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Prevalence and factors associated with cognitive deficit in women with gynecologic malignancies

  • Anne Van Arsdale
    Affiliations
    Montefiore Medical Center, Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and Women's Health, Bronx, NY, United States
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  • Debra Rosenbaum
    Affiliations
    Montefiore Medical Center, Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and Women's Health, Bronx, NY, United States
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  • Gurpreet Kaur
    Affiliations
    Montefiore Medical Center, Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and Women's Health, Bronx, NY, United States
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  • Priya Pinto
    Affiliations
    Montefiore Medical Center, Department of Family Medicine, Palliative Medicine, Bronx, NY, United States
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  • Dennis Yi-Shin Kuo
    Affiliations
    Montefiore Medical Center, Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and Women's Health, Bronx, NY, United States

    Albert Einstein Cancer Center, Albert Einstein College of Medicine, Bronx, NY, United States
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  • Ruben Barrera
    Affiliations
    Montefiore Medical Center, Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and Women's Health, Bronx, NY, United States
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  • Gary L. Goldberg
    Affiliations
    Montefiore Medical Center, Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and Women's Health, Bronx, NY, United States

    Albert Einstein Cancer Center, Albert Einstein College of Medicine, Bronx, NY, United States
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  • Nicole S. Nevadunsky
    Correspondence
    Corresponding author at: Montefiore Medical Center, Albert Einstein College of Medicine, Department of Obstetrics, Gynecology and Women's Health, 3332 Rochambeau Ave, Bronx, NY 10467, United States.
    Affiliations
    Montefiore Medical Center, Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and Women's Health, Bronx, NY, United States

    Albert Einstein Cancer Center, Albert Einstein College of Medicine, Bronx, NY, United States
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      Highlights

      • 60% of women with gynecologic cancers have decreased cognition by MoCa screening.
      • Age, race, education, cancer site and pain were associated with decreased cognition.
      • Decreased cognition was associated with pain > 5, but not with opioid use.

      Abstract

      Objective

      Cognitive impairment has implications in counseling, treatment, and survivorship for women with gynecologic malignancies. The purpose of our study was to evaluate the prevalence and risk factors associated with cognition in women with gynecologic malignancies.

      Methods

      After Institutional Review Board approval, 165 women at an urban ambulatory gynecologic oncology facility were queried using a Montreal Cognitive Assessment (MoCA), Wong–Baker pain scale, neuropathy scale, Patient Health Questionnaire 9 (PHQ-9) Depression Scale, and Generalized Anxiety Disorder Scale (GAD 7). Univariate and multivariate analyses were utilized to evaluate the association of cognitive deficit with age, education, race/ethnicity, disease site, stage, treatment, pain, neuropathy, anxiety, and depression.

      Results

      The mean MoCA score for the entire cohort was 24.1 (range 13–30.) 24% of patients had MoCA scores less than 22. Low scores (<22) were associated with older age, non-white race/ethnicity, lower education level, uterine and vulvar cancers, and pain ≥5 (p < 0.05). There was a trend toward lower cognition scores for women treated with both chemotherapy and radiation (p = 0.10). While clinically significant pain was associated with low cognition, there was no association with use of opioid pain medication and low cognition scores.

      Conclusions

      There was a high prevalence of cognitive deficit in women with gynecologic malignancies. The association of low cognition with report of clinically significant pain, but not with use of opioid pain medications, should be further explored. Research is needed to evaluate the impact of cognitive deficits on treatment adherence and outcomes for women with gynecologic malignancies.

