Kevin R. Krull, Ph.D., Member, St. Jude Faculty, Endowed Chair in Cancer Survivorship at St. Jude Children’s Research Hospital. In this video, he speaks about the article in ASH Clinical News – Long-Term Childhood Hodgkin Lymphoma Survivors Have Increased Risk of Neurocognitive Impairment.
Neurocognitive impairment is more common in long-term survivors of juvenile Hodgkin lymphoma (HL). According to a study published in Blood, exercise and smoking are modifiable risk factors for this impairment that could be used as therapy targets to improve functional results.
A total of 1,781 adult HL survivors were enrolled in the multi-institutional Childhood Cancer Survivor Study (CCSS) cohort for the cross-sectional study. In addition, the researchers included 3,196 siblings from the CCSS cohort as a comparison group. At the time of the study, the average ages of survivors and siblings were 37.5 and 33.2 years, respectively. In HL survivors, the median period from diagnosis was 23 years.
Participants’ neurocognitive function (Neurocognitive Questionnaire), emotional distress (Brief Symptom Inventory-18), health-related quality of life (QoL; Medical Outcomes Short Form-36), social attainment (e.g., education, income, employment, and independent living), smoking, and physical activity were all assessed through cross-sectional surveys.
In a study that controlled for age, gender, and race/ethnicity, HL survivors were shown to be considerably more likely than siblings to have impairments in a variety of neurocognitive domains, including:
* organization (relative risk [RR] = 1.32; 95% CI 1.01-1.73)
* memory (RR=1.72; 95% CI 1.21-2.44)
* emotional regulation (RR=1.56; 95% CI 1.23-1.99)
* task efficiency (RR=1.37; 95% CI 1.01-1.85)
Current and previous smokers who survived HL showed the highest risk of memory, emotional regulation, and task efficiency deficits. Those who exercised according to the Centers for Disease Control and Prevention (CDC) guidelines had a lower chance of task efficiency (RR=0.69; 95 percent CI 0.51-0.93) and organization (RR=0.59; 95 percent CI 0.44-0.78) impairment. Obesity was linked to a higher risk of task efficiency (RR=1.64; 95 percent CI 1.26-2.13) and memory deficits (RR=1.61; 95 percent CI 1.04-2.47) in survivors.
HL survivors had a higher risk of anxiety (RR=1.31; 95 percent CI 1.01-2.85) and depression (RR=1.33; 95 percent CI 1.08-1.64) than their siblings. Current smoking was linked to a greater risk of anxiety and depression in survivors, but those who exercised according to CDC guidelines had a decreased risk of depression.
While HL survivors had a higher chance of impairment in all QoL dimensions than siblings, pain domains were not different. Smoking and obesity were modifiable risk factors related to deterioration in eight of the QoL dimensions in HL survivors. Physical exercise, on the other hand, was linked to a lower probability of impairment in each QoL dimension.
All four neurocognitive domains, anxiety, and depression, as well as all QoL domains, were linked to impairment in grade 2 cardiovascular and neurologic disorders.
HL survivors were more likely than siblings to be unemployed (RR=2.02; 95 percent CI 1.68-2.42) or working part-time (RR=1.71; 95 percent CI 1.31-2.23), and to earn less than $20,000 (RR=1.80; 95 percent CI 1.35-2.40). Task efficiency impairment was also linked to a higher likelihood of poor income (RR=1.42; 95 percent CI 1.08-1.87) and unemployment (RR=3.41; 95 percent CI 1.91-6.07). Although memory impairment (RR=1.89; 95 percent CI 1.02-3.48) and depression (RR=1.87; 95 percent CI 1.01-3.46) were linked to a higher chance of unemployment, anxiety (RR=0.37; 95 percent CI 0.17-0.81) was linked to a lower risk.
Clinicians can use the Children’s Oncology Group guidelines to conduct risk-based screening for numerous chronic health issues that are frequent in HL survivors and thereby target modifiable risk factors to enhance long-term outcomes, according to Dr. Krull.