Perceived cognitive impairment in people with colorectal cancer who do and do not receive chemotherapy
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Cognitive symptoms are common after cancer, but poorly associated with neuropsychological results. We previously reported colorectal cancer (CRC) patients had more cognitive impairment than controls. Here, we explore relationships between cognitive symptoms and neuropsychological domains.
Subjects with CRC (N = 362) and 72 healthy controls completed neuropsychological assessments and Functional Assessment of Cancer Therapy-Cognition (FACT-COG) at baseline (pre-chemotherapy) and 6, 12, and 24 months. Associations between neuropsychological and FACT-COG scores were explored: perceived cognitive impairment (PCI), perceived cognitive ability (PCA), impact of PCI on quality of life (CogQOL).
Of 362 CRC subjects, 289 had loco-regional disease and 173 received chemotherapy (CTh+). At baseline, groups did not differ on total FACT-COG, PCI, or PCA scores. All scores, except PCA, were worse at 6 months in CTh+. CRC patients not receiving chemotherapy did not differ from controls on FACT-COG domains. PCA associated weakly (r = 0.28–0.34) with attention/executive function, visual memory, and global deficit score. There was no association between PCI and neuropsychological domains. Fatigue, anxiety/depression, and poorer quality of life were associated with PCI and CogQOL (r = 0.44–0.51) in CRC patients.
No association was seen between total FACT-COG or PCI, and neuropsychological domains. A weak-moderate association was found between PCA and attention/executive function and visual memory.
The study was registered with clinicaltrials.gov (trial registration: NCT00188331).
Implications for cancer survivors
Cognitive symptoms are associated with fatigue, anxiety/depression, and poorer quality of life, and do not appear to be related to actual cognitive performance. Rates were lower than that reported in breast cancer survivors. Cognitive symptoms were greatest in those who received chemotherapy, with no significant difference between the non-chemotherapy survivors and healthy controls.
KeywordsCognitive function Colorectal cancer Survivorship Quality of life
We would like to thank Anna Dodd for her work as study coordinator in Toronto and David Laurence for his work as data manager. Collaborators, study coordinators, and participants from the following hospitals are also gratefully acknowledged: Toronto: Princess Margaret, Toronto General, Toronto Western, Mt. Sinai, Sunnybrook, Credit Valley, Humber River, St. Michael’s, Toronto East General; Sydney: Concord Repatriation General, Royal Prince Alfred, Bankstown, Royal North Shore, Prince of Wales, Nepean.
This work was supported by the National Cancer Institute of Canada [grant number #15261, 2004]; the American Society of Clinical Oncology Young Investigator Award to JV ; the National Health Medical Research Council [grant number 457386, 2007]; and the Cancer Institute New South Wales [grant number 05/CRF/1-06, 2006; grant number 09/RIG1-13, 2010] to JV.
Compliance with ethical standards
All procedures performed in this study 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.
Conflict of interest
The authors declare that they have no conflict of interest.
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