Preliminary comparison of neuropsychological performance in patients with non-small-cell lung cancer treated with chemotherapy or targeted therapy

Abstract

Purpose

This cross-sectional pilot study aimed to compare the effects of chemotherapy and targeted therapy on neuropsychological performance and psychiatric symptoms in patients with non-small-cell lung cancer (NSCLC).

Patients and methods

A total of 113 patients with NSCLC were recruited. According to their type of cancer treatment, the patients were classified into chemotherapy (n=40), targeted therapy (n=33), and untreated control (n=40) groups. All participants completed five objective tests measuring various domains of cognitive function, a subjective cognitive functioning scale (Functional Assessment of Cancer Therapy–Cognitive Function; FACT-cog), and the Hospital Anxiety and Depression Scale (HADS) either within 6 months after diagnosis (for the untreated group) or about 18 months after treatment.

Results

Overall, there were no significant intergroup differences in the proportions of patients with abnormal cognitive performance and psychiatric disturbances. Among the untreated NSCLC patients, 35% had impaired performance in at least one cognitive domain, and a comparable finding (30%–35%) was made for the other two treatment groups. The proportion of patients with impaired psychomotor speed was the highest (10%–15%) across various cognitive domains. Moreover, a significant proportion of NSCLC patients (15%–20%) exhibited HADS-defined anxiety and depression disorder. Finally, significant correlations were found between FACT-cog total scores and the HADS Depression subscale across all three groups.

Conclusion

This study demonstrated that 1) a substantial proportion of NSCLC patients exhibited cognitive impairments (especially regarding psychomotor speed) and psychiatric disturbances; 2) no significant differences were observed among the three patient groups for any subjective or objective measure of cognitive deficit; and 3) perceived cognitive impairment was significantly associated with depression or anxiety. Prompt treatment of psychiatric disorders to minimize their impact is therefore recommended.

Keywords:

• non-small-cell lung cancer
• neuropsychological performance
• psychomotor speed
• anxiety
• depression

Supplementary materials

Supplementary S1 Description of cognitive tests

The Vocabulary subtest of the Wechsler Adult Intelligence Scale-III (WAIS-III):

It comprises 33 words that are listed in order of difficulty. The participants are asked for definitions of words. One or two points are given for each acceptable definition, depending on its accuracy and aptness.

The Digit Span subtest of the WAIS-III:

It comprises two different tests, Digits Forward and Digits Backward, each of which involves different mental activities. Both tests consist of pairs of random numbers of increasing sequence length that the examiner reads aloud. The number of correct repetitions is measured.

The Digit Symbol Substitution subtest of the WAIS-III:

It consists of digit-symbol pairs followed by a list of digits. Under each digit, the participants should write down the corresponding symbol as fast as possible. The number of correct symbols within the allowed time (120 seconds) is measured.

The Color Trails Test (CTT):

It comprises two parts, each involving numbered circles that are printed with vivid pink or yellow backgrounds. For the CTT Part 1, the participants use a pencil to rapidly connect circles numbered 1 through 25 in sequence. For the CTT Part 2, the participants rapidly connect numbered circles in sequence, but alternates between pink and yellow colors. The length of time (in seconds) to complete each trial is recorded, along with qualitative features of performance indicative of brain dysfunction, such as near-misses, prompts, number sequence errors, and color sequence errors.¹

Reference

• D’EliaLSatzPUchiyamaCWhiteTColor Trails Test Professional ManualOdessa, FLPsychological Assessment Resources1996
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Acknowledgments

This study was supported by grants from Chang Gung Memorial Hospital, Chiayi, Taiwan (grant number: CMRPG6F0321, CORPG6G0101, CORPG6G0141). The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Author contributions

All the authors contributed to data analysis, drafting, and critical revision of this paper, approved the final version for publication and agreed to be accountable for all aspects of the research.

Disclosure

The authors report no conflicts of interest in this work.