Abstract #11: The Disruptions to Cognition, Everyday Function, and Quality of Life in Oncology Patients: A Therapeutic Opportunity?

Abstract

Introduction Patents with a variety of forms of cancer often report cognitive difficulties, and cognitive testing has confirmed the presence of impairments to attention and memory in several oncology populations. The purpose of this evaluation was to assess the profile of impairments across major cognitive domains, and relate this to a variety of factors including quality of life (QOL), everyday function, cancer type, age, depression, and anxiety. Methods The study population comprised 432 females (mean age 57.6 years; range 18 to 86) and 456 males (mean age 60.6 years; range 18 to 88), diagnosed with either Hodgkin's disease, non-Hodgkin's lymphoma, chronic lymphocytic leukemia, or multiple myeloma. An automated cognitive test battery (the CDR System) was administered which assessed core aspects of cognition including attention, working and episodic memory. The ECOG Performance Status Score, the FACT-AN, and the Cancer Linear Analog Scales (CLAS) were also administered. The CDR System normative data base of over 6000 healthy individuals was used to determine the cognitive deficits using Cohen's d effect sizes in five age cohorts. Functional ability on the ECOG was related to cognitive function in these age cohorts, and the relationships between cognitive function and various QOL measures were also examined. Results Patients in all age bands showed marked impairments to the Power of Attention measure from the CDR System, with large effect sizes, together with notable slowings in the speed of retrieval of information from memory. The older patients also showed deficits in other aspects of attention and working and episodic memory. There were clear associations between cognitive function and various quality of life indices, and a good overall relationship was established between the ECOG Performance Status Score and cognitive function; the strength of this relationship increased with age. Conclusions There is a clear cognitive deficit profile in cancer patients, which increases both in range and magnitude with aging. The strong relationship of the CDR attentional measures to everyday function and QOL is consistent with findings in other clinical populations (e.g., dementia). Cognitive dysfunction is a therapeutic target in many diseases, and the deficits identified here suggest that treatment would be valuable in oncology. Early results with modafinil and epoetin alfa have been encouraging in this respect.