Head and neck cancer survivors have long-lasting cognitive problems

(Reuters Health) - Patients who survive head and neck cancer may be more likely to experience declines in cognitive function than people who don’t have these tumors, a recent study suggests.

The findings are drawn from cognitive assessments for 80 survivors of these tumors and a control group of 40 otherwise similar people who didn’t have these malignancies. Two years after cancer treatment, 38 percent of the survivors had impaired cognitive functioning, but nobody in the control group did.

“This suggests that up to at least two years after treatment is complete, a substantial minority of patients who are treated for head and neck cancer will be at risk of having deficits in several areas of cognitive function, such as being able to concentrate and remember things,” said senior study author Lori Bernstein of the University of Toronto.

Previous research has linked radiation and chemotherapy to cognitive deficits that can develop and progress many years after treatment, Bernstein said by email.

With many types of cancer treated with chemotherapy, patients can develop what’s called “chemo brain.” Symptoms vary but include things like poor focus or memory. Treatment-related pain, fatigue and malnutrition could worsen symptoms, which usually clear up after chemo is complete.

“In addition to chemotherapy treatment, incidental radiation doses to the brain might also have an effect on cognition,” said James Root of the Neurocognitive Research Lab at Memorial Sloan Kettering Cancer Center in New York City.

“Much less is known about the effects of lower dose, incidental radiation on the brain,” Root, who wasn’t involved in the study, said by email.

For the current study, researchers wanted to see how cognitive function might change over time in patients with these tumors who had both chemo and radiation.

They did four cognitive assessments, once prior to treatment and then again 6, 12 and 24 months later.

Compared to the people without cancer, the head and neck cancer survivors declined over time in several different cognitive domains, including concentration, verbal memory, and executive function, researchers report in JAMA Otolaryngology Head and Neck Surgery.

People who had less education or suffered from depression at the start of the study were more likely to develop cognitive problems, the study also found.

The study wasn’t a controlled experiment designed to prove whether or how cancer treatments might cause cognitive deficits.

Another limitation of the study is that researchers only followed patients for two years, and it’s unclear what happens to cognitive abilities over longer periods of time, the authors note. Different radiation doses also might get different results.

“While this current study alone is not enough to conclude that the neurocognitive deficits experienced by study patients are as a direct result of definitive treatment, we know that there are very important side effects associated with these treatments that have become mainstay in our fight against head and neck cancers,” said Dr. Nosayaba Osazuwa-Peters, a researcher at Saint Louis University School of Medicine who wasn’t involved in the study.

Patients and families need to be prepared for the possibility that cognitive problems can develop and linger for years, Dr. Osazuwa-Peters said by email.

This comes on top of difficulties eating that result from cancer and treatments. Many survivors have trouble swallowing food, experience changes in their sense of taste or a diminished appetite, or suffer from reflux that makes meals uncomfortable.

These challenges can lead to social isolation and depression, especially when people mark special occasions with food and family meals.

“When a patient already struggling with socializing with family and friends also has to deal with loss of memory or comprehension, this may cause additional anxiety and stress, not only to the patient, but also the family and caregivers,” Osazuwa-Peters said. “It is important to recognize the possibility of loss of cognition as part of the “new normal” for these patients.”

SOURCE: JAMA Otolaryngology Head and Neck Surgery, online November 22, 2017.