Assessment of Neurocognitive Impairment and Speech Functioning Before Head and Neck Cancer Treatment

Abstract

IMPORTANCE Head and neck cancer (HNC) and its treatment may negatively alter neurocognitive and speech functioning. However, the prevalence of neurocognitive impairment among patients with HNC before treatment is poorly studied, and the association between neurocognitive and speech functioning is unknown, which hampers good interpretability of the effect of HNC treatment on neurocognitive and speech function.OBJECTIVES To document neurocognitive functioning in patients with HNC before treatment and to investigate the association between neurocognitive and speech functioning. DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study of newly diagnosed patients with HNC before treatment using a large sample obtained in a nationwide, multicenter setting (Netherlands Quality of Life and Biomedical Cohort Study in Head and Neck Cancer [NET-QUBIC] project). MAIN OUTCOME AND MEASURESObjective neuropsychological measures of delayed recall, letter fluency, and executive functioning, as well as patient-reported outcome measures on neurocognitive speech and functioning, were collected before treatment. RESULTSIn total, 254 patients with HNC participated (71.7% male), with a mean (SD) age of 62 (10) years. The response rate ranged from 81.9% (208 of 254) to 84.6% (215 of 254). Objective neurocognitive measures indicated that 4.7% (10 of 212) to 15.0% (32 of 214) of patients were initially seen with moderate to severe cognitive impairment. Mild to moderate impairment was found in 12.3% (26 of 212) to 26.2% (56 of 214) of patients. The most altered domains were delayed recall and letter fluency. Seven percent (15 of 208) of the patients reported high levels of everyday neurocognitive failure, and 42.6% (89 of 209) reported speech problems. Objective neurocognitive function was not significantly associated with patient-reported neurocognitive or speech functioning, but the results from patient-reported outcome measures were significantly correlated. CONCLUSIONS AND RELEVANCEResults of this study demonstrate a high prevalence of impaired speech functioning among patients with HNC before treatment, which is in line with previous findings. A novel finding is that neurocognitive impairment is also highly prevalent as objectively measured and as self-perceived. Understanding the reason why patients with HNC are initially seen with neurocognitive impairment before the start of treatment is important because this impairment may complicate patient-clinician interaction and alter treatment adherence and because treatment itself may further worsen cognitive functioning. In addition, low self-perceived neurocognitive and speech functioning before treatment may decrease a patient's confidence in communicative participation and perceived quality of life. Disentangling the associations between objective and patient-reported neurocognitive and speech functions is an important area for future research.

Prevalence of neurocognitive and perceived speech deficits in patients with head and neck cancer before treatment: Associations with demographic, behavioral, and disease‐related factors

“…Patients' characteristics are presented in Table 1. The cross‐sectional sample reported here ( N ≥ 444) partly overlaps with our previous study 8 (being a larger dataset than the initially analyzed sample of N = 254, enabling more in‐depth analysis). Appropriate statistical procedures were followed as a result 19 …”

“…Note that these latter findings are not based on a populations with head and neck cancer. However, due to relatively small sample sizes in previous studies, 10,11 including our own, 8 it is unclear how pretreatment neurocognitive functioning differs across different tumor subsites and to what extent chronic alcohol and tobacco use contribute to poor neurocognitive functioning in these tumor subgroups.…”

“…Speech deficits may be present before the beginning of treatment because of the damage to the organs and muscles involved in speaking 12 . In a previous report of the multicenter Netherlands Quality of Life and Biomedical Cohort Study (NET‐QUBIC) 13 including 254 patients pretreatment, we found between 5% and 15% of patients had moderate‐to‐severe neurocognitive impairment and 43% of patients had speech impairment 8 . Moreover, patient‐reported outcome measures of speech and neurocognition were modestly correlated 8 .…”

Identifying Patient-Reported Outcome Measures (PROMs) for Routine Surveillance of Physical and Emotional Symptoms in Head and Neck Cancer Populations: A Systematic Review

“…A total of 14 studies examined voice and speech impairment with prevalence ranging from 9% to 88% (Table 2) [21,38,39,41,42,45,55,63,65,66,71,76,114,115]. Among oral and oropharyngeal cancer patients, the pre-treatment prevalence of speech impairment was found to be 42%; however, it is unclear if these patients had undergone any prior treatments [42].…”

Study retention and attrition in a longitudinal cohort study including patient-reported outcomes, fieldwork and biobank samples: results of the Netherlands quality of life and Biomedical cohort study (NET-QUBIC) among 739 head and neck cancer patients and 262 informal caregivers

“…The overarching objective of NET-QUBIC is to optimize diagnosis, treatment and supportive care by advancing interdisciplinary research [11,12]. So far, more than 20 derivate studies are ongoing or have been published that use NET-QUBIC data and samples [12][13][14][15][16][17][18]. Further insight in study retention and attrition will facilitate patients.…”