Effect of chemotherapy on cognition and depression among solid tumor cancer patients in a tertiary care hospital
DOI:
https://doi.org/10.18203/2319-2003.ijbcp20262864Keywords:
Chemotherapy, Cognitive impairment, Depression, FACT-Cog, Quality of life, Solid tumors, Medication adherenceAbstract
Background: Chemotherapy is a key treatment modality for solid tumors but is often associated with cognitive impairment, depression, and reduced quality of life. Early identification of these complications is important for improving patient outcomes and treatment adherence.
Methods: A prospective cohort study was conducted over six months in the Department of Medical Oncology, Sri Ramachandra Hospital, Chennai. Adult patients (18-65 years) with solid tumors receiving platinum-based agents, taxanes, or antitumor antibiotics were enrolled. A total of 267 patients completed the study. Cognitive function, depression, quality of life, and medication adherence were assessed at baseline and follow-up using the Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog), Brief Edinburgh Depression Scale (BEDS), European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), and Medication Adherence Rating Scale (MARS), respectively.
Results: Among the 267 participants, females constituted the majority. Significant deterioration in cognitive function and increased depression scores were observed during chemotherapy, particularly among patients receiving platinum-based regimens. Depression scores showed significant worsening at weeks 8 and 12 in the platinum-based group (p<0.05). Quality of life declined significantly, with reductions in physical, emotional, role, and cognitive functioning. Overall health status deteriorated in 75.6% of patients. Medication adherence remained satisfactory throughout the study. Adverse drug reactions were reported more frequently in patients receiving platinum-based chemotherapy.
Conclusions: Platinum-based chemotherapy is associated with increased cognitive impairment, depression, and reduced quality of life in patients with solid tumors. Routine screening for cognitive dysfunction and depression should be incorporated into oncology care to enable timely interventions and improve patient-centered outcomes.
Metrics
References
National Cancer Institute. Understanding Cancer. Bethesda (MD): National Cancer Institute; 2021. Available at: https://www.cancer.gov/about-cancer/understanding. Accessed on March 9, 2023.
Bukhtoyarov OV, Samarin DM. Pathogenesis of cancer: Cancer reparative trap. J Cancer Ther. 2015;6(5):399-412. DOI: https://doi.org/10.4236/jct.2015.65043
Kulothungan V, Sathishkumar K, Leburu S, Ramamoorthy T, Stephen S, Basavarajappa D, et al. Burden of cancers in India: estimates of cancer crude incidence, YLLs, YLDs and DALYs for 2021 and 2025 based on National Cancer Registry Program. BMC Cancer. 2022;22:527. DOI: https://doi.org/10.1186/s12885-022-09578-1
Rajpal S, Kumar A, Joe W. Economic burden of cancer in India: Evidence from cross-sectional nationally representative household survey, 2014. PLoS One. 2018;13(2):e0193320. DOI: https://doi.org/10.1371/journal.pone.0193320
National Cancer Institute. Types of Cancer Treatment. Available at: https://www.cancer.gov/about-cancer/treatment/types. Accessed on June 9, 2026.
EBIS Medical. Home - Personalized AI Cancer Care. Available at: https://www.ebismedical.com. Accessed on June 9, 2026.
Cancer.Net. Side Effects of Chemotherapy. Available at: https://www.cancer.net/navigating-cancer-care/how-cancer-treated/chemotherapy/side-effects-chemotherapy. Accessed on June 9, 2026.
Healthline.com. Depression Symptoms: How to Manage Depression. Available at: https://www.healthline.com/health/depression/symptoms. Accessed on June 9, 2026.
National Cancer Institute. Depression (PDQ®)-Health Professional Version. Available at: https://www.cancer.gov/about-cancer/coping/feelings/depression-hp-pdq. Accessed on June 9, 2026.
Krebber AMH, Buffart LM, Kleijn G, Riepma IC, de Bree R, Leemans CR, et al. Prevalence of depression in cancer patients: A meta-analysis of diagnostic interviews and self-report instruments. Psychooncology. 2014;23(2):121-30. DOI: https://doi.org/10.1002/pon.3409
Snyderman D, Wynn D. Depression in cancer patients. Prim Care. 2009;36(4):703-19. DOI: https://doi.org/10.1016/j.pop.2009.07.008
Smith HR. Depression in cancer patients: Pathogenesis, implications and treatment. Oncol Lett. 2015;9(4):1509-14. DOI: https://doi.org/10.3892/ol.2015.2944
American Cancer Society. What is Chemo Brain? Available at: https://www.cancer.org/cancer/managing-cancer/side-effects/changes-in-mood-or-thinking/chemo-brain.html. Accessed on June 9, 2026.
