Childhood cancer survivors with diabetes mellitus (DM) have an increased risk of neurocognitive impairment when compared to survivors without DM, according to findings published in Cancer.
Using data from the Childhood Cancer Survivor Study, researchers examined associations between DM and neurocognitive impairment as well as mechanistic associations with treatment and moderating associations with cardiovascular disease (CVD) and lifestyle factors.
The analysis included 16,196 childhood cancer survivors, 615 (4%) of whom had DM. Results showed that having DM was independently associated with an increased risk of neurocognitive impairment. The odds ratios (ORs) were 1.49 (95% CI, 1.16-1.90) for impairment in task efficiency, 1.44 (95% CI, 1.05-1.96) for emotional regulation, and 1.5 (95% CI, 1.12-2.00) for organization.
In an ad hoc analysis that removed childhood cancer survivors who had been exposed to cranial radiation — which was associated with all domains of neurocognitive impairment — DM remained a significant risk factor for neurocognitive impairment.
“Cranial radiation was directly associated with neurocognitive impairment and indirectly affected neurocognitive outcomes through DM,” the researchers noted. “These findings indicate that DM is an important mechanism that partially explains the effect of cranial radiation on neurocognitive functioning in survivors. However, the influence of DM on neurocognitive impairment was not completely explained by cranial radiation.”
The researchers also found that grade 3 or higher CVD was associated with an increased risk of impaired task efficiency in childhood cancer survivors without DM. For survivors with DM, the probability of impaired task efficiency was similar whether they had grade 3 or higher CVD or not.
There were no significant interactions between DM and grade 3 or higher CVD for emotional regulation, organization, or memory, but CVD and DM were independently associated with impairment in these areas.
Having both DM and CVD did not predict “worse concurrent neurocognitive impairment,” but “the presence of CVD in survivors with DM increased the risk for further decline in neurocognitive functioning over time,” the researchers explained.
They also found that smoking was associated with an increased risk of impaired emotional regulation and memory, and physical inactivity was associated with an increased risk of impairment across all neurocognitive domains. However, lifestyle factors did not moderate the associations between DM and neurocognitive outcomes, the researchers noted.
These findings highlight the importance of screening and prevention for DM and CVD to reduce the risk of neurocognitive impairment, the researchers wrote.
“Treatment among survivors with and without DM should focus on preventing CVD onset and/or managing CVD conditions,” the researchers concluded. “Novel therapeutics are emerging to target both, although potential benefits have largely been unexplored in survivors.”
Disclosures: This research was supported by the National Cancer Institute and the American Lebanese Syrian Associated Charities. Some study authors disclosed conflicts of interest. Please see the original reference for complete disclosures.
This article originally appeared on Cancer Therapy Advisor
