Self-Reported Cognitive Impairment in Patients With Cancer

Abstract

Purpose: Cancer patients often report cognitive impairment, manifested as problems with concentration and memory, following cancer therapy. As part of a large multicenter survey of cancer patients undergoing treatment, we investigated the frequency and severity of self-reported problems with memory and concentration over time.Methods: A total of 595 patients undergoing treatment for solid tumors self-rated problems with memory and concentration, using an 11-point Likert scale (0 ϭ "not present" to 10 ϭ "as bad as you can imagine") at baseline before treatment began (T1), at their worst during treatment (T2), and at 6 months following treatment (T3). Any symptom level Ն 7 was classified as "severe." Paired or independent t tests (as appropriate) with a Bonferroni correction were used to examine differences in symptoms over time and between patients treated with chemotherapy, radiation therapy, or both.Results: Concentration problems were reported by 48% of the 595 participants at T1 (5% severe), 67% at T2 (18% severe), and 58% (8% severe) at T3. Problems with memory were reported by 53% at T1 (4% severe), 67% (18% severe) at T2, and 68% (11% severe) at T3. The average frequency and severity of both symptoms in patients receiving chemotherapy, with or without radiation, increased significantly between T1 and T2 (P Ͻ .001). Both symptoms were less severe in patients receiving radiation alone at all three measurements than in either of the chemotherapy groups (all P values Ͻ .001). Symptoms at T3 were significantly higher than T1 for all groups (P Ͻ .001). Conclusion:A significant proportion of patients undergoing cancer therapy self-report problems with memory and concentration. Cognitive problems get worse during treatment and are still in evidence 6 months following the conclusion of treatments.

Self-reported cognitive problems in testicular cancer patients: Relation to neuropsychological performance, fatigue, and psychological distress

“…Cognitive problems such as concentration and memory problems are frequently reported by cancer patients [1][2][3]. This has led to an increasing scientific focus on cognitive function (CF) after cancer treatment.…”

“…Evaluations were performed after orchidectomy (surgical removing of the affected testicle) but prior to any additional treatment (baseline), and then at 1 year after end of treatment (follow-up). To our knowledge, this is the first prospective study of self-reported CF in TCPs, and the aims of the study were (1) to compare the proportions of TCPs with an increase of self-reported cognitive problems from baseline to 1-year follow-up among patients treated with different treatment modalities (no chemotherapy, one cycle of chemotherapy, or multiple cycles of chemotherapy) and (2) to study variables associated with an increase of self-reported cognitive problems from baseline to 1-year follow-up. Based on previous research, we hypothesized that (1) a larger proportion of TCPs treated with multiple cycles of chemotherapy have an increase of self-reported cognitive problems from baseline to 1-year follow-up compared with TCPs treated with no or with one cycle of chemotherapy; (2) an increase of self-reported cognitive problems from baseline to 1-year follow-up is significantly associated with psychological distress and fatigue at follow-up, but not with a decline in neuropsychological test performance.…”

Prevalence, mechanisms, and management of cancer-related cognitive impairment

“…While many studies have investigated the impact of chemotherapy, other studies have evaluated the impact of radiation therapy and hormonal therapies on cognitive function and found deficits in similar domains as with chemotherapy treatments (Castellon et al, 2004; Kohli et al, 2007; Schilder et al, 2009; Schilder et al, 2010; Schilder et al, 2012). Studies with comparison groups of patients treated with chemotherapy to those with hormonal therapies both show declines compared to healthy controls suggesting that hormone therapies can also lead to CRCI (Ahles, et al, 2010), and the combined treatment of tamoxifen and chemotherapy leads to greater difficulties than chemotherapy alone (Castellon, et al, 2004) (Palmer et al, 2008).…”

Vocational identity, positive affect, and career thoughts in a group of young adult central nervous system cancer survivors

“…Earlier studies suggested that neurocognitive problems because of surgery, chemotherapy, or radiotherapy may negatively influence CNS cancer survivors' capacity of career problem-solving and decision-making (Green et al, 2005;Kohli et al, 2007;Gehring et al, 2008). Examples of cognitive dysfunctions that may lead to negative effects on career problem-solving and decisionmaking are delirium, attention, memory, or executive function (Green et al, 2005).…”