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Post-treatment cognitive dysfunction in women treated with thyroidectomy for papillary thyroid carcinoma

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Abstract

Purpose

The purpose of the study is to assess cognitive function in papillary thyroid cancer, one type of differentiated thyroid cancer, and to identify factors associated with cognitive dysfunction.

Methods

Korean women treated with papillary thyroid cancer post thyroidectomy (n = 90) and healthy women similar in age and educational level (n = 90) performed attention and working memory tests and completed self-report questionnaires on cognitive complaints, psychological distress, symptom distress, and cultural characteristics. Comparative and multivariable regression analyses were performed to determine differences in cognitive function and possible predictors of neurocognitive performance and cognitive complaints.

Results

Thyroid cancer survivors performed and perceived their function to be significantly worse on tests of attention and working memory compared to individuals without thyroid cancer. Regression analyses found that having thyroid cancer, older age, and lower educational level were associated with worse neurocognitive performance, while greater fatigue, more sleep problems, and higher levels of childrearing burden but not having thyroid cancer were associated with lower perceived effectiveness in cognitive functioning.

Conclusions

Findings suggest that women receiving thyroid hormone replacement therapy after thyroidectomy for papillary thyroid cancer are at risk for attention and working memory problems. Coexisting symptoms and culture-related women’s burden affected perceived cognitive dysfunction. Health care providers should assess for cognitive problems in women with thyroid cancer and intervene to reduce distress and improve quality of life.

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References

  1. La Vecchia C, Malvezzi M, Bosetti C, Garavello W, Bertuccio P, Levi F, Negri E (2015) Thyroid cancer mortality and incidence: a global overview. Int J Cancer 136:2187–2195. doi:10.1002/ijc.29251

    Article  CAS  PubMed  Google Scholar 

  2. Rahib L, Smith BD, Aizenberg R, Rosenzweig AB, Fleshman JM, Matrisian LM (2014) Projecting cancer incidence and deaths to 2030: the unexpected burden of thyroid, liver, and pancreas cancers in the United States. Cancer Res 74:2913–2921. doi:10.1158/0008-5472.CAN-14-0155

    Article  CAS  PubMed  Google Scholar 

  3. Jung KW, Won YJ, Kong HJ, Oh CM, Cho H, Lee DH, Lee KH (2015) Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2012. Cancer Res Treat 47:127–141. doi:10.4143/crt.2015.060

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Aschebrook-Kilfoy B, James B, Nagar S, Kaplan S, Seng V, Ahsan H, Angelos P, Kaplan EL, Guerrero MA, Kuo JH, Lee JA, Mitmaker EJ, Moalem J, Ruan DT, Shen WT, Grogan RH (2015) Risk factors for decreased quality of life in thyroid cancer survivors: initial findings from the North American thyroid cancer survivorship study. Thyroid 25:1313–1321. doi:10.1089/thy.2015.0098

    Article  PubMed  PubMed Central  Google Scholar 

  5. Von Ah D, Russell KM, Storniolo AM, Carpenter JS (2009) Cognitive dysfunction and its relationship to quality of life in breast cancer survivors. Oncol Nurs Forum 36:326–336. doi:10.1188/09.ONF.326-334

    Article  PubMed  Google Scholar 

  6. Askren MK, Jung M, Berman MG, Zhang M, Therrien B, Peltier S, Ossher L, Hayes DF, Reuter-Lorenz PA, Cimprich B (2014) Neuromarkers of fatigue and cognitive complaints following chemotherapy for breast cancer: a prospective fMRI investigation. Breast Cancer Res Treat 147:445–455. doi:10.1007/s10549-014-3092-6

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Berman MG, Askren MK, Jung M, Therrien B, Peltier S, Noll DC, Zhang M, Ossher L, Hayes DF, Reuter-Lorenz PA, Cimprich B (2014) Pretreatment worry and neurocognitive responses in women with breast cancer. Health Psychol 33:222–231. doi:10.1037/a0033425

    Article  PubMed  Google Scholar 

  8. Liu L, Fiorentino L, Natarajan L, Parker BA, Mills PJ, Sadler GR, Dimsdale JE, Rissling M, He F, Ancoli-Israel S (2009) Pre-treatment symptom cluster in breast cancer patients is associated with worse sleep, fatigue and depression during chemotherapy. Psychooncology 18:187–194. doi:10.1002/pon.1412

    Article  PubMed  PubMed Central  Google Scholar 

  9. Merriman JD, Von Ah D, Miaskowski C, Aouizerat BE (2013) Proposed mechanisms for cancer- and treatment-related cognitive changes. Semin Oncol Nurs 29:260–269. doi:10.1016/j.soncn.2013.08.006

