Downstream consequences of abnormal cognitive screening in older adults seen pretreatment in a geriatric oncology clinic

Abstract

IntroductionAlthough screening for cognitive impairment (CI) is an important part of a comprehensive geriatric assessment (CGA), little is known about the downstream work-up of abnormal screening or its impact on cancer treatment. We characterized the downstream workup in diagnosing CI and its impact on cancer treatment decision-making. MethodsPatients who underwent a pre-treatment CGA at an academic Geriatric Oncology (GO) clinic between July 2015 and June 2018 and had a positive Mini-Cog (≤ 3 out of 5) screen were included. Data were collected from medical charts and database review. Analyses were primarily descriptive. ResultsOf 82 patients seen in the pre-treatment setting, 46 (56.1%) had a positive Mini-Cog screen. Of those, 12 (26.1%) were diagnosed with dementia, 8 (17.4%) were diagnosed with mild cognitive impairment and 10 (21.7%) had CI not otherwise specified. Although 46 patients had a positive screen, only 30 patients (65.2%) were classified as cognitively “abnormal” in the GO team final assessment. Change to oncologic treatment due to CI was seen in 12 (40.0%) cases. Increased delirium risk was identified in 9 (75.0%) of 12 surgical cases; however, delirium prevention was only recommended in 5 cases (55.6%). Strategies to optimize patients with CI included targeting falls prevention (n = 13), home/personal safety (n = 7), medication safety (n = 7), and nutrition (n = 6). Pharmacotherapy for cognition was not recommended in any case. ConclusionUndiagnosed CI is prevalent in the GO setting and influenced treatment in 40.0% of cases. Gaps were identified in clinician and patient/caregiver education around delirium risk. Addressing these issues may improve patient care.