Cognitive functioning in thyroid cancer survivors: a systematic review and meta-analysis

Omar Saeed; Lori J. Bernstein; Rouhi Fazelzad; Mary Samuels; Lynn A. Burmeister; Lehana Thabane; Shereen Ezzat; David P. Goldstein; Jennifer Jones; Anna M. Sawka

doi:10.1007/s11764-019-00745-1

Cognitive functioning in thyroid cancer survivors: a systematic review and meta-analysis

Omar Saeed, Lori J. Bernstein, Rouhi Fazelzad, Mary Samuels, Lynn A. Burmeister, Lehana Thabane, Shereen Ezzat, David P. Goldstein, Jennifer Jones, Anna M. Sawka

Medicine - Endocrine and Diabetes Division

Research output: Contribution to journal › Review article › peer-review

6 Scopus citations

Abstract

BACKGROUND: Some thyroid cancer (TC) survivors experience cognitive symptoms.

PURPOSE: The purpose of this study is to perform a systematic literature review and meta-analysis comparing cognitive performance in TC survivors to controls.

METHODS: We performed a seven-database electronic search and hand-search. We performed duplicate independent reviews and data abstraction. Random effects meta-analyses reported standardized mean differences (SMDs) with 95% confidence intervals (CIs), where a negative value implies worse performance in the TC group.

RESULTS: We reviewed 1174 unique citations and 10 full-text papers. We included seven studies of 241 treated TC survivors and 273 controls. Cognitive function was statistically significantly worse in TC survivors in the following domains: Attention and Concentration (Digit Span Forwards) SMD - 0.37 (95% CI - 0.62, - 0.13, p = 0.003, four studies), Speed of Processing (Trail Making A) SMD - 0.36 (95% CI - 0.66, - 0.05, p = 0.022, four studies), and Language (Controlled Oral Word Association [COWAT]-Categories) SMD - 0.97 (95% - 1.31, - 0.64, p < 0.001, two studies). Executive Function results varied: COWAT-Letters SMD - 0.60 (95% CI - 0.94, - 0.27, p < 0.001, two studies), Digit Span Backwards SMD - 0.40 (95% CI - 0.64, - 0.15, p = 0.002, four studies), and Trail Making B test SMD - 0.20 (95% CI - 0.51, 0.10, p = 0.191, four studies). Statistical heterogeneity limited the COWAT-Categories and Digit Span Backwards meta-analyses.

CONCLUSIONS: Cognitive function was worse in TC survivors in multiple domains. Limitations included few studies, potential confounding, and lack of prospective data.

IMPLICATIONS FOR CANCER SURVIVORS: TC survivors may experience impairments in cognitive function and should report cognitive concerns to healthcare practitioners.

Original language	English (US)
Pages (from-to)	231-243
Number of pages	13
Journal	Journal of Cancer Survivorship
Volume	13
Issue number	2
DOIs	https://doi.org/10.1007/s11764-019-00745-1
State	Published - Apr 15 2019

Bibliographical note

Funding Information:
Acknowledgments AMS was supported, in part, by a University of Toronto Department of Medicine Clinician Scientist Merit Award. The authors would like to thank Mrs. Coreen Marino, for assistance in retrieving the full-text papers for review. The authors would also like to thank Drs. Jan Jaracz and Moira A. Visovatti, for kindly responding to our queries about their studies.

Funding Information:
Grants from the Seoul National University Bundang Hospital and the Korean Ministry for Health, Welfare, and Family Affairs National Institutes of Health grants

Publisher Copyright:
© 2019, Springer Science+Business Media, LLC, part of Springer Nature.

Keywords

Cancer survivorship
Meta-analysis
Neurocognitive function
Systematic review
Thyroid cancer

PubMed: MeSH publication types

Review
Journal Article

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This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1007/s11764-019-00745-1

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Cognitive functioning in thyroid cancer survivors : a systematic review and meta-analysis. / Saeed, Omar; Bernstein, Lori J.; Fazelzad, Rouhi; Samuels, Mary; Burmeister, Lynn A.; Thabane, Lehana; Ezzat, Shereen; Goldstein, David P.; Jones, Jennifer; Sawka, Anna M.

In: Journal of Cancer Survivorship, Vol. 13, No. 2, 15.04.2019, p. 231-243.

