How Common Is Cognitive Impairment Among Older Patients With Blood Cancers?
Posted: Thursday, March 29, 2018
For older patients with hematologic cancers, cognitive impairment may be prevalent and perhaps predictive of a shortened median survival, according to prospective observational findings published in JAMA Oncology. Tammy T. Hshieh, MD, of the Dana-Farber Cancer Institute in Boston, and colleagues indicate that targeted interventions may be warranted for this patient population.
“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.
More than 360 consecutive patients 75 years or older who presented for initial consultation in the leukemia (n = 117), myeloma (n = 123), or lymphoma (n = 123) clinics of a large tertiary hospital in Boston consented to frailty screening. About one-third had aggressive disease, and two-thirds had indolent disease.
Of the 341 participants who completed cognitive screening tests, 127 had probable executive dysfunction (identified by the Clock-in-the-Box test), and 62 had probable impairment in working memory (identified by a 5-word delayed recall test).
In regard to outcomes in these patients, impairment in working memory was associated with a shortened survival, by a median of 1.3 months, whereas impairment in executive function was not. In addition, in those undergoing intensive treatment, impaired working memory and executive dysfunction was linked to worse survival. However, this difference in median survival was “arguably small,” the authors wrote, “but in oncology, new treatments have been approved for even smaller gains.”
