Neurocognitive function in patients with head and neck cancer undergoing primary or adjuvant chemoradiation treatment

Abstract

Purpose Cancer and cancer therapy-related neurocognitive changes negatively affect quality of life, yet few studies have examined neurocognitive changes in patients with head and neck cancer. The purpose of this study was to evaluate neurocognitive performance in patients with head and neck cancer at baseline before starting treatment and 3 months after treatment completion to assess treatment-associated changes in performance. Methods Patients with head and neck cancer who were to receive primary or adjuvant chemoradiation (N = 55) underwent neuropsychological testing before and 3 months posttreatment. Changes in neurocognitive performance were assessed using a practice effect adjusted Reliable Change Index.Results At baseline, 38 % of patients exhibited global neurocognitive impairment. Posttreatment, 21.8 % demonstrated declines in neurocognitive performance in at least one domain. Declines in domain-specific performance ranged from 1.8 to 12.7 % with the greatest decline in language, specifically verb retrieval. Domain-specific improvements ranged from 0 to 7.3 %. Conclusions Patients had a high prevalence of baseline neurocognitive impairment. While neurocognitive performance posttreatment remained unchanged in the majority, almost 13 % suffered declines in language. Small percentages of patients exhibited improvements in their performance. Long-term effects and risk factors for neurocognitive decline in this population should be studied on a larger scale.

Long-term cognitive, psychosocial, and neurovascular complications of unilateral head and neck irradiation in young to middle-aged adults

“…The small sample limits statistical analysis and inferences as possible confounders, such as cardiovascular disease, alcohol use, concomitant treatment (among others surgical intervention and chemotherapeutic treatment), and time-since-treatment could not be corrected for. These concomitant treatments are, however, known to affect cognitive performance in HNC patients [ 7 , 8 , 11 , 77 ]. Furthermore, pre-treatment cognitive and psychosocial functioning were not assessed, while a decreased cognitive performance has been reported before treatment in HNC patients [ 60 , 78 , 79 ].…”

The Older Adult With Locoregionally Advanced Head and Neck Squamous Cell Carcinoma: Knowledge Gaps and Future Direction in Assessment and Treatment

“…111 Patients experience declines in short-term memory, language abilities, and verbal fluency after RT-based therapy with higher RT doses associated with greater cognitive decline. 103,112–114 These changes have significant implications for patients’ ability to engage in daily activities, such as their ability to drive. 115 To date, studies of neurocognitive function in patients with HNSCC have been conducted in relatively young patients (average age <60 years).…”

The Hippocampus: A New Organ at Risk for Postoperative Radiation Therapy for Bucco-alveolar Cancer? A Dosimetric and Biological Analysis

“…(9,10) The hippocampus, located in the ventromedial portion of temporal lobe, is the seat of neurogenesis, owing to the 'stem cell niche', rendering it more radiosensitive than other brain sub-structures. (11) The positive correlation of impaired neurocognitive function (NCF) with temporal lobe and hippocampal doses is not limited only to cranial irradiation (primary and metastatic brain tumors) but has also been associated with head-neck radiotherapy (HN-RT), (10,(12)(13)(14)(15) primarily thought to be due to temporal lobe injury as the mechanism of neurotoxicity. (9,(16)(17)(18)(19) The correlation between temporal lobe injury and NCF decline could hypothetically be secondary to hippocampal hypoxic injury due to radiation.…”