Changes of Cognitive Function and Fatigue following Chemotherapy in Patients with Gastrointestinal Cancer: A Prospective Controlled Study

Abstract

Chemotherapy-related cognitive impairment (CRCI) is one of the most frequently reported side effects of chemotherapy. About 15~70% of cancer patients experience a decline in memory, face problems with attention, and complain of an inability to multitask following chemotherapy. and 17~35% of these cases persist long-term. Even if cognitive decline in cancer patients is mild, it can have a negative impact on their quality of life due to the difficulties it can cause in daily living and work. CRCI primarily presents with abnormalities in pathways connecting the frontal lobe and the subcortical regions, as well as hippocampal damage, leading to the impairment of memory and working memory (immediate memory), attention, and information processing speed. Cognitive function includes receptive functions such as selecting, acquiring, and unifying information, memory and learning, which involves storage and retrieval, mental organization of information and organized thinking, as well as expressive functions such as behavior and communication of information. In terms of anticancer agents that affect CRCI, metabolic inhibitors (e.g., 5-FU, methotrexate), alkylating agents (cyclophosphamide, carmustine), and paclitaxel are reported to be toxic to neural progenitor cells and oligodendrocytes, which form the myelin sheaths in the central nervous system. These anticancer agents are commonly prescribed to patients with stomach or colorectal cancer, which are the most prevalent cancers in Korea. The symptoms and severity of CRCI are affected by various factors, including the cumulative dose of anticancer agents, age, and nutritional status. Interest in CRCI has prompted research in diverse areas, including the treatment agents, as well as the incidence, duration, and extent of cognitive impairment. So far, basic research to manage cognitive decline in cancer patients has focused on investigating the causes of chemotherapy-related cognitive decline. Most studies that have investigated the effects of anticancer treatment itself, including drug dose (standard vs high dose) and hormone therapy, on cognitive function have dealt with breast cancer patients. Thus, further research is required to determine Changes of Cognitive Function and Fatigue following Chemotherapy in Patients with Gastrointestinal Cancer: A Prospective Controlled Study Oh, Pok-Ja ∙ Moon, Sun Mi Department of Nursing, Sahmyook University, Seoul; Surgical Department, Korea Cancer Center Hospital, Seoul, South Korea