Pre-treatment cognitive impairment in patients with NSCLC: Prevalence and psychosocial factors

Background: Cancer-related cognitive impairment (CRCI) is increasingly recognized in patients with non-central nervous system malignancies, including non-small cell lung cancer (NSCLC), although evidence on pre-treatment cognitive functioning and associated psychosocial factors remains limited. This exploratory study investigated baseline cognitive functioning in NSCLC patients before oncological treatment and examined the role of cognitive reserve, emotional distress, sleep quality, and subjective cognitive complaints. Methods: Fifty NSCLC patients underwent comprehensive neuropsychological and psychological assessment before treatment initiation. Cognitive functioning was evaluated through standardized tests assessing global cognition, executive functions, memory, attention/processing speed, and language. Cognitive impairment was classified according to International Cognition and Cancer Task Force criteria. Psychological measures included subjective cognitive complaints, depressive symptoms, anxiety, sleep quality, cognitive reserve, and quality of life. Associations with a Composite Cognitive Score (CCS) and domain-specific scores were examined using univariable linear regression analyses. Results: Eighteen patients (36%) met criteria for objective cognitive impairment at baseline. Higher cognitive reserve was associated with better global cognitive performance and stronger attention/processing speed and executive functioning. Conversely, depressive symptoms, anxiety, and poorer sleep quality were associated with lower CCS and worse performance across several domains, particularly global cognition, memory, and attention/processing speed. Subjective cognitive complaints showed partial concordance with objective cognitive performance. Conclusions: Cognitive impairment may already be present in a substantial proportion of NSCLC patients before treatment initiation. Early cognitive and psychosocial assessment may help identify patients at higher risk for CRCI and guide supportive interventions. These findings support early multidisciplinary screening strategies targeting vulnerable patients before treatment.