Journal of Cancer Survivorship

, Volume 12, Issue 2, pp 178–185 | Cite as

Perceived cognitive impairment in people with colorectal cancer who do and do not receive chemotherapy

  • Haryana M. Dhillon
  • Ian F. Tannock
  • Gregory R. Pond
  • Corrinne Renton
  • Sean B. Rourke
  • Janette L. Vardy



Cognitive symptoms are common after cancer, but poorly associated with neuropsychological results. We previously reported colorectal cancer (CRC) patients had more cognitive impairment than controls. Here, we explore relationships between cognitive symptoms and neuropsychological domains.


Subjects with CRC (N = 362) and 72 healthy controls completed neuropsychological assessments and Functional Assessment of Cancer Therapy-Cognition (FACT-COG) at baseline (pre-chemotherapy) and 6, 12, and 24 months. Associations between neuropsychological and FACT-COG scores were explored: perceived cognitive impairment (PCI), perceived cognitive ability (PCA), impact of PCI on quality of life (CogQOL).


Of 362 CRC subjects, 289 had loco-regional disease and 173 received chemotherapy (CTh+). At baseline, groups did not differ on total FACT-COG, PCI, or PCA scores. All scores, except PCA, were worse at 6 months in CTh+. CRC patients not receiving chemotherapy did not differ from controls on FACT-COG domains. PCA associated weakly (r = 0.28–0.34) with attention/executive function, visual memory, and global deficit score. There was no association between PCI and neuropsychological domains. Fatigue, anxiety/depression, and poorer quality of life were associated with PCI and CogQOL (r = 0.44–0.51) in CRC patients.


No association was seen between total FACT-COG or PCI, and neuropsychological domains. A weak-moderate association was found between PCA and attention/executive function and visual memory.

Trial registration

The study was registered with (trial registration: NCT00188331).

Implications for cancer survivors

Cognitive symptoms are associated with fatigue, anxiety/depression, and poorer quality of life, and do not appear to be related to actual cognitive performance. Rates were lower than that reported in breast cancer survivors. Cognitive symptoms were greatest in those who received chemotherapy, with no significant difference between the non-chemotherapy survivors and healthy controls.


Cognitive function Colorectal cancer Survivorship Quality of life 



We would like to thank Anna Dodd for her work as study coordinator in Toronto and David Laurence for his work as data manager. Collaborators, study coordinators, and participants from the following hospitals are also gratefully acknowledged: Toronto: Princess Margaret, Toronto General, Toronto Western, Mt. Sinai, Sunnybrook, Credit Valley, Humber River, St. Michael’s, Toronto East General; Sydney: Concord Repatriation General, Royal Prince Alfred, Bankstown, Royal North Shore, Prince of Wales, Nepean.


This work was supported by the National Cancer Institute of Canada [grant number #15261, 2004]; the American Society of Clinical Oncology Young Investigator Award to JV [2004]; the National Health Medical Research Council [grant number 457386, 2007]; and the Cancer Institute New South Wales [grant number 05/CRF/1-06, 2006; grant number 09/RIG1-13, 2010] to JV.

