Identification of the predictors of cognitive impairment in patients with cancer in palliative care: a prospective longitudinal analysis
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Studies with neuropsychological assessments in patients with cancer are sparse, and the evidence is very limited regarding their status of cognitive function over time. This study aimed at assessing the prevalence and predictors of cognitive impairment in patients with cancer in palliative care.
Prospective longitudinal investigation derived from the European Palliative Care Cancer Symptom study (2011–2013) including patients with cancer in palliative care, ≥18 years, and with at least one assessment post-inclusion. For cognitive assessment, a 4-item version of the Mini Mental State Examination was applied at inclusion and after 4 to 16 weeks. Logistic regression model with multiple imputations was applied.
The sample consisted of 1568 patients (50% male, mean age 65.5, 42% with 10–12 years schooling, mean Karnofsky Performance Status—KPS 68%). Longitudinal analysis of the patients with complete MMSE at both assessments (n = 801) showed that 64.5% were not impaired, 12.5% remained cognitively impaired, 11.4% developed impairment, and 11.6% improved. Those who improved cognitively also reported reduced pain intensity and increased appetite. The predictive model (n = 1351) showed that those with low KPS (OR = 1.6, 95% CI 1.0–2.5) most often developed cognitive impairment, while patients with breast cancer (OR = 0.4, 95% CI 0.2–0.7) had lower odds for impairment.
During palliative care, a substantial number of patients remained cognitively impaired or developed cognitive impairment; however, it is noteworthy that improvement was also observed. Physical performance and cancer type may predict cognitive impairment.
KeywordsNeoplasms Cognitive symptoms Cognition Palliative care Quality of life Longitudinal studies
The EPCCS is a collaborative effort between the European Palliative Care Research Centre (PRC) and the European Association for Palliative Care Research Network (EAPC RN). This study was partially funded by grant no. 6070 from the Joint Research Council at Norwegian University of Science and Technology (NTNU) and St. Olavs Hospital-Trondheim University Hospital.
We would like to thank Morten Aagaard Petersen for assistance with statistical analysis.
Project management: Marianne J. Hjermstad, PRC/NTNU; Stein Kaasa, PRC/NTNU/EAPC RN; Dagny F. Haugen, PRC/NTNU; Pål Klepstad, PRC/NTNU, and Gunnhild Jakobsen PRC/NTNU, Norway; Augusto Caraceni, PRC/EAPC RN, and Cinzia Brunelli, PRC, Italy; Per Sjøgren, EAPC RN, Denmark; Florian Strasser, Switzerland; Barry Laird, PRC/UK.
Project steering committee: Marianne J. Hjermstad, Stein Kaasa, Augusto Caraceni, Cinzia Brunelli, Per Sjøgren, Luc Deliens (EAPC RN, Belgium), Mike Bennett (EAPC RN, UK), David Currow (Australia), Vickie Baracos (Canada).
Core center collaborators: Erik Løhre, St. Olavs Hospital-Trondheim University Hospital; Nina Aass, Oslo University Hospital; Elisabeth Brenne, Øya Helsehus; and Inge Raknes, Haraldsplass Deaconess Hospital, Norway; Geana Kurita, Rigshospitalet and Mogens Groenvold, Bispebjerg Hospital, Denmark; Florian Strasser, Cantonal Hospital St. Gallen, and Cristian Camartin, Kantonspital, Graubünden, Switzerland; Alessandra Pigni, Fondazione IRCCS Istituto Nazionale dei Tumori, and Luigi Cavanna, Oncologia Medica Ospedale Di Piacenza; Adriana Turriziani, Hospice Villa Speranza, Roma; Franco Rizzi, U.O. Complessa di Cure Palliative e Terapia del Dolore. AO ICP, Milan; Laura Piva, Unità di Cure Palliative Azienda Ospedaliera San Paolo, Milan; Federica Aielli, Oncologia Medica Università degli Studi, L’Aquila; and Rondini Ermanno, U.O. Oncologia Medica Arcispedale S. Maria Nuova–IRCCS, Reggio Emilia, Italy; Mike Bennett, Leeds Institute of Health Sciences/University of Leeds; Barry Laird, Western General Hospital Edinburgh/Beatson West of Scotland Cancer Centre, Edinburgh; Andrew Wilcock, Nottingham University Hospitals NHS Trust, Nottingham, and Karen Harvie, Marie Curie Hospice, Glasgow, UK; Maria Nabal, Hospital Universitário Arnau de Vilanova Lleida; Antonio N. Tejedor, Hospital Centro de Cuidados Laguna, Madrid; Josep Porta Sales, Institut Català d’Oncologia, Barcelona; and Marina Martínez, Clinica Universidad De Navarra Pamplona; Spain; Konrad Fassbender, University of Alberta, Canada; David Currow, Flinders University, Australia; Nikolay Yordanov, Comprehensive Cancer Center Vratsa, Bulgaria; Koen Pardon, Ghent University Hospital Flanders, Belgium; Ioseb Abesadze, Cancer Prevention Center, Tblisi, Georgia; Madalena Feio, Instituto Português de Oncologia Francisco Gentil Lisbon, Portugal.
Compliance with ethical standards
The study was approved by The Regional Research Ethics Committee in Medicine, Central Norway (ref. 2010/25945), and registered in the ClinicalTrials.gov database (no. NCT01362816). In addition, approval from ethical committees was obtained at each site. The study was performed according to the Declaration of Helsinki.
Conflict of interest
Stein Kaasa has stock/ownership of Eir Solutions and a consulting/advisory role at Helsinn Healthcare SA. The other authors declare no conflicts of interest.
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