hochschule Fresenius, University of Applied Sciences, Psychology School, Munich, Germany (KHä); Breast Center, Department of Gynecology and Obstetrics, District Hospital of Ebersberg, Ebersberg, Germany (SH); Breast Center, Department of Gynecology and Obstetrics, Hospital of Landshut, Landshut, Germany (IB); Breast Center, Department of Gynecology and Obstetrics, Helios Amper Hospital Dachau, Dachau, Germany (GD); Department of Psychosomatic Medicine and Psychotherapy, Division of Psychosocial Oncology, Roman Herzog Comprehensive Cancer Center, Technical University of Munich, Munich, Germany (PH).

    ,

    Affiliations of authors: Breast Center, Department of Gynecology and Obstetrics (KHer, FN, JK, VV, RW, ND, KHä, SH, SM, NH), and Institute for Clinical Radiology (KHel, DRD), CCCLMU University Hospital of Munich, Munich, Germany; Department of Psychology, Division of Psychological Methods and Assessment, Ludwig Maximilian University of Munich, Munich, Germany (MBü, PS); Department of Psychology, Division of Neuropsychology, Ludwig Maximilian University of Munich, Munich, Germany (KM); Breast Center, Department of Gynecology, Red Cross Hospital, Munich, Germany (MBr); Breast Center, Department of Gynecology and Obstetrics, Dritter Orden Hospital, Munich, Germany (FEvK); Hochschule Fresenius, University of Applied Sciences, Psychology School, Munich, Germany (KHä); Breast Center, Department of Gynecology and Obstetrics, District Hospital of Ebersberg, Ebersberg, Germany (SH); Breast Center, Department of Gynecology and Obstetrics, Hospital of Landshut, Landshut, Germany (IB); Breast Center, Department of Gynecology and Obstetrics, Helios Amper Hospital Dachau, Dachau, Germany (GD); Department of Psychosomatic Medicine and Psychotherapy, Division of Psychosocial Oncology, Roman Herzog Comprehensive Cancer Center, Technical University of Munich, Munich, Germany (PH).

    ,

    Affiliations of authors: Breast Center, Department of Gynecology and Obstetrics (KHer, FN, JK, VV, RW, ND, KHä, SH, SM, NH), and Institute for Clinical Radiology (KHel, DRD), CCCLMU University Hospital of Munich, Munich, Germany; Department of Psychology, Division of Psychological Methods and Assessment, Ludwig Maximilian University of Munich, Munich, Germany (MBü, PS); Department of Psychology, Division of Neuropsychology, Ludwig Maximilian University of Munich, Munich, Germany (KM); Breast Center, Department of Gynecology, Red Cross Hospital, Munich, Germany (MBr); Breast Center, Department of Gynecology and Obstetrics, Dritter Orden Hospital, Munich, Germany (FEvK); Hochschule Fresenius, University of Applied Sciences, Psychology School, Munich, Germany (KHä); Breast Center, Department of Gynecology and Obstetrics, District Hospital of Ebersberg, Ebersberg, Germany (SH); Breast Center, Department of Gynecology and Obstetrics, Hospital of Landshut, Landshut, Germany (IB); Breast Center, Department of Gynecology and Obstetrics, Helios Amper Hospital Dachau, Dachau, Germany (GD); Department of Psychosomatic Medicine and Psychotherapy, Division of Psychosocial Oncology, Roman Herzog Comprehensive Cancer Center, Technical University of Munich, Munich, Germany (PH).

    ,

    Affiliations of authors: Breast Center, Department of Gynecology and Obstetrics (KHer, FN, JK, VV, RW, ND, KHä, SH, SM, NH), and Institute for Clinical Radiology (KHel, DRD), CCCLMU University Hospital of Munich, Munich, Germany; Department of Psychology, Division of Psychological Methods and Assessment, Ludwig Maximilian University of Munich, Munich, Germany (MBü, PS); Department of Psychology, Division of Neuropsychology, Ludwig Maximilian University of Munich, Munich, Germany (KM); Breast Center, Department of Gynecology, Red Cross Hospital, Munich, Germany (MBr); Breast Center, Department of Gynecology and Obstetrics, Dritter Orden Hospital, Munich, Germany (FEvK); Hochschule Fresenius, University of Applied Sciences, Psychology School, Munich, Germany (KHä); Breast Center, Department of Gynecology and Obstetrics, District Hospital of Ebersberg, Ebersberg, Germany (SH); Breast Center, Department of Gynecology and Obstetrics, Hospital of Landshut, Landshut, Germany (IB); Breast Center, Department of Gynecology and Obstetrics, Helios Amper Hospital Dachau, Dachau, Germany (GD); Department of Psychosomatic Medicine and Psychotherapy, Division of Psychosocial Oncology, Roman Herzog Comprehensive Cancer Center, Technical University of Munich, Munich, Germany (PH).

    ,

    Affiliations of authors: Breast Center, Department of Gynecology and Obstetrics (KHer, FN, JK, VV, RW, ND, KHä, SH, SM, NH), and Institute for Clinical Radiology (KHel, DRD), CCCLMU University Hospital of Munich, Munich, Germany; Department of Psychology, Division of Psychological Methods and Assessment, Ludwig Maximilian University of Munich, Munich, Germany (MBü, PS); Department of Psychology, Division of Neuropsychology, Ludwig Maximilian University of Munich, Munich, Germany (KM); Breast Center, Department of Gynecology, Red Cross Hospital, Munich, Germany (MBr); Breast Center, Department of Gynecology and Obstetrics, Dritter Orden Hospital, Munich, Germany (FEvK); Hochschule Fresenius, University of Applied Sciences, Psychology School, Munich, Germany (KHä); Breast Center, Department of Gynecology and Obstetrics, District Hospital of Ebersberg, Ebersberg, Germany (SH); Breast Center, Department of Gynecology and Obstetrics, Hospital of Landshut, Landshut, Germany (IB); Breast Center, Department of Gynecology and Obstetrics, Helios Amper Hospital Dachau, Dachau, Germany (GD); Department of Psychosomatic Medicine and Psychotherapy, Division of Psychosocial Oncology, Roman Herzog Comprehensive Cancer Center, Technical University of Munich, Munich, Germany (PH).

    Affiliations of authors: Breast Center, Department of Gynecology and Obstetrics (KHer, FN, JK, VV, RW, ND, KHä, SH, SM, NH), and Institute for Clinical Radiology (KHel, DRD), CCCLMU University Hospital of Munich, Munich, Germany; Department of Psychology, Division of Psychological Methods and Assessment, Ludwig Maximilian University of Munich, Munich, Germany (MBü, PS); Department of Psychology, Division of Neuropsychology, Ludwig Maximilian University of Munich, Munich, Germany (KM); Breast Center, Department of Gynecology, Red Cross Hospital, Munich, Germany (MBr); Breast Center, Department of Gynecology and Obstetrics, Dritter Orden Hospital, Munich, Germany (FEvK); Hochschule Fresenius, University of Applied Sciences, Psychology School, Munich, Germany (KHä); Breast Center, Department of Gynecology and Obstetrics, District Hospital of Ebersberg, Ebersberg, Germany (SH); Breast Center, Department of Gynecology and Obstetrics, Hospital of Landshut, Landshut, Germany (IB); Breast Center, Department of Gynecology and Obstetrics, Helios Amper Hospital Dachau, Dachau, Germany (GD); Department of Psychosomatic Medicine and Psychotherapy, Division of Psychosocial Oncology, Roman Herzog Comprehensive Cancer Center, Technical University of Munich, Munich, Germany (PH).

    Source

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    28521364