Cognitive function and fatigue after diagnosis of colorectal cancer
Menée en Australie auprès de 72 patients atteints d'un cancer colorectal de stade I à III (âge médian : 59 ans) et de 72 témoins, cette étude longitudinale analyse les facteurs associés à une fatigue et à une dégradation de leurs fonctions cognitives
Background : Cognitive impairment and fatigue have been associated with cancer and its treatment. We present baseline data from a large longitudinal study that evaluates cognitive function, fatigue, and potential underlying mechanisms following diagnosis of colorectal cancer (CRC). Patients and methods : We evaluated CRC patients with stage I-III disease before or after surgery, participants with limited metastatic disease and healthy controls (HC). Neuropsychological evaluation included clinical and computerised tests. Participants completed questionnaires for fatigue and quality-of-life (QOL)-(FACT-F), anxiety/depression, and cognitive symptoms (FACT-Cog). Ten cytokines, clotting factors, sex hormones, CEA, and apolipoprotein-E genotype were evaluated. Primary endpoints were cognitive function on clinical tests evaluated by a Global Deficit Score (GDS) and fatigue. Associations between test results, demographic, and disease related factors were explored. Results : We evaluated 291 participants with early-stage disease (median age 59 [23-75 years], 63% men), 72 with metastatic disease, and 72 HC. Using GDS, 45% (126/281) of participants with early-stage CRC had cognitive impairment versus 15% (11/72) of HC (OR 4.51, 95%CI 2.28,8.93; p<0.001), with complex processing speed, attention/working memory and verbal learning efficiency being most affected. Women with early-stage CRC had greater cognitive impairment than men (55/105 [52%] vs 71/176 [40%]:p<0.050). Cognitive symptoms were self-reported by 21% (59/286) of early-stage patients versus 17% (12/72) of HC; fatigue by 52% (149/287) of early-stage patients and 26% (19/72) of HC (p<0.0001). Women reported more fatigue than men (p=0.003). Fatigue, QOL, anxiety/depression, and cognitive symptoms were associated with each other (r=0.43-0.71), but not with neuropsychological performance. Most cytokines were elevated in cancer patients. Cognitive function was not associated with cytokines, sex hormones, clotting factors, CEA, or apolipoprotein-E genotype. Conclusions : The incidence of cognitive impairment was 3-5 times higher in CRC patients than HC, with women having higher impairment rates than men. The cognitive impairment profile suggests dysfunction primarily in fronto-subcortical brain systems.Trial registration NCT00188331