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Cognitive Dysfunction in non-Hodgkin's Lymphoma Patients Treated with Front-Line Chemotherapy Open Access


Other title
Cognitive dysfunction
Type of item
Degree grantor
University of Alberta
Author or creator
Hewitt, Joanne D
Supervisor and department
Dr. Karin Olson (Faculty of Nursing)
Dr. Andrew Belch (Department of Oncology, Faculty of Medicine and Dentistry)
Examining committee member and department
Dr. Sunita Ghosh (Department of Oncology, Faculty of Medicine and Dentistry)
Dr. Carolyn Ross (Faculty of Nursing)
Dr. Joanne Olson (Faculty of Nursing)
Dr. Kristin Campbell (Department of Physical Therapy, Faculty of Medicine, University of British Columbia)
Dr. Anna Santos Salas (Faculty of Nursing)
Dr. Dr. Bryan Kolb (Department of Neuroscience and Canadian Centre for Behavioral Neuroscience, Univeristy of Lethbridge)
Dr. Priscilla Koop (Faculty of Nursing)
Faculty of Nursing

Date accepted
Graduation date
Doctor of Philosophy
Degree level
Despite the research to date, the characteristics and impact of cognitive dysfunction (CD) in cancer patients following chemotherapy is still not well understood. It is estimated approximately 20% of patients will manifest measurable cognitive deficits on neuropsychological testing post-chemotherapy. Given the increasing incidence of cancer, significant numbers of patients could potentially experience CD. Declines in cognitive function may compromise the ability to adhere to treatment requirements, to make informed treatment-related decisions, and to manage work-related activities. The purpose of this study was to document the frequency of occurrence, severity and duration of CD in non-Hodgkin’s lymphoma patients receiving front-line chemotherapy, and to determine what factors (if any) are correlated with CD in these patients. A quantitative, descriptive, prospective, observational design was utilized: Data were collected at five time points (pre-treatment, mid-treatment, and at one, six and 12 months post-treatment). Both subjective (patient perception) (FACT-Cog) and objective (neuropsychological) testing measures (CogState) were used. An estimate of premorbid intelligence was obtained using the NAART35. Information on possible confounding variables (eg. depression, anxiety, stress, fatigue, quality of life, hemoglobin) was collected via standardized questionnaires at each timepoint. Total time for completion of the testing at each timepoint was approximately 1 hour. A total of 100 subjects (65 males, 35 females) between 26 to 88 years of age were enrolled into this study between November 2010 and February 2014. The analyses of the results for this dissertation include the first 3 assessment time-points, and were completed using group data: Within-subject statistics will be obtained at the completion of all follow-up assessments. A subset of subjects reported worsening of perceived cognitive function over time as they progressed through their course of chemotherapy, with up to 41% of subjects reporting deterioration in quality of life as a consequence of cognitive impairment and with a worse quality of life associated with more subjective cognitive complaints. Perceived cognitive impairment was associated with higher levels of fatigue, depression, anxiety and stress. Doxorubicin-containing chemotherapy was associated with an increase in concerns regarding cognitive abilities, compared to non-doxorubicin containing regimens. Modest to moderate correlations were seen between the objective tasks measuring visual attention, working memory, attention and executive function and perceived (subjective) cognitive concerns. To my knowledge, this is the first longitudinal, prospective study investigating cognitive function in lymphoma patients receiving standard dose chemotherapy. As such, the results of the study will add important information to the literature in this group of patients.
Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. Where the thesis is converted to, or otherwise made available in digital form, the University of Alberta will advise potential users of the thesis of these terms. The author reserves all other publication and other rights in association with the copyright in the thesis and, except as herein before provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission.
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