A prospective study of cognitive function in men with non-seminomatous germ cell tumors

ObjectiveLongitudinal neuropsychological assessments were performed to determine if adjuvant chemotherapy was associated with cognitive dysfunction in men with non-seminomatous germ cell tumors (NSGCT). MethodsPatients with NSGCT status post-orchiectomy that either received adjuvant chemotherapy (n= 55) or did not (n= 14) were recruited. Patients were tested before chemotherapy, 1week post-chemotherapy (or 3months later in the surveillance group) and 12months after the baseline evaluation. ResultsCompared with the surveillance group, patients treated with chemotherapy had higher rates of cognitive decline at 12months (overall cognitive decline: 0%, 52%, and 67% in the surveillance, low exposure (LE), and high exposure (HE) group, respectively), greater number of tests that declined (mean of 0.1, 1.4, and 2.0 in the surveillance, LE, and HE group, respectively), and more frequent worsening in motor dexterity (0%, 48%, and 46% in the surveillance, LE, and HE group, respectively). Compared with the surveillance group, patients receiving more cycles of chemotherapy demonstrated worse psychomotor speed and learning and memory. Younger age was associated with greater incidence of overall cognitive decline at 12-month follow-up. ConclusionsMen with NSGCT that received chemotherapy demonstrated greater rates of cognitive decline in a dose-response manner. Reductions in motor dexterity were most common. Decline in learning and memory also was evident particularly at later follow-up time points and in men receiving more chemotherapy. Men that receive chemotherapy for NSGCT are at risk for cognitive decline and may benefit from monitoring and referral for psychosocial care.