Neurocognitive concerns and neurocognitive impairment in long-term survivors of oropharyngeal cancer post (chemo)radiotherapy.

Background: Little is known about neurocognitive concerns (NCC) and neurocognitive function (NCF) in survivors of oropharyngeal cancer (OPC) following (chemo)radiotherapy.

Methods: A multicentre cross-sectional study was conducted in non-surgically treated OPC. Using the Medical Outcomes Study Cognitive Functioning Scale (MOS-Cog), NCC were classed as having concerns at least some of the time (MOS-Cog score of ≤ 60 across all items). Patients were also invited to complete an online cognitive test battery (Amsterdam Cognition Scan; ACS) to assess NCF. Using norm scores from 708 individuals from the UK general population, significant NCF impairment was defined as Z score ≤  - 2 in one domain or ≤  - 1.5 in at least two domains. Regression analysis was performed to identify factors associated with NCC/NCF.

Results: Three hundred thirty-eight patients treated for OPC, with median age at treatment of 58.6 years and median follow-up of 6 years (IQR 4-8) post-treatment, were recruited. NCC were present in 14.8% of patients. Amongst 93 patients who completed the ACS, 33% demonstrated significant impairment in NCF. Memory and attention were the most affected domains in NCC and NCF. On multivariable regression analysis, mental fatigue, mood, general fatigue, and physical fatigue significantly predicted NCC. Multivariate analysis revealed a small but statistically significant negative association between mood and NCF. No statistically significant correlations were found between NCC/NCF impairment and radiation dose received by the posterior fossa.

Conclusion: NCC and NCF impairment affects a substantial proportion of long-term survivors of OPC. Assessment of NCC and NCF is essential for a comprehensive understanding of cognitive health in this population.

Implications For Cancer Survivors: This study highlights that a substantial proportion of long-term oropharyngeal cancer survivors experience both subjective NCC and objective NCF impairment. The findings underscore the need for neurocognitive screening and a multidisciplinary approach to survivorship care, incorporating psychological and cognitive support alongside traditional follow-up.