Perceived cognitive deficits during adjuvant chemotherapy: exploring the experiences of colorectal cancer patients

Abstract

Background: Chemotherapy-related cognitive impairment – known anecdotally as ‘chemobrain’ – is often reported by cancer patients. This condition has primarily been investigated in breast cancer populations, where perceived cognitive impairment (PCI) has been linked to fatigue, anxiety, and mood. This study explores whether colorectal cancer (CRC) patients report similar experiences of PCI during chemotherapy. Methods: Post-surgery CRC patients due to receive adjuvant chemotherapy (n=24) completed the FACT-Cognitive Scale, FACIT-Fatigue Scale, and the Hospital Anxiety and Depression Scale prior to starting treatment (T1) and again 12 weeks later (T2). Assessments were also completed by a surgery-only control group (n=10) at comparative time-points. Analysis explored between-group comparisons, changes over time, and relationships between variables. Findings: At T1 there were no significant differences in PCI between chemotherapy (M=50.67, SD=15.69) and surgery-only patients (M=58.60, SD=12.62; t[32]=1.42, p=0.19); however, at T2, PCI was significantly higher in chemotherapy (M=47.14, SD=15.23) compared to surgery-only patients (M=59.90, SD=7.3; t[28]=2.19, p=0.016). At T2, there were significant correlations between PCI and fatigue (r=0.724, p=<0.001), anxiety (r=-0.681, p=0.001), and mood (r=-0.574, p=0.005) in chemotherapy patients; whilst anxiety alone was significantly correlated with PCI in surgery-only patients (r=-0.759, p=0.029). There were no significant changes in PCI between T1 and T2 in either group; however, surgery-only patients did experience significantly reduced fatigue. Discussion: Chemotherapy-related PCI occurs in CRC, with links to experiences of fatigue, anxiety, and mood. Although causality remains unclear, it is possible that PCI is part of a wider psychological response to treatment, presenting opportunities for cognitive-behavioural interventions to improve outcomes.