Top

Supportive Care in Cancer

Published in:

01-05-2016 | Original Article

Cognitive function in cancer survivors: analysis of the 1999–2002 National Health and Nutrition Examination Survey

Authors: A. M. Williams, M. C. Janelsins, E. van Wijngaarden

Published in: Supportive Care in Cancer | Issue 5/2016

Abstract

Purpose

Cancer and its treatment may affect cognitive function through a number of direct and indirect pathways including inflammation, lipid metabolism, vascular damage, and changes in the blood–brain barrier. While short-term treatment-related cognitive changes are well recognized, only limited research is available in older, long-term survivors of cancer.

Methods

Using NHANES data from 1999 to 2002, 408 cancer survivors and 2639 non-cancer participants aged 60 years old and above were identified. Cognitive function of these groups were compared using the Digit Symbol Substitution Test (DSST) and self-reported problems with memory or confusion.

Results

After adjustment for covariates, cancer survivors scored, on average, 1.99 points lower on the DSST compared to non-cancer survivors (−1.99, 95 % CI −3.94, −0.05). Cancer survivors also had 17 % higher odds of self-reporting problems with memory or confusion (OR 1.17, 95 % CI 0.89, 1.53).

Conclusion

In this nationally representative sample of older US adults, cancer survivors had lower DSST scores than non-survivors and had more self-reported problems with memory or confusion.

Asher A (2011) Cognitive dysfunction among cancer survivors. Am J Phys Med Rehabil / Assoc Acad Physiatrists 90(5 Suppl 1):S16–26. doi:10.1097/PHM.0b013e31820be463 CrossRef

de Moor JS, Mariotto AB, Parry C, Alfano CM, Padgett L, Kent EE, Forsythe L, Scoppa S, Hachey M, Rowland JH (2013) Cancer survivors in the United States: prevalence across the survivorship trajectory and implications for care. Cancer Epidemiol Biomarkers & Prev a Pub Am Assoc Cancer Res Am Soc Prev Oncol 22(4):561–570. doi:10.1158/1055-9965.epi-12-1356

Society AC (2014) Cancer facts & figures 2014. American Cancer Society, Atlanta

Janelsins MC, Kesler SR, Ahles TA, Morrow GR (2014) Prevalence, mechanisms, and management of cancer-related cognitive impairment. Int Rev Psychiatry 26(1):102–113. doi:10.3109/09540261.2013.864260 CrossRefPubMedPubMedCentral

Hodgson KD, Hutchinson AD, Wilson CJ, Nettelbeck T (2013) A meta-analysis of the effects of chemotherapy on cognition in patients with cancer. Cancer Treat Rev 39(3):297–304. doi:10.1016/j.ctrv.2012.11.001 CrossRefPubMed

Lindner OC, Phillips B, McCabe MG, Mayes A, Wearden A, Varese F, Talmi D (2014) A meta-analysis of cognitive impairment following adult cancer chemotherapy. Neuropsychology 28(5):726–740. doi:10.1037/neu0000064 CrossRefPubMedPubMedCentral

Jim HS, Phillips KM, Chait S, Faul LA, Popa MA, Lee YH, Hussin MG, Jacobsen PB, Small BJ (2012) Meta-analysis of cognitive functioning in breast cancer survivors previously treated with standard-dose chemotherapy. J Clin Oncol Off J Am Soc Clin Oncol 30(29):3578–3587. doi:10.1200/JCO.2011.39.5640 CrossRef

Hermelink K, Untch M, Lux MP, Kreienberg R, Beck T, Bauerfeind I, Munzel K (2007) Cognitive function during neoadjuvant chemotherapy for breast cancer: results of a prospective, multicenter, longitudinal study. Cancer 109(9):1905–1913. doi:10.1002/cncr.22610 CrossRefPubMed

Stewart A, Collins B, Mackenzie J, Tomiak E, Verma S, Bielajew C (2008) The cognitive effects of adjuvant chemotherapy in early stage breast cancer: a prospective study. Psycho-Oncology 17(2):122–130. doi:10.1002/pon.1210 CrossRefPubMed

10.