    Article  PubMed  Google Scholar 

  10. Ritchie M, Yeap BB (2015) Thyroid hormone: influences on mood and cognition in adults. Maturitas 81:266–275. doi:10.1016/j.maturitas.2015.03.016

    Article  CAS  PubMed  Google Scholar 

  11. Cimprich B, So H, Ronis DL, Trask C (2005) Pre-treatment factors related to cognitive functioning in women newly diagnosed with breast cancer. Psychooncology 14:70–78. doi:10.1002/pon.821

    Article  PubMed  Google Scholar 

  12. Jung MS, Cimprich B (2014) Cognitive deficits in Korean women treated with chemotherapy for breast cancer. Cancer Nurs 37:E31–E42. doi:10.1097/NCC.0b013e3182980383

    Article  PubMed  Google Scholar 

  13. Burmeister LA, Ganguli M, Dodge HH, Toczek T, DeKosky ST, Nebes RD (2001) Hypothyroidism and cognition: preliminary evidence for a specific defect in memory. Thyroid 11:1177–1185. doi:10.1089/10507250152741037

    Article  CAS  PubMed  Google Scholar 

  14. Botella-Carretero JI, Galan JM, Caballero C, Sancho J, Escobar-Morreale HF (2003) Quality of life and psychometric functionality in patients with differentiated thyroid carcinoma. Endocr Relat Cancer 10:601–610

    Article  CAS  PubMed  Google Scholar 

  15. Jaracz J, Kucharska A, Rajewska-Rager A, Lacka K (2012) Cognitive functions and mood during chronic thyrotropin-suppressive therapy with L-thyroxine in patients with differentiated thyroid carcinoma. J Endocrinol Investig 35:760–765. doi:10.3275/8013

    CAS  Google Scholar 

  16. Moon JH, Ahn S, Seo J, Han JW, Kim KM, Choi SH, Lim S, Park YJ, do Park J, Kim KW, Jang HC (2014) The effect of long-term thyroid-stimulating hormone suppressive therapy on the cognitive function of elderly patients with differentiated thyroid carcinoma. J Clin Endocrinol Metab 99:3782–3789. doi:10.1210/jc.2013-4454

    Article  CAS  PubMed  Google Scholar 

  17. Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198

    Article  CAS  PubMed  Google Scholar 

  18. Arroll B, Goodyear-Smith F, Crengle S, Gunn J, Kerse N, Fishman T, Falloon K, Hatcher S (2010) Validation of PHQ-2 and PHQ-9 to screen for major depression in the primary care population. Ann Fam Med 8:348–353. doi:10.1370/afm.1139

    Article  PubMed  PubMed Central  Google Scholar 

  19. Vardy J, Tannock I (2007) Cognitive function after chemotherapy in adults with solid tumours. Crit Rev Oncol Hematol 63:183–202. doi:10.1016/j.critrevonc.2007.06.001

    Article  PubMed  Google Scholar 

  20. Bender CM, Thelen BD (2013) Cancer and cogntive changes: the complexity of the problem. Semin Oncol Nurs 29:232–237

    Article  PubMed  Google Scholar 

  21. Lezak MD, Howieson DB, Loring DW (2004) Neuropsychological assessment, 4th edn. Oxford University Press, Oxford

    Google Scholar 

  22. Visovatti MA, Reuter-Lorenz PA, Chang AE, Northouse L, Cimprich B (2016) Assessment of cognitive impairment and complaints in individuals with colorectal cancer. Oncol Nurs Forum 43:169–178. doi:10.1188/16.ONF.43-02AP

    Article  PubMed  Google Scholar 

  23. Kang Y, Chin J, Na DL, Lee J, Park JS (2000) A normative study of the Korean version of controlled oral word association test (COWAT) in the elderly. Korean J Clin Psychol 19:385–392

    Google Scholar 

  24. Cimprich B, Visovatti M, Ronis DL (2011) The Attentional Function Index—a self-report cognitive measure. Psychooncology 20:194–202. doi:10.1002/pon.1729

    Article  PubMed  Google Scholar 

  25. Jung MS (2012) Cognitive function in Korean women diagnosed with early stage breast cancer. Doctoral dissertateion. University of Michigan, Ann Arbor

    Google Scholar 

  26. Yellen SB, Cella DF, Webster K, Blendowski C, Kaplan E (1997) Measuring fatigue and other anemia-related symptoms with the Functional Assessment of Cancer Therapy (FACT) measurement system. J Pain Symptom Manag 13:63–74

    Article  CAS  Google Scholar 

  27. Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ (1989) The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 28:193–213

    Article  CAS  PubMed  Google Scholar 

  28. Sohn SI, do Kim H, Lee MY, Cho YW (2012) The reliability and validity of the Korean version of the Pittsburgh Sleep Quality Index. Sleep Breath 16:803–812. doi:10.1007/s11325-011-0579-9

