학술논문
Hypogonadism and neurocognitive outcomes among childhood cancer survivors.
Document Type
Academic Journal
Author
Yoshida T; Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN 38105, United States.; Alexander T; Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN 38105, United States.; Xing M; Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN 38105, United States.; Mirzaei S; Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN 38105, United States.; Williams AM; Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN 38105, United States.; Lubas M; Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN 38105, United States.; Brinkman TM; Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN 38105, United States.; Department of Psychology and Biobehavioral Sciences, St. Jude Children's Research Hospital, Memphis, TN 38105, United States.; Chemaitilly W; Division of Endocrinology and Diabetes, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA 15224, United States.; Robison LL; Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN 38105, United States.; Hudson MM; Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN 38105, United States.; Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN 38105, United States.; Krull KR; Department of Psychology and Biobehavioral Sciences, St. Jude Children's Research Hospital, Memphis, TN 38105, United States.; Delaney A; Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN 38105, United States.; Department of Pediatric Medicine-Endocrinology, St. Jude Children's Research Hospital, Memphis, TN 38105, United States.
Source
Publisher: Oxford University Press Country of Publication: England NLM ID: 9423848 Publication Model: Print Cited Medium: Internet ISSN: 1479-683X (Electronic) Linking ISSN: 08044643 NLM ISO Abbreviation: Eur J Endocrinol Subsets: MEDLINE
Subject
Language
English
Abstract
Objective: Childhood cancer survivors are at risk for hypogonadism. The impact of hypogonadism on neurocognitive impairment and emotional distress in the non-cancer population has been shown; however, the relationship among the childhood cancer survivor population is unknown. We aimed to evaluate the contribution of hypogonadism to neurocognitive impairment and emotional distress among survivors.
Design: Cross-sectional study using retrospective cohort.
Methods: In total, 3628 survivors who completed standard neurocognitive tests (six domains: processing speed, memory, executive function, attention, academics, and global cognition) and self-reported emotional distress were included in our study. Participants were stratified by sex and gonadal status. Outcomes were compared between hypogonadal and eugonadal groups by multivariable analysis, adjusting for established predictors, and mediation analyses to determine the direct/indirect effects of hypogonadism on outcomes.
Results: The hypogonadal group exhibited a higher prevalence of neurocognitive impairment across domains, but no difference in emotional distress. Hypogonadal females exhibited higher relative risk (1.7, 95% CI, 1.2-2.5) for impaired visual processing speed, compared to eugonadal females after adjusting for cancer-related variables. In mediation models, hypogonadism had a significant direct (P < .01) and indirect (from P < .01) impact on impairment in visual processing speed among females. Males demonstrated direct (P = .03) and indirect (P = .04) impact of hypogonadism on motor processing speed.
Conclusion: Processing speed may be the most vulnerable neurocognitive domain associated with hypogonadism in survivors, while other domains were mainly impacted by cancer-related variables. Our findings support the need for further evaluation of the impact of sex hormone replacement therapy on neurocognitive function.
Competing Interests: Conflict of interest: None of the authors have any conflicts of interest.
(© The Author(s) 2024. Published by Oxford University Press on behalf of European Society of Endocrinology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)
Design: Cross-sectional study using retrospective cohort.
Methods: In total, 3628 survivors who completed standard neurocognitive tests (six domains: processing speed, memory, executive function, attention, academics, and global cognition) and self-reported emotional distress were included in our study. Participants were stratified by sex and gonadal status. Outcomes were compared between hypogonadal and eugonadal groups by multivariable analysis, adjusting for established predictors, and mediation analyses to determine the direct/indirect effects of hypogonadism on outcomes.
Results: The hypogonadal group exhibited a higher prevalence of neurocognitive impairment across domains, but no difference in emotional distress. Hypogonadal females exhibited higher relative risk (1.7, 95% CI, 1.2-2.5) for impaired visual processing speed, compared to eugonadal females after adjusting for cancer-related variables. In mediation models, hypogonadism had a significant direct (P < .01) and indirect (from P < .01) impact on impairment in visual processing speed among females. Males demonstrated direct (P = .03) and indirect (P = .04) impact of hypogonadism on motor processing speed.
Conclusion: Processing speed may be the most vulnerable neurocognitive domain associated with hypogonadism in survivors, while other domains were mainly impacted by cancer-related variables. Our findings support the need for further evaluation of the impact of sex hormone replacement therapy on neurocognitive function.
Competing Interests: Conflict of interest: None of the authors have any conflicts of interest.
(© The Author(s) 2024. Published by Oxford University Press on behalf of European Society of Endocrinology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)