Cognitive impairment in men with testicular cancer prior to adjuvant therapy.
BACKGROUND
Cognitive dysfunction experienced by individuals with cancer represents an important survivorship issue because of its potential to affect occupational, scholastic, and social activities. Whereas early efforts to characterize cognitive dysfunction primarily focused on the effects of chemotherapy, more recent evidence indicates that impairment may exist before systemic treatment. This study characterized cognitive dysfunction before adjuvant chemotherapy in a sample of men diagnosed with nonseminomatous germ cell tumors (NSGCT) of the testis.


METHODS
Men with newly diagnosed NSGCT were recruited after orchiectomy but before adjuvant chemotherapy. Patients completed neuropsychological tests to assess attention, learning, language, executive function, and motor function. Self-report measures of depression and anxiety were also administered. An overall cognitive function index was computed for participants. Cognitive impairment was defined as a z-score of less than or equal to -1.5 on 2 or more tests, or a z-score of less than or equal to -2.0 on a single test.


RESULTS
Approximately 46% of patients exhibited cognitive impairment at the time of assessment, which is significantly greater than would be expected considering healthy population norms (binomial test: P < .0001). Patients exhibited impairments in motor function, verbal learning, and executive function much more frequently relative to normative expectations (binomial test: P < .0001).


CONCLUSIONS
The prevalence of cognitive impairment in men with newly diagnosed NSGCT is unexpectedly high before the receipt of adjuvant chemotherapy. Efforts to track cognitive function over time and to develop effective interventions are warranted.
Wefel
Jeffrey S
JS
Department of Neuro-Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA. jwefel@mdanderson.org
Vidrine
Damon J
DJ
Veramonti
Tracy L
TL
Meyers
Christina A
CA
Marani
Salma K
SK
Hoekstra
Harald J
HJ
Hoekstra-Weebers
Josette E H M
JE
Shahani
Lokesh
L
Gritz
Ellen R
ER
D000970:Antineoplastic Agents / Q000627:therapeutic use; D001288:Attention; D017024:Chemotherapy, Adjuvant; D003072:Cognition Disorders / Q000209:etiology*; D003131:Combined Modality Therapy; D056344:Executive Function; D006801:Humans; D008297:Male; D008568:Memory; D009048:Motor Skills; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy / Q000523:psychology / Q000601:surgery; D009483:Neuropsychological Tests; D009919:Orchiectomy; D013066:Speech-Language Pathology; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000523:psychology* / Q000601:surgery
D000970:Antineoplastic Agents