Outcomes for Elderly With Hematologic Cancers Effected by Cognitive Impairments
Impairments such as dementia may be exasperated by medication use.
Cognitive impairment may be predictive of mortality among elderly patients with hematologic cancer, according to a study published in JAMA Oncology.1
A variety of cognitive impairments are common in the elderly US population, with as many as 14% of individuals over 70 being affected by dementia. These impairments, which can affect a variety of domains, including executive function and working memory, may be exasperated by medication use. Preliminary data suggest, furthermore, that cognitive impairments may be linked to worse survival among patients with hematologic cancer.
For this study, researchers “performed cognitive and frailty screening on all patients with blood cancer 75 years and older who presented for an initial visit” at a center in Boston, Massachusetts. A 5-word delayed recall test and a “Clock-in-the-Box” test were used to assess working memory and executive function, respectively.
Of 360 enrolled patients, 64.4% were men, the mean age was 79.8 years, 12.5% were frail, 58.6% were prefrail, and 28.9% were robust, and 36.7% had aggressive disease. About one-third each were treated at leukemia, myeloma, and lymphoma clinics.
Executive functions, as assessed by the Clock-in-the-Box test, were normal in 34.4% of patients, possible impaired in 25.3% of patients, and probably impaired in 35.3% of patients; 5% of patients declined the test. Working memory was normal in 60.8% of patients, possibly impaired in 19.2% of patients, and probably impaired in 17.2% of patients; 2.8% declined the test.
Impaired working memory was linked with a worse median survival (10.9 months vs 12.2 months for non-impaired patients; log-rank P < .001), regardless of stratification for indolent/aggressive disease, and after adjusting for age, comorbidities, and disease aggressiveness (odds ratio, 0.26). Impaired executive function was linked to worse overall survival only among patients who received intensive treatment (log-rank P = .03).
The authors concluded that “routine domain-specific screening for cognitive impairment can be integrated into the care of older patients with blood cancer and…the prevalence of impairment is substantial.”
- Hshieh TT, Jung WF, Grande LJ, et al. Prevalence of cognitive impairment and association with survival among older patients with hematologic cancers. JAMA Oncol. 2018 Mar 1. doi: 10.1001/jamaoncol.2017.5674 [Epub ahead of print]