Does hormone therapy impact cognition in patients with prostate cancer? A systematic review and meta‐analysis

Abstract

BackgroundHormone therapy, which is widely prescribed for prostate cancer, might induce cognitive impairment and affect the autonomy of elderly patients. However, previous studies provided conflicting results. The aim of this systematic review and meta‐analysis was to synthesize the longitudinal impact of hormone therapy on objective (cognitive tests) and subjective (questionnaires) cognition.MethodsA search was performed of the PubMed, Web of Science, and PsycINFO databases. Studies that longitudinally assessed cognition in patients undergoing androgen‐deprivation therapy and new‐generation hormone therapy were considered. To perform a meta‐analysis, available scores were aggregated and classified into six objective domains and one subjective domain. Weighted mean effect sizes were computed using a random effect model.ResultsTwenty studies were included in the systematic review (1440 patients), and 15 could be included in the meta‐analysis (1093 patients). In the systematic review, 20%–50% of patients had objective cognitive impairment before treatment initiation. The meta‐analysis revealed a decline in subjective cognition (g = −0.44; p = .03) with androgen‐deprivation therapy and new‐generation hormone therapy. All other effect sizes were small (from g = −0.02 to g = 0.18), and none of them indicated a significant decline in objective cognition. Significant heterogeneity was observed in all domains of objective cognition.ConclusionsThis synthesis presents the first meta‐analytic evidence of the negative impact of androgen‐deprivation therapy and new‐generation hormone therapy on subjective cognition. In contrast, there was no conclusive evidence of a decline in objective cognition. The high heterogeneity underscores the need for homogeneous cognitive research on prostate cancer.Plain Language Summary There is no consensus on the cognitive impairment induced by hormone therapy for prostate cancer, despite the implications for patients’ care and daily life. This synthesis of published studies demonstrated an increase in perceived cognitive difficulties but did not prove a decline in cognitive performance during treatment.

Effect of hormonal therapies for prostate cancer on cognition: The ongoing search for clarity

“…meta-analysis by Boué et al in this issue of Cancer is the latest and most robust synthesis of the literature thus far, with the inclusion of both ADT and ARAT studies and an analysis of cognitive effects by specific cognitive domains. 4 Previous systematic reviews and meta-analyses produced inconsistent results, and most omitted the newer ARATs in favor of ADTs only. In 2015, McGinty et al's meta-analysis of 14 studies found that patients treated with ADT performed worse than controls or their own baseline on visuomotor tasks, although none of the other six cognitive domains showed significant changes.…”