User menu

Accès à distance ? S'identifier sur le proxy UCLouvain

Vulnerabilities in Older Patients when Cancer Treatment is Initiated: Does a Cognitive Impairment Impact the Two-Year Survival?

Primary tabs

download
  • Open access
  • PDF
  • 254.06 K
Libert, Yves Dubruille, Stéphanie Borghgraef, Cindy Etienne, Anne-Marie Merckaert, Isabelle Reynaert, Christine [UCL] Razavi, Darius

(eng) INTRODUCTION: Dementia is a known predictor of shorter survival times in older cancer patients. However, no empirical evidence is available to determine how much a cognitive impairment shortens survival in older patients when cancer treatment is initiated. PURPOSE: To longitudinally investigate how much a cognitive impairment detected at the initiation of cancer treatment influences survival of older patients during a two-year follow-up duration and to compare the predictive value of a cognitive impairment on patients survival with the predictive value of other vulnerabilities associated with older age. METHODS: Three hundred and fifty-seven consecutive patients (≥65 years old) admitted for breast, prostate, or colorectal cancer surgeries were prospectively recruited. A cognitive impairment was assessed with the Montreal Cognitive Assessment (MoCA<26). Socio-demographic, disease-related, and geriatric vulnerabilities were assessed using validated tools. Univariate and subsequent multivariate Cox proportional hazards models stratified for diagnosis (breast/prostate cancer versus colorectal cancer) and disease status (metastatic versus non-metastatic) were used. RESULTS: A cognitive impairment was detected in 46% (n = 163) of patients. Survival was significantly influenced by a cognitive impairment (HR = 6.13; 95% confidence interval [CI] = 2.07-18.09; p = 0.001), a loss in instrumental autonomy (IADL ≤7) (HR = 3.06; 95% CI = 1.31-7.11; p = 0.009) and fatigue (Mob-T<5) (HR = 5.98; 95% CI = 2.47-14.44; p <0.001). CONCLUSIONS: During the two years following cancer treatment initiation, older patients with a cognitive impairment were up to six times more likely to die than patients without. Older patients should be screened for cognitive impairments at cancer treatment initiation to enable interventions to reduce morbidity and mortality. Further studies should address processes underlying the relationship between cognitive impairments and an increased risk of dying in older cancer patients.