Bai L, Yu E, Bai Y. A narrative review of risk factors and interventions for cancer-related cognitive impairment. Ann Transl Med. 2021;9(1):72. DOI: https://doi.org/10.21037/atm-20-6443
Nayak MG, George A, Vidyasagar MS, Mathew S, Nayak S, Nayak BS, et al. Quality of life among cancer patients. Indian J Palliat Care. 2017;23(4):445-50.
European Organisation for Research and Treatment of Cancer. EORTC QLQ-C30 (Version 3). Brussels: EORTC Quality of Life Group. Available at: https://qol.eortc.org/questionnaire/eortc-qlq-c30/. Accessed June 9, 2026.
Sprangers MAG. Quality-of-life assessment in oncology: achievements and challenges. Acta Oncol. 2002;41(3):229-37. DOI: https://doi.org/10.1080/02841860260088764
Fialko L, Garety PA, Kuipers E, Dunn G, Bebbington PE, Fowler D, et al. A large-scale validation study of the Medication Adherence Rating Scale (MARS). Schizophr Res. 2008;100(1-3):53-9. DOI: https://doi.org/10.1016/j.schres.2007.10.029
Kaplan SV, Limbocker RA, Gehringer RC, Divis JL, Osterhaus GL, Newby MD, et al. Impaired brain dopamine and serotonin release and uptake in Wistar rats following treatment with carboplatin. ACS Chem Neurosci. 2016;7(6):689-99. DOI: https://doi.org/10.1021/acschemneuro.5b00029
Henderson FM, Cross AJ, Baraniak AR. “A new normal with chemobrain”: Experiences of the impact of chemotherapy-related cognitive deficits in long-term breast cancer survivors. Health Psychol Open. 2019;6(1):2055102919832234. DOI: https://doi.org/10.1177/2055102919832234
Kim K. Effect of chemotherapy and radiotherapy on cognitive impairment in colorectal cancer: Evidence from Korean National Health Insurance Database Cohort. Cancer Res Treat. 2021;43:e2021093 DOI: https://doi.org/10.4178/epih.e2021093
De Rosa N, Della Corte L, Giannattasio A, Giampaolino P, Di Carlo C, Bifulco G. Cancer-related cognitive impairment (CRCI), depression and quality of life in gynecological cancer patients: A prospective study. Arch Gynecol Obstet. 2021;303(6):1581-8. DOI: https://doi.org/10.1007/s00404-020-05896-6
Liposits G, Eshøj HR, Möller S, Winther SB, Skuladottir H, Ryg J, et al. Quality of life in vulnerable older patients with metastatic colorectal cancer receiving palliative chemotherapy: The randomized NORDIC9 study. Cancers (Basel). 2021;13(11):2604. DOI: https://doi.org/10.3390/cancers13112604
Gour S, Maurya RK, Singh PP, Ahirwar V, Dhakar M, Maravi P. Psychological impact among cancer patients undergoing chemotherapy in Bundelkhand region, Central India. Int J Res Med Sci. 2021;9(3):706-10. DOI: https://doi.org/10.18203/2320-6012.ijrms20210510
Durán-Gómez N, López-Jurado CF, Nadal-Delgado M, Pérez-Civantos D, Guerrero-Martín J, Cáceres MC. Chemotherapy-related cognitive impairment in patients with breast cancer based on functional assessment and NIRS analysis. J Clin Med. 2022;11(9):2363. DOI: https://doi.org/10.3390/jcm11092363
Laquente B, Macarulla T, Bugés C, Martín M, García C, Pericay C, et al. Quality of life of patients with metastatic pancreatic adenocarcinoma initiating first-line chemotherapy in routine practice. BMC Palliat Care. 2020;19(1):103. DOI: https://doi.org/10.1186/s12904-020-00610-4
Ramasubbu SK, Pasricha RK, Nath UK, Rawat VS, Das B. Quality of life and factors affecting it in adult cancer patients undergoing cancer chemotherapy in a tertiary care hospital. Cancer Rep (Hoboken). 2021;4(2):e1312. DOI: https://doi.org/10.1002/cnr2.1312
Rodríguez Martín B, Fernández Rodríguez EJ, Rihuete Galve MI, Cruz Hernández JJ. Study of chemotherapy-induced cognitive impairment in women with breast cancer. Int J Environ Res Public Health. 2020;17(23):8896. DOI: https://doi.org/10.3390/ijerph17238896
Zamel ON, Inocian EP, Alshehry AS, Tumala RB, Patalagsa JG, Alsaleh KA. Quality of life among breast and colon cancer patients before and after first-cycle chemotherapy. J Holist Nurs. 2021;39(2):116-25. DOI: https://doi.org/10.1177/0898010120958859
