Impact of Hormone Therapy on Cognition in Prostate Cancer Still Unclear

There is no consensus on how hormone therapy impacts cognition in patients with prostate cancer, according to researchers.

They conducted a systematic review and meta-analysis of studies designed to assess cognition in patients receiving androgen deprivation therapy (ADT) and new‐generation hormone therapy (NGHT) for prostate cancer.

The results showed a decline in subjective cognition but “no conclusive evidence of a decline in objective cognition,” according to the researchers. They reported these findings in Cancer.

The systematic review included 20 studies encompassing 1440 patients, and the meta-analysis included 15 studies encompassing 1093 patients.

The systematic review revealed that 20% to 50% of patients who were about to receive ADT alone or in combination with NGHT had impairments in objective cognitive performance at baseline.

“Pretreatment impairment was mainly evidenced on memory tasks, both in verbal and visual modalities,” the researchers wrote. “Pretreatment cognitive impairment may be associated with cancer‐related factors and premorbid conditions, such as anxiety, depression, and fatigue.”

Seven of the 20 studies in the systematic review revealed a decline in objective cognition or greater impairment in objective cognition in patients who were assigned hormone therapy than in those who were not.

In the meta-analysis, there was no indication that hormone therapy had a significant effect on objective cognition. However, hormone therapy was associated with a significant decrease in subjective cognition, which was assessed using questionnaires (P =.03). In addition, patients had improvements in visual memory (P =.02) and executive functions (P =.05) from baseline.

“To our knowledge, this is the first meta‐analysis to examine the impact of ADT and NGHT on specific measures of subjective cognition,” the researchers wrote. “Interestingly, we found no meta‐analytic evidence or agreement between studies of a decline in objective cognition during treatments, but baseline cognitive impairment was reported.”

“In patients with PC [prostate cancer], cognitive impairment is likely to complicate care … and compromise the patient’s ability to make complex decisions necessary for active participation in therapeutic choices,” the researchers continued. “In addition, patients with cognitive impairment maybe less adherent to oral treatment. Therefore, the anticipation of cognitive change upstream of therapeutic decisions represents a challenge for oncologists.”

Disclosures: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

This article originally appeared on Cancer Therapy Advisor