Neurocognitive Effects of Chemotherapy for Colorectal Cancer: A Systematic Review and a Meta-Analysis of 11 Studies

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Authors: Soo Young Hwang ; Kwanghyun Kim ; Byeonggwan Ha ; Dongkyu Lee ; Seonung Kim ; Seongjun Ryu ; Jisu Yang ; Sun Jae Jung

MeSH: Antineoplastic Combined Chemotherapy Protocols / adverse effects* ; Colorectal Neoplasms / drug therapy* ; Colorectal Neoplasms / pathology ; Humans ; Neurocognitive Disorders / chemically induced ; Neurocognitive Disorders / epidemiology ; Neurocognitive Disorders / pathology* ; Prognosis

Keywords: Cognitive dysfunction ; Colorectal neoplasms ; Drug therapy ; Meta-analysis

Abstract: Purpose: Chemotherapy-related cognitive impairment (CRCI) is a controversial concept not much explored on colorectal cancer patients.

Materials and methods: We identified 11 prospective studies: eight studies on 696 colorectal cancer patients who received chemotherapy and three studies on 346 rectal cancer patients who received neoadjuvant chemoradiotherapy. Standardized mean differences (SMDs) of neuropsychological test results and the cognitive quality-of-life scale were calculated using random effect models. A meta-regression was conducted to investigate the association between mean study population age and effect sizes.

Results: The association between chemotherapy and cognitive impairment was not clear in colorectal cancer patients (SMD, 0.003; 95% confidence interval, ‒0.080 to 0.086). However, a meta-regression showed that older patients are more vulnerable to CRCI than younger patients (β=‒0.016, p < 0.001).

Conclusion: Chemotherapy has an overall positive negligible effect size on the cognitive function of colorectal patients. Age is a significant moderator of CRCI.