Cognitive Function in Patients at Different Stages of Treatment for Colorectal Cancer: A Comparative Cross-Sectional Study

Colorectal cancer (CRC) is the third most commonly diagnosed cancer worldwide and the second most common cause of cancer-related death, accounting for approximately 916,000 deaths in 2020 globally.1 In Taiwan, CRC has the third highest incidence rate among all cancers and ranks second in terms of cancer-related death.2 Recent advancements in screening techniques and medical treatments have resulted in an increase in life expectancy worldwide3; the 5-year survival rate of patients with CRC is approximately 65%.4 However, these patients experience multiple co-occurring symptoms5 and considerable adverse outcomes result from the cancer and its treatment6,7; among these problems, altered cognitive function is a prominent one.5,8,9 Cognitive change or impairment is prevalent in patients with CRC and CRC survivors.10 This presents a major challenge for the patients and survivors in returning to their former lives11 and negatively affects their daily functioning,10,12 work,13 and quality of life.14

Cancer-related cognitive impairment (CRCI) is associated with a persistent and distressing symptom path; this condition is common in patients and survivors who have received chemotherapy.11,15,16 The incidence rate of cognitive impairment has been reported as ranging from 13.3% to 57% in patients at different stages of CRC treatment.10 Patients with CRC typically undergo surgery following chemotherapy or are treated with 5-fluorouracil or FOLFOX chemotherapy regimens (folinic acid [leucovorin], 5-fluorouracil, and oxaliplatin), which may be associated with a risk of cognitive impairment in CRC survivors.10,17 Attention (or concentration), memory, and executive function are the most frequently identified domain of cognition impaired by chemotherapy.8, 9, 10 Impairment in these domains negatively affects individuals’ abilities to pay attention, remember information, find words, and think rapidly.17 Furthermore, in a relevant study,10 the incidence rates of cognitive impairment were respectively reported to be 19% to 57%, 21.1% to 57%, and 13.3% to 50% at 6, 12, and 24 months after the initiation of chemotherapy. This suggests that chemotherapy exerts long-lasting negative effects on cognitive function.18

We identified only two studies on the assessment of subjective and objective cognitive function; in these studies, patients with CRC who had received chemotherapy and those who had not received chemotherapy were compared in terms of their CRCI at baseline (prechemotherapy) and at 6, 12, and 24 months after chemotherapy.19,20 In one study, a subjective cognitive function scale was used; patients’ posttherapy (6 months) scores on this scale revealed that the proportion of patients who experienced cognitive symptoms was higher among those who had received chemotherapy than it was among those who had not.20 Furthermore, at 6, 12, and 24 months after chemotherapy, perceived cognitive impairment scores were significantly higher in the chemotherapy group than they were in the nonchemotherapy group.20 By contrast, another study using a clinical neuropsychological test revealed no significant differences between patients receiving chemotherapy and those not receiving chemotherapy.19 Nonetheless, the development of cognitive impairment is associated with not only chemotherapy but also cancer.15

To the best of our knowledge, no studies have focused on comparing patients with a new diagnosis of CRC (pretreatment) with those who received chemotherapy in terms of their cognitive function. Furthermore, few studies have explored the long-term effects of cognitive symptoms in CRC survivors >2 years after the completion of chemotherapy. Given the high incidence rate of CRC and the prolonged life expectancy of CRC survivors, the differences in cognitive function among patients at different stages of CRC treatment must be investigated. Such information may enable efficient management of cognitive symptoms in patients given a new diagnosis of CRC and prevent them from experiencing chronic symptoms during long-term survival. Therefore, in the present study, we compared the subjective and objective cognitive functions among patients at the following three stages of CRC treatment: new diagnosis (pretreatment; Group A), ≤2 years since chemotherapy completion (Group B), and >2 years since chemotherapy completion (Group C).

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