Whitford HS, Kalinowski P, Schembri A, Grimison P, Stockler M, Martin A, et al. The impact of chemotherapy on cognitive function: A multicentre prospective cohort study in testicular cancer. Support Care Cancer. 2020;28(7):3081-91. DOI: https://doi.org/10.1007/s00520-019-05095-3
Vaidya SS, Sharma SK. Depression in cancer patients undergoing chemotherapy in a tertiary care hospital: A cross-sectional study. Int J Community Med Public Health. 2019;6(7):3102-6. DOI: https://doi.org/10.18203/2394-6040.ijcmph20192858
Shirisha J, Rajamouli J, Gurnule S, Manoj P. Assessment of depression among patients receiving chemotherapy in a tertiary care cancer hospital, Karimnagar. MedPulse Int J Physiol. 2019;10(2):9-14. DOI: https://doi.org/10.26611/1031023
Agarwal N, Singh D, Dana R, Sharma S, Verma M, Dadhich P. Assessment of depression in cancer patients receiving chemotherapy in a tertiary care hospital. Int J Contemp Med Res. 2019;6(3):C1-5. DOI: https://doi.org/10.21276/ijcmr.2019.6.3.49
Liu Z, Han X, Tian C, Chen J, Lei L, Liang Q, et al. A study on the relationship between chemotherapy-induced cognitive impairment and age in patients with breast cancer. J BUON. 2018;23(6):1601-5.
Naga Sunanda V, Priyanka M, Architha J, Shravan M, Srinivasa Rao A, Abdul Hadi M. Quality of life assessment in cancer patients of regional centre of Hyderabad City. J Appl Pharm Sci. 2018;8(12):125-30.
Nayak MG, George A, Vidyasagar MS, Mathew S, Nayak S, Nayak BS, et al. Quality of life among cancer patients. Indian J Palliat Care. 2017;23(4):445-50. DOI: https://doi.org/10.4103/IJPC.IJPC_82_17
Deka K, Barman S, Sarkar M, Talukdar D. Depression in cancer patients undergoing chemotherapy in a tertiary care hospital of North Bengal, India. Indian J Public Health. 2017;61(1):14-8. DOI: https://doi.org/10.4103/0019-557X.200252
Cheung YT, Ng T, Shwe M, Ho HK, Foo KM, Cham MT, et al. Association of proinflammatory cytokines and chemotherapy-associated cognitive impairment in breast cancer patients: A multicentered prospective cohort study. Ann Oncol. 2015;26(7):1446-51. DOI: https://doi.org/10.1093/annonc/mdv206
de Souza BF, de Moraes JA, Inocenti A, dos Santos MA, Silva AEBC, Miasso AI. Women with breast cancer taking chemotherapy: Depression symptoms and treatment adherence. Rev Lat Am Enfermagem. 2014;22(5):866-73. DOI: https://doi.org/10.1590/0104-1169.3564.2491
Dehkordi AH, Heydarnejad MS, Fatehi D. Quality of life in cancer patients undergoing chemotherapy. Oman Med J. 2009;24(3):204-7. DOI: https://doi.org/10.5001/omj.2009.40
Jackson SS, Marks MA, Katki HA, et al. Sex disparities in the incidence of 21 cancer types: Quantification of the contribution of risk factors. Cancer. 2022;128(19):3531-40. DOI: https://doi.org/10.1002/cncr.34390
White MC, Holman DM, Boehm JE, Peipins LA, Grossman M, Henley SJ. Age and cancer risk: A potentially modifiable relationship. Am J Prev Med. 2014;46(3 Suppl 1):S7-S15. DOI: https://doi.org/10.1016/j.amepre.2013.10.029
Binotto M, Reinert T, Werutsky G, Zaffaroni F, Schwartsmann G. Health-related quality of life before and during chemotherapy in patients with early-stage breast cancer. E Cancer Medi Sci. 2020;14:1007. DOI: https://doi.org/10.3332/ecancer.2020.1007
Ramachandiran B, Dubashi B, Kayal S, Menon V, Yuvaraj K, Deepika C, et al. Assessment of oral anticancer medication adherence: A survey from a tertiary cancer center. South Asian J Cancer. 2021;10(2):127-30. DOI: https://doi.org/10.1055/s-0041-1723120
Chopra D, Rehan HS, Sharma V, Mishra R. Chemotherapy-induced adverse drug reactions in oncology patients: A prospective observational survey. Indian J Med Paediatr Oncol. 2016;37(1):42-6. DOI: https://doi.org/10.4103/0971-5851.177015
Downloads
Published
How to Cite
Issue
Section