Document type Article de périodique (Journal article) – Article de recherche
Access type Accès libre
Publication date 2016
Language Anglais
Journal information "PLoS One" - Vol. 11, no. 8, p. e0159734 [1-14] (2016)
Peer reviewed yes
Publisher Public Library of Science ((United States) San Francisco, CA)
e-issn 1932-6203
Publication status Publié
Affiliations UCL - SSS/IREC/MONT - Pôle Mont Godinne
UCL - SSS/IRSS - Institut de recherche santé et société
UCL - (MGD) Service de médecine psychosomatique
Links
  1. Neuman Heather B., O'Connor Erin S., Weiss Jennifer, LoConte Noelle K., Greenblatt David Y., Greenberg Caprice C., Smith Maureen A., Surgical treatment of colon cancer in patients aged 80 years and older : Analysis of 31,574 patients in the SEER-Medicare database, 10.1002/cncr.27765
  2. Goodwin J. S., Samet J. M., Hunt W. C., Determinants of Survival in Older Cancer Patients, 10.1093/jnci/88.15.1031
  3. Louwman W.J., Janssen-Heijnen M.L.G., Houterman S., Voogd A.C., van der Sangen M.J.C., Nieuwenhuijzen G.A.P, Coebergh J.W.W., Less extensive treatment and inferior prognosis for breast cancer patient with comorbidity: A population-based study, 10.1016/j.ejca.2004.12.025
  4. Robb Claire, Boulware David, Overcash Janine, Extermann Martine, Patterns of care and survival in cancer patients with cognitive impairment, 10.1016/j.critrevonc.2009.07.002
  5. Gussekloo J, Westendorp R G J, Remarque E J, Lagaay A M, Heeren T J, Knook D L, Impact of mild cognitive impairment on survival in very elderly people: cohort study, 10.1136/bmj.315.7115.1053
  6. Dubruille Stéphanie, Libert Yves, Roos Myriam, Vandenbossche Sandrine, Collard Aurélie, Meuleman Nathalie, Maerevoet Marie, Etienne Anne-Marie, Reynaert Christine, Razavi Darius, Bron Dominique, Identification of clinical parameters predictive of one-year survival using two geriatric tools in clinically fit older patients with hematological malignancies: Major impact of cognition, 10.1016/j.jgo.2015.07.006
  7. Dubruille Stéphanie, Libert Yves, Merckaert Isabelle, Reynaert Christine, Vandenbossche Sandrine, Roos Myriam, Bron Dominique, Razavi Darius, The prevalence and implications of elderly inpatients' desire for a formal psychological help at the start of cancer treatment : Elderly cancer inpatients and formal psychological help, 10.1002/pon.3636
  8. Swan Gary E., Carmelli Dorit, LaRue Asenath, Performance on the Digit Symbol Substitution Test and 5-Year Mortality in the Western Collaborative Group Study, 10.1093/oxfordjournals.aje.a117342
  9. Anstey Kaarin J., Luszcz Mary A., Giles Lynne C., Andrews Gary R., Demographic, health, cognitive, and sensory variables as predictors of mortality in very old adults., 10.1037/0882-7974.16.1.3
  10. Mandelblatt Jeanne S., Jacobsen Paul B., Ahles Tim, Cognitive Effects of Cancer Systemic Therapy: Implications for the Care of Older Patients and Survivors, 10.1200/jco.2014.55.1259
  11. Lange Marie, Rigal Olivier, Clarisse Bénédicte, Giffard Bénédicte, Sevin Emmanuel, Barillet Marie, Eustache Francis, Joly Florence, Cognitive dysfunctions in elderly cancer patients: A new challenge for oncologists, 10.1016/j.ctrv.2014.03.003
  12. Etgen Thorleif, Bickel Horst, Förstl Hans, Metabolic and endocrine factors in mild cognitive impairment, 10.1016/j.arr.2010.01.003
  13. Raji Mukaila A., Kuo Yong-Fang, Freeman Jean L., Goodwin James S., Effect of a Dementia Diagnosis on Survival of Older Patients After a Diagnosis of Breast, Colon, or Prostate Cancer : Implications for Cancer Care, 10.1001/archinte.168.18.2033
  14. Inouye Sharon K., Delirium in Older Persons, 10.1056/nejmra052321
  15. Ahles Tim A., Brain vulnerability to chemotherapy toxicities : Chemotherapy-induced cognitive change, 10.1002/pon.3196
  16. Amieva Hélène, Stoykova Ralitsa, Matharan Fanny, Helmer Catherine, Antonucci Toni C., Dartigues Jean-François, What Aspects of Social Network Are Protective for Dementia? Not the Quantity But the Quality of Social Interactions Is Protective Up to 15 Years Later : , 10.1097/psy.0b013e3181f5e121
  17. Nasreddine Ziad S., Phillips Natalie A., Bédirian Valérie, Charbonneau Simon, Whitehead Victor, Collin Isabelle, Cummings Jeffrey L., Chertkow Howard, The Montreal Cognitive Assessment, MoCA: A Brief Screening Tool For Mild Cognitive Impairment : MOCA: A BRIEF SCREENING TOOL FOR MCI, 10.1111/j.1532-5415.2005.53221.x
  18. Newman John C., Copyright and Bedside Cognitive Testing : Why We Need Alternatives to the Mini-Mental State Examination, 10.1001/jamainternmed.2015.2159
  19. Tsoi Kelvin K. F., Chan Joyce Y. C., Hirai Hoyee W., Wong Samuel Y. S., Kwok Timothy C. Y., Cognitive Tests to Detect Dementia : A Systematic Review and Meta-analysis, 10.1001/jamainternmed.2015.2152
