Cognitive Dysfunction in non-Hodgkin's Lymphoma Patients Treated with Front-Line Chemotherapy
Despite the research to date, the characteristics and impact of cognitive dysfunction (CD) in cancer patients following chemotherapy is still not well understood. It is estimated approximately 20% of patients will manifest measurable cognitive deficits on neuropsychological testing post-chemotherapy. Given the increasing incidence of cancer, significant numbers of patients could potentially experience CD. Declines in cognitive function may compromise the ability to adhere to treatment
... ts, to make informed treatment-related decisions, and to manage work-related activities. The purpose of this study was to document the frequency of occurrence, severity and duration of CD in non-Hodgkin's lymphoma patients receiving front-line chemotherapy, and to determine what factors (if any) are correlated with CD in these patients. A quantitative, descriptive, prospective, observational design was utilized: Data were collected at five time points (pre-treatment, mid-treatment, and at one, six and 12 months post-treatment). Both subjective (patient perception) (FACT-Cog) and objective (neuropsychological) testing measures (CogState) were used. An estimate of premorbid intelligence was obtained using the NAART35. Information on possible confounding variables (eg. depression, anxiety, stress, fatigue, quality of life, hemoglobin) was collected via standardized questionnaires at each timepoint. Total time for completion of the testing at each timepoint was approximately 1 hour. A total of 100 subjects (65 males, 35 females) between 26 to 88 years of age were enrolled into this study between November 2010 and February 2014. The analyses of the results for this dissertation include the first 3 assessment time-points, and were completed iii using group data: Within-subject statistics will be obtained at the completion of all followup assessments. A subset of subjects reported worsening of perceived cognitive function over time as they progressed through their course of chemotherapy, with up to 41% of subjects reporting deterioration in quality of life as a consequence of cognitive impairment and with a worse quality of life associated with more subjective cognitive complaints. Perceived cognitive impairment was associated with higher levels of fatigue, depression, anxiety and stress. Doxorubicin-containing chemotherapy was associated with an increase in concerns regarding cognitive abilities, compared to non-doxorubicin containing regimens. Modest to moderate correlations were seen between the objective tasks measuring visual attention, working memory, attention and executive function and perceived (subjective) cognitive concerns. To my knowledge, this is the first longitudinal, prospective study investigating cognitive function in lymphoma patients receiving standard dose chemotherapy. As such, the results of the study will add important information to the literature in this group of patients. iv Preface This thesis is an original work by Joanne Dorothea Hewitt.