Research output: Contribution to journal › Review article › peer-review

@article{9993071c113a4704bff050e0202c81c8,

title = "Cognitive functioning in thyroid cancer survivors: a systematic review and meta-analysis",

abstract = "BACKGROUND: Some thyroid cancer (TC) survivors experience cognitive symptoms.PURPOSE: The purpose of this study is to perform a systematic literature review and meta-analysis comparing cognitive performance in TC survivors to controls.METHODS: We performed a seven-database electronic search and hand-search. We performed duplicate independent reviews and data abstraction. Random effects meta-analyses reported standardized mean differences (SMDs) with 95% confidence intervals (CIs), where a negative value implies worse performance in the TC group.RESULTS: We reviewed 1174 unique citations and 10 full-text papers. We included seven studies of 241 treated TC survivors and 273 controls. Cognitive function was statistically significantly worse in TC survivors in the following domains: Attention and Concentration (Digit Span Forwards) SMD - 0.37 (95% CI - 0.62, - 0.13, p = 0.003, four studies), Speed of Processing (Trail Making A) SMD - 0.36 (95% CI - 0.66, - 0.05, p = 0.022, four studies), and Language (Controlled Oral Word Association [COWAT]-Categories) SMD - 0.97 (95% - 1.31, - 0.64, p < 0.001, two studies). Executive Function results varied: COWAT-Letters SMD - 0.60 (95% CI - 0.94, - 0.27, p < 0.001, two studies), Digit Span Backwards SMD - 0.40 (95% CI - 0.64, - 0.15, p = 0.002, four studies), and Trail Making B test SMD - 0.20 (95% CI - 0.51, 0.10, p = 0.191, four studies). Statistical heterogeneity limited the COWAT-Categories and Digit Span Backwards meta-analyses.CONCLUSIONS: Cognitive function was worse in TC survivors in multiple domains. Limitations included few studies, potential confounding, and lack of prospective data.IMPLICATIONS FOR CANCER SURVIVORS: TC survivors may experience impairments in cognitive function and should report cognitive concerns to healthcare practitioners.",

keywords = "Cancer survivorship, Meta-analysis, Neurocognitive function, Systematic review, Thyroid cancer",

author = "Omar Saeed and Bernstein, {Lori J.} and Rouhi Fazelzad and Mary Samuels and Burmeister, {Lynn A.} and Lehana Thabane and Shereen Ezzat and Goldstein, {David P.} and Jennifer Jones and Sawka, {Anna M.}",

note = "Funding Information: Acknowledgments AMS was supported, in part, by a University of Toronto Department of Medicine Clinician Scientist Merit Award. The authors would like to thank Mrs. Coreen Marino, for assistance in retrieving the full-text papers for review. The authors would also like to thank Drs. Jan Jaracz and Moira A. Visovatti, for kindly responding to our queries about their studies. Funding Information: Grants from the Seoul National University Bundang Hospital and the Korean Ministry for Health, Welfare, and Family Affairs National Institutes of Health grants Publisher Copyright: {\textcopyright} 2019, Springer Science+Business Media, LLC, part of Springer Nature.",

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day = "15",

doi = "10.1007/s11764-019-00745-1",

language = "English (US)",

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pages = "231--243",

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TY - JOUR

T1 - Cognitive functioning in thyroid cancer survivors

T2 - a systematic review and meta-analysis

AU - Saeed, Omar

AU - Bernstein, Lori J.

AU - Fazelzad, Rouhi

AU - Samuels, Mary

AU - Burmeister, Lynn A.

AU - Thabane, Lehana

AU - Ezzat, Shereen

AU - Goldstein, David P.

AU - Jones, Jennifer

AU - Sawka, Anna M.

N1 - Funding Information: Acknowledgments AMS was supported, in part, by a University of Toronto Department of Medicine Clinician Scientist Merit Award. The authors would like to thank Mrs. Coreen Marino, for assistance in retrieving the full-text papers for review. The authors would also like to thank Drs. Jan Jaracz and Moira A. Visovatti, for kindly responding to our queries about their studies. Funding Information: Grants from the Seoul National University Bundang Hospital and the Korean Ministry for Health, Welfare, and Family Affairs National Institutes of Health grants Publisher Copyright: © 2019, Springer Science+Business Media, LLC, part of Springer Nature.

