Pretreatment Cognitive Impairment Is Common in Patients With Head and Neck Cancer

December 1, 2017

Results from a study of patients with newly diagnosed head and neck cancer indicate that cognitive screening should be incorporated into pretreatment assessment for patients in order to improve outcomes.

Cognitive impairment is common among patients with newly diagnosed head and neck cancer (HNC) and correlates with quality of life (QoL), according to researchers at the Henry Ford Health System in Detroit, Michigan. Patient quality of life and cognitive performance should be assessed before treatment, the authors argued.

Their case-series study of 83 patients was published in JAMA Otolaryngology-Head & Neck Surgery.

“Slightly more than 50% of patients presented with at least mild cognitive impairment at pretreatment assessment,” reported lead study author Amy M. Williams, PhD, and colleagues. “Together with previous research indicating that cognitive function and QoL can influence treatment adherence and outcomes, the results argue for the incorporation of cognitive screening and QoL assessment as part of pretreatment assessment for patients.”

Current use of benzodiazepine and tobacco, and history of heavy alcohol consumption, were all associated with lower QoL in various domains, they noted.

Little previous research had assessed suspected associations between QoL and cognitive function in patients diagnosed with HNC. The study authors therefore analyzed demographic and cancer data, substance use history (heavy alcohol, tobacco, marijuana, cocaine, and heroin), psychiatric symptoms (depressive, anxiety, trauma symptoms, and passive suicidal ideation), psychotropic medication history, QoL, and Montreal Cognitive Assessment (MoCA) scores. Demographic variables included age, sex, race, education level, employment and marital status at diagnosis, and social support.

Forty-six (55%) of the 83 patients with HNC were cognitively impaired before treatment began. Cognitive impairment was associated with older age and lower levels of education attainment.

“The number of depressive symptoms was associated with impairments in delayed recall and QoL; cognitive impairment and delayed recall were associated with lower QoL; and past substance use was associated with current QoL and cognitive function,” they reported. The authors also said that the number of depressive symptoms (mean, 2.43; 95% CI: 2.06-2.89) was associated with delayed recall impairment and “all domains of QoL”.

Patients reporting heavy alcohol use had lower scores for emotional and functional well-being, head and neck–specific well-being, and overall QoL. Past heavy drug use was associated with lower functional well-being and MoCA scores, and poorer delayed recall. Current smokers had lower overall QoL and social and functional well-being, and lower language-subscale performance scores.

“Patients with human papillomavirus type p16–positive disease reported higher social well-being” (P = .03), the authors reported. “Stage at presentation and whether the patient followed tumor board recommendations were not associated with overall MoCA or subscales or with overall QoL or the well-being scales.”

The study’s cross-sectional design precludes conclusions about causality and comorbidities that affect cognitive function were not analyzed, the authors cautioned.

The new study shows that multidisciplinary cognitive function assessment is practical, they concluded. However, additional research is needed to confirm and elucidate causal relationships among the associated variables, according to the authors.