The Impact of Cognitive Impairment on Treatment Toxicity, Treatment Completion, and Survival among Older Adults Receiving Chemotherapy: A Systematic Review

Abstract

Cognitive impairment (CI) is common among older adults with cancer, but its effect on cancer outcomes is not known. This systematic review sought to identify research investigating clinical endpoints (toxicity risk, treatment completion, and survival) of chemotherapy treatment in those with baseline CI. A systematic search of five databases (inception to March 2021) was conducted. Eligible studies included randomized trials, prospective studies, and retrospective studies in which the sample or a subgroup were older adults (aged ≥ 65) screened positive for CI prior to receiving chemotherapy. Risk of bias assessment was performed using the Quality in Prognosis Studies (QUIPS) tool. Twenty-three articles were included. Sample sizes ranged from n = 31 to 703. There was heterogeneity of cancer sites, screening tools and cut-offs used to ascertain CI, and proportion of patients with CI within study samples. Severity of CI and corresponding proportion of each level within study samples were unclear in all but one study. Among studies investigating CI in a qualified multivariable model, statistically significant findings were found in 4/6 studies on survival and in 1/1 study on nonhematological toxicity. The lack of robust evidence indicates a need for further research on the role of CI in predicting survival, treatment completion, and toxicity among older adults receiving chemotherapy, and the potential implications that could shape treatment decisions.

Cancer care for people with dementia: Literature overview and recommendations for practice and research

“…For example, a review of studies by Sattar et al examining pretreatment cognitive impairment on chemotherapy toxicity revealed mixed findings and highlighted that such studies often exclude PLWD versus people who have milder cognitive impairment. 90 Consequently, Sattar et al concluded that, to date, research has not adequately explored the effect of baseline cognition or cognitive impairment, particularly dementia. 90 Concerning other complications, single studies have found that dementia is associated with an increased risk of fractures after hormone therapy for prostate cancer, 91 but not with an increased rate of systemic or local wound complications after breast cancer surgery.…”

“…90 Consequently, Sattar et al concluded that, to date, research has not adequately explored the effect of baseline cognition or cognitive impairment, particularly dementia. 90 Concerning other complications, single studies have found that dementia is associated with an increased risk of fractures after hormone therapy for prostate cancer, 91 but not with an increased rate of systemic or local wound complications after breast cancer surgery. 17 Insufficient research has examined cancer treatment-related effects on BPSD and on dementia-related symptoms and functioning more broadly.…”

“…Because cancer clinical trials and treatment‐focused research largely exclude PLWD, 80,81 little research has examined the effect of dementia on the risk of cancer treatment complications, with too few studies to draw conclusions about vulnerability to specific complications. For example, a review of studies by Sattar et al examining pretreatment cognitive impairment on chemotherapy toxicity revealed mixed findings and highlighted that such studies often exclude PLWD versus people who have milder cognitive impairment 90 . Consequently, Sattar et al.…”

Communication with physicians and family about breast Cancer recurrence

“…However, BCR may be inadequately communicated with breast cancer survivors, such that survivors are unaware of (1) their recurrence risk, (2) factors that influence risk, and (3) health behaviors to decrease their risk [ [22] , [23] , [24] ]. Along with challenges of limited clinician time restricting communication, patients may not remember that risk information was being communicated (perhaps due to the trauma of diagnosis [ 25 , 26 ], chemotoxicity [ 27 ], or challenges with numeracy [ 28 ] or health disparities [ 29 ]). Adequate physician-patient communication about recurrence is vital to quality of life [ 30 ] and to informed decision-making about survivorship care [ 21 , 31 , 32 ].…”

Advances in Geriatric Oncology: Exploring Practical Ways to Optimize Treatment in Older Patients with Cancer

“…Moreover, GA can predict cancer treatment toxicity, treatment completion, and survival. The prognostic impact of each GA-domain and their evolution during cancer remain to be clarified and give rise to numerous research works [ 6 , 7 , 8 , 9 ].…”