PY - 2019/4/15

Y1 - 2019/4/15

N2 - BACKGROUND: Some thyroid cancer (TC) survivors experience cognitive symptoms.PURPOSE: The purpose of this study is to perform a systematic literature review and meta-analysis comparing cognitive performance in TC survivors to controls.METHODS: We performed a seven-database electronic search and hand-search. We performed duplicate independent reviews and data abstraction. Random effects meta-analyses reported standardized mean differences (SMDs) with 95% confidence intervals (CIs), where a negative value implies worse performance in the TC group.RESULTS: We reviewed 1174 unique citations and 10 full-text papers. We included seven studies of 241 treated TC survivors and 273 controls. Cognitive function was statistically significantly worse in TC survivors in the following domains: Attention and Concentration (Digit Span Forwards) SMD - 0.37 (95% CI - 0.62, - 0.13, p = 0.003, four studies), Speed of Processing (Trail Making A) SMD - 0.36 (95% CI - 0.66, - 0.05, p = 0.022, four studies), and Language (Controlled Oral Word Association [COWAT]-Categories) SMD - 0.97 (95% - 1.31, - 0.64, p < 0.001, two studies). Executive Function results varied: COWAT-Letters SMD - 0.60 (95% CI - 0.94, - 0.27, p < 0.001, two studies), Digit Span Backwards SMD - 0.40 (95% CI - 0.64, - 0.15, p = 0.002, four studies), and Trail Making B test SMD - 0.20 (95% CI - 0.51, 0.10, p = 0.191, four studies). Statistical heterogeneity limited the COWAT-Categories and Digit Span Backwards meta-analyses.CONCLUSIONS: Cognitive function was worse in TC survivors in multiple domains. Limitations included few studies, potential confounding, and lack of prospective data.IMPLICATIONS FOR CANCER SURVIVORS: TC survivors may experience impairments in cognitive function and should report cognitive concerns to healthcare practitioners.

AB - BACKGROUND: Some thyroid cancer (TC) survivors experience cognitive symptoms.PURPOSE: The purpose of this study is to perform a systematic literature review and meta-analysis comparing cognitive performance in TC survivors to controls.METHODS: We performed a seven-database electronic search and hand-search. We performed duplicate independent reviews and data abstraction. Random effects meta-analyses reported standardized mean differences (SMDs) with 95% confidence intervals (CIs), where a negative value implies worse performance in the TC group.RESULTS: We reviewed 1174 unique citations and 10 full-text papers. We included seven studies of 241 treated TC survivors and 273 controls. Cognitive function was statistically significantly worse in TC survivors in the following domains: Attention and Concentration (Digit Span Forwards) SMD - 0.37 (95% CI - 0.62, - 0.13, p = 0.003, four studies), Speed of Processing (Trail Making A) SMD - 0.36 (95% CI - 0.66, - 0.05, p = 0.022, four studies), and Language (Controlled Oral Word Association [COWAT]-Categories) SMD - 0.97 (95% - 1.31, - 0.64, p < 0.001, two studies). Executive Function results varied: COWAT-Letters SMD - 0.60 (95% CI - 0.94, - 0.27, p < 0.001, two studies), Digit Span Backwards SMD - 0.40 (95% CI - 0.64, - 0.15, p = 0.002, four studies), and Trail Making B test SMD - 0.20 (95% CI - 0.51, 0.10, p = 0.191, four studies). Statistical heterogeneity limited the COWAT-Categories and Digit Span Backwards meta-analyses.CONCLUSIONS: Cognitive function was worse in TC survivors in multiple domains. Limitations included few studies, potential confounding, and lack of prospective data.IMPLICATIONS FOR CANCER SURVIVORS: TC survivors may experience impairments in cognitive function and should report cognitive concerns to healthcare practitioners.

KW - Cancer survivorship

KW - Meta-analysis

KW - Neurocognitive function

KW - Systematic review

KW - Thyroid cancer

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DO - 10.1007/s11764-019-00745-1

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JO - Journal of Cancer Survivorship

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SN - 1932-2259

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ER -

Cognitive functioning in thyroid cancer survivors: a systematic review and meta-analysis

Abstract

Bibliographical note

Keywords

PubMed: MeSH publication types

UN SDGs

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