    Article  PubMed  Google Scholar 

  29. Kelly W (2004) A brief measure of general worry: the three item worry index. N Am J Psychol 6:219–226

    Google Scholar 

  30. Chon K, Kim K (2008) Life stress and coping styles of Korean housewives. Korean J Health Psychol 8:1–39

    Google Scholar 

  31. Pearlin LI, Schooler C (1978) The structure of coping. J Health Soc Behav 19:2–21

    Article  CAS  PubMed  Google Scholar 

  32. Lindner OC, Phillips B, McCabe MG, Mayes A, Wearden A, Varese F, Talmi D (2014) A meta-analysis of cognitive impairment following adult cancer chemotherapy. Neuropsychology 28:726–740. doi:10.1037/neu0000064

    Article  PubMed  PubMed Central  Google Scholar 

  33. Hermelink K, Kuchenhoff H, Untch M, Bauerfeind I, Lux MP, Buhner M, Manitz J, Fensterer V, Munzel K (2010) Two different sides of ‘chemobrain’: determinants and nondeterminants of self-perceived cognitive dysfunction in a prospective, randomized, multicenter study. Psychooncology 19:1321–1328. doi:10.1002/pon.1695

    Article  PubMed  Google Scholar 

  34. Samuels MH (2008) Cognitive function in untreated hypothyroidism and hyperthyroidism. Curr Opin Endocrinol Diabetes Obes 15:429–433. doi:10.1097/MED.0b013e32830eb84c

    Article  PubMed  Google Scholar 

  35. Zhu DF, Wang ZX, Zhang DR, Pan ZL, He S, Hu XP, Chen XC, Zhou JN (2006) fMRI revealed neural substrate for reversible working memory dysfunction in subclinical hypothyroidism. Brain 129:2923–2930. doi:10.1093/brain/awl215

    Article  PubMed  Google Scholar 

  36. Mustian KM, Morrow GR, Carroll JK, Figueroa-Moseley CD, Jean-Pierre P, Williams GC (2007) Integrative nonpharmacologic behavioral interventions for the management of cancer-related fatigue. Oncologist 12:52–67. doi:10.1634/theoncologist.12-S1-52

    Article  PubMed  Google Scholar 

  37. Chiu HY, Chiang PC, Miao NF, Lin EY, Tsai PS (2014) The effects of mind-body interventions on sleep in cancer patients: a meta-analysis of randomized controlled trials. J Clin Psychiatry 75:1215–1223. doi:10.4088/JCP.13r08918

    Article  PubMed  Google Scholar 

  38. Von Ah D, Storey S, Jansen CE, Allen DH (2013) Coping strategies and interventions for cognitive changes in patients with cancer. Semin Oncol Nurs 29:288–299. doi:10.1016/j.soncn.2013.08.009

    Article  PubMed  Google Scholar 

  39. Biegler KA, Chaoul MA, Cohen L (2009) Cancer, cognitive impairment, and meditation. Acta Oncol 48:18–26. doi:10.1080/02841860802415535

    Article  PubMed  Google Scholar 

  40. Cimprich B, Ronis DL (2003) An environmental intervention to restore attention in women with newly diagnosed breast cancer. Cancer Nurs 26:284–292

    Article  PubMed  Google Scholar 

  41. Pharr JR, Dodge Francis C, Terry C, Clark MC (2014) Culture, caregiving, and health: exploring the influence of culture on family caregiver experiences. ISRN Public Health 2014:1–8. doi:10.1155/2014/689826

    Article  Google Scholar 

  42. Lockwood S (2009) Contemporary issues in women’s cancers. Jones and Bartlett, Burlington

    Google Scholar 

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Acknowledgements

The research was funded by the 2014 Research Fund of the Chungnam National University (2014-0661-01). We are most appreciative of the study participants and research teams who made this research possible.

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Authors and Affiliations

  1. College of Nursing, Chungnam National University, Daejeon, South Korea

    Mi Sook Jung

  2. School of Nursing, University of Michigan, 400 N. Ingalls, Room 2185, Ann Arbor, MI, 48109-5482, USA

    Moira Visovatti

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Correspondence to Moira Visovatti.

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The authors declare that they have no competing interests.

Research involving human participants and/or animals

1. Statement of human rights. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

2. Statement of welfare of animals. This article does not contain any studies with animals performed by any of the authors.

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Informed consent was obtained from all participants included in the study.

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Jung, M.S., Visovatti, M. Post-treatment cognitive dysfunction in women treated with thyroidectomy for papillary thyroid carcinoma. Support Care Cancer 25, 915–923 (2017). https://doi.org/10.1007/s00520-016-3481-y

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  • DOI: https://doi.org/10.1007/s00520-016-3481-y

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