Relationship between neurocognitive functioning and medication management ability over the first 6 months following allogeneic stem cell transplantation

Abstract

Although neurocognitive impairment has been established as a major issue among cancer survivors, the real-world consequences of this impairment are unclear. This study investigated the relationship between neurocognitive functioning and medication management ability over time among 58 patients treated with allogeneic hematopoietic stem cell transplantation (HCT). Participants completed a neuropsychological test battery and a simulated medication management task at three time points: pretransplant (T0), Day 100 (T1) and 6 months post transplant (T2). Neurocognitively impaired participants performed worse on the medication management task than neurocognitively normal participants at each time point, and were more likely to score in the impaired range of medication management ability post transplant (72% vs 20%, P o 0.001 at T1; 67% vs 23%, P = 0.013 at T2). In multivariate analyses, worse performance in executive functioning/working memory consistently predicted impaired medication management ability, even when controlling for sociodemographic and clinical confounders (odds ratio = 0.89, 95% confidence interval (0.80, 0.98), P = 0.023). Lower physical symptom distress also predicted impaired medication management ability, but this effect decreased over time. Self-reported cognitive problems were not correlated with medication management ability at any time point. Findings suggest that poor neurocognitive functioning, particularly in the domain of executive functioning/working memory, is associated with worse medication management ability within the first 6 months after allogeneic HCT.

Neurocognitive dysfunction in hematopoietic cell transplant recipients: expert review from the late effects and Quality of Life Working Committee of the CIBMTR and complications and Quality of Life Working Party of the EBMT

“…10 Similarly, Booth-Jones and colleagues noted significant relationships between fatigue and depression and neurocognitive dysfunction in a cohort of patients at least six months following HCT. 30 However, it should be noted that two studies found no significant relationship between fatigue or depression and neurocognitive dysfunction, 19,29 and that two other studies found anxiety to be significantly associated with neurocognitive dysfunction. 30,113 …”

“…In this area of research, most studies have focused on fatigue and depressive symptoms. 10,19,29,30 For example, one longitudinal study examined cancer-related symptoms associated with neurocognitive dysfunction and found significant relationships over time among several domains of neurocognitive function and symptoms such as fatigue, depression, and perceived stress. 113 Another study examined patients with multiple myeloma who completed autologous HCT and found similar associations between neurocognitive function and symptoms (e.g.…”

“…10,21 These side effects may lead to difficulty with medication management, including dosing errors and non-adherence, in the early period following HCT. 30 …”

Neurocognitive Dysfunction in Hematopoietic Cell Transplant Recipients: Expert Review from the Late Effects and Quality of Life Working Committee of the Center for International Blood and Marrow Transplant Research and Complications and Quality of Life Working Party of the European Society for Blood and Marrow Transplantation

“…Not surprisingly, higher incidences of anxiety, fatigue, depression, emotional distress, and poor physical and social functioning have also been reported among HCT survivors with neurocognitive dysfunction [10,25]. These side effects may lead to difficulty with medication management, including dosing errors and noncompliance, in the early period after HCT [40].…”

Blood-based biomarkers of cancer-related cognitive impairment in non-central nervous system cancer: protocol for a scoping review

“… 1 2 CRCI is typically characterised by problems in memory, attention, processing speed and executive functioning. 3 4 The potential consequences of CRCI on survivors’ quality of life are significant, including challenges with emotional well-being, return to work and ability to engage effectively in self-care 5 6 in the months to years after treatment.…”