Systematic Review of Cognitive Impairment in Colorectal Cancer Survivors Who Received Chemotherapy

Chan, Ya-Ning; Bryant, Ashley Leak; Conklin, Jamie; Girdwood, Tyra Claire; Piepmeier, Aaron; Hirschey, Rachel

doi:10.1188/21.onf.634-647

Cited by 11 publications

(11 citation statements)

References 48 publications

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“…Cognitive impairment was found in 13%-57% of CRC patients treated with chemotherapy ( 9 ), which was similar to the study reporting the prevalence of cognitive impairment ranged from 17% to 75% among patients of various cancer types ( 10 ). Another study found that 18-24% of CRC patients had perceived cognitive impairment before treatment based on the Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog) while the impaired cognition in those who treated with chemotherapy was aggravated ( 11 ).…”

Section: Introductionsupporting

confidence: 87%

Chemotherapy-induced functional brain abnormality in colorectal cancer patients: a resting‐state functional magnetic resonance imaging study

Liu

Guo

et al. 2022

Front. Oncol.

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IntroductionChemotherapy-induced cognitive impairment (i.e., “chemobrain”) is a common neurotoxic side-effect experienced by many cancer survivors who undergone chemotherapy. However, the central mechanism underlying chemotherapy-related cognitive impairment is still unclear. The purpose of this study was to investigate the changes of intrinsic brain activity and their associations with cognitive impairment in colorectal cancer (CRC) patients after chemotherapy.MethodsResting‐state functional magnetic resonance imaging data of 29 CRC patients following chemotherapy and 29 matched healthy controls (HCs) were collected in this study, as well as cognitive test data including Mini Mental State Exam (MMSE), Montreal Cognitive Assessment (MoCA) and Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog). The measure of fractional amplitude of low-frequency fluctuation (fALFF) was calculated and compared between groups. The correlations between the fALFF of impaired brain region and cognitive performance were also analyzed.ResultsCompared with HCs, CRC patients following chemotherapy showed decreased fALFF values in the left anterior cingulate gyrus (ACG) and middle frontal gyrus, as well as increased fALFF values in the left superior frontal gyrus (orbital part) and middle occipital gyrus. Moreover, positive associations were identified between fALFF values of the left ACG and the total scores of MMSE, MoCA and FACT-Cog in the patient group.ConclusionThese findings indicated that CRC patients after chemotherapy had decreased intrinsic brain activity in the left ACG, which might be vulnerable to the neurotoxic side-effect of chemotherapeutic drugs and related to chemotherapy-induced cognitive impairment.

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Section: Introductionsupporting

confidence: 87%

Chemotherapy-induced functional brain abnormality in colorectal cancer patients: a resting‐state functional magnetic resonance imaging study

Liu

Guo

et al. 2022

Front. Oncol.

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“…10 The affected neural areas, such as the frontal cortex, are mainly important for executive function and memory. Chan et al 27 shows that colorectal survivors report subjective impairment regardless of treatment but data suggests that severity is higher among those receiving chemotherapy.…”

Section: Crci Among Different Cancers and Treatmentsmentioning

confidence: 99%

Cancer‐related cognitive impairment in survivors of adolescent and young adult non‐central nervous system cancer: A scoping review

2022

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Objectives Cancer‐related cognitive impairments (CRCI) are common after treatment and can have important impacts on the lives of adolescent and young adult (AYA) cancer survivors—those cancer survivors diagnosed between ages 15 and 39. However, most research focuses on survivors diagnosed under age 15 or over age 39 so we know relatively little about CRCI among AYA survivors of non‐central nervous system (CNS) cancers. Here we review the research on CRCI among AYA survivors of non‐CNS cancers to determine prevalence, associated factors, and impact on survivors' lives as well as implications for future research. Methods In November 2021 we performed a systematic search of the literature in MEDLINE, Web of Science, PsycInfo, CINAHL, EMBASE, and Cochrane Central Register of Controlled Trials to identify peer‐reviewed English language articles describing original research with at least one cognitive outcome and conducted with AYA survivors of non‐CNS cancer diagnosed as AYAs. We screened 6003 articles and 21 met eligibility criteria. Guided by the PRISMA‐ScR Checklist, we extracted study information to meet review objectives. Results Most studies employed cross‐sectional surveys or interviews, though some employed longitudinal methods, neurocognitive assessments, or brain imaging. From the subset of articles that reported a prevalence we calculated a weighted mean prevalence of 25.75% and weighted median prevalence of 27.8%. The factors associated with CRCI included female gender, higher dose chemotherapy, and comorbidities. CRCI impacted the lives of AYA survivors through impaired role functioning, financial toxicity, and unmet needs. Conclusions CRCI is highly prevalent among non‐CNS cancer survivors diagnosed as AYAs and impacts quality of life and role functioning. This review suggests a need for further longitudinal, imaging, and mixed methods research and provision of resources to help achieve better quality of life and educational and occupational attainment during what is potentially a decades‐long survivorship period. However, although interventions might improve cognition and functioning, the review identified only one pilot study. Digital interventions may be a practical and effective option for this age group, but they have yet to be adequately investigated.

