Cancer-Related Cognitive Impairment in Patients With Lung Cancer

Abstract

Objectives: The aim of this study was to identify biomarkers of cancer-related cognitive impairment (CRCI) in patients with small-cell lung cancer (SCLC).

Methods: Patients with SCLC were prospectively recruited between 2019 and 2023 and evaluated using neuropsychological (NPS) battery; structural MRI; and serologic analysis of neuronal antibodies, cytokines, brain-derived neurotrophic factor (BDNF), and cognitive-related single nucleotide variants (SNVs). Voxel-based morphometry and tract-based analysis assessed gray and white matter integrity. One month after completing chemotherapy, patients were re-evaluated.

Results: Fifty-two patients were initially evaluated: 16 (31%) exhibited cognitive impairment (CI), primarily affecting executive functioning. MRI disclosed gray matter damage in precuneus and fusiform-parahippocampal regions, linked to visuospatial abilities and memory, and white matter damage in cingulum and corpus callosum. After chemotherapy, 31 patients were re-evaluated: 10 (32%) exhibited CI, of whom 7 (23%) had persistent CI and 3 (10%) developed de novo CI (chemobrain). The chemobrain group had higher smoking exposure (60 vs 44 pack-years, p = 0.05) while the persistent CI group had more advanced disease at diagnosis (80% vs 20%, p = 0.004), compared to the never CI group (15/31, 48%).

Discussion: CRCI affected one-third of our patients with SCLC at diagnosis while chemobrain was uncommon and primarily associated with tobacco use. These findings underscore the role of early biomarkers in predicting CRCI and its persistence in patients with SCLC.