Patterns of self-reported neurocognitive (NC) deficits in head and neck cancer (HNC) patients during concurrent chemoradiation therapy (CCR).

Abstract

Listen

Translate article

e16015 Background: Although changes in NC function are often reported by patients with cancer, few studies have examined this issue in HNC patients receiving CCR. We conducted a prospective observational cohort study to examine NC impairment before, during, and after HNC therapy. Almost half (49%) of patients exhibited impaired baseline neuropsychological function. Here we describe the patterns of self-reported NC function during treatment. Methods: NC deficits were assessed in 59 patients undergoing CCR using the following self-report measures: the Alertness Behavior Subscale (ABS) of the Sickness Impact Profile, the Neurocognitive Subscale of the modified Memorial Symptom Assessment Scale – Short Form (MSAS-SF), and the Confusion Subscale of the Profile of Mood States (POMS). Patients underwent assessments at baseline and weekly during CCR. A group-based, log-likelihood, trajectory modeling approach was used to detect clusters of trajectories (patterns of change) in NC function. Results: The HNC patients were predominantly male (80%), Caucasian (92%), and married (76%), with at least a high school education (86%). Mean age was 55 years (SD 9.2; Range 33-70). Primary sites included: oropharynx (54%), larynx (14%), paranasal sinus/nasal cavity (7%), unknown (7%), nasopharynx (5%), and other (13%). A majority of patients (76%) received induction chemotherapy followed by CCR; the remainder had CCR postoperatively or as primary treatment. Similar patterns of self-reported NC deficits were noted across the three instruments. Three distinct patterns of NC function were identified: (1) patients who perceived higher levels of NC deficits at baseline which persisted through CCR, (2) patients who perceived none to minimal NC deficits at baseline or at any point during therapy, and (3) patients who perceived minimal NC deficits at baseline but reported increasing deficits during therapy. Conclusions: As with other cancers, a proportion of patients present with self-reported NC deficits. In addition, a subset of patients develops perceived NC deficits during CCR. The cause and social/medical implications of NC impairment in these patients are unknown and need to be explored. No significant financial relationships to disclose.