Associations between Lifestyle Factors and Neurocognitive Impairment among Chinese Adolescent and Young Adult (AYA) Survivors of Sarcoma

• Published in: Cancers 2023-01, Vol.15 (3), p.799
• Main Authors: Cheung, Yin Ting, Ma, Chung Tin, Li, Michael Can Heng, Zhou, Keary Rui, Loong, Herbert Ho Fung, Chan, Agnes Sui Yin, Wong, Kwok Chuen, Li, Chi Kong
• Format: Article
• Language: English
• Subjects: Age; Alcohol use; Attention; Bone cancer; Bone tumors; Brain cancer; Cancer in children; Cancer survivors; Cancer therapies; Chemotherapy; Cognition; Cognition disorders; Cognitive ability; Diagnosis; Drug use; Ewings sarcoma; Executive function; Fatigue; Health aspects; Information processing; Leukemia; Life style; Lifestyles; Memory; Osteosarcoma; Patient outcomes; Pediatrics; Physical activity; Risk factors; Sarcoma; Sleep; Smoking; Survival; Tumors; Young adults
• ISSN: 2072-6694; 2072-6694
• DOI: 10.3390/cancers15030799

The effect of lifestyle on neurocognitive impairment among cancer survivors remain an understudied area. This study explored the association between lifestyle factors and neurocognitive outcomes (specifically, attention, memory, processing speed and cognitive flexibility) in AYA survivors (aged 15-39 years) of sarcoma. This study recruited 116 AYA survivors (age 28.2 (SD = 8.2) years), who were diagnosed with osteosarcoma (49%) or soft-tissue sarcoma (51%) at age 13.3 (SD = 7.2) years. The neurocognitive battery included measures of attention, memory, motor-processing speed, and cognitive flexibility. Survivors reported health-damaging practices, which included: physical inactivity, smoking, alcohol intake, inadequate sleep (9 h/day). General linear modeling was conducted to examine the association between lifestyle factors and neurocognitive outcomes, adjusting for age at diagnosis, sex, education attainment and clinical/treatment variables. At 14.9 (SD = 7.6) years post-diagnosis, survivors demonstrated impairment in attentiveness (4.3-13.0%), processing speed (34.5%) and cognitive flexibility (18.1%). Nearly half (45.7%) had developed a chronic health condition (CHC). Low physical activity (estimate = -0.97, = 0.003) and sleep-related fatigue (estimate = -0.08, = 0.005) were associated with inattention. Survivors who worked >9 h/day (n = 15) demonstrated worse attention (estimate = 5.42, = 0.023) and cognitive flexibility (estimate = 5.22, = 0.005) than survivors who worked ≤9 h/day (n = 66). Interaction analysis (CHCs* ) showed that survivors who developed CHCs and reported low physical activity had worse attention ( = 0.032) and cognitive-flexibility ( = 0.019) scores than other subgroups. Treatment-related CHCs, coupled with continued physical inactivity, may exacerbate inattention and executive dysfunction among survivors. Long working hours and sleep-related fatigue are associated with worse functioning; this finding should be validated with prospective assessment of work-related stressors and objective sleep measures.