Cognitive impairment and treatment effects among gastrointenstinal stromal tumor survivors: Results of a large online survey.

Abstract

e23092 Background: Cancer-related cognitive impairment (CRCI) is chronic and negatively affects quality of life (QOL) for a large portion of cancer survivors. To date, no studies have exclusively examined CRCI among gastrointestinal stromal tumor (GIST) survivors. Tyrosine kinase inhibitors (TKI), such as imatinib mesylate, have greatly increased median survival of individuals with GIST, so evaluating CRCI for this group is important. We report results of a large online survey of GIST survivors to ascertain prevalence, course and features of CRCI. Methods: A web-based survey utilizing validated patient reported outcomes (PRO’s) and de-identified demographic questions was developed. Respondents answered questions on age, gender, education, medical/cancer history and treatment. Estimated IQ was derived from demographic indexing. The FACT-Cog V3 and PROMIS Short Forms 8a assessed cognitive complaints, fatigue, mood, and anxiety. The survey was distributed through GIST Support International, the GIST Cancer Research Fund, Sarcoma Patients EuroNet and the Life Raft Group. Results: Across 4 continents, 485 adult GIST survivors (median age = 59 years, 71.8% female, 88.7% Caucasian) completed the survey. Respondents were 6.29 (sd = 5.19) years post-diagnosis with 88.0% percent on, or at least having started, imatinib. A majority (63.9%) indicated significant negative QOL impact as assessed by FACT-Cog Perceived Cognitive Impairments scale (PCI). PCI did not correlate with emotional distress or fatigue, as in other cancer samples. Type of surgery, current use/non-use of imatinib or other therapy was not associated with PCI. However, GIST survivors ≥ 5 years post-diagnosis had significantly worse PCI scores than survivors < 5 years post-diagnosis (p < 0.05). No differences between survivors with/without B12 deficiency or anemia were found and PCI did not correlate with cognitive reserve (years of education or IQ). Conclusions: Nearly two-thirds of GIST survivors report significant QOL impact of CRCI. Those with ≥ 5 year survival report worse cognitive symptoms, regardless of being on or off current TKI and cognitive symptoms do not appear associated with emotional distress or fatigue. CRCI among GIST survivors appears long term but further research to objectively determine CRCI magnitude and trajectory is warranted.