Hedayati E, Alinaghizadeh H, Schedin A, Nyman H, Albertsson M (2012) Effects of adjuvant treatment on cognitive function in women with early breast cancer. Eur J Oncol Nurs 16(3):315–322. doi:10.1016/j.ejon.2011.07.006 CrossRefPubMed

11.

Phillips KA, Bernhard J (2003) Adjuvant breast cancer treatment and cognitive function: current knowledge and research directions. J Natl Cancer Inst 95(3):190–197CrossRefPubMed

12.

Conroy SK, McDonald BC, Smith DJ, Moser LR, West JD, Kamendulis LM, Klaunig JE, Champion VL, Unverzagt FW, Saykin AJ (2013) Alterations in brain structure and function in breast cancer survivors: effect of post-chemotherapy interval and relation to oxidative DNA damage. Breast Cancer Res Treat 137(2):493–502. doi:10.1007/s10549-012-2385-x CrossRefPubMed

13.

Janelsins MC, Kohli S, Mohile SG, Usuki K, Ahles TA, Morrow GR (2011) An update on cancer- and chemotherapy-related cognitive dysfunction: current status. Semin Oncol 38(3):431–438. doi:10.1053/j.seminoncol.2011.03.014 CrossRefPubMedPubMedCentral

14.

Weaver KE, Forsythe LP, Reeve BB, Alfano CM, Rodriguez JL, Sabatino SA, Hawkins NA, Rowland JH (2012) Mental and physical health-related quality of life among U.S. cancer survivors: population estimates from the 2010 National Health Interview Survey. Cancer Epidemiol Biomark Prev Pub Am Assoc Cancer Res Am Soc Prev Oncol 21(11):2108–2117. doi:10.1158/1055-9965.epi-12-0740 CrossRef

15.

Koppelmans V, Breteler MM, Boogerd W, Seynaeve C, Gundy C, Schagen SB (2012) Neuropsychological performance in survivors of breast cancer more than 20 years after adjuvant chemotherapy. J Clin Oncol Off J Am Soc Clin Oncol 30(10):1080–1086. doi:10.1200/jco.2011.37.0189 CrossRef

16.

Heflin LH, Meyerowitz BE, Hall P, Lichtenstein P, Johansson B, Pedersen NL, Gatz M (2005) Cancer as a risk factor for long-term cognitive deficits and dementia. J Natl Cancer Inst 97(11):854–856. doi:10.1093/jnci/dji137 CrossRefPubMed

17.

Falleti MG, Sanfilippo A, Maruff P, Weih L, Phillips KA (2005) The nature and severity of cognitive impairment associated with adjuvant chemotherapy in women with breast cancer: a meta-analysis of the current literature. Brain Cogn 59(1):60–70. doi:10.1016/j.bandc.2005.05.001 CrossRefPubMed

18.

Jansen CE, Miaskowski C, Dodd M, Dowling G, Kramer J (2005) A metaanalysis of studies of the effects of cancer chemotherapy on various domains of cognitive function. Cancer 104(10):2222–2233. doi:10.1002/cncr.21469 CrossRefPubMed

19.

Hutchinson AD, Hosking JR, Kichenadasse G, Mattiske JK, Wilson C (2012) Objective and subjective cognitive impairment following chemotherapy for cancer: a systematic review. Cancer Treat Rev 38(7):926–934. doi:10.1016/j.ctrv.2012.05.002 CrossRefPubMed

20.

Keating NL, Norredam M, Landrum MB, Huskamp HA, Meara E (2005) Physical and mental health status of older long-term cancer survivors. J Am Geriatr Soc 53(12):2145–2152. doi:10.1111/j.1532-5415.2005.00507.x CrossRefPubMed

21.

Porter KE (2013) “Chemo brain”—is cancer survivorship related to later-life cognition? Findings from the health and retirement study. J Aging Health 25(6):960–981. doi:10.1177/0898264313498417 CrossRefPubMed

22.

