Immediate-term cognitive impairment following intravenous (IV) chemotherapy: a prospective pre-post design study

Abstract

Background Cognitive impairment is commonly reported in patients receiving chemotherapy, but the acuity of onset is not known. This study utilized the psychomotor vigilance test (PVT) and trail-making test B (TMT-B) to assess cognitive impairment immediately post-chemotherapy. Methods Patients aged 18–80 years receiving first-line intravenous chemotherapy for any stage of breast or colorectal cancer were eligible. Patient symptoms, peripheral neuropathy and Stanford Sleepiness Scale were assessed. A five-minute PVT and TMT-B were completed on a tablet computer pre-chemotherapy and immediately post-chemotherapy. Using a mixed linear regression model, changes in reciprocal transformed PVT reaction time (mean 1/RT) were assessed. A priori, an increase in median PVT reaction times by > 20 ms (approximating PVT changes with blood alcohol concentrations of 0.04–0.05 g%) was considered clinically relevant. Results One hundred forty-two cancer patients (73 breast, 69 colorectal, median age 55.5 years) were tested. Post-chemotherapy, mean 1/RT values were significantly slowed compared to pre-chemotherapy baseline ( p = 0.01). This corresponded to a median PVT reaction time slowed by an average of 12.4 ms. Changes in PVT reaction times were not correlated with age, sex, cancer type, treatment setting, or use of supportive medications. Median post-chemotherapy PVT reaction time slowed by an average of 22.5 ms in breast cancer patients and by 1.6 ms in colorectal cancer patients. Post-chemotherapy median PVT times slowed by > 20 ms in 57 patients (40.1%). Exploratory analyses found no statistically significant association between the primary outcome and self-reported anxiety, fatigue or depression. TMT-B completion speed improved significantly post-chemotherapy ( p = 0.03), likely due to test-retest phenomenon. Conclusions PVT reaction time slowed significantly immediately post-chemotherapy compared to a pre-chemotherapy baseline, and levels of impairment similar to effects of alcohol consumption in other studies was seen in 40% of patients. Further studies assessing functional impact of cognitive impairment on patients immediately after chemotherapy are warranted. Electronic supplementary material The online version of this article (10.1186/s12885-019-5349-2) contains supplementary material, which is available to authorized users.

Brain morphological alterations and their correlation to tumor differentiation and duration in patients with lung cancer after platinum chemotherapy

“…Moreover, patients with or without chemotherapy showed a significant decrease in cortical thickness, mainly in the frontal lobe, temporal lobe, and insular lobe in the analysis of the three groups and a more extensive decrease in brain regions in the analysis of the paired groups. Most of these altered regions are related to cognitive, executive, emotional, and motor functions ( 5 , 6 , 30 ).…”

“…Chemotherapy-related brain changes may accelerate brain morphological changes; however, empirical evidence supporting this theory is limited ( 3 , 4 ). Accordingly, it is urgent to understand the neurological morphology that can provide a theoretical basis for rehabilitation treatment strategies in survivors ( 5 ).…”

Age‐related differences in self‐report and objective measures of cognitive function in older patients prior to chemotherapy

“…The TMTs A & B do not have established cutoff scores (Luck et al, 2018;Tombaugh, 2004). The TMT is a valid measure to assess cognitive function in older patients (Reitan, 1958;Tombaugh, 2004) and was used in several studies of older oncology patients (Hlubocky et al, 2018;Khan et al, 2019;Weerink et al, 2018). Reliability testing for all of the study measures was done on an annual basis with all of the research staff.…”