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Observational Study
. 2022 Jul 21;29(7):5164-5178.
doi: 10.3390/curroncol29070409.

Cognitive Trajectories in Older Patients with Cancer Undergoing Radiotherapy-A Prospective Observational Study

Guro Falk Eriksen  1   2   3 , Jūratė Šaltytė Benth  1   4   5 , Bjørn Henning Grønberg  6   7 , Siri Rostoft  3   8 , Øyvind Kirkevold  1   9   10 , Sverre Bergh  1   9 , Anne Hjelstuen  11 , Darryl Rolfson  12 , Marit Slaaen  1   3
Affiliations
Observational Study

Cognitive Trajectories in Older Patients with Cancer Undergoing Radiotherapy-A Prospective Observational Study

Guro Falk Eriksen et al. Curr Oncol. .

Abstract

Cognitive function can be affected by cancer and/or its treatment, and older patients are at a particular risk. In a prospective observational study including patients ≥65 years referred for radiotherapy (RT), we aimed to investigate the association between patient- and cancer-related factors and cognitive function, as evaluated by the Montreal Cognitive Assessment (MoCA), and sought to identify groups with distinct MoCA trajectories. The MoCA was performed at baseline (T0), RT completion (T1), and 8 (T2) and 16 (T3) weeks later, with scores ranging between 0 and 30 and higher scores indicating better function. Linear regression and growth mixture models were estimated to assess associations and to identify groups with distinct MoCA trajectories, respectively. Among 298 patients with a mean age of 73.6 years (SD 6.3), the baseline mean MoCA score was 24.0 (SD 3.7). Compared to Norwegian norm data, 37.9% had cognitive impairment. Compromised cognition was independently associated with older age, lower education, and physical impairments. Four groups with distinct trajectories were identified: the very poor (6.4%), poor (8.1%), fair (37.9%), and good (47.7%) groups. The MoCA trajectories were mainly stable. We conclude that cognitive impairment was frequent but, for most patients, was not affected by RT. For older patients with cancer, and in particular for those with physical impairments, we recommend an assessment of cognitive function.

Trial registration: ClinicalTrials.gov NCT03071640.

Keywords: Montreal Cognitive Assessment; cancer-related cognitive impairment; cognitive function; frailty; geriatric oncology; physical impairment.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Patient flow chart and MoCA completion rates. a Patients receiving ≤9 fractions, per protocol, did not perform the MoCA test at the time of RT completion. b Excluding per protocol exceptions and deceased patients. c Patients alive at time of assessment and recruited from municipalities that did not participate in performing the mGA during follow-up.
Figure 2
Figure 2
Distribution of MoCA z-scores (SD) based on Norwegian normative data.
Figure 3
Figure 3
Groups with distinct MoCA score trajectories during the course of radiotherapy.
See this image and copyright information in PMC

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