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

Research output: Contribution to journalReview articlepeer-review

6 Scopus citations


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 languageEnglish (US)
Pages (from-to)231-243
Number of pages13
JournalJournal of Cancer Survivorship
Issue number2
StatePublished - 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.


  • Cancer survivorship
  • Meta-analysis
  • Neurocognitive function
  • Systematic review
  • Thyroid cancer

PubMed: MeSH publication types

  • Review
  • Journal Article


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