Ahles TA, Saykin AJ, McDonald BC, Li Y, Furstenberg CT, Hanscom BS, Mulrooney TJ, Schwartz GN, Kaufman PA (2010) Longitudinal assessment of cognitive changes associated with adjuvant treatment for breast cancer: impact of age and cognitive reserve. J Clin Oncol Off J Am Soc Clin Oncol 28(29):4434–4440. doi:10.1200/JCO.2009.27.0827 CrossRef

23.

Baudouin A, Clarys D, Vanneste S, Isingrini M (2009) Executive functioning and processing speed in age-related differences in memory: contribution of a coding task. Brain Cogn 71(3):240–245. doi:10.1016/j.bandc.2009.08.007 CrossRefPubMed

24.

Jansen C, Miaskowski C, Dodd M, Dowling G, Kramer J (2005) Potential mechanisms for chemotherapy-induced impairments in cognitive function. Oncol Nurs Forum 32(6):1151–1163. doi:10.1188/05.onf.1151-1163 CrossRefPubMed

25.

Lezak MD, Howieson DB, Loring DW (2004) Neuropsychological assessment. Oxford University Press, New York

26.

Bettcher BM, Libon DJ, Kaplan E, Swenson R, Penney DL (2011) Encyclopedia of clinical neuropsychology. Springer, New York. doi:10.1007/978-0-387-79948-3

27.

Nguyen CM, Yamada TH, Beglinger LJ, Cavanaugh JE, Denburg NL, Schultz SK (2013) Cognitive features 10 or more years after successful breast cancer survival: comparisons across types of cancer interventions. Psycho-Oncology 22(4):862–868. doi:10.1002/pon.3086 CrossRefPubMed

28.

Yamada TH, Denburg NL, Beglinger LJ, Schultz SK (2010) Neuropsychological outcomes of older breast cancer survivors: cognitive features ten or more years after chemotherapy. J Neuropsychiatry Clin Neurosci 22(1):48–54. doi:10.1176/appi.neuropsych.22.1.48 CrossRefPubMedPubMedCentral

29.

Cheung YT, Tan EH, Chan A (2012) An evaluation on the neuropsychological tests used in the assessment of postchemotherapy cognitive changes in breast cancer survivors. Support Care Cancer Off J Multinational Assoc Support Care in Cancer 20(7):1361–1375. doi:10.1007/s00520-012-1445-4

30.

van Wijngaarden E, Winters PC, Cory-Slechta DA (2011) Blood lead levels in relation to cognitive function in older U.S. adults. Neurotoxicology 32(1):110–115. doi:10.1016/j.neuro.2010.11.002 CrossRefPubMed

31.

Ahles TA, Root JC, Ryan EL (2012) Cancer- and cancer treatment-associated cognitive change: an update on the state of the science. J Clin Oncol Off J Am Soc Clin Oncol 30(30):3675–3686. doi:10.1200/jco.2012.43.0116 CrossRef

32.

Collins B, Mackenzie J, Kyeremanteng C (2013) Study of the cognitive effects of chemotherapy: considerations in selection of a control group. J Clin Exp Neuropsychol 35(4):435–444. doi:10.1080/13803395.2013.781995 CrossRefPubMed

33.

Gondi V, Paulus R, Bruner DW, Meyers CA, Gore EM, Wolfson A, Werner-Wasik M, Sun AY, Choy H, Movsas B (2013) Decline in tested and self-reported cognitive functioning after prophylactic cranial irradiation for lung cancer: pooled secondary analysis of radiation therapy oncology group randomized trials 0212 and 0214. Int J Radiat Oncol Biol Phys 86(4):656–664. doi:10.1016/j.ijrobp.2013.02.033 CrossRefPubMedPubMedCentral

34.

Krull KR, Sabin ND, Reddick WE, Zhu L, Armstrong GT, Green DM, Arevalo AR, Krasin MJ, Srivastava DK, Robison LL, Hudson MM (2012) Neurocognitive function and CNS integrity in adult survivors of childhood Hodgkin lymphoma. J Clin Oncol Off J Am Soc Clin Oncol 30(29):3618–3624. doi:10.1200/jco.2012.42.6841 CrossRef

35.

