Subjective and Objective Cancer-Related Cognitive Impairments Among Systemic and Radiation Therapy-Naïve Female Cancer Patients.

Background: Cancer-related cognitive impairment (CRCI) is a frequent and burdensome problem that is still insufficiently understood and managed. We investigated subjective and objective measures of CRCI, as recommended by the International Cancer and Cognition Task Force (ICCTF) in cancer patients prior to systemic or radiation therapy with respect to potential influencing or associated psychosocial, demographic, or lifestyle factors.

Methods: Female patients with breast or gynecological tumors (n = 239, mean age = 55.5, SD = 11.6) prior to any systemic or radiation therapy completed validated subjective (FACT-Cog: perceived cognitive impairment [PCI], perceived cognitive ability [PCA], impact on quality of life [IQoL]) and objective measures of CRCI (Trail Making Test [TMT-A and -B], Controlled Oral Word Association Test [COWA], and Hopkins Verbal Learning Test-Revised [HVLT-R]). Association with cross-sectionally assessed age, body mass index, education, smoking, alcohol intake, sleep problems, social support, anxiety, and pain was investigated using multiple linear regression models.

Results: A quarter (25.1%) of patients showed indication for CRCI based on the PCI score. Subjective and objective CRCI measures showed no or only weak correlations, also when adjusting for age and education (partial Spearman correlations with each other, all |r| ≤ 0.21). Anxiety, sleep problems, and pain were significantly associated with low subjective cognitive function (PCI, PCA, and IQoL). Poor objective cognitive values (TMT, COWA, and HVLT-R) were mainly determined by higher age and lower education.

Conclusions: Cancer-related cognitive impairment is not solely (chemo-)therapy-induced but may be triggered or influenced by anxiety, sleep problems, and pain. Addressing these issues early in the treatment phase could potentially alleviate perceived CRCI. The ICCTF-recommended neuropsychological tests do not adequately capture this CRCI prior to systemic or radiation therapy, but could serve as complementary tools to monitor cognitive changes over time, independent of psychosocial influences.