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“…Several meta-analyses have confirmed the presence of objective cognitive deficits in patients undergoing chemotherapy across a range of cancers. 5,6 Whilst initially solely attributed to treatment with chemotherapy, hence the term 'chemobrain', it is becoming clear that a range of factors including the cancer, surgery, anaesthesia, fatigue and mood may play a role in the aetiology of cognitive impairment in cancer patients with some research indicating cognitive impairment present prior to systemic treatment. 5,[7][8][9][10][11] Research in CRC is limited with few longitudinal studies available to give accurate indications of the prevalence and incidence of cognitive impairment in CRC.…”

mentioning

confidence: 99%

“…5,6 Whilst initially solely attributed to treatment with chemotherapy, hence the term 'chemobrain', it is becoming clear that a range of factors including the cancer, surgery, anaesthesia, fatigue and mood may play a role in the aetiology of cognitive impairment in cancer patients with some research indicating cognitive impairment present prior to systemic treatment. 5,[7][8][9][10][11] Research in CRC is limited with few longitudinal studies available to give accurate indications of the prevalence and incidence of cognitive impairment in CRC. 6 Existing studies suggests that CRC patients display greater cognitive impairment than matched healthy controls (43% vs 15%).…”

mentioning

confidence: 99%

“…12 The relationship between chemotherapy and cognitive impairment in CRC remains unclear with research to-date presenting conflicting results, with some studies finding chemotherapy to be associated with poorer cognitive performance, but other studies finding no association. 5,12,13 Despite the publication of international guidelines for researching cognitive impairment in cancer survivors, 14 a recent systematic review in colorectal cancer highlighted the need for future research to use standardised criteria and measures to define and assess cognitive impairment. 5 Furthermore, the review called for more research into the relationships between emotional distress and cognitive impairment to attempt to clarify these associations.…”

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confidence: 99%

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The impact of chemotherapy on cognitive performance post‐surgery in patients with colorectal cancer: A prospective cohort study

et al. 2023

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Objectives: Subjective reports of cognitive impairment following chemotherapy are frequent in cancer patients. Objective cognitive impairment has been observed in cancer patients regardless of treatment regimen suggesting the relationship between cognitive impairment and chemotherapy is not clear cut. Little research has explored the effects of chemotherapy on cognition following surgery in colorectal cancer (CRC). The present study explored the effects of chemotherapy on cognitive performance in a sample of CRC patients. Methods: 136 participants were recruited into a prospective cohort study: 78 CRC patients undergoing surgery and adjuvant chemotherapy, 58 CRC patients undergoing surgery only. A battery of neuropsychological tests was administered to participants 4 weeks post-surgery (T1), 12 weeks after first chemotherapy (T2) and 3 months after last chemotherapy (T3) or equivalent time-points.Results: Using the criterion of scoring at least two standard-deviations below the group norm on at least one neuropsychological test, 45%-55% of all CRC patients showed cognitive deficits 10 months after surgery (T3) and 14% on at least 3 tests. However, cognition did not significantly differ between patients who had chemotherapy and those who did not. A time by group interaction effect was found on the composite cognition score using multi-level modelling suggesting a greater improvement in cognition in the surgery only group over time (p < 0.05).Conclusions: CRC patients display cognitive impairment 10 months after surgery.Chemotherapy did not worsen cognitive impairment but did appear to slow cognitive recovery relative to those undergoing surgery only. The findings demonstrate a clear need for supportive cognitive interventions for all CRC patients following treatment.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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Systematic Review of Cognitive Impairment in Colorectal Cancer Survivors Who Received Chemotherapy

Cited by 11 publications

References 48 publications

Chemotherapy-induced functional brain abnormality in colorectal cancer patients: a resting‐state functional magnetic resonance imaging study

Chemotherapy-induced functional brain abnormality in colorectal cancer patients: a resting‐state functional magnetic resonance imaging study

Cancer‐related cognitive impairment in survivors of adolescent and young adult non‐central nervous system cancer: A scoping review

The impact of chemotherapy on cognitive performance post‐surgery in patients with colorectal cancer: A prospective cohort study

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