|M.Sc Student||Trachtenberg Estherina|
|Subject||Cognitive Impairment in Hodgkin Lymphoma|
|Department||Department of Medicine||Supervisors||Professor Eldad Dann|
|Professor Judith Aharon-Peretz|
|Full Thesis text|
Hodgkin lymphoma (HL) mostly affects
young adults (median age 33y). Due to the use of efficient staging techniques
and treatment methods, HL patients have a 5-year survival of 97%.
Cancer-related cognitive impairment (CRCI) is a frequent complaint among HL
survivors (HLS). CRCI is commonly reported following the administration of
chemotherapy (“chemo-brain”). CRCI is characterized by impairment in memory,
attention, executive functions and a decrease in processing speed. However,
CRCI in HLS is not extensively studied. The current study aimed to assess the
incidence and characteristics of CRCI in HLS.
HLS who completed first-line therapy (chemo±RT) and remained in complete remission for 6 months to 5 years from the end of therapy were evaluated. Age-and education-matched individuals served as healthy controls (HC). Test results were compared to population norms and to HCs.Study participants completed self-reported questionnaires evaluating fatigue (MFI-20), depression (BDIII), anxiety (HA), quality of life (QLQ-C30) and cognitive function (FACT-cog) and underwent a neurocognitive evaluation. The test battery included: The California verbal learning test (CVLT), digit span (WAIS-III), trail making tests (TMT) A, Stroop and Raven progressive matrices tests and 5 sub-tests from the CANTAB Computerized Battery, assessing the processing speed, memory, attention, executive functions, and intelligence domains. Test results were presented in standard scores. Since each neuropsychological test measures multiple parameters, significant representative test-parameters were chosen for each test. A domain was regarded impaired when the subject scored ≤ 1.5 SD below the expected norm, in at least one significant representative parameter belonging to a neuropsychological test. Test results were compared to population norms and to HCs.
Our findings in the present study included 51 HLS with a median age of 28 years (range 19-48), mean education of 14.5±2.5 years and median time from end of therapy equating to 24 months (range 4-59) as well as 14 HC with a median age of 27.5 years (range 20-38) and mean education of 14.8±2.2 years. Complaints related to cognitive deterioration (Fact-Cog) and fatigue (MFI-20) were significantly more severe and more frequent in HLS compared to HC. Severe depression and anxiety were infrequent among HLS. Notably, the HC group had significantly fewer complaints and symptoms across all scales. In the neuropsychological evaluation, HLS scored within the impaired range on ≥1 significant representative test-parameter assessing domain: 41% on executive functions, 28% on memory and learning, 12% on attention, and 22% on processing speed. All the evaluated significant representative test-parameters are listed in Table 2. We found that 35% of HLS were impaired on ≥1 cognitive domain and 30% on ≥ 2 cognitive domains. In conclusion the present study demonstrates that fatigue and cognitive impairment, predominantly in executive functions and memory, constitute frequent and alarming complaints in HLS. These adverse effects can persist and may exert an impact on all aspects of life. Given the young age of HLS and the enormous impact of CRCI on life aspects, benefit versus risk profiles of the therapeutic protocols applied in HL should be reconsidered and individually tailored.