Androgen-deprivation therapy and cognitive decline in the NEON-PC prospective study during the COVID-19 pandemic

N Araújo,A Costa,L Lopes-Conceição,A Ferreira,F Carneiro,J Oliveira,I Braga,S Morais,L Pacheco-Figueiredo,L Ruano,V.T Cruz,S Pereira,N Lunet

doi:10.1016/j.esmoop.2022.100448

N Araújo, A Costa + Show 11 more

Open Access

https://doi.org/10.1016/j.esmoop.2022.100448

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Journal: ESMO open	Publication Date: Mar 7, 2022
Citations: 5	License type: cc-by

Affiliation: University of Porto, IPO Porto, University of Minho

Abstract

BackgroundAndrogen-deprivation therapy (ADT) has been associated with cognitive decline, but results are conflicting. This study describes changes in cognitive performance in patients with prostate cancer, according to ADT, during the first year after prostate cancer diagnosis.Patients and methodsPatients with prostate cancer treated at the Portuguese Institute of Oncology of Porto (n = 366) were evaluated with the Montreal Cognitive Assessment (MoCA), before treatment and after 1 year. All baseline evaluations were performed before the coronavirus disease 2019 (COVID-19) pandemic and 69.7% of the 1-year assessments were completed after the first lockdown. Cognitive decline was defined as the decrease in MoCA from baseline to the 1-year evaluation below 1.5 standard deviations of the distribution of changes in the whole cohort. Participants scoring below age- and education-specific normative reference values in the MoCA were considered to have cognitive impairment. Age- and education-adjusted odds ratios (aORs) were computed for the association between ADT and cognitive outcomes.ResultsMean MoCA scores increased from baseline to the 1-year evaluation (22.3 versus 22.8, P < 0.001). Cognitive decline was more frequent in the ADT group, and even more after the onset of the COVID-19 pandemic (aOR 6.81 versus 1.93, P for interaction = 0.233). The 1-year cumulative incidence of cognitive impairment was 6.9% (9.1% before and 3.7% after the pandemic onset), which was higher among patients receiving ADT, but only after the pandemic (aOR 5.53 versus 0.49, P for interaction = 0.044).ConclusionsADT was associated with worse cognitive performance of patients with prostate cancer, mostly among those evaluated after the first COVID-19 lockdown.

Highlights

With nearly 5 million 5-year prevalent cases estimated in 2020, patients with prostate cancer represent the largest population of male cancer survivors worldwide.[1]
Mean Montreal Cognitive Assessment (MoCA) scores increased from baseline to the 1-year evaluation [mean (SD): 22.3 (3.7) versus 22.8 (3.8), respectively; P < 0.001), but this variation, when the 1-year evaluation was performed after the onset of COVID-19 pandemic, was not statistically significant
Even while using a cognitive test that may not detect subtle changes in cognitive performance, our results show that Androgen-deprivation therapy (ADT) is associated with the deterioration of overall cognitive function

Summary

Introduction

With nearly 5 million 5-year prevalent cases estimated in 2020, patients with prostate cancer represent the largest population of male cancer survivors worldwide.[1] Half of these patients may have been submitted to Androgendeprivation therapy (ADT) during the course of the disease.[2]. Cognitive decline was more frequent in the ADT group, and even more after the onset of the COVID-19 pandemic (aOR 6.81 versus 1.93, P for interaction 1⁄4 0.233). The 1-year cumulative incidence of cognitive impairment was 6.9% (9.1% before and 3.7% after the pandemic onset), which was higher among patients receiving ADT, but only after the pandemic (aOR 5.53 versus 0.49, P for interaction 1⁄4 0.044). Conclusions: ADT was associated with worse cognitive performance of patients with prostate cancer, mostly among those evaluated after the first COVID-19 lockdown.

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