Survivorship and Patients Perspective
Ferenc Magyari1, Tibor Ivánka2, Anikó Égerházi2, Zsófia Simon1, Zsófia Miltényi1, Karolina Kósa3, Árpád Illés1
1Department of Haematology, Faculty of Medicine,2Department of Psychiatry, Faculty of Medicine,3Department of Behavioral Sciences, Faculty of Public Health - University of Debrecen, Hungary
Introduction: Using up-to-date methods of clinical investigation and risk and response adapted therapy, 80–85% of patients with Hodgkin-lymphoma (HL) show long-term survival and recovery. However, the long-term side effects associated with the treatment become more prominent. One such well-known side effect is cognitive dysfunction that appears in HL patients after chemotherapy. During our work we aimed at measuring cognitive dysfunction in our HL patients, looking for correlations between the patients and their disease and the factors involved in the treatment.
Materials and Methods: We carried out a computer assisted assessment (Cambridge Neuropsychological Test Automated Battery-CANTAB) of cognitive dysfunction in 118 patients treated at the Department of Haematology. We examined the domains of visual memory, functions of attention, working memory and planning. We regarded as having reduced cognitive function patients who performed worse than the normal population by 1.5 standard deviation or if the results of at least one test was already positive.
Results: Median mean age of 64 females and 54 males at diagnosis was 29 (13–74), and 41 (21–81) years at completion of the CANTAB investigation; this examination took place 11 years (0.5- 44) after diagnosis. 52.5% of all patients examined showed cognitive decay. In 35% (42/118) of patients it was attention that suffered, working memory and planning were damaged in 25%, (30/118) while visual memory was affected in 22% (26/118 patients). All three functions showed significant correlation with age at diagnosis and at the time of the examination A close correlation was found between attention and inactive employment and radiation therapy on the one hand and another correlation between working memory and planning and disability pensioner and inactive status on the other. Visual memory showed a close correlation with disability pension and inactive employment status and the effects of persistent drug use on the central nervous system.
Conclusions: Our results draw attention to the fact that, like with other malignant diseases, cognitive decay is a real problem in patients with HL. In our patients damage to the attention function was the most detectable. Our investigation suggests that patients with inactive employment status require enhanced attention. Their cognitive function and, through that, their quality of life can be improved by their retun to work if possible or by the use of cognitive therapy.