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 The findings are drawn from cognitive assessments for 80 survivors
of these tumors and a control group of 40 otherwise similar people
who didn’t have these malignancies. Two years after cancer
treatment, 38 percent of the survivors had impaired cognitive
functioning, but nobody in the control group did.
“This suggests that up to at least two years after treatment is
complete, a substantial minority of patients who are treated for
head and neck cancer will be at risk of having deficits in several
areas of cognitive function, such as being able to concentrate and
remember things,” said senior study author Lori Bernstein of the
University of Toronto.
Previous research has linked radiation and chemotherapy to cognitive
deficits that can develop and progress many years after treatment,
Bernstein said by email.
With many types of cancer treated with chemotherapy, patients can
develop what’s called “chemo brain.” Symptoms vary but include
things like poor focus or memory. Treatment-related pain, fatigue
and malnutrition could worsen symptoms, which usually clear up after
chemo is complete.
“In addition to chemotherapy treatment, incidental radiation doses
to the brain might also have an effect on cognition,” said James
Root of the Neurocognitive Research Lab at Memorial Sloan Kettering
Cancer Center in New York City.
“Much less is known about the effects of lower dose, incidental
radiation on the brain,” Root, who wasn’t involved in the study,
said by email.
For the current study, researchers wanted to see how cognitive
function might change over time in patients with these tumors who
had both chemo and radiation.
They did four cognitive assessments, once prior to treatment and
then again 6, 12 and 24 months later.
Compared to the people without cancer, the head and neck cancer
survivors declined over time in several different cognitive domains,
including concentration, verbal memory, and executive function,
researchers report in JAMA Otolaryngology Head and Neck Surgery.
People who had less education or suffered from depression at the
start of the study were more likely to develop cognitive problems,
the study also found.
The study wasn’t a controlled experiment designed to prove whether
or how cancer treatments might cause cognitive deficits.
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Another limitation of the study is that researchers only followed
patients for two years, and it’s unclear what happens to cognitive
abilities over longer periods of time, the authors note. Different
radiation doses also might get different results.
“While this current study alone is not enough to conclude that the
neurocognitive deficits experienced by study patients are as a
direct result of definitive treatment, we know that there are very
important side effects associated with these treatments that have
become mainstay in our fight against head and neck cancers,” said
Dr. Nosayaba Osazuwa-Peters, a researcher at Saint Louis University
School of Medicine who wasn’t involved in the study.
Patients and families need to be prepared for the possibility that
cognitive problems can develop and linger for years, Dr. Osazuwa-Peters
said by email.
This comes on top of difficulties eating that result from cancer and
treatments. Many survivors have trouble swallowing food, experience
changes in their sense of taste or a diminished appetite, or suffer
from reflux that makes meals uncomfortable.
These challenges can lead to social isolation and depression,
especially when people mark special occasions with food and family
meals.
“When a patient already struggling with socializing with family and
friends also has to deal with loss of memory or comprehension, this
may cause additional anxiety and stress, not only to the patient,
but also the family and caregivers,” Osazuwa-Peters said. “It is
important to recognize the possibility of loss of cognition as part
of the “new normal” for these patients.”
SOURCE: http://bit.ly/2nZNaXF JAMA Otolaryngology Head and Neck
Surgery, online November 22, 2017.
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