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Cognitive functioning in thyroid cancer survivors: a systematic review and meta-analysis

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Abstract

Background

Some thyroid cancer (TC) survivors experience cognitive symptoms.

Purpose

The purpose of this study is to perform a systematic literature review and meta-analysis comparing cognitive performance in TC survivors to controls.

Methods

We performed a seven-database electronic search and hand-search. We performed duplicate independent reviews and data abstraction. Random effects meta-analyses reported standardized mean differences (SMDs) with 95% confidence intervals (CIs), where a negative value implies worse performance in the TC group.

Results

We reviewed 1174 unique citations and 10 full-text papers. We included seven studies of 241 treated TC survivors and 273 controls. Cognitive function was statistically significantly worse in TC survivors in the following domains: Attention and Concentration (Digit Span Forwards) SMD − 0.37 (95% CI − 0.62, − 0.13, p = 0.003, four studies), Speed of Processing (Trail Making A) SMD − 0.36 (95% CI − 0.66, − 0.05, p = 0.022, four studies), and Language (Controlled Oral Word Association [COWAT]-Categories) SMD − 0.97 (95% − 1.31, − 0.64, p < 0.001, two studies). Executive Function results varied: COWAT-Letters SMD − 0.60 (95% CI − 0.94, − 0.27, p < 0.001, two studies), Digit Span Backwards SMD − 0.40 (95% CI − 0.64, − 0.15, p = 0.002, four studies), and Trail Making B test SMD − 0.20 (95% CI − 0.51, 0.10, p = 0.191, four studies). Statistical heterogeneity limited the COWAT-Categories and Digit Span Backwards meta-analyses.

Conclusions

Cognitive function was worse in TC survivors in multiple domains. Limitations included few studies, potential confounding, and lack of prospective data.

Implications for Cancer Survivors

TC survivors may experience impairments in cognitive function and should report cognitive concerns to healthcare practitioners.

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Acknowledgments

AMS was supported, in part, by a University of Toronto Department of Medicine Clinician Scientist Merit Award. The authors would like to thank Mrs. Coreen Marino, for assistance in retrieving the full-text papers for review. The authors would also like to thank Drs. Jan Jaracz and Moira A. Visovatti, for kindly responding to our queries about their studies.

Funding

Library service expenses were funded, in part, from a University Health Network Thyroid Cancer Research Fund (private charitable donations to the UHN Foundation).

Author information

Authors and Affiliations

  1. Division of Endocrinology, St. Michael’s Hospital, Toronto, Canada

    Omar Saeed

  2. Division of Endocrinology, University of Toronto, Toronto, Canada

    Omar Saeed & Anna M. Sawka

  3. Department of Supportive Care and Department of Psychiatry, University Health Network and University of Toronto, Toronto, Canada

    Lori J. Bernstein & Jennifer Jones

  4. Princess Margaret Cancer Centre, University Health Network Library and Information Services, Toronto, Canada

    Rouhi Fazelzad

  5. Division of Endocrinology, Diabetes and Clinical Nutrition, Oregon Health and Science University, Portland, OR, USA

    Mary Samuels

  6. Division of Diabetes, Endocrinology, and Metabolism, University of Minnesota, Minneapolis, MN, USA

    Lynn A. Burmeister

  7. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada

    Lehana Thabane

  8. Department of Endocrine Oncology, Princess Margaret Cancer Centre and University of Toronto, Toronto, Canada

    Shereen Ezzat

  9. Department of Otolaryngology, Head and Neck Surgery, University Health Network and University of Toronto, Toronto, Canada

    David P. Goldstein

  10. Division of Endocrinology, University Health Network (Toronto General Hospital), Toronto, Canada

    Anna M. Sawka

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  1. Omar Saeed
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Correspondence to Anna M. Sawka.

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Appendix

Appendix

Table 5 Sample references for cognitive tests included in this review
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Saeed, O., Bernstein, L.J., Fazelzad, R. et al. Cognitive functioning in thyroid cancer survivors: a systematic review and meta-analysis. J Cancer Surviv 13, 231–243 (2019). https://doi.org/10.1007/s11764-019-00745-1

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