Although cognition can be severely impacted by oncology treatments, the evaluation of this side effect is often discussed less than more commonly cited side effects, such as fatigue, weakened immune system, and digestive issues.
From 2007 to 2017, cancer death rates decreased by 15% for both men and women1. This is extraordinary news in relation to the effectiveness of oncology treatments at improving survivability. Yet, this means that there are more patients living with cancer than ever before. With 39% of women and 40% of men developing cancer at some point in their lives, the need for cancer treatments that can improve not only survival, but quality of life, is critical2.
75% of cancer patients experience some form of cognitive impairment, and the deterioration of cognitive abilities can severely impact the lives of people living with cancer by affecting their routines, relationships, and independence3. However, the impact of oncology treatments on cognition can be difficult to measure, especially because cognitive impairment can be subtle and can vary so widely across treatments and patients. Patients have reported feeling anywhere from “a little more slower” to “less confident”, to in some situations saying they “just gave up”4.
To comprehensively measure cognitive performance during cancer treatments, it is important to use both objective and subjective cognitive assessments. Measures of each type may reveal different insights that can have a large impact on decision making. For example, in breast cancer patients receiving chemotherapy, objective measures showed a decrease in concentration during chemotherapy cycles which subsequently returned to baseline levels 28 days post treatment. Subjectively, however, patients still reported significant cognitive impairment 28 days post treatment5. Compensatory mechanisms could be at play so that objectively, cognitive function seems normal, but subjectively, the patient may be working twice as hard to complete a task that was once easy for them to complete. The difference between the objective and subjective cognitive assessments are important to keep in mind as sponsors think about how to apply new measures in drug development programs.
Patient Reported Outcomes (PROs) are an important tool that can collect subjective data on cognitive effects in oncology patients. With today’s technology, patients want and are more willing to complete PROs throughout their treatment, especially when they can be completed at home and electronically. This applies to older individuals as well, as they are typically more technologically aware and capable than assumed. However, it’s extremely important to not overburden patients with PROs by avoiding redundancy and ensuring the relevancy of questions and content to patients.
1NIH, National Cancer Institute, Annual Report to the Nation 2020
2American Cancer Society, Cancer Facts & Figures 2020
3Hardy et al., 2018 ASCO Educational Book
4Von Ah et al., 2013 Euro J Oncology Nurs 17:236-41
5Phillips et al Neurology in press
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