Cognitive impairment in adolescent and young adult cancer patients: Pre‐treatment findings of a longitudinal study

• Published in: Cancer medicine (Malden, MA) Vol. 12; no. 4; pp. 4821 - 4831
• Main Authors: Chan, Alexandre, Cheng, Ivy, Wang, Claire, Tan, Chia Jie, Toh, Yi Long, Ng, Ding Quan, Koh, Yong Qin, Zhou, Hanzhang, Foo, Koon Mian, Chan, Raymond Javan, Ho, Han Kiat, Chew, Lita, Farid, Mohamad, Tannock, Ian
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01.02.2023; John Wiley and Sons Inc; Wiley
• Subjects: Adolescent; adolescent and young adult; Adult; Age; Automation; Biomarkers; Brain research; Brain-Derived Neurotrophic Factor; Breast cancer; Cancer; Cancer therapies; cancer‐related cognitive impairment; Chemotherapy; cognition; Cognitive ability; Cognitive Dysfunction - diagnosis; Cognitive Dysfunction - etiology; Cohort Studies; Cytokines; Humans; Inflammation; inflammatory cytokines; Informed consent; Interleukin 10; Interleukin 2; Interleukin 4; Interleukin 6; Interleukin 8; Likert scale; Longitudinal Studies; Medical diagnosis; Memory; Multitasking; Neoplasms - complications; Neoplasms - psychology; Neuropsychology; Observational studies; Patients; Quality of Life; Questionnaires; Radiation therapy; Rehabilitation; Risk factors; Womens health; Young Adult; Young adults; γ-Interferon; Singapore; cancer-related cognitive impairment; cancer; brain-derived neurotrophic factor; inflammatory cytokines; cognition; adolescent and young adult
• ISSN: 2045-7634; 2045-7634
• DOI: 10.1002/cam4.5295

Background There is little information about cancer‐related cognitive impairment (CRCI) in adolescent and young adults (AYA, 15–39 years old) due to its rare incidence. Here, we present the pre‐treatment (before chemotherapy or radiotherapy) evaluation of cognitive function and ability of AYA with cancer (AYAC) in a multicentered cohort study. Methods Newly diagnosed AYAC and age‐matched healthy controls (HC) were recruited between 2018 and 2021. The primary outcome was the comparison of pre‐treatment cognitive impairment defined as 2 standard deviations (SDs) below the HC on ≥1 cognitive test, or >1.5 SDs below on ≥2 tests using CANTAB® between AYAC and HC. Secondary outcomes included self‐perceived cognitive ability assessed by FACT‐Cog v3 and biomarkers (inflammatory cytokines and brain‐derived neurotrophic factor [BDNF]). Results We recruited 74 AYAC (median age = 34) and 118 HC (median age = 32). On objective cognitive testing, we observed three times more AYAC patients performed poorly on at least 2 cognitive tests compared to HC (40.5% vs. 13.6%, p < 0.001). AYAC self‐perceived less degree of cognitive impairment than HC (p < 0.001). However, AYAC perceived a greater impact of cognitive changes on their quality of life compared to HC (p = 0.039). Elevated baseline inflammatory markers (IL‐2, IL‐4, IL‐6, IL‐8, IL‐10 and IFN‐γ) were observed among AYAC compared to HC, and baseline BDNF was lower in AYAC compared to HC. Interaction effects between cancer diagnosis and biomarkers were observed in predicting cognitive function. Conclusion With the pre‐existence of CRCI and risk factors of neuroinflammation even prior to systemic therapy, AYAC should receive early rehabilitation to prevent further deterioration of cognitive function after initiation of systemic therapies. (ClinicalTrials.gov Identifier: NCT03476070). This study reported about pre‐treatment cancer‐related cognitive impairment between newly diagnosed AYAC and age‐matched healthy control. There were higher proportions of subjects with impairment and elevated inflammatory marker levels among AYAC compared to controls. At the same time, lower levels of self‐perceived impairment and lower baseline BDNF levels were reported in this patient group.