Some patients have cognitive impairment and fatigue after chemotherapy. We evaluated these symptoms and potential mechanisms in CRC patients and healthy controls (HC).
Cognitive function was evaluated in CRC patients and HC at baseline (pre-chemotherapy), 6 and 12 months. Group 1A received chemotherapy and Gr 1B none. Gr 2 had limited metastatic CRC. All completed cognitive assessment and self-reported fatigue, QOL, anxiety/depression, and perceived cognitive function. Blood tests evaluated: 10 cytokines, clotting factors, sex hormones, CEA, CBC and apolipoprotein genotyping as causal factors. Primary endpoints: cognitive function and fatigue at 12 months. Associations between results and demographic and disease-related factors were sought.
365 CRC patients (176 Gr 1A, 117 Gr 1B, 72 Gr. 2) and 72 HC were assessed. Median age 59 (23-75); 62% male. Cognitive impairment: baseline Gr 1A 33.5% vs 1B 32%, Gr 1 33% vs HC 10% (OR 4.5 [95%CI 2-10.2]); 12 months Gr 1A 19% vs 1B 16%, Gr 1 19% vs HC 4% (OR 4.9 [1.5-16.5]). Cognitive decline from 0-12 months: Gr 1A 31%, Gr 1B 22%, and HC 13% (p=.03). Perceived cognitive impairment at 12 months: Gr 1A 19% vs 1B 7% (p=.04), Gr 1 14% vs HC 0% (p=.009). Fatigue was greatest in Gr 1A (70%) at 6 months; at 12 months Gr. 1A 45% vs 1B 31% (p=0.056), Gr 2 61%, HC 36%. Cytokines were elevated in CRC patients compared to HC. No association was found with cognitive function and: fatigue, QOL, anxiety/depression, cytokines, sex hormones, clotting factors, CEA or apoE genotype. Objective cognitive function was weakly associated with perceived cognitive function.
CRC patients had more cognitive impairment at baseline, 6 and 12 months than HC. Impairment was not significantly different between those who did and did not receive chemotherapy. Mechanisms of cognitive impairment remain unknown. Fatigue improved with time.