Predictors of Cognitive Decline
The study revealed differences in results by sex. In self-reported assessments, the female lymphoma patients reported more cognitive impairment than did the male patients. However, objective assessments showed greater cognitive impairment in men than in women.
“On a day-to-day level, what it means is that more women are noticing, feeling the impact [of], and reporting changed cognitive ability over time from diagnosis to survivorship than men,” Dr Fardell said. “Men themselves are also experiencing cognitive difficulties … but are reporting less difficulties over time.”
The split in self-assessment versus objective assessment tracks with known reporting patterns in other symptoms, such as fatigue, anxiety, and depression, according to editorial author Janette Vardy, MD, PhD, a professor at the University of Sydney in Australia.
Dr Vardy added that women may generally be “more attuned” to or willing to report these symptoms compared with men.
In addition to sex, the study suggested that age, education, and mental health are predictors of cognitive decline in lymphoma patients. Specifically, older patients performed significantly worse on objective tests and self-reported greater cognitive impairment.
Having a college education was associated with better performance on tests, and having a lower WRAT-4 reading score was associated with worse performance. Higher baseline anxiety and depressive symptoms were associated with worse performance on tests and by self-report.
On the other hand, the study showed no differences in cognitive outcomes between patients with Hodgkin lymphoma and those with non-Hodgkin lymphoma.
Likewise, there were no differences whether patients received bendamustine and rituximab, R-CHOP (rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, and prednisone), or ABVD (doxorubicin, bleomycin, vinblanstine, and dacarbazine).
Implications for Practice
Understanding and supporting cognitive function in lymphoma is especially important because the disease tends to affect younger people “who are at their most productive in terms of family and career and can generally look forward to a long duration of survival,” Dr Vardy and Dr Fardell wrote in the editorial.
The pair recommend that care teams take cognitive decline into account when managing a patient’s treatment and recovery, especially insofar as managing patients’ expectations of their own experiences with cancer and treatment.
“Probably the most important thing is that care teams need to warn patients about [the] possibility of further cognitive difficulties with treatment in the same way they warn them about other potential side effects,” Dr Vardy said.
Ideally, patients who are experiencing cognitive difficulties before treatment should be offered neuropsychological testing, she added.
Dr Fardell also recommends that care teams keep tabs on cognitive function before and throughout a patient’s treatment. Knowing a patient’s baseline can make it easier to flag a change and offer clinical support, which will ultimately lessen the burden of the experience.
“In many ways, it’s about planning for quality survival and quality of life after cancer,” she said.
“At present, we don’t have great evidence for how to prevent [cognitive decline] or how best to treat it after it has occurred,” Dr Vardy said. “But often just validating it is a real problem is helpful for people.”
Disclosures: The editorialists and study authors reported having no disclosures.
- Janelsins MC, Mohamed M, Peppone LJ, et al. Longitudinal changes in cognitive function in a nationwide cohort study of patients with lymphoma treated with chemotherapy. J Natl Cancer Inst. Published July 13, 2021. doi:10.1093/jnci/djab133
- Vardy JL, Fardell J. Understanding longitudinal changes in cognitive function in lymphoma patients: Where to next? J Natl Cancer Inst. Published July 13, 2021. doi:10.1093/jnci/djab134