The course of self-perceived cognitive functioning among patients with lymphoma and the co-occurrence with fatigue and psychological distress

Afke Ekels; Simone Oerlemans; Sanne B Schagen; Djamila E Issa; Noortje Thielen; Marten R Nijziel; Marjolein W M van der Poel; Lindy P J Arts; Eduardus F M Posthuma; Lonneke V van de Poll-Franse

doi:10.1007/s11764-023-01458-2

The course of self-perceived cognitive functioning among patients with lymphoma and the co-occurrence with fatigue and psychological distress

J Cancer Surviv. 2023 Sep 27. doi: 10.1007/s11764-023-01458-2. Online ahead of print.

Authors

Afke Ekels^{1

2}, Simone Oerlemans³, Sanne B Schagen^{4

5}, Djamila E Issa⁶, Noortje Thielen⁷, Marten R Nijziel⁸, Marjolein W M van der Poel⁹, Lindy P J Arts¹⁰, Eduardus F M Posthuma^{11

12

13}, Lonneke V van de Poll-Franse^{11

4

14}

Affiliations

¹ Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands. a.ekels@IKNL.nl.
² Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands. a.ekels@IKNL.nl.
³ Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands. s.oerlemans@IKNL.nl.
⁴ Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands.
⁵ Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands.
⁶ Department of Internal Medicine, Jeroen Bosch Hospital, S-Hertogenbosch, the Netherlands.
⁷ Department of Internal Medicine, Diakonessenhuis, Utrecht, the Netherlands.
⁸ Department of Hemato-Oncology, Catharina Cancer Institute, Catharina Hospital, Eindhoven, the Netherlands.
⁹ Department of Internal Medicine, Division of Hematology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands.
¹⁰ Department of Psychology, Revalis Clinics, S-Hertogenbosch, the Netherlands.
¹¹ Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands.
¹² Department of Internal Medicine, Reinier de Graaf Group, Delft, the Netherlands.
¹³ Department of Hematology, Leiden University Medical Center, Leiden, the Netherlands.
¹⁴ Department of Medical and Clinical Psychology, Center of Research On Psychological and Somatic Disorders (CoRPS), Tilburg University, Tilburg, the Netherlands.

PMID: 37755680
DOI: 10.1007/s11764-023-01458-2

Abstract

Purpose: To investigate the proportion of patients with lymphoma with persistent clinically relevant cognitive impairment, and its relation to treatment, fatigue, and psychological distress.

Methods: Patients with diffuse-large-B-cell-lymphoma (DLBCL), follicular-lymphoma (FL), and chronic-lymphocytic-leukemia (CLL)/small-lymphocytic-lymphoma (SLL), diagnosed between 2004-2010 or 2015-2019, were followed up to 8 years post-diagnosis. Sociodemographic and clinical data were obtained from the Netherlands Cancer Registry and the Population-based HAematological Registry for Observational Studies. The EORTC QLQ-C30 was used to assess cognitive functioning and fatigue, and the HADS to assess psychological distress. Individual growth curve models were performed. Results were compared with an age- and sex-matched normative population.

Results: A total of 924 patients were included (70% response rate). Persistent cognitive impairment was twice as high in patients (30%) compared to the normative population (15%). Additionally, 74% of patients reported co-occurring symptoms of persistent fatigue and/or psychological distress. Patients with FL (- 23 points, p < 0.001) and CLL/SLL (- 10 points, p < 0.05) reported clinically relevant deterioration of cognitive functioning, as did the normative population (FLnorm - 5 points, DLBCLnorm - 4 points, both p < 0.05). Younger age, higher fatigue, and/or psychological distress at inclusion were associated with worse cognitive functioning (all p's < 0.01). Treatment appeared less relevant.

Conclusion: Almost one-third of patients with lymphoma report persistent cognitive impairment, remaining present up to 8 years post-diagnosis. Early onset and co-occurrence of symptoms highlight the need for clinicians to discuss symptoms with patients early.

Implications for cancer survivors: Early recognition of cognitive impairment could increase timely referral to suitable supportive care (i.e., lifestyle interventions) and reduce (long-term) symptom burden.

Keywords: Cognition; Lymphoma; Patient-reported outcome; Population-based registry; Quality of life.

Abstract

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