A prospective study of cognitive function in men with non‐seminomatous germ cell tumors

Abstract

Objective Longitudinal neuropsychological assessments were performed to determine if adjuvant chemotherapy was associated with cognitive dysfunction in men with non-seminomatous germ cell tumors (NSGCT). Methods Patients with NSGCT status post orchiectomy that either received adjuvant chemotherapy (n=55) or did not (n=14) were recruited. Patients were tested before chemotherapy, one week post chemotherapy (or three months later in the surveillance group) and 12 months after the baseline evaluation. Results Compared to the surveillance group, patients treated with chemotherapy had higher rates of cognitive decline at 12 months (overall cognitive decline: 0%, 52% and 67% in the surveillance, LE and HE group, respectively), greater number of tests that declined (mean of 0.1, 1.4 and 2.0 in the surveillance, LE and HE group, respectively), and more frequent worsening in motor dexterity (0%, 48% and 46% in the surveillance, LE and HE group, respectively). Compared to the surveillance group, patients receiving more cycles of chemotherapy demonstrated worse psychomotor speed and learning and memory. Younger age was associated with greater incidence of overall cognitive decline at 12 month follow-up. Conclusions Men with NSGCT that received chemotherapy demonstrated greater rates of cognitive decline in a dose-response manner. Reductions in motor dexterity were most common. Decline in learning and memory also was evident particularly at later follow up time points and in men receiving more chemotherapy. Men that receive chemotherapy for NSGCT are at risk for cognitive decline and may benefit from monitoring and referral for psychosocial care.

Lower cognitive performance and white matter changes in testicular cancer survivors 10 years after chemotherapy

“…Evidence for short and long‐term adverse effects of CT has mainly been found in the field of breast cancer research. Till now only a few neuropsychological studies have investigated cognitive function in other types of non‐CNS cancer for which CT is an important treatment strategy, such as testicular cancer (TC) [Pedersen et al, ; Schagen et al, ; Skaali et al, ; Wefel et al, ]…”

“…Evidence for short and longterm adverse effects of CT has mainly been found in the field of breast cancer research. Till now only a few neuropsychological studies have investigated cognitive function in other types of non-CNS cancer for which CT is an important treatment strategy, such as testicular cancer (TC) Schagen et al, 2008;Skaali et al, 2011a;Wefel et al, 2011Wefel et al, , 2014 It is known that cisplatin, which is the cornerstone of combination CT in the treatment of TC, may have neurotoxic side effects. Although cisplatin is generally believed to have poor penetration of the blood-brain barrier, studies have shown adverse effects of cisplatin on healthy cells through several mechanisms such as oxidative stress, apoptosis and neurogenesis [Dietrich et al, 2006;Fosså et al, 2009;Rzeski et al, 2004;Seigers et al, 2013;Troy et al, 2000].…”

Prevalence of perceived cognitive dysfunction in survivors of a wide range of cancers: results from the 2010 LIVESTRONG survey

“…The preponderance of research on this topic has focused on breast cancer [8]. Perceptions of cognitive dysfunction and its impact on daily functioning for survivors of other types of cancer have begun to receive more recent research attention including colon cancer [22], testicular cancer [23], and patients undergoing allogeneic hematopoietic cell transplantation [24]. Particularly lacking are comparisons of the severity of these issues across survivors of different types of cancer.…”

Late effects of adjuvant chemotherapy for breast cancer on fine motor function

“…CMF chemotherapy is no longer the main adjuvant treatment regimen for breast cancer. However, we think our results may still apply to contemporary regimens considering that these regimens still include cyclophosphamide and 5‐fluorouracil, considering that the currently incorporated taxanes are associated with neuropathy, and considering that the (less frequently prescribed) contemporary cisplatin‐based chemotherapy has also been associated with worse fine motor skills .…”