Survivors of head and neck cancers (HNCs) are at risk for delayed neurocognitive deficits (NCD) for at least two years following radiotherapy or chemotherapy, according to a prospective longitudinal study published recently in JAMA Otolaryngology–Head and Neck Surgery.
The study authors, based at Princess Margaret Cancer Centre in Toronto, Ontario, assessed neurocognitive function and self-reported symptoms in 80 patients with histologically proven HNC requiring definitive chemoradiotherapy or radiotherapy and in 40 healthy controls. They conducted a 90-minute neurocognitive test battery at four points: baseline (≤2 weeks before starting treatment), at the end of treatment (6 months after baseline), and at 12 and 24 months after baseline.
Neurocognitive test scores were converted to age-corrected z scores and reported as mean scores, standardized regression-based scores, and frequencies of impairments in intellectual capacity, concentration, memory, executive function, processing speed, and motor dexterity. A multivariable analysis was used to identify factors associated with NCD two years following treatment.
Their analyses revealed deficits in the patient group increasing over time in intellectual capacity, concentration and short-term attention span, verbal memory, executive function, and global cognitive function. However, both the control and the patient groups performed equally well in processing speed and visual memory.
Specifically, 38% of the patient group showed an increased rate of impaired global neurocognitive functioning among patients at 24 months, while none of the control group did. The proportion of participants with declines at 24 months was higher among patients in the domains of intellectual capacity (27% of patients vs. 3% of controls), verbal memory (21% vs. 3%), processing speed (12% vs. 0%), executive function (26% vs 6%), and motor dexterity (10% vs 0%).
The researchers concluded that survivors of HNC have neurocognitive sequelae up to two years following definitive chemoradiotherapy or radiation treatment. They advised patients and healthcare to be aware of these potential risks, and recommend further research to determine the best strategies to avoid, reduce, and compensate for these declines.