Self-reported cognitive outcomes among adolescent and young adult patients with noncentral nervous system cancers.

Chia Jie Tan,Alexandre Chan,Mohamad Farid Harunal Rashid,Jaclyn Jia Jun Mah,Wei Lin Goh,Eileen Poon

doi:10.1002/pon.5456

Abstract

ObjectiveCancer‐related cognitive impairment (CRCI) among adolescent and young adult (AYA) cancer patients with noncentral nervous system (CNS) cancers has not been well studied. In this study, we aimed to describe CRCI‐associated trends and characteristics among AYA cancer patients.MethodsIn a longitudinal cohort of AYA cancer patients without CNS disease, CRCI was evaluated over 1 year using the Functional Assessment of Cancer Therapy‐Cognitive Function Instrument, a self‐reported cognitive outcome measure. CRCI prevalence was quantified using the previously established minimal clinically important difference. CRCI‐associated longitudinal trends and factors were evaluated with mixed‐effects model analysis.ResultsNinety‐one patients (mean age = 28.4 ± 6.7 years) were included. Approximately one‐third (34.1%) experienced CRCI at least once during the study follow‐up. Female gender (P = .02), Indian ethnicity (P < .01), current smokers (P < .01), anxiety/depressive symptoms (P < .01) and fatigue (P < .01) were found to be associated with poorer cognitive function among AYAs.ConclusionsAlthough AYA cancer patients were relatively young and without CNS disease involvement, a significant proportion of them experienced clinically important decline in cognitive function. With improved understanding of this subject, effective strategies can be formulated to promote awareness of CRCI and mitigate its negative effects among AYA cancer patients.

Highlights

Cancer-related cognitive impairment (CRCI) is one of the complications that plague cancer patients from the point of diagnosis to beyond disease remission, even in the absence of organic causes such as central nervous system (CNS) tumors
Even among cancers that are common within the AYA age range, such as Hodgkin's lymphoma[5] and testicular cancer,[6] representation of AYA patients is often low, and subgroup analysis of AYA patients has not been presented in the literature
Compared to previous studies investigating subjective CRCI, the proportion of patients with subjective CRCI in our study was lower than that observed among breast cancer patients receiving chemotherapy (20%-50%)[21,22,23] but higher than patients who did not undergo chemotherapy (10%-15%).[21]

Summary

Introduction

Cancer-related cognitive impairment (CRCI) is one of the complications that plague cancer patients from the point of diagnosis to beyond disease remission, even in the absence of organic causes such as central nervous system (CNS) tumors. The International Cancer and Cognition Taskforce (ICCTF) defines CRCI as a decline in memory, attention, concentration, and executive function among cancer patients.[1] Extensive research has been performed in order to evaluate CRCI in single tumor type cohorts, for example, breast and colorectal. Age-specific CRCI studies have been limited far to survivors of childhood cancers[7] and the elderly,[8] indicating a lack of robust studies quantifying the prevalence and characterizing CRCI trends in AYA patients diagnosed with malignancies

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