A Pilot Study to Assess Cognitive burden of Ovarian Cancer and Chemotherapy
Anupama C 1, Singh A1, K P Kochhar2, Das S2, Khurana S3, Singhal S1, Meena J1, Kumari R1, Singh N1 , Tomar S1 ,Malhotra N1
Departments of 1Obstetrics and Gynaecology , 2Physiology, 3Medical Oncology
All India Institute of Medical Sciences, New Delhi, India
Introduction
●Chemo-brain refers to cognitive impairment related to cancer and its treated and is contributed by the cancer itself, chemotherapy, hormonal imbalances(oophorectomy) and psychological factors. [1]
●Upto 70% of ovarian cancer patients report cognitive-changes following treatment for their cancer. [2]
Objective
To assess cognitive function via objective methods in Indian women with ovarian cancer at diagnosis, after first three months and six months after chemotherapy.
Study Design
●Pilot study- included 34 women newly diagnosed with ovarian cancer tested at time of diagnosis, after 3 cycles and after 6 cycles of chemotherapy.
●Inclusion criteria: Women with a diagnosis of ovarian cancer between ages 25-65 years who are able to perform the test with normal or corrected vision.
●Tools used: MOCA questionnaire, Motor-related cortical potentials using Nihan-Kohden MEB-2300, fNIRS using COBI software
Materials and Methods
MOCA Scale
●Subjective measure of cognitive function
Motor-related cortical potentials (MRCP)
●Measure of motor cognition and planning
●Measured using Nihan- Kohden MEB-2300
fNIRS: functional near-infrared spectroscopy
●Measures hemodynamic responses in the frontal cortex during the go-no go assessment task across three time points
●Changes in oxygenated hemoglobin (HbO) and deoxygenated hemoglobin (HbR) were measured across 16 optodes.
Results
Mean MOCA score decreased from 29.5±1.4 at diagnosis to 28.1±1.7 at the first follow-up and 28.0±1.8 at the second follow-up (p=0.001). Orientation domain was worst-affected: (p value=0.04)
●Total latency significantly increased between the first and second follow-up (p = 0.03).
●Early latency: Initial phase of cortical activation showed an increasing trend- not statistically-significant (p = 0.9).
●Late latency showed significant increase observed across the three time points (p = 0.01)
Non-significant reduction in brain oxygen uptake indicated by greater decline in de-oxygenated hemoglobin values than oxygenated hemoglobin
Discussion
●Wang et al. [1] found that 72.38% of newly diagnosed ovarian cancer patients showed cognitive impairment, with a mean MoCA score of 23.11 ± 4.5, especially in delayed recall and executive functions.
●Correa et al. [2] observed reduced brain activation and poorer attention, memory, and executive performance in patients with gynecological cancers compared to healthy controls.
●Kochhar et al. [3] reported flatter brain potential waveforms in Parkinson’s patients, with early amplitude changes and later latency alterations as disease severity increased. Changes were most pronounced at the Cz electrode site. There are no known studies on ovarian cancer yet
Conclusion
●This prospective pilot study provides comprehensive insights into the cognitive function of patients with ovarian cancer undergoing chemotherapy.
●Further studies are required due to multifaceted mechanisms of chemo-brain and development of targeted therapies
References
1.Wang L, et al. The association between neuropsychological impairment, self-perceived cognitive deficit, symptoms, and health-related quality of life in newly diagnosed ovarian cancer patients. Asia Pac J Oncol Nurs. 2024
2.Correa H, Gaidica M, Braidy N, et al. Brain structure and function in patients with ovarian cancer treated with first-line chemotherapy: a pilot study. Brain Imaging Behav. 2017
3.Kochhar K. Bereitschafts potentials as a Tool to Study Motor Neuroscience. Int J Sci Res 2015.
