Journal of Cancer Survivorship

, Volume 13, Issue 2, pp 231–243 | Cite as

Cognitive functioning in thyroid cancer survivors: a systematic review and meta-analysis

  • Omar Saeed
  • Lori J. Bernstein
  • Rouhi Fazelzad
  • Mary Samuels
  • Lynn A. Burmeister
  • Lehana Thabane
  • Shereen Ezzat
  • David P. Goldstein
  • Jennifer Jones
  • Anna M. SawkaEmail author



Some thyroid cancer (TC) survivors experience cognitive symptoms.


The purpose of this study is to perform a systematic literature review and meta-analysis comparing cognitive performance in TC survivors to controls.


We performed a seven-database electronic search and hand-search. We performed duplicate independent reviews and data abstraction. Random effects meta-analyses reported standardized mean differences (SMDs) with 95% confidence intervals (CIs), where a negative value implies worse performance in the TC group.


We reviewed 1174 unique citations and 10 full-text papers. We included seven studies of 241 treated TC survivors and 273 controls. Cognitive function was statistically significantly worse in TC survivors in the following domains: Attention and Concentration (Digit Span Forwards) SMD − 0.37 (95% CI − 0.62, − 0.13, p = 0.003, four studies), Speed of Processing (Trail Making A) SMD − 0.36 (95% CI − 0.66, − 0.05, p = 0.022, four studies), and Language (Controlled Oral Word Association [COWAT]-Categories) SMD − 0.97 (95% − 1.31, − 0.64, p < 0.001, two studies). Executive Function results varied: COWAT-Letters SMD − 0.60 (95% CI − 0.94, − 0.27, p < 0.001, two studies), Digit Span Backwards SMD − 0.40 (95% CI − 0.64, − 0.15, p = 0.002, four studies), and Trail Making B test SMD − 0.20 (95% CI − 0.51, 0.10, p = 0.191, four studies). Statistical heterogeneity limited the COWAT-Categories and Digit Span Backwards meta-analyses.


Cognitive function was worse in TC survivors in multiple domains. Limitations included few studies, potential confounding, and lack of prospective data.

Implications for Cancer Survivors

TC survivors may experience impairments in cognitive function and should report cognitive concerns to healthcare practitioners.


Neurocognitive function Cancer survivorship Thyroid cancer Systematic review Meta-analysis 



AMS was supported, in part, by a University of Toronto Department of Medicine Clinician Scientist Merit Award. The authors would like to thank Mrs. Coreen Marino, for assistance in retrieving the full-text papers for review. The authors would also like to thank Drs. Jan Jaracz and Moira A. Visovatti, for kindly responding to our queries about their studies.

Funding information

Library service expenses were funded, in part, from a University Health Network Thyroid Cancer Research Fund (private charitable donations to the UHN Foundation).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Omar Saeed
    • 1
    • 2
  • Lori J. Bernstein
    • 3
  • Rouhi Fazelzad
    • 4
  • Mary Samuels
    • 5
  • Lynn A. Burmeister
    • 6
  • Lehana Thabane
    • 7
  • Shereen Ezzat
    • 8
  • David P. Goldstein
    • 9
  • Jennifer Jones
    • 3
  • Anna M. Sawka
    • 2
    • 10
    Email author
  1. 1.Division of EndocrinologySt. Michael’s HospitalTorontoCanada
  2. 2.Division of EndocrinologyUniversity of TorontoTorontoCanada
  3. 3.Department of Supportive Care and Department of PsychiatryUniversity Health Network and University of TorontoTorontoCanada
  4. 4.Princess Margaret Cancer CentreUniversity Health Network Library and Information ServicesTorontoCanada
  5. 5.Division of Endocrinology, Diabetes and Clinical NutritionOregon Health and Science UniversityPortlandUSA
  6. 6.Division of Diabetes, Endocrinology, and MetabolismUniversity of MinnesotaMinneapolisUSA
  7. 7.Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonCanada
  8. 8.Department of Endocrine OncologyPrincess Margaret Cancer Centre and University of TorontoTorontoCanada
  9. 9.Department of Otolaryngology, Head and Neck SurgeryUniversity Health Network and University of TorontoTorontoCanada
  10. 10.Division of EndocrinologyUniversity Health Network (Toronto General Hospital)TorontoCanada

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