Nursing - Theses

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Subject: Cancer × Subject: Cancer related cognitive impairment ×

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    A Longitudinal Feasibility Study Exploring Cancer-Related Cognitive Impairment in Patients with Newly Diagnosed Aggressive Lymphoma
    Gates, Priscilla Ruth ( 2022)
    Background Cancer-related cognitive impairment (CRCI) is a recognised adverse consequence of cancer and its treatment. Published evidence speaks to the challenges of prospective, longitudinal CRCI studies, and, to date, the feasibility of collecting data on cognition in this patient cohort has not been evaluated. This study assessed the feasibility of collecting longitudinal data on cognition in patients with newly diagnosed, aggressive lymphoma undergoing standard therapy with curative intent via self-report, neuropsychological assessment, peripheral markers of inflammation and neuroimaging. An exploration and description of patterns of cancer-related cognitive impairment over the course of treatment and recovery was also undertaken. Methods Eligible participants completed comprehensive assessments pre-chemotherapy, mid-chemotherapy, and six to eight weeks post-chemotherapy completion. Participants completed neuropsychological tests and self-report measures including cognitive and other patient-reported outcome measures. Full blood examination counts were used to calculate blood cell-based inflammatory markers at all three time points. Neuroimaging was undertaken in a subset of patients; 18F-FDG-PET/CT scans were undertaken at all three time points; MRI scans were undertaken pre-chemotherapy and six to eight weeks post-chemotherapy completion. Results 30 of 33 eligible participants (91%, 95% CI: 76%, 97%) were recruited over 10 months. The recruitment rate was 3 patients/month (95% CI: 2.0, 4.3 patients/month). Mean age was 57 years (SD=17 years) and 16/30 (53%) were male. The neuroimaging sub-study was optional; 11/30 participants (37%) were eligible to take part, and all agreed. Retention and compliance with all assessments was high at all time points. Only one patient was withdrawn from the study due to disease progression. On average, the study sample performed worse on neuropsychological tests compared with population norms and healthy controls pre-chemotherapy. Notable changes from pre-chemotherapy at follow-up were observed on some neuropsychological tests and self-report measures including improvements in verbal fluency as assessed by the Controlled Oral Word Association Test and verbal memory as assessed by the Hopkins Verbal Learning Test; deterioration in perceived cognitive impairment and abilities as assessed by the Functional Assessment of Cancer Therapy-Cognitive Function measure; improvements in emotional wellbeing as assessed by the Functional Assessment of Cancer Therapy-General measure; worsening of fatigue as assessed by the Functional Assessment of Chronic Illness Therapy-Fatigue measure; and improvements in anxious symptomatology as assessed by the Patient-Reported Outcome Measurement Information System Anxiety 7a measure. Most associations between a global deficit score calculated based on responses to neuropsychological tests and self-report measures were trivial. Most associations between perceived cognitive impairment and abilities, and other self-report measures were small- to large-sized. Conclusion Findings from this PhD demonstrate that it is feasible to longitudinally assess cognitive status and impairment in people with newly diagnosed aggressive lymphoma during their initial treatment and recovery. Compared with population norms and healthy controls, mean neuropsychological test scores pre-chemotherapy indicate cognitive impairments may precede treatment for aggressive lymphoma. Estimates of change in cognitive function based on neuropsychological tests provided evidence of improvement in verbal fluency and memory. Conversely, estimates of change in cognitive function based on self-report measures provided evidence of deterioration in perceived cognitive impairment and abilities. Most associations between objective tests and subjective measures were trivial. This PhD has generated knowledge to inform the development of future research to test efficacy of novel interventions to improve patient experiences and cognitive outcomes.