Prevalence, predictive factors, and the influential role of physical activity trajectories of cancer-related cognitive impairment among patients newly diagnosed with non-small cell lung cancer

Purpose Evidence on the prevalence, trajectory, and predictors of cancer-related cognitive impairment (CRCI) in newly diagnosed non-small cell lung cancer (NSCLC) patients remains limited, particularly regarding the role of physical activity patterns. This study aimed to estimate the prevalence of CRCI, assess changes in objective and subjective cognitive functions, and identify predictors of CRCI, focusing on physical activity trajectories among patients newly diagnosed with NSCLC in Hong Kong. Methods A prospective observational study was conducted with 327 NSCLC patients newly diagnosed within 4 weeks. Cognitive function was objectively assessed using the HK-MoCA 5-Minute Protocol and subjectively measured using the FACT-Cog scale at baseline and monthly for six months. Physical activity patterns were analyzed through group-based trajectory modelling. Multivariate logistic regression identified predictors of CRCI, adjusting for demographic and clinical factors. Results The prevalence of objective CRCI ranged from 17.5% to 29.1% over the 6-month period, with 24.1% affected at 6 months. Three distinct physical activity trajectories emerged: consistently low (43.1%), consistently high (11.9%), and declining from high to moderate activity (45%). Both consistently high and declining physical activity trajectories were associated with a significantly reduced CRCI risk (93.8% and 85.9% lower risk, respectively) compared to the consistently low activity group. Consistently high physical activity trajectories were also correlated with better objective and subjective cognitive performance. Additional predictors of CRCI included lower baseline perceived cognitive function and self-efficacy for exercise. Conclusion This study provides novel evidence that physical activity trajectories are associated with CRCI in newly diagnosed lung cancer patients.