A new study has identified both shared and distinct biological mechanisms underlying cancer-related cognitive impairment (CRCI) and anxiety in patients undergoing chemotherapy. The findings may inform the development of targeted interventions for these frequently co-occurring and debilitating symptoms.

Researchers assessed patients diagnosed with breast, gastrointestinal, gynecological, or lung cancer, collecting self-reported measures of CRCI and anxiety six times across two chemotherapy cycles. Whole blood was drawn prior to the second or third cycle, and gene expression was analyzed to determine perturbed biological pathways. Latent profile analysis was used to classify patients into lower versus higher symptom profiles, both individually and jointly.

Pathway analysis revealed 79 significantly perturbed pathways associated with CRCI, 41 with anxiety, and 25 with the co-occurrence of both symptoms. Notably, neurodegenerative-related pathways emerged as a common thread across all symptom profiles. “Pathways related to neurodegeneration were common across all three symptom profiles,” the study reported, suggesting a potential unifying biological mechanism.

In contrast, distinct pathway alterations were observed depending on the symptom. CRCI was linked to disruptions in endocrine pathways, while anxiety was associated with cell growth and death pathways. These distinctions could reflect symptom-specific mechanisms that contribute to severity and progression.

“This study is the first to identify common and distinct perturbed biological pathways associated with lower versus higher levels of CRCI, anxiety, and the co-occurrence of CRCI and anxiety in patients receiving chemotherapy,” the authors stated.

The research supports a mechanistic basis for the frequent co-occurrence of CRCI and anxiety and highlights potential targets for intervention. Clinicians should consider both shared and unique symptom biology when addressing these conditions in cancer patients, especially during chemotherapy. Early identification of patients at risk based on biological profiling may enhance symptom management strategies in oncology care.

Source:

Oppegaard K, Shin J, Cooper B, Paul S, Conley Y, Miaskowski C. Common and Distinct Perturbed Biological Pathways Are Associated With Cognitive Impairment and Anxiety in Patients Receiving Chemotherapy. Presented at the 50th Annual ONS Congress; April 9-12, 2025. Denver, CO.