Androgen deprivation therapy and radiation for prostate cancer—cognitive impairment, sleep, symptom burden: a prospective study

Objectives This paper (1) sought to compare sleep, mood and physical symptom profiles of men with prostate cancer (PCa) who experienced subjective and objective cancer-related cognitive impairment (CRCI) during the first year of treatment and (2) examine if fluctuations in mood and physical symptoms are associated with change in subjective or objective CRCI. Methods This prospective observational cohort study examined 24 new patients with PCa receiving androgen deprivation therapy (ADT) and radiation therapy (RT) during the first 12 months of treatment. Participants completed subjective and objective assessments of cognition, sleep continuity and self-report measures of insomnia, fatigue, depression and anxiety. Independent sample t-tests, correlations and hierarchical regressions were used to compare groups, explore associations, and assess change over time. Effects are reported as corrected Cohen’s d (d c ). Results Men with objective CRCI reported worse subjective time asleep (d c =0.47) and more depression (d c =0.55). Men with subjective CRCI reported worse insomnia (d c =0.99), hot flashes (d c =0.76), sleep quality (d c =0.54), subjective total sleep time (d c =0.41), wake after sleep onset (d c =0.71), sleep efficiency (d c =0.49), fatigue (d c =0.67) and objectively estimated sleep latency (d c =0.72) than men without subjective CRCI. Declines in perceived cognition was associated with higher anxiety (p=0.05), fatigue (p≤0.01) and symptoms of insomnia (p=0.01). Finally, subjective time awake during the night (p=0.03) and fatigue (p=0.02) were associated with subjective cognitive decline, controlling for objective change. Conclusions Subjective concerns of CRCI appear more critical to patient experience than objective measurements in men with PCa who have received RT and ADT. Interventions to improve sleep may result in an improved perception of cognition.