  20. Petersen Ronald C., Thomas Ronald G., Grundman Michael, Bennett David, Doody Rachelle, Ferris Steven, Galasko Douglas, Jin Shelia, Kaye Jeffrey, Levey Allan, Pfeiffer Eric, Sano Mary, van Dyck Christopher H., Thal Leon J., Vitamin E and Donepezil for the Treatment of Mild Cognitive Impairment, 10.1056/nejmoa050151
  21. Petersen Ronald C., Doody Rachelle, Kurz Alexander, Mohs Richard C., Morris John C., Rabins Peter V., Ritchie Karen, Rossor Martin, Thal Leon, Winblad Bengt, Current Concepts in Mild Cognitive Impairment, 10.1001/archneur.58.12.1985
  22. Copeland G. P., Jones D., Walters M., POSSUM: A scoring system for surgical audit, 10.1002/bjs.1800780327
  23. McLennan S.N., Mathias J.L., Brennan L.C., Stewart S., Validity of the Montreal Cognitive Assessment (MoCA) as a Screening Test for Mild Cognitive Impairment (MCI) in a Cardiovascular Population, 10.1177/0891988710390813
  24. Katz S., Downs T. D., Cash H. R., Grotz R. C., Progress in Development of the Index of ADL, 10.1093/geront/10.1_part_1.20
  25. Lawton M. P., Brody E. M., Assessment of Older People: Self-Maintaining and Instrumental Activities of Daily Living, 10.1093/geront/9.3_part_1.179
  26. Podsiadlo Diane, Richardson Sandra, The Timed “Up & Go”: A Test of Basic Functional Mobility for Frail Elderly Persons, 10.1111/j.1532-5415.1991.tb01616.x
  27. Fieo Robert A., Mortensen Erik L., Rantanen Taina, Avlund Kirsten, Improving a Measure of Mobility-Related Fatigue (The Mobility-Tiredness Scale) by Establishing Item Intensity, 10.1111/jgs.12122
  28. Guigoz Yves, Vellas Bruno, Garry Philip J., Assessing the Nutritional Status of the Elderly: The Mini Nutritional Assessment as Part of the Geriatric Evaluation, 10.1111/j.1753-4887.1996.tb03793.x
  29. Zigmond A. S., Snaith R. P., The Hospital Anxiety and Depression Scale, 10.1111/j.1600-0447.1983.tb09716.x
  30. JI YJ Sheikh (1986)
  31. Gnjidic Danijela, Hilmer Sarah N., Blyth Fiona M., Naganathan Vasi, Waite Louise, Seibel Markus J., McLachlan Andrew J., Cumming Robert G., Handelsman David J., Le Couteur David G., Polypharmacy cutoff and outcomes: five or more medicines were used to identify community-dwelling older men at risk of different adverse outcomes, 10.1016/j.jclinepi.2012.02.018
  32. Charlson Mary E., Pompei Peter, Ales Kathy L., MacKenzie C.Ronald, A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation, 10.1016/0021-9681(87)90171-8
  33. Razavi D., Delvaux N., Farvacques C., Robaye E., Screening for adjustment disorders and major depressive disorders in cancer in-patients, 10.1192/bjp.156.1.79
  34. Kamangar Farin, Dores Graça M., Anderson William F., Patterns of Cancer Incidence, Mortality, and Prevalence Across Five Continents: Defining Priorities to Reduce Cancer Disparities in Different Geographic Regions of the World, 10.1200/jco.2005.05.2308
  35. L Balducci, Oncology (Williston Park), 20, 135 (2006)
  36. Avlund Kirsten, Schultz-Larsen Kirsten, Davidsen Michael, Tiredness in Daily Activities at Age 70 as a Predictor of Mortality During the Next 10 Years, 10.1016/s0895-4356(97)00296-5
  37. Lange Marie, Giffard Bénédicte, Noal Sabine, Rigal Olivier, Kurtz Jean-Emmanuel, Heutte Natacha, Lévy Christelle, Allouache Djelila, Rieux Chantal, Fel Johan Le, Daireaux Aurélie, Clarisse Bénédicte, Veyret Corinne, Barthélémy Philippe, Longato Nadine, Eustache Francis, Joly Florence, Baseline cognitive functions among elderly patients with localised breast cancer, 10.1016/j.ejca.2014.05.026
  38. Monk Terri G., Weldon B Craig, Garvan Cyndi W., Dede Duane E., van der Aa Maria T., Heilman Kenneth M., Gravenstein Joachim S., Predictors of Cognitive Dysfunction after Major Noncardiac Surgery : , 10.1097/01.anes.0000296071.19434.1e
  39. Dong YanHong, Lee Wah Yean, Basri Nur Adilah, Collinson Simon Lowes, Merchant Reshma A., Venketasubramanian Narayanaswamy, Chen Christopher Li-Hsian, The Montreal Cognitive Assessment is superior to the Mini–Mental State Examination in detecting patients at higher risk of dementia, 10.1017/s1041610212001068
  40. Rich Michael W., Baldus Gray Diane, Beckham Valerie, Wittenberg Carol, Luther Priya, Effect of a multidisciplinary intervention on medication compliance in elderly patients with congestive heart failure, 10.1016/s0002-9343(96)00172-6
  41. Stewart Simon, Marley John E, Horowitz John D, Effects of a multidisciplinary, home-based intervention on planned readmissions and survival among patients with chronic congestive heart failure: a randomised controlled study, 10.1016/s0140-6736(99)03428-5
Bibliographic reference Libert, Yves ; Dubruille, Stéphanie ; Borghgraef, Cindy ; Etienne, Anne-Marie ; Merckaert, Isabelle ; et. al. Vulnerabilities in Older Patients when Cancer Treatment is Initiated: Does a Cognitive Impairment Impact the Two-Year Survival?. In: PLoS One, Vol. 11, no. 8, p. e0159734 [1-14] (2016)
Permanent URL http://hdl.handle.net/2078.1/176056