The relevance of online cognitive assessment in oncology The Amsterdam Cognition Scan

An increasing number of studies show that cancer and cancer treatment is associated with cognitive impairment, underlining the need for further research. For this reason, the Amsterdam Cognition Scan (ACS) was developed earlier —an online cognitive test battery that patients can complete independently. The first aim of this thesis was to further develop the ACS. The second aim was to implement cognitive tests in studies on cognitive effects of endocrine therapy (ET).
First, it was investigated how to correct for computer experience when analyzing online cognitive test performance. It was shown that correction was best done using a self-report measure of computer experience. Second, cross-lingual word criteria were developed for new word lists for the ACS verbal memory subtest. The criteria were shown to develop new parallel word lists. Third, a data-driven subgrouping method was applied using ACS data, supporting the existence of two cognitive subgroups in breast cancer (BC) patients who underwent chemotherapy.
Subsequently, the literature is described on cognitive effects of ET in patients with hormone-receptor positive (HR+) BC. Increasing evidence for cognitive effects of ET was found, with potentially differential effects between ET agents. Then, cognitive effects of tamoxifen and exemestane were investigated in women with HR+ BC. It was found that tamoxifen alone and after switching to exemestane was associated with cognitive effects, while exemestane was not. Last, the long-term effect of risk-reducing salphingo-oophorectomy (RRSO) was examined on cognition in women at increased risk for ovarian cancer. Approximately 18 years after RRSO, no association was found between premenopausal RRSO and cognition.