Abstract
Introduction: Hodgkin lymphoma (HL) mostly affects young adults (median age 31y). Due to the use of efficient staging techniques and treatment methods, HL patients have a 5-year survival of 97%. Cancer-related cognitive impairment (CRCI) is a frequent complaint among HL survivors (HLS). CRCI is commonly reported following the administration of chemotherapy ("chemo-brain"). CRCI is characterized by impairment in memory, attention, executive functions and a decrease in processing speed. However, CRCI in HLS is not extensively studied. The current study aimed to assess the incidence and characteristics of CRCI in HLS.
Methods: HLS who completed first-line therapy (chemo±RT) and remained in complete remission for 6 months to 5 years from the end of therapy were evaluated. Age - and education-matched healthy individuals served as controls (HC). Study participants completed self-reported questionnaires evaluating fatigue (MFI-20), depression (BDI-II), anxiety (HA), quality of life (QLQ-C30) and cognitive function (FACT-cog) and underwent a neurocognitive evaluation. The test battery included: The California verbal learning test, digit span (WAIS-III), trail making tests A+B, Stroop and Raven progressive matrices tests and 5 sub-tests from the CANTAB Computerized Battery, assessing the processing speed, memory, attention, executive functions, and intelligence domains. Test results were presented in standard scores. Since each neuropsychological test measures multiple parameters, significant representative test-parameters were chosen for each test. A domain was regarded impaired when the subject scored ≤ 1.5 SD below the expected norm, in at least one significant representative parameter belonging to a neuropsychological test.
Results: The present study included 51 HLS with a median age of 28 years (range 19-48), mean education of 14.5±2.5 years and median time from end of therapy equating to 24 months (range 4-59) as well as 14 HC with a median age of 27.5 years (range 20-38) and mean education of 14.8±2.2 years.
HLS reported the experience of fatigue and cognitive impairment. Severe physical fatigue was reported by to 41% of HLS and up to 25% of HC. Up to 39% HLS reported experiencing cognitive impairment versus only 17% of HC. Notably, the latter group also had significantly fewer complaints and symptoms across all scales (Table 1).
In the neuropsychological evaluation, HLS scored within the impaired range on ≥1 significant representative test-parameter assessing domain: 41% on executive functions, 28% on memory and learning, 12% on attention, and 22% on processing speed. All the evaluated significant representative test-parameters are listed in (Table 2). We found that 35% of HLS were impaired on ≥1 cognitive domain and 30% - on ≥ 2 cognitive domains.
Conclusions: The results of the current study evaluating CRCI in HLS are similar to those observed in other malignancies. Executive functions were the most frequently affected domain.
Higher education positively correlated with superior cognitive outcomes. Given the young age of HLS and the enormous impact of CRCI on life aspects, benefit versus risk profiles of the therapeutic protocols applied in HL should be reconsidered and individually tailored.
No relevant conflicts of interest to declare.
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