Compliance with ethical standards

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Janelsins MC, Kohli S, Mohile SG, et al. An update on cancer- and chemotherapy-related cognitive dysfunction: current status. Semin Oncol. 2011;38:431–8.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Wefel JS, Vardy J, Ahles T, Schagen SB. International Cognition and Cancer Task Force recommendations to harmonise studies of cognitive function in patients with cancer. Lancet Oncol. 2011;12:703–8.CrossRefPubMedGoogle Scholar
  3. 3.
    Aaronson NK, Ahmedzai S, Bergman B, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993;85:365–76.CrossRefPubMedGoogle Scholar
  4. 4.
    Mandelblatt JS, Clapp JD, Luta G, et al. Long-term trajectories of self-reported cognitive function in a cohort of older survivors of breast cancer: CALGB 369901 (Alliance). Cancer. 2016;Google Scholar
  5. 5.
    Vardy JL, Dhillon HM, Pond GR, et al. Cognitive function in patients with colorectal cancer who do and do not receive chemotherapy: a prospective, longitudinal, controlled study. J Clin Oncol. 2015;33:4085–92.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Boykoff N, Moieni M, Subramanian SK. Confronting chemobrain: an in-depth look at survivors’ reports of impact on work, social networks, and health care response. J Cancer Surviv. 2009;Google Scholar
  7. 7.
    Downie FP, Mar Fan HG, Houede-Tchen N, et al. Cognitive function, fatigue, and menopausal symptoms in breast cancer patients receiving adjuvant chemotherapy: evaluation with patient interview after formal assessment. Psychooncology. 2006;15:921–30.CrossRefPubMedGoogle Scholar
  8. 8.
    Hutchinson AD, Hosking JR, Kichenadasse G, et al. Objective and subjective cognitive impairment following chemotherapy for cancer: a systematic review. Cancer Treat Rev. 2012;38:926–34.CrossRefPubMedGoogle Scholar
  9. 9.
    Von Ah D, Tallman EF. Perceived cognitive function in breast cancer survivors: evaluating relationships with objective cognitive performance and other symptoms using the functional assessment of cancer therapy-cognitive function instrument. J Pain Symptom Manag. 2015;49:697–706.CrossRefGoogle Scholar
  10. 10.
    Ganz PA, Kwan L, Castellon SA, et al. Cognitive complaints after breast cancer treatments: examining the relationship with neuropsychological test performance. J Natl Cancer Inst. 2013;Google Scholar
  11. 11.
    Vardy J, Dhillon HM, Pond GR, et al. Cognitive function and fatigue after diagnosis of colorectal cancer. Ann Oncol. 2014;25:2404–12.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Vardy JL, Dhillon HM, Pond GR, et al. Fatigue in people with localized colorectal cancer who do and do not receive chemotherapy: a longitudinal prospective study. Ann Oncol. 2016;27:1761–7.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Lai J-S, Butt Z, Wagner L, et al. Evaluating the dimensionality of perceived cognitive function. J Pain Symptom Manag. 2009;37Google Scholar
  14. 14.
    Wagner L, Sweet J, Butt Z, et al. Measuring patient self-reported cognitive function: development of the Functional Assessment of Cancer Therapy - Cognitive Function instrument. J Support Oncol. 2009;7:W32–9.Google Scholar
  15. 15.
    Lai JS, Wagner LI, Jacobsen PB, Cella D. Self-reported cognitive concerns and abilities: two sides of one coin? Psycho-Oncology. 2014;23:1133–41.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Janelsins MC, Heckler CE, Peppone LJ et al. Cognitive complaints in survivors of breast cancer after chemotherapy compared with age-matched controls: an analysis from a nationwide, multicenter, prospective longitudinal study. J Clin Oncol. 2016; JCO2016685856.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Haryana M. Dhillon
    • 1
  • Ian F. Tannock
    • 2
  • Gregory R. Pond
    • 3
  • Corrinne Renton
    • 1
  • Sean B. Rourke
    • 4
  • Janette L. Vardy
    • 1
    • 2
    • 5
    • 6
  1. 1.Centre for Medical Psychology and Evidence-based Decision-makingUniversity of SydneySydneyAustralia
  2. 2.Princess Margaret Cancer CentreUniversity of TorontoTorontoCanada
  3. 3.Juravinski Hospital and Cancer CentreMcMaster UniversityHamiltonCanada
  4. 4.St. Michael’s HospitalUniversity of TorontoTorontoCanada
  5. 5.Concord Cancer CentreConcord Repatriation General HospitalConcordAustralia
  6. 6.Sydney Medical SchoolUniversity of SydneyConcordAustralia

Personalised recommendations