In the Journals Plus

Cognitive impairment common among elderly with blood cancers

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March 2, 2018

Cognitive and memory impairments appeared common among older patients with hematologic cancers, according to study data.

“Dementia affects as many as 14% of individuals older than 70 years in the United States, and its incidence will likely triple by the year 2050,” Tammy T. Hshieh, MD, MPH, associate physician in the department of medical oncology at Dana-Farber Cancer Institute, and colleagues wrote. “Although associated with higher rates of toxic effects of treatment and mortality [among] patients with solid tumors, cognitive impairment often goes undetected in the oncology clinic. Intact cognition is especially important for patients with hematologic or blood cancers because cure is often still possible in advanced disease, and treatment regimens are complex and frequently include inpatient components.”

The researchers performed a prospective observational cohort study of 420 consecutive patients aged 75 years and older who were treated for leukemia, myeloma or lymphoma at a large tertiary hospital. Hshieh and colleagues screened patients for frailty and cognitive dysfunction. They assessed executive function using the Clock-in-the-Box test; screened for working memory impairment using a five-word delayed recall test; and classified patients as robust, prefrail or frail using the Fried frailty phenotype and Rockwood cumulative deficit model of frailty.

Most patients (n = 360; mean age, 79.8 years; 64.4% men) underwent frailty assessments. Of these patients, 341 completed both cognitive screening tests.

More than one-third of patients (35.3%) demonstrated probable executive dysfunction, whereas 17.2% (n = 62) had probable impaired working memory.

Both executive dysfunction and impaired working memory appeared modestly associated with Fried frailty phenotype (Clock-in-Box test, = .177, delayed recall, = .17; P = .01 for both).

However, patients considered robust also had probable cognitive impairment on the Clock-in-Box test (23.1%) and for delayed recall (8.7%).

Median survival appeared worse among patients with impaired working memory compared with those who did not have memory impairments (10.9 months vs. 12.2 months; P < .001). This held true after stratifying patients as having indolent (P = .01) or aggressive (P < .001) cancer, as well as in a multivariate analysis adjusted for disease aggressiveness, age and comorbidities (OR = 0.26; 95% CI, 0.13-0.5).

Further, patients undergoing intensive therapy also showed an association between impaired working memory and worse survival (P < .001).

Executive function appeared associated with worse survival only among patients undergoing intensive treatment (P = .03).

“Our data suggest that routine domain-specific screening for cognitive impairment can be integrated into the care of older patients with blood cancer and that the prevalence of impairment is substantial,” the researchers wrote. “Further research should focus on tailored strategies to mitigate domain-specific cognitive dysfunction in this patient population.” – by Andy Polhamus

Disclosures: The authors report no relevant financial disclosures.