Patients with head and neck cancer (HNC) often suffer from cognitive impairment and may benefit from cognitive screening and quality of life (QoL) assessments during pretreatment, according to a study published in JAMA Otolaryngology Head & Neck Surgery.

Cognitive impairment has significant implications for treatment adherence, and has been associated with significantly worsened outcomes in patients with cancer. The purpose of this study was to investigate the association between QoL and cognitive functioning in patients prior to HNC treatment.

For this study, researchers collected data on psychosocial and psychiatric variables of 83 patients with HNC prior to treatment and assessed their outcomes. Psychosocial variables included current and past substance abuse and whether or not the patient had adequate social support. Psychiatric variables included current and past psychiatric care, medication use, and symptoms. Cognitive function was evaluated using the Montreal Cognitive Assessment (MoCA), and the Functional Assessment of Cancer Therapy-Head & Neck (FACT-H&N) was used to measure QoL during the pretreatment assessment. 

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More than 50% (46 of 83) of patients were found to be cognitively impaired at baseline.

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The number of depressive symptoms (mean symptoms, 2.43; 95% CI, 57.23 to 61.73) was associated with delayed recall impairment (r = –0.28; 95% CI, –0.47 to –0.07) and all measurements of QoL.

Patients experienced lower QoL and decreased emotional and functional well-being if they had cognitive impairment in delayed recall.

Other factors that reduced QoL were current benzodiazepine use and history of tobacco and heavy alcohol abuse.

The authors concluded the results indicate that cognitive screening and QoL assessment should be incorporated into pretreatment evaluation of patients. In addition, further research into more direct, causal relationships via longitudinal, prospective studies are needed.


Williams AM, Lindholm J, Cook D, et al. Association between cognitive function and quality of life in patients with head and neck cancer [published online November 9, 2017]. JAMA Otolaryngol Head Neck Surg. doi: 10.1001/jamaoto.2017.2014