Danielsen Josefine T, Zachariae Robert, Schmidt Henrik, Kallehauge Jesper F, Thomadsen Julie K, Wefel Jeffrey S, Wu Lisa M, Amidi Ali
Unit for Psycho-Oncology and Health Psychology, Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark.
Department of Oncology, Aarhus University Hospital, Aarhus, Denmark.
Cancer. 2025 Jan 15;131(2):e35683. doi: 10.1002/cncr.35683. Epub 2024 Dec 11.
Cancer-related cognitive impairment (CRCI) is a significant concern in patients with cancer but understanding its prevalence and risk factors in patients with malignant melanoma (MMPs) remains limited. This study explores CRCI via a multifaceted approach integrating neurobiological, genetic, and psychological assessments.
Cognitive functioning across multiple domains was assessed via neuropsychological tests in 47 MMPs before adjuvant immune checkpoint inhibitor therapy, compared with 53 matched healthy controls (HCs). Self-reported cognitive complaints, brain gray matter (GM) properties, catechol-O-methyltransferase (COMT) genotype, and psychological and behavioral factors were evaluated. Between-group differences were analyzed with t-tests and χ tests, and associations were explored with correlation analyses. GM properties were assessed in a subset of 23 MMPs and 47 HCs.
MMPs exhibited significantly lower cognitive functioning across multiple tests (all p < .05), with a high CRCI prevalence (68.1% vs. 26.4% in HCs). MMPs reported higher fatigue, anxiety, and insomnia severity and poorer sleep quality and quality of life (all p < .01). Self-reported cognitive complaints in MMPs were associated with some cognitive test scores (all p < .05), fatigue (p < .001), and anxiety (p = .045). GM analyses revealed a smaller left cuneus volume in MMPs and significant associations between MMPs' processing speed and cortical thickness (right precentral and left inferior parietal regions) and between delayed verbal memory and right postcentral GM volume (all p < .01).
These findings underscore the need for comprehensive assessments in MMPs to better understand and address CRCI. A multifaceted approach would provide valuable insights that could inform future interventions and improve patient outcomes and quality of life.
癌症相关认知障碍（CRCI）是癌症患者的一个重要问题，但对于恶性黑色素瘤（MMP）患者中其患病率和危险因素的了解仍然有限。本研究通过整合神经生物学、遗传学和心理学评估的多方面方法来探究CRCI。
在47例MMP患者接受辅助免疫检查点抑制剂治疗前，通过神经心理学测试评估其多个领域的认知功能，并与53例匹配的健康对照（HC）进行比较。评估了自我报告的认知主诉、脑灰质（GM）特性、儿茶酚-O-甲基转移酶（COMT）基因型以及心理和行为因素。采用t检验和χ检验分析组间差异，并通过相关性分析探索关联。在23例MMP患者和47例HC的子集中评估了GM特性。
MMP患者在多项测试中的认知功能显著较低（所有p <.05），CRCI患病率较高（MMP患者为68.1%，HC为26.4%）。MMP患者报告疲劳、焦虑和失眠严重程度更高，睡眠质量和生活质量更差（所有p <.01）。MMP患者自我报告的认知主诉与一些认知测试分数（所有p <.05）、疲劳（p <.001）和焦虑（p =.045）相关。GM分析显示，MMP患者左侧楔叶体积较小，且MMP患者的处理速度与皮质厚度（右侧中央前回和左侧顶下小叶区域）之间以及延迟言语记忆与右侧中央后回GM体积之间存在显著关联（所有p <.01）。
这些发现强调了对MMP患者进行全面评估以更好地理解和解决CRCI的必要性。多方面方法将提供有价值的见解，可为未来干预提供参考并改善患者结局和生活质量。