      Keywords

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      References

        • Boykoff N.
        • Moieni M.
        • Subramanian S.K.
        Confronting chemobrain: an in-depth look at survivors' reports of impact on work, social networks, and health care response.
        J. Cancer Surviv. 2009; 3: 223-232
        • Castellon S.A.
        • Ganz P.A.
        • Bower J.E.
        • Petersen L.
        • Abraham L.
        • Greendale G.A.
        Neurocognitive performance in breast cancer survivors exposed to adjuvant chemotherapy and tamoxifen.
        J. Clin. Exp. Neuropsychol. 2004; 26: 955-969
        • Joly F.
        • Rigal O.
        • Noal S.
        • Giffard B.
        Cognitive dysfunction and cancer: which consequences in terms of disease management?.
        Psycho-Oncology. 2011; 20: 1251-1258
        • de Ruiter M.B.
        • Reneman L.
        • Boogerd W.
        • Veltman D.J.
        • van Dam F.S.
        • Nederveen A.J.
        • et al.
        Cerebral hyporesponsiveness and cognitive impairment 10 years after chemotherapy for breast cancer.
        Hum. Brain Mapp. 2011; 32: 1206-1219
        • Kreukels B.P.
        • Schagen S.B.
        • Ridderinkhof K.R.
        • Boogerd W.
        • Hamburger H.L.
        • Muller M.J.
        • et al.
        Effects of high-dose and conventional-dose adjuvant chemotherapy on long-term cognitive sequelae in patients with breast cancer: an electrophysiologic study.
        Clin. Breast Cancer. 2006; 7: 67-78
        • Kaiser J.
        • Bledowski C.
        • Dietrich J.
        Neural correlates of chemotherapy-related cognitive impairment.
        Cortex. 2014; 54: 33-50
        • Ahles T.A.
        • Saykin A.J.
        • McDonald B.C.
        • Furstenberg C.T.
        • Cole B.F.
        • Hanscom B.S.
        • et al.
        Cognitive function in breast cancer patients prior to adjuvant treatment.
        Breast Cancer Res. Treat. 2008; 110: 143-152
        • Wefel J.S.
        • Saleeba A.K.
        • Buzdar A.U.
        • Meyers C.A.
        Acute and late onset cognitive dysfunction associated with chemotherapy in women with breast cancer.
        Cancer. 2010; 116: 3348-3356
        • McDonald B.C.
        • Conroy S.K.
        • Smith D.J.
        • West J.D.
        • Saykin A.J.
        Frontal gray matter reduction after breast cancer chemotherapy and association with executive symptoms: a replication and extension study.
        Brain Behav. Immun. 2013; 30: S117-S125
        • Wefel J.S.
        • Kesler S.R.
        • Noll K.R.
        • Schagen S.B.
        Clinical characteristics, pathophysiology, and management of noncentral nervous system cancer-related cognitive impairment in adults.
        CA Cancer J. Clin. 2015; 65: 123-138
        • Asher A.
        • Myers J.
        The effect of cancer treatment on cognitive function.
        Clin. Adv. Hematol. Oncol. 2015; 13
        • Vardy J.
        • Wefel J.S.
        • Ahles T.
        • Tannock I.F.
        • Schagen S.B.
        Cancer and cancer-therapy related cognitive dysfunction: an international perspective from the Venice cognitive workshop.
        Ann. Oncol. 2008; 19: 623-629
        • Matsuda T.
        • Takayama T.
        • Tashiro M.
        • Nakamura Y.
        • Ohashi Y.
        • Shimozuma K.
        Mild cognitive impairment after adjuvant chemotherapy in breast cancer patients—evaluation of appropriate research design and methodology to measure symptoms.
        Breast Cancer (Tokyo, Japan). 2005; 12: 279-287
        • Dumas J.A.
        • Makarewicz J.
        • Schaubhut G.J.
        • Devins R.
        • Albert K.
        • Dittus K.
        • et al.
        Chemotherapy altered brain functional connectivity in women with breast cancer: a pilot study.
        Brain Imaging Behav. 2013; 7: 524-532
        • Weis J.
        • Poppelreuter M.
        • Bartsch H.H.
        Cognitive deficits as long-term side-effects of adjuvant therapy in breast cancer patients: ‘subjective’ complaints and ‘objective’ neuropsychological test results.
        Psycho-Oncology. 2009; 18: 775-782
