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Patient-reported outcomes and chemotherapy-related cognitive impairment in gynecologic malignancy
  1. Stephanie Alimena1,
  2. Lauren Philp2,
  3. Endel John Orav3,
  4. Mackenzie W Sullivan1,2,
  5. Marcela Del Carmen2,
  6. Annekathryn Goodman2,
  7. Whitfield B Growdon2,
  8. Amy Bregar2,
  9. Eric Eisenhauer2 and
  10. Rachel Clark Sisodia2
  1. 1Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts, USA
  2. 2Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts, USA
  3. 3Department of Biostatistics, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
  1. Correspondence to Dr Stephanie Alimena, Dept of OBGYN, Division of Gynecologic Oncology, Brigham and Women's Hospital, Boston, MA 02115, USA; salimena{at}


Objective Chemotherapy has multiple adverse effects, including chemotherapy-related cognitive impairment, the phenomenon colloquially referred to as ‘chemobrain’. The objective of this study was to understand patient-reported experiences of this phenomenon in relation to chemotherapy administration among gynecologic oncology patients.

Methods A prospective patient-reported outcomes program was implemented in the Gynecologic Oncology clinic of a tertiary academic institution in January 2018. Patients with endometrial or ovarian cancer who received chemotherapy were included through September 2019 in this cohort study. Patients completed the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire. Serial responses were compared before, during, and after chemotherapy using a mixed effects linear regression with random effects for repeated measures within patients and a fixed effect for endometrial versus ovarian cancer.

Results Fifty patients were included who completed a total of 152 patient-reported outcome measures. Thirty-five questionnaires were administered before chemotherapy, 59 during treatment, and 58 at a median of 161 days after the final cycle of chemotherapy. Seventy-one percent of patients reported no difficulties with concentration before chemotherapy, which remained stable after chemotherapy (72%). Sixty-six percent reported no difficulty with memory before chemotherapy versus 52% after chemotherapy. There were significant differences in feeling tension (p<0.001), worry (p<0.001), and depression (p=0.02) before and after chemotherapy on mixed effects linear regression, with higher levels of adverse emotional symptoms before chemotherapy administration compared with after. Women reported more interference with their social lives during chemotherapy (mean 1.08) compared with before (mean 0.85) and after chemotherapy (0.75, p=0.04).

Conclusions While no overt memory issues were discovered with serial administration of patient-reported outcome measures, rates of adverse emotional symptoms such as depression, tension, and worry diminished after chemotherapy administration. Further study is needed about the phenomenon of chemotherapy-related cognitive impairment using a larger cohort.

  • ovarian cancer
  • quality of life (PRO)/palliative care
  • uterine cancer

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Correction notice This article has been corrected since it was first published. Reference 13, Rock et al, was omitted and has now been included.

  • Contributors The authors confirm contribution to the paper as follows: study conception and design: RCS, WBG, LP, SA, MDC, AG, AB, EE; collection: LP, SA, MWS; interpretation of results: SA, EJO, LP, RCS; draft manuscript preparation: SA, LP, RCS; manuscript edits and revisions: MWS, EJO, MDC, AG, WBG, AB, EE, RCS; guarantor: RCS. All authors reviewed the results and approved the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.