Long-term neurocognitive problems a concern for head and neck cancer survivors
medwireNews: Head and neck cancer survivors are at risk for delayed neurocognitive deficits (NCD) for at least 2 years after radiotherapy or chemotherapy, according to a prospective longitudinal study.
The study assessed neurocognitive function and self-reported symptoms in 80 patients with head and neck cancer requiring definitive chemoradiotherapy or radiotherapy and 40 healthy controls. Significant differences were found between the performance of patients and controls in several domains, with patient deficits increasing over time.
“[F]indings indicate that neurocognitive function, although not immediately affected after treatment, progressively declines in the 2 years after definitive treatment with chemotherapy or radiation,” write Lori Bernstein (Princess Margaret Cancer Centre & University of Toronto, Ontario, Canada) and colleagues in JAMA Otolaryngology–Head & Neck Surgery.
The researchers conducted a 90-minute neurocognitive test battery at four time points: baseline (≤2 weeks before starting treatment), at the end of treatment (6 months after baseline), and 12 and 24 months after baseline. Test scores were converted into age-corrected z scores, and models were adjusted for baseline performance, age, education, and depression.
Overall, patients showed declines in global cognitive function, intellectual capacity, concentration/short-term attention span, verbal memory, executive function, and motor dexterity at 6, 12, and 24 months. However, patients and controls performed equally well in processing speed and visual memory.
While the patient and control cohorts had comparable frequencies of decline in all domains at 6 months, the proportion of individuals with declines at 24 months was higher among patients in the domains of intellectual capacity (27% of patients vs 3% of controls), verbal memory (21 vs 3%), processing speed (12 vs 0%), executive function (26 vs 6%), and motor dexterity (10 vs 0%). In addition, 38% of patients exhibited impaired global cognitive function compared with none of the controls, a result the researchers describe as “especially concerning.”
Exploratory multivariable analyses conducted to assess possible prognostic factors for NCD found that lower education levels and higher baseline depression scores were the only patient characteristics prognostic for patients’ NCD across multiple domains. However, the researchers “noticed no consistent pattern to suggest reliable risk between receiving any particular chemotherapy regimen or radiation dose and having greater NCD.”
Nonetheless, they conclude, “Strategies to reduce toxic effects and cognitive rehabilitation options should be available for [head and neck cancer] survivors.”
By Catherine Booth
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