        • Correa D.D.
        • Zhou Q.
        • Thaler H.T.
        • Maziarz M.
        • Hurley K.
        • Hensley M.L.
        Cognitive functions in long-term survivors of ovarian cancer.
        Gynecol. Oncol. 2010; 119: 366-369
        • Correa D.D.
        • Hess L.M.
        Cognitive function and quality of life in ovarian cancer.
        Gynecol. Oncol. 2012; 124: 404-409
        • Smith T.
        • Gildeh N.
        • Holmes C.
        The Montreal Cognitive Assessment: validity and utility in a memory clinic setting.
        Can. J. Psychiatr. 2007; 52: 329-332
        • Kroenke K.
        • Spitzer R.L.
        • Williams J.B.
        The PHQ-9: validity of a brief depression severity measure.
        J. Gen. Intern. Med. 2001; 16: 606-613
        • Spitzer R.L.
        • Kroenke K.
        • Williams J.B.
        • Lowe B.
        A brief measure for assessing generalized anxiety disorder: the GAD-7.
        Arch. Intern. Med. 2006; 166: 1092-1097
        • van Dam F.S.
        • Schagen S.B.
        • Muller M.J.
        • Boogerd W.
        • vd Wall E.
        • Droogleever Fortuyn M.E.
        • et al.
        Impairment of cognitive function in women receiving adjuvant treatment for high-risk breast cancer: high-dose versus standard-dose chemotherapy.
        J. Natl. Cancer Inst. 1998; 90: 210-218
        • Bruera E.
        • Macmillan K.
        • Hanson J.
        • MacDonald R.N.
        The cognitive effects of the administration of narcotic analgesics in patients with cancer pain.
        Pain. 1989; 39: 13-16
        • Sjogren P.
        • Olsen A.K.
        • Thomsen A.B.
        • Dalberg J.
        Neuropsychological performance in cancer patients: the role of oral opioids, pain and performance status.
        Pain. 2000; 86: 237-245
        • Eccleston C.
        • Crombez G.
        • Aldrich S.
        • Stannard C.
        Attention and somatic awareness in chronic pain.
        Pain. 1997; 72: 209-215
        • Ersek M.
        • Cherrier M.M.
        • Overman S.S.
        • Irving G.A.
        The cognitive effects of opioids.
        Pain Manag. Nurs. 2004; 5: 75-93
        • Clemons M.
        • Regnard C.
        • Appleton T.
        Alertness, cognition and morphine in patients with advanced cancer.
        Cancer Treat. Rev. 1996; 22: 451-468
        • Banning A.
        • Sjogren P.
        • Kaiser F.
        Reaction time in cancer patients receiving peripherally acting analgesics alone or in combination with opioids.
        Acta Anaesthesiol. Scand. 1992; 36: 480-482
        • Bruera E.
        • Fainsinger R.L.
        • Miller M.J.
        • Kuehn N.
        The assessment of pain intensity in patients with cognitive failure: a preliminary report.
        J. Pain Symptom Manag. 1992; 7: 267-270
        • Vainio A.
        • Ollila J.
        • Matikainen E.
        • Rosenberg P.
        • Kalso E.
        Driving ability in cancer patients receiving long-term morphine analgesia.
        Lancet (London, England). 1995; 346: 667-670
        • Kurita G.P.
        • Sjogren P.
        • Ekholm O.
        • Kaasa S.
        • Loge J.H.
        • Poviloniene I.
        • et al.
        Prevalence and predictors of cognitive dysfunction in opioid-treated patients with cancer: a multinational study.
        J. Clin. Oncol. Off. J. Am. Soc. Clin. Oncol. 2011; 29: 1297-1303
        • Cimprich B.
        • So H.
        • Ronis D.L.
        • Trask C.
        Pre-treatment factors related to cognitive functioning in women newly diagnosed with breast cancer.
        Psycho-Oncology. 2005; 14: 70-78
        • Hess L.
        • Huang H.
        • Hanlon A.
        • et al.
        Cognitive function during and six months following chemotherapy for front line treatment of ovarian, primary peritoneal or fallopian tube cancer: an NRG oncology/gynecologic group study.
        Gynecol. Oncol. 2015; 139: 541-545
        • Knotkova Cruciani R.
        Non-invasive transcranial direct current stimulation for the study and treatment of neuropathic pain.
        Methods Mol. Biol. 2010; 617: 505-515