Hypogonadism and Neurocognitive Outcomes among Childhood Cancer Survivors

Abstract

Objective

Childhood cancer survivors are at risk for hypogonadism. Impact of hypogonadism on neurocognitive impairment and emotional distress in the non-cancer population has been shown, however, the relationship among 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

3628 survivors who completed standard neurocognitive tests (six domains: processing speed, memory, executive function, attention, academics, 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 higher prevalence of neurocognitive impairment across domains, but no difference in emotional distress. Hypogonadal females exhibited higher relative risk (1.7, 95% confidence interval 1.2–2.5) for impaired visual processing speed, compared to eugonadal females after adjusting for cancer-related variables. In mediation models, hypogonadism had significant direct (P < 0.01) and indirect (from P < 0.01) impact on impairment in visual processing speed among females. Males demonstrated direct (P =0.03) and indirect (P =0.04) 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.