Patterns of care and survival in cancer patients with cognitive impairment

Abstract

8083 Background: Literature on survival patterns of geriatric patients with cancer and cognitive impairment is scant. The existing analects reveal cancer patients with cognitive impairment have twice the mortality of their non-impaired counterparts. The reason for the high mortality rates is unclear. There is an obvious need for clinical research to guide oncologists in the treatment of these patients. Methods: We conducted a retrospective case-control study in geriatric oncology patients aged 70 and older. Patients seen in Moffitt's Senior Adult Oncology Program (SAOP) presenting at initial CGA a MMSE of 24 or less were paired with patients presenting a MMSE of 25 or higher. Patients were matched for tumor type and stage. Baseline criteria were obtained from the SAOP prospective cohort database. Patterns of care and morbidity outcomes (PFS, OS) were obtained from Moffitt Cancer registry. Data were adjusted for baseline ECOG PS, ADL/IADL, CIRS - G and Charlson scores, GDS, age and sex with a Cox regression model. Results: Ninety-four cognitively impaired patients and 199 controls were included. Significant differences were found in survival rates and other assayed variables. At baseline cognitively impaired patients had worse PS (mean 1.4 vs. 0.49), were more dependent in ADL (median 1 vs.0) and IADL (mean 20.5 points vs. 26.7). A higher proportion of them screened as depressed (49% vs. 12%). They also had more severe comorbidities. Evaluated treatments were surgery, radiation, hormonal and chemotherapy. There were no major differences in the percentages of cases that received chemotherapy versus the controls. Median survival (272 pts) was 41.8 months in cognitively impaired and 95.3 months in the controls. Only 44% of the cases were living five years after treatment versus 63% of the controls (all p - values < 0.0001). The respective weights of the various health parameters on outcomes will be presented at ASCO. Conclusion: The cognitively impaired have worse survival duration than the controls. Nevertheless the cognitively impaired can expect to live on average 3.5 years. These results suggest that there is a significant potential for intervention in cognitively impaired cancer patients. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Aventis