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6 January 2023

Using CANTAB to assess cognitive function in long-term Hodgkin lymphoma survivors

We caught up with Dr Ferenc Magyari from the University of Debrecen, who told us how CANTABTM has helped them to understand the long-term cognitive impact of Hodgkin’s Lymphoma. 

I started working as an internal medicine resident doctor at the University of Debrecen, Hungary, in 2009. I have worked in the general hematology and stem cell transplant departments, the emergency, and the intensive care unit. I obtained my board certification in internal medicine in 2014. I completed my training as a hematologist in 2016. I am also involved in educating medical students and in clinical trials as a co-investigator. I got my Ph.D. degree in January 2019 investigating clinical experience with Hodgkin lymphoma, with particular regard for treatment-related late complications, fatigue and mental health. 

Our center treats approximately 10% of all Hungarian Hodgkin’s Lymphoma (HL) patients, with a total of 715 patients treated between 1980-20141

What are you trying to find out?

Treatment of Hodgkin’s Lymphoma has become one of the success stories of oncohematology over the past decades. HL has had a continuously increasing survival rate as thanks to PET/CT adapted treatment there is an 85–90% long-term survival.

However, the cancer and treatment puts patients at risk for long-term complications and health-related quality-of-life impairment. HL primarily affects active young adults: many patients recieve a diagnosis before they are 40 years old. Therefore, the social and economic implications of the disease outweigh its incidence rate2. Neuropsychological (NP) studies have shown cognitive dysfunction in 13–75% of patients receiving chemotherapy for solid cancers or hematological malignancies. However, 15–35% may also experience permanent cognitive deficits even after chemotherapy has ended3,4. Cancer-related cognitive impairment (CRCI) is associated with decreased quality of life; reduced ability to work, read, or drive; and decreased social functioning. 

A significant proportion of clinical trials investigating the impact of the type of cancer on quality of life have been conducted with solid cancer patients, for example breast cancer survivors. However, most clinical trials in hematological disorders focus on the long-term impacts on survivors of acute lymphoblastic leukemia and primary central nervous system lymphoma. There are few published data available on the impact of Hodgkin’s Lymphoma on the long-term quality of life of survivors.

What did you discover?

The present study results (n=118) show that several cognitive domains are already impaired in long-term HL survivors. 

Based on the results of reaction time (RTI) and its psychomotor speed subtest, there was a clear association with stage III and IV HL, which might emphasize the role and the cycles of chemotherapies among HL survivors. Our findings regarding reaction time are similar to preliminary data, which had detected that receiving a lower number of chemotherapy cycles was associated with better neurocognitive performance. 

More than half of our long-term HL patients (52%, n=62) showed impairment based on at least one cognitive domain. Attention (and processing speed) was impaired in 35% of patients, working memory and planning (executive function) were damaged in 25%, while visual memory (memory and learning) was affected in 22%.  

We identifed associations between objective neurocognitive defcits (all three cognitive domains) and inactive employment status. According to our results, being older at diagnosis or when completing the survey and disability pension status was related to poorer cognitive function on attention and visual memory. Our investigation suggests that an older age and inactive employment status require enhanced attention. Our results draw attention to the fact that cognitive impairment is a real problem in patients with cured HL, similar to other malignant diseases. Further longitudinal clinical studies could help characterize the neurocognitive outcomes of HL survivors.

Why did you choose CANTABTM for your study?

According to literature data, neuropsychological tests to measure cognitive function often take more than four hours and require trained investigators. However, CANTABTM covers a wide range of cognition (visual memory, attention, working memory, and planning function), can be performed within two hours5, and is relatively simple to set up and administer.  It is also independent of language and culture. We examined the domains of visual memory (PAL, DMS, SRM), functions of attention (IED, RTI, RVP, PRM), working memory, and planning (SSP, SWM, SOC). Although the CANTABTM battery emphasizes assessment of frontostriatal functions (SWM, IED, SOC, and SWP), it also includes tests sensitive to temporal lobe (PAL, DMS, PRM, SSP) function. 

What are your plans for the future?  

We are currently assessing changes in cognitive function before and after treatment with the CANTABTM in our Hodgkin lymphoma patients.

References:
1. llés, Á., Jóna, Á., Simon, Zs., et al.  Novel treatment options in relapsed and refracter Hodgkin lymphomas. Orv. Hetil., 2015, 156(45), 1824–1833.
2. Magyari, F., Kósa, K., Berecz, R. et al. Employment status and health related quality of life among Hodgkin-lymphoma survivors’– results based on data from a major treatment center in Hungary. Health Qual Life Outcomes 15, 180 (2017). https://doi.org/10.1186/s12955-017-0758-x.
3. Janelsins MC, Kesler SR, Ahles TA et al (2014) Prevalence, mechanisms, and management of cancer-related cognitive impairment. Int Rev Psychiatry 26:102–113.
4. Asher A, Myers JS (2015) The effect of cancer treatment on cognitive function. Clin Adv Hematol Oncol 13:441–450.
5. Magyari, F., Virga, I., Simon, Z. et al. Assessment of cognitive function in long-term Hodgkin lymphoma survivors, results based on data from a major treatment center in Hungary. Support Care Cancer 30, 5249–5258 (2022). https://doi.org/10.1007/s00520-022-06918-6.
 

Tags : cantab | cantab testimonial | crci | cancer | cognition

Author portrait

Ferenc Magyari, University of Debrecen