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

作者：Libert Yves; Dubruille Stephanie; Borghgraef Cindy; Etienne Anne Marie; Merckaert Isabelle; Paesmans Marianne; Reynaert Christine; Roos Myriam; Slachmuylder Jean Louis; Vandenbossche Sandrine; Bron Dominique; Razavi Darius^*

来源：PLos One, 2016, 11(8): e0159734.

DOI：10.1371/journal.pone.0159734

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.

• 出版日期2016-8-1