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The impact of chemotherapy on cognitive function: a multicentre prospective cohort study in testicular cancer

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Abstract

Purpose

The causal link between chemotherapy and cognitive impairment is unclear. We studied testicular cancer patients’ objective and subjective cognitive function longitudinally, comparing a surgery group with a surgery + chemotherapy group, addressing prior methodological issues using a computerized test to limit assessment issues, and controlling for confounding variables.

Methods

Prospectively, of 145 patients from 16 centres with sufficient data, n = 61 receiving surgery + chemotherapy (etoposide and cisplatin ± bleomycin, BEP/EP; or single agent carboplatin) were compared to n = 41 receiving surgery alone. CogHealth assessed six objective cognitive tasks. The Cognitive Failures Questionnaire assessed self-perceived cognitive dysfunction. The Functional Assessment of Chronic Illness Therapy-Fatigue and the Hospital Anxiety and Depression Scale assessed psychological influences. Linear mixed models compared changes from baseline (< 6 months post-surgery/pre-chemotherapy) to follow-up (12–18 months post-baseline), controlling covariates.

Results

There were no significant interaction effects for five objective cognitive function tasks suggesting that changes over time were not due to group membership. However, psychomotor function (controlling for age) and physical well-being were significantly worse for the chemotherapy versus the surgery group at baseline, with groups converging by follow-up. Groups showed no differences in subjective cognitive dysfunction. The chemotherapy group showed higher anxiety, poorer functional well-being and worse fatigue compared to the surgery-only group at baseline, but not by follow-up. For both groups, emotional well-being, functional well-being and anxiety significantly improved over time.

Conclusion

No substantive differences in objective or subjective cognitive dysfunction in either group persisted 12–18 months post-baseline. Patients undergoing chemotherapy for testicular cancer differ from findings in breast cancer populations.

Trial registration

ClinicalTrials.gov Identifier: ACTRN12609000545268

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Acknowledgements

This project was funded by a Multi-State Cancer Council Grant, including Cancer Council New South Wales, Cancer Council Victoria, and Cancer Council South Australia (INO). IDD is supported by an NHMRC Practitioner Fellowship (APP1102604), and ANZUP received funding from Cancer Council Australia and Cancer Institute New South Wales. We sincerely thank the study participants for their commitment to providing longitudinal data, and the dedicated staff for accruing patients at the 16 contributing centres, who persisted with data collection throughout the entirety of the project.

Author information

Authors and Affiliations

  1. University of South Australia Cancer Research Institute, Adelaide, South Australia, Australia

    Hayley S. Whitford

  2. Cogstate Limited, Melbourne, Victoria, Australia

    Pawel Kalinowski, Adrian Schembri & Paul Maruff

  3. Chris O’Brien Lifehouse, Sydney, New South Wales, Australia

    Peter Grimison

  4. NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia

    Martin Stockler & Andrew Martin

  5. Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

    Guy C. Toner

  6. Monash University Eastern Health Clinical School, Melbourne, Victoria, Australia

    Ian D. Davis

  7. Faculty of Health and Medical Sciences, University of Adelaide, Frome Road, Adelaide, South Australia, 5005, Australia

    Ian N. Olver

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  1. Hayley S. Whitford
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For the Australian and New Zealand Urogenital and Prostate Cancer Trials Group

Corresponding author

Correspondence to Ian N. Olver.

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Within the authorship we have full control of the data which is held at COGState and the NHMRC data centre and we agree to allow the journal to review the data if requested.

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Whitford, H.S., Kalinowski, P., Schembri, A. et al. The impact of chemotherapy on cognitive function: a multicentre prospective cohort study in testicular cancer. Support Care Cancer 28, 3081–3091 (2020). https://doi.org/10.1007/s00520-019-05095-3

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