Abstract
BACKGROUND: Cancer-related cognitive impairment (CRCI) has received little attention among adolescent and young adult (AYA; 18-39 years of age) cancer survivors. The goal of this study was to evaluate differences in objective and subjective cognitive performance and quality of life between AYA survivors and individuals without a cancer history. METHODS: AYA cancer survivors were recruited from clinic databases, and noncancer controls were identified through Research Match. Objective cognitive performance was measured using the Cambridge Neuropsychological Test Connect Automated Battery which assessed attention, executive functioning, and memory. Participants completed questionnaires on PROMIS measures of subjective cognition and quality of life (QOL). Mean differences were evaluated using ANCOVAs, independent of age and education. RESULTS: The sample included 88 AYA survivors and 96 noncancer controls (NC). The AYA survivors were older (M(AYA) = 34.1, M(NC) = 28.8, p < 0.001) and less likely to have a college education (%(AYA) = 67.0, %(NC) = 79.2, p = 0.063). The AYA group averaged almost 4 years since the end of treatment, and the majority were lymphoma/leukemia survivors (27%), followed by breast cancer survivors (14%). On objective tests of cognition, there was a trend (p = 0.061) for lower performance in attention among AYA survivors (d = 0.11), but no differences were observed for executive functioning (d = 0.03) or memory (d = 0.03). AYA survivors rated their cognition as worse than the NC group on PROMIS measures of subjective cognitive function (d = 0.69) and cognitive function abilities (d = 0.57; p < 0.001). Significant group differences were seen on multiple PROMIS QOL measures (d ranging from 0.32 to 0.77), all in favor of the NC group (p < 0.05). CONCLUSIONS: Results indicated that AYA survivors performed similarly on measures of objective cognitive performance, despite reporting worse subjective cognitive functioning and poorer quality of life. Further research is needed to address the disconnect between objective and subjective cognitive performance among AYA cancer survivors.