Jean-Pierre P, Winters PC, Ahles TA, Antoni M, Armstrong FD, Penedo F, Lipshultz SE, Miller TL, Fiscella K (2012) Prevalence of self-reported memory problems in adult cancer survivors: a national cross-sectional study. J Oncol Pract 8(1):30–34. doi:10.1200/jop.2011.000231 CrossRefPubMed

36.

Mandelblatt JS, Stern RA, Luta G, McGuckin M, Clapp JD, Hurria A, Jacobsen PB, Faul LA, Isaacs C, Denduluri N, Gavett B, Traina TA, Johnson P, Silliman RA, Turner RS, Howard D, Van Meter JW, Saykin A, Ahles T (2014) Cognitive impairment in older patients with breast cancer before systemic therapy: is there an interaction between cancer and comorbidity? J Clin Oncol Off J Am Soc Clin Oncol 32(18):1909–1918. doi:10.1200/JCO.2013.54.2050 CrossRef

37.

Ahles TA, Saykin AJ, Furstenberg CT, Cole B, Mott LA, Skalla K, Whedon MB, Bivens S, Mitchell T, Greenberg ER, Silberfarb PM (2002) Neuropsychologic impact of standard-dose systemic chemotherapy in long-term survivors of breast cancer and lymphoma. J Clin Oncol Off J Am Soc Clin Oncol 20(2):485–493CrossRef

38.

Ahles TA, Saykin A (2001) Cognitive effects of standard-dose chemotherapy in patients with cancer. Cancer Investig 19(8):812–820CrossRef

39.

Schagen SB, Muller MJ, Boogerd W, Rosenbrand RM, van Rhijn D, Rodenhuis S, van Dam FS (2002) Late effects of adjuvant chemotherapy on cognitive function: a follow-up study in breast cancer patients. Ann Oncol Off J Eur Soc Med Oncol / ESMO 13(9):1387–1397CrossRef

40.

van Dam FS, Schagen SB, Muller MJ, Boogerd W, van de Wall E, Droogleever Fortuyn ME, Rodenhuis S (1998) Impairment of cognitive function in women receiving adjuvant treatment for high-risk breast cancer: high-dose versus standard-dose chemotherapy. J Natl Cancer Inst 90(3):210–218CrossRefPubMed

41.

Schagen SB, Boogerd W, Muller MJ, Huinink WT, Moonen L, Meinhardt W, Van Dam FS (2008) Cognitive complaints and cognitive impairment following BEP chemotherapy in patients with testicular cancer. Acta oncologica (Stockholm, Sweden) 47(1):63–70. doi:10.1080/02841860701518058 CrossRef

42.

Reid-Arndt SA, Yee A, Perry MC, Hsieh C (2009) Cognitive and psychological factors associated with early posttreatment functional outcomes in breast cancer survivors. J Psychosoc Oncol 27(4):415–434. doi:10.1080/07347330903183117 CrossRefPubMedPubMedCentral

43.

Myers JS (2012) Chemotherapy-related cognitive impairment: the breast cancer experience. Oncol Nurs Forum 39(1):E31–40. doi:10.1188/12.onf.e31-e40 CrossRefPubMed

Title: Cognitive function in cancer survivors: analysis of the 1999–2002 National Health and Nutrition Examination Survey
Authors: A. M. Williams
M. C. Janelsins
E. van Wijngaarden
Publication date: 01-05-2016
Publisher: Springer Berlin Heidelberg
Published in: Supportive Care in Cancer / Issue 5/2016
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-015-2992-2

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 5/2016

Longitudinal patterns of cancer patient reported outcomes in end of life care predict survival

Assessing cancer-related distress in cancer patients and caregivers receiving outpatient psycho-oncological counseling

Risk factors for anthracycline-associated cardiotoxicity

How sedentary and physically active are breast cancer survivors, and which population subgroups have higher or lower levels of these behaviors?

Identifying functional impairment and rehabilitation needs in patients newly diagnosed with inoperable lung cancer: a structured literature review

Mode of prostate cancer detection is associated with the psychological wellbeing of survivors: results from the PiCTure study

Keynote webinar | Spotlight on antibody–drug conjugates in cancer