Downstream consequences of abnormal cognitive screening in older adults seen pretreatment in a geriatric oncology clinic

Malik, Uzair; Alam, Zuhair; Loucks, Allison; Jin, Rana; Yokom, Daniel; Watt, Sarah; Berger, Arielle; Romanovsky, Lindy; Puts, Martine; Alibhai, Shabbir M.H.

doi:10.1016/j.jgo.2019.10.022

Cited by 13 publications

(8 citation statements)

References 22 publications

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“…Cognitive impairment is frequently underdiagnosed in geriatric patients with cancer. 110 Impaired cognitive function can complicate disease management and treatment decision-making while impacting QoL and daily functioning. In older men who have PC, cognitive deficits may arise from patient factors, concomitant medications for chronic nonmalignant comorbidities, and treatment with second-generation ARIs plus ADT ( Figure 1 ), which may combine to exert additive or synergistic effects that further impact the cognitive function of patients with PC and impede their overall QoL.…”

Section: Clinical Management Of Cognitive Dysfunction In the Pc Settingmentioning

confidence: 99%

Risk of Cognitive Effects in Comorbid Patients With Prostate Cancer Treated With Androgen Receptor Inhibitors

Morgans

Renzulli

Olivier

et al. 2021

Clinical Genitourinary Cancer

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Prostate cancer (PC) is pr imar ily a disease of older men. As the risk of neurocognitive decline increases as people age, cognitive dysfunction is a potential complication in men with PC, imposing detrimental effects on functional independence and quality of life. Importantly, risk of cognitive decline may increase with exposure to androgen deprivation therapy and other hormonal therapies. Particular consideration should be given to patients with castrationresistant PC (CRPC), many of whom require continuous, long-term androgen deprivation therapy combined with a second-generation androgen receptor inhibitor. Non-comparative evidence from interventional trials of androgen receptor inhibitors in men with non-metastatic CRPC suggests differential effects on cognitive function and central nervous system-related adverse events within this dr ug class. Dr ug-dr ug interactions with concomitant medications for chronic, non-malignant comorbidities differ among ARIs and thus may contribute further to cognitive impairment. Hence, establishing baseline cognitive function is a prerequisite to identifying subsequent clinical decline associated with androgen receptor-targeted therapies. Although brief, sensitive screening tools for cancer-related cognitive dysfunction are lacking, mental status can be ascertained from the initial medical history and neurocognitive examination, progressing to more in-depth evaluation when impairment is suspected. On-treatment neurocognitive monitoring should be integrated into regular clinical follow-up to preserve cognitive function and quality of life throughout disease management. This review summarizes the multiple factors that may contribute to cognitive decline in men with CRPC, awareness of which will assist clinicians to optimize individual treatment. Practical, clinic-based strategies for managing the risks for and symptoms of cognitive dysfunction are also discussed.

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Section: Clinical Management Of Cognitive Dysfunction In the Pc Settingmentioning

confidence: 99%

Risk of Cognitive Effects in Comorbid Patients With Prostate Cancer Treated With Androgen Receptor Inhibitors

Morgans

Renzulli

Olivier

et al. 2021

Clinical Genitourinary Cancer

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“…In the study by Trevino et al [ 20 ], psychological and social support was only offered to 25% of patients who were identified to have elevated distress or poor social support. Malik et al revealed that cognitive screening allowed for the identification of increased delirium risks for surgical patients, but the impact of preventive strategies was not evaluated in this study [ 21 ].…”

Section: Resultsmentioning

confidence: 99%

Inside the Black Box: A Narrative Review on Comprehensive Geriatric Assessment-Driven Interventions in Older Adults with Cancer

Thibaud

Billy

Prud'Homm

et al. 2022

Cancers

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There is a consensus that the use of comprehensive geriatric assessment (CGA) is good clinical practice for older patients with solid tumors or hematological malignancies. To be complete, a CGA must include a geriatric assessment and an intervention plan. According to the SIOG consensus, a CGA should assess several domains: functional status, comorbidity, cognition, mental health status, fatigue, social status and support, nutrition, and the presence of geriatric syndromes. Progress has been made in the definition of the best way to detect problems, but the benefits are mostly based on prognosis stratification and on the adaptation of cancer treatment. The present review aims to evaluate the level of evidence regarding geriatric interventions proposed following the detection of a problem in cancer patients in each domain mentioned in the SIOG consensus. An online search of the PubMed database was performed using predefined search algorithms specific for each domain of the CGA. Eligible articles had to have well-defined interventions targeting specific domains of the CGA. We screened 1864 articles, but only a few trials on single-domain interventions were found, and often, these studies involved small groups of patients. This review highlights the scarcity of published studies on this topic. The specific impacts of CGA-based interventions have not yet been demonstrated. Multi-domain interventions seem promising, especially when they are based on global assessments. However, standardization seems difficult considering the lack of evidence for each domain. New studies are necessary in multiple care contexts, and innovative designs must be used to balance internal and external validity. An accurate description of the intervention and what “usual care” means will improve the external validity of such studies.

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“…Similarly, while delirium is a separate entity of acute cognitive decline, it is important to be aware that those with baseline cognitive impairment are at a far higher risk of developing a delirium episode during their cancer treatment phase [1,8]. Education regarding delirium monitoring for these patients and their caregivers is required [10,115,116].…”

Section: Discussionmentioning

confidence: 99%

Cognitive Assessment Tools Recommended in Geriatric Oncology Guidelines: A Rapid Review

et al. 2021

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Cognitive assessment is a cornerstone of geriatric care. Cognitive impairment has the potential to significantly impact multiple phases of a person’s cancer care experience. Accurately identifying this vulnerability is a challenge for many cancer care clinicians, thus the use of validated cognitive assessment tools are recommended. As international cancer guidelines for older adults recommend Geriatric Assessment (GA) which includes an evaluation of cognition, clinicians need to be familiar with the overall interpretation of the commonly used cognitive assessment tools. This rapid review investigated the cognitive assessment tools that were most frequently recommended by Geriatric Oncology guidelines: Blessed Orientation-Memory-Concentration test (BOMC), Clock Drawing Test (CDT), Mini-Cog, Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Short Portable Mental Status Questionnaire (SPMSQ). A detailed appraisal of the strengths and limitations of each tool was conducted, with a focus on practical aspects of implementing cognitive assessment tools into real-world clinical settings. Finally, recommendations on choosing an assessment tool and the additional considerations beyond screening are discussed.

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Downstream consequences of abnormal cognitive screening in older adults seen pretreatment in a geriatric oncology clinic

Cited by 13 publications

References 22 publications

Risk of Cognitive Effects in Comorbid Patients With Prostate Cancer Treated With Androgen Receptor Inhibitors

Risk of Cognitive Effects in Comorbid Patients With Prostate Cancer Treated With Androgen Receptor Inhibitors

Inside the Black Box: A Narrative Review on Comprehensive Geriatric Assessment-Driven Interventions in Older Adults with Cancer

Cognitive Assessment Tools Recommended in Geriatric Oncology Guidelines: A Rapid Review

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