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

Abstract

Abstract Purpose: To investigate the proportion of patients with lymphoma with persistent clinically relevant cognitive impairment, and its relation with 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 eight 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: 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 eight 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.