Cognitive and neurobehavioral symptoms in patients with non-metastatic prostate cancer treated with androgen deprivation therapy or observation: A mixed methods study

Abstract

BACKGROUND Few studies have investigated prostate cancer patients’ experiences of cognitive functioning or neurobehavioral symptoms (i.e., behavioral changes associated with neurological dysfunction) following androgen deprivation therapy (ADT). METHODS Semi-structured interviews conducted from the US by phone and in-person were used to explore and characterize the: 1) experience of cognitive and neurobehavioral functioning in non-metastatic prostate cancer patients undergoing ADT (n=19) compared with patients who had not undergone ADT (n=20); 2) perceived causes of cognitive and neurobehavioral symptoms; 3) impact of these symptoms on quality of life; and 4) strategies used to cope with or compensate for these symptoms. Neuropsychological performance was assessed to characterize the sample. RESULTS Overall, ADT patients experienced marginally more cognitive problems than non-ADT (nADT) patients even though there were no significant differences between groups in neuropsychological performance. ADT patients also experienced more declines in prospective memory and multi-tasking than nADT patients. Significant proportions of participants in both groups also experienced retrospective memory, attention and concentration, and information processing difficulties. With respect to neurobehavioral symptoms, more ADT patients experienced emotional lability and impulsivity (both aspects of disinhibition) than nADT patients. Among the causes to which participants attributed declines, both groups attributed them primarily to aging. A majority of ADT patients also attributed declines to ADT. For both groups, increased cognitive and neurobehavioral symptoms negatively impacted quality of life, and most participants developed strategies to ameliorate these problems. CONCLUSION ADT patients are more vulnerable to experiencing specific cognitive and neurobehavioral symptoms than nADT patients. This study highlights the importance of capturing: a) cognitive symptoms not easily detected using neuropsychological tests; b) neurobehavioral symptoms that can be confused with psychological symptoms, and c) causal beliefs that may affect how people cope with these symptoms. Effective interventions are needed to assist prostate cancer patients in managing these symptoms.

A review of prostate cancer treatment impact on the CNS and cognitive function

“…Taken together, the emerging data suggest that the risk of ADT-associated cognitive disorders may vary in patients with PC, and calls for uniform methods of assessment coupled with a recognition of diverse genetic, societal, and comorbid features that may influence cognitive function. Further, methodological differences across studies likely contribute to conflicting results [20,48,49]. One important issue is the inconsistent definition of cognitive impairment [40] and the use of different measures of cognitive function [40].…”

Cervical cancer survivors’ perceived cognitive complaints and supportive care needs in mainland China: a qualitative study

“… 4 15 Qualitative research studies would enable us to identify the presence of cognitive symptoms that quantitative approaches cannot detect, either by self-reported cognitive measures or neurocognitive tests. 15 In addition, qualitative in-depth interviews could provide information about how cognitive impairment impacts cancer patients’ QOL, and could allow researchers to obtain information about the numerous coping strategies to ameliorate cognitive dysfunction symptoms, as well as to develop intervention strategies. 15 …”

Cognitive impairment following hormone therapy: current opinion of research in breast and prostate cancer patients

“…Patient and caregiver studies using quantitative and qualitative approaches to examine self-reported or observed cognitive impairments and their impact upon daily life functioning are also necessary. Indeed, such work has highlighted areas of concern not typically measured by neuropsychological tests, such as prospective memory and multi-tasking in ADT patients [56] and the real-life impact of hormone therapy on activities of daily living, work functioning, and relationships [57–59]. It is also possible that self-report of cognitive complaints may be more sensitive to subtle cognitive changes than neuropsychological tests [60].…”

“…Owing to growing concern among cancer patients about cognitive impairment [65, 56], it is important to comment on potentially efficacious interventions to ameliorate hormone therapy-induced cognitive impairment, even if somewhat premature. A recent review of the clinical and basic studies suggested that exercise may be beneficial for treating hormone therapy-induced cognitive impairments in women treated for breast cancer [66].…”