Immediate-term chemotherapy-related cognitive impairment (CRCI) following administration of intravenous (IV) chemotherapy.

Abstract

10084 Background: The acute impact of chemotherapy on cognition is unknown. This study utilized performance on the psychomotor vigilance task (PVT) and trail-making test B (TMT) to assess CRCI immediately following chemotherapy administration. Methods: Patients aged 18-80 years receiving first-line IV chemotherapy for any stage of breast or colorectal cancer were eligible. Patients with brain metastases, neurologic disorders or allergic reactions to chemotherapy were excluded. Patient symptoms, peripheral neuropathy and Stanford Sleepiness Scale were assessed. A five-minute PVT and TMT were completed on a tablet computer pre-chemotherapy and immediately post-chemotherapy. Paired Wilcoxon Rank Sum tests were used to assess change in median PVT reaction time, TMT completion time, TMT errors and PVT lapses. A priori, an increase in median PVT reaction times by over 20 ms (approximating reaction time changes with blood alcohol concentrations of 0.04 to 0.05 g%) was considered a clinically relevant change. Results: 144 patients (74 breast, 70 colorectal, median age 55.5 years) were tested. Post-chemotherapy, median PVT reaction time slowed by an average of 12.4 ms ( p = 0.01). Post-chemotherapy median PVT times slowed by over 20 ms in 59 patients (40.9%). TMT completion post-chemotherapy was faster by an average of 6.1 seconds ( p < 0.001). No differences were seen in TMT errors ( p = 0.417) or PVT lapses ( p = 0.845). Change in median PVT reaction time was not associated with age, gender, number of prior chemotherapy cycles, peripheral neuropathy grade, self-reported symptoms (anxiety, fatigue or depression). Change in median PVT reaction time was also not significantly associated with use of any specific chemotherapeutic drug or class, including paclitaxel (which includes ethanol as an excipient). Conclusions: Median PVT reaction time was significantly slower immediately after chemotherapy compared to a pre-chemotherapy baseline, and impairment correlating to effects of alcohol was seen in 41% of patients. This effect appears independent of age, self-reported symptoms or prior chemotherapy cycles. Further studies assessing functional impact of immediate-term CRCI are warranted.