Colorectal Cancer Treatment Has Long-Term Cognitive, Functional Effects on Survivors

Colorectal cancer (CRC) survivors experience significant physical and mental functional changes during and after treatment. These findings were presented at the 47th Annual Oncology Nursing Society (ONS) Congress.

Neurocognitive impairments have been reported in patients with colorectal cancer (CRC) before and after treatment compared with a matched group of healthy individuals (healthy controls [HC]). Therefore, researchers conducted a feasibility descriptive study to investigate neurocognitive function and quality of life (QOL) at baseline (T1), 12 weeks (T2), and 24 weeks (T3) in patients with CRC and the HC group.

Several hypotheses were investigated: patients with CRC would have lower QOL compared with the HC group at baseline, patients with CRC receiving adjuvant chemotherapy would experience declines in QOL, and changes in QOL would associate with changes in executive function network (EFN)-related activity. This study was guided by the Chemotherapy-Related Changes in Cognitive Function model.

A total of 40 patients were enrolled and screenings were completed at surgery and medical oncology clinics at a Midwestern medical center. Participants were enrolled 4 to 6 weeks after surgery (CTX−; 11 participants) or before starting chemotherapy (CTX+; 15 participants). CTX+ participants were age, gender, and education matched to the HC group (14 participants). Of 40 participants, 31 (77.5%) completed at least 1 assessment after the baseline screening.

Data collected included age, sex, education, marital status, race, cancer stage, and chemotherapy regimen. Neuropsychological performance was assessed via Trail Making A&B, Stroop, Symbol Digit modalities, and auditory-verbal-learning (AVLT attention and memory); global deficit scores were used to detect mild cognitive impairment. EFN-activity was assessed via electro-encephalography (EEG) and brain volume and function connectivity were assessed with rsfMRI. QOL measures included MD Anderson Symptom Inventory (MDASI; symptoms), Medical Outcomes Study Short Form 36 (MOS SF-36v1; health status), Functional Assessment of Cancer Therapy Cognitive Function (FACT-Cog; cognition), and Beck Depression Inventory (BDI-II; depression).

Analyses included Spearman’s correlations to test associations between neurocognitive performance, EEG amplitudes of EFN-related activity, and QOL, and linear mixed effects models to report between-group differences and within-group changes. A variable was created to reflect measurements at the last visit, allowing T2 data to be used as T3 data when no T3 data was available.

The researchers found that QOL was lower in patients with CRC compared with the HC group at baseline, which continued in later measurements. A significant interaction was observed between days since baseline and group on cognition. Post-hoc analyses revealed significant declines in CogPCA scores in the CTX+ group from baseline to T2 and T3, but not in the CTX− or HC groups. Significant associations were found between changes in EEG measures of EFN-related amplitudes with changes in QOL measure between baseline and last study visits, reported Ann Berger, PhD, APRN, FAAN, of University of Nebraska Medical Center in Omaha.

“All results were in the hypothesized direction and consistent with the theoretical framework and prior research,” concluded Dr Berger. These results support a growing concern that patients with CRC may experience declines in neurocognitive function and QOL during and after undergoing treatment for their disease.

Read more of Oncology Nurse Advisor‘s coverage of the 47th Annual ONS Congress by visiting the conference page.

Reference

Berger A, Grem J, Anderson D, Garlinghouse M, Schmid K, Lyden E. Differences in neurocognitive function and quality of life in colorectal cancer patients and controls. Oral presentation at: 47th Annual ONS Congress; April 27-May 1, 2022; Anaheim, California.