Dwek Marie-Rose, Newman Stanton P, Brini Stefano, Holder Pru, Machesney Michael, Propper David, Rixon Lorna R, Hirani Shashivadan P, Hurt Catherine S
Centre for Health Services Research, School of Health and Psychological Sciences, City, University of London, London, UK.
Barts Health NHS Trust, Whipps Cross Hospital, London, UK.
Psychooncology. 2023 Jul;32(7):1057-1066. doi: 10.1002/pon.6147. Epub 2023 May 19.
Subjective reports of cognitive impairment following chemotherapy are frequent in cancer patients. Objective cognitive impairment has been observed in cancer patients regardless of treatment regimen suggesting the relationship between cognitive impairment and chemotherapy is not clear cut. Little research has explored the effects of chemotherapy on cognition following surgery in colorectal cancer (CRC). The present study explored the effects of chemotherapy on cognitive performance in a sample of CRC patients.
136 participants were recruited into a prospective cohort study: 78 CRC patients undergoing surgery and adjuvant chemotherapy, 58 CRC patients undergoing surgery only. A battery of neuropsychological tests was administered to participants 4 weeks post-surgery (T1), 12 weeks after first chemotherapy (T2) and 3 months after last chemotherapy (T3) or equivalent time-points.
Using the criterion of scoring at least two standard-deviations below the group norm on at least one neuropsychological test, 45%-55% of all CRC patients showed cognitive deficits 10 months after surgery (T3) and 14% on at least 3 tests. However, cognition did not significantly differ between patients who had chemotherapy and those who did not. A time by group interaction effect was found on the composite cognition score using multi-level modelling suggesting a greater improvement in cognition in the surgery only group over time (p < 0.05).
CRC patients display cognitive impairment 10 months after surgery. Chemotherapy did not worsen cognitive impairment but did appear to slow cognitive recovery relative to those undergoing surgery only. The findings demonstrate a clear need for supportive cognitive interventions for all CRC patients following treatment.
癌症患者化疗后认知功能受损的主观报告很常见。无论采用何种治疗方案，癌症患者都存在客观认知功能受损，这表明认知功能受损与化疗之间的关系并不明确。很少有研究探讨化疗对结直肠癌（CRC）患者术后认知功能的影响。本研究探讨了化疗对一组CRC患者认知表现的影响。
136名参与者被纳入一项前瞻性队列研究：78名接受手术及辅助化疗的CRC患者，58名仅接受手术的CRC患者。在术后4周（T1）、首次化疗后12周（T2）以及最后一次化疗后3个月（T3）或同等时间点，对参与者进行了一系列神经心理学测试。
根据至少一项神经心理学测试得分低于组均值至少两个标准差的标准，所有CRC患者中有45%-55%在术后10个月（T3）出现认知缺陷，14%在至少3项测试中出现认知缺陷。然而，接受化疗的患者与未接受化疗的患者在认知方面没有显著差异。使用多水平模型在综合认知得分上发现了时间与分组的交互效应，表明仅接受手术的组随着时间推移认知改善更大（p<0.05）。
CRC患者在术后10个月出现认知功能受损。化疗并未使认知功能受损恶化，但相对于仅接受手术的患者，化疗似乎减缓了认知恢复。研究结果表明，所有CRC患者在治疗后都迫切需要支持性认知干预。
