Longitudinal trajectories of cancer-related cognitive impairment and influential factors among patients with lung cancer

Abstract

Objective

This study aimed to investigate longitudinal cognitive changes and identify factors associated with cancer-related cognitive impairment (CRCI) among lung cancer survivors.

Methods

Cognitive function was assessed using the FACT-Cog (subjective) and TICS-M (objective). The baseline assessment was completed before the use of chemotherapy drugs and recorded as T0. After completing the first cycle of chemotherapy, it was recorded as T1; after the second cycle, as T2; after the third cycle, as T3; after the fourth cycle, as T4; and after the fifth cycle, as T5. Linear mixed-effect models evaluated associations between clinical/sociodemographic factors and cognitive outcomes.

Results

Higher education level and later treatment progression were correlated with increased TICS-M scores. In contrast, Rural residence (β = −1.89, p = 0.021) and more comorbidities (β = −2.15, p = 0.033) were associated with reduced FACT-Cog scores. Treatment progression correlated with improved TICS-M scores (β = 0.716, p = 0.001). No significant differences were observed between the chemotherapy and chemoimmunotherapy groups (p > 0.05). A key finding was the observed discordance between stable subjective reports and modestly improving objective scores over time. There was a discrepancy between subjective and objective cognitive evaluations, as FACT-Cog scores remained consistent over time (mean 129.8 ± 20.2), while TICS-M scores showed a slight improvement (from 23.4 ± 4.9 to 24.4 ± 3.7).

Discussion

The influence of education, residence, and comorbidities on CRCI trajectories in lung cancer patients highlights the need for integrated evaluation tools. This longitudinal analysis not only identifies distinct risk profiles for CRCI but also underscores the critical need for proactive screening and tailored supportive care programs. These priorities provide a guide for improving cognitive health outcomes in lung cancer survivorship care.