Patient-reported cognitive complaints in older adults with gastrointestinal malignancies at diagnosis– Results from the Cancer & Aging Resilience Evaluation (CARE) study

Abstract

Objectives: Patient-reported cognitive complaint (CI) is poorly described in older adults with cancer. The purpose of this study was to quantify the prevalence and examine the associations of patient-reported CI in older adults with gastrointestinal (GI) malignancies at diagnosis. Materials and Methods: Using participants ≥60 years with GI malignancies from the Cancer & Aging Resilience Evaluation (CARE) Registry that underwent a Geriatric Assessment (GA), we examined CI using the Patient-Reported Outcomes Measurement Information System (PROMIS®) Short Form 4a Cognitive Function. Cognition scores were dichotomized into normal (scores of 15-20) and impaired (4-14), and bivariate and multivariate analyses were used to examine associations. Results: A total of 264 participants with GI malignancy were included, mean age of 70.0 ± 7.1, 55.7% male, pancreatic cancer was the most common cancer (24.2%) and majority were stage III/IV (68.2%). 29.3% of participants endorsed CI. CI was not associated with demographic and clinical domains, but was associated with many GA impairments including instrumental Activities of Daily Living (iADL) impairment (adjusted odds ratio [aOR] 6.0, 95% confidence interval 3.0-11.8), falls (aOR 2.7, 1.4-5.4), anxiety (aOR 10.3, 5.2-20.4), and depression (aOR 10.2,. CI was also associated with reduced global mental (aOR 18.7,) quality of life, and prior hospitalizations (aOR 2.4, 1.2-4.8). Conclusion: We found a high prevalence of patient-reported CI in older adults with GI malignancies that was associated with increased GA impairments, reduced health-related quality of life, and increased healthcare utilization.Published by Elsevier Ltd.

Use of Single-Item Self-Rated Health Measure to Identify Frailty and Geriatric Assessment-Identified Impairments Among Older Adults with Cancer

“…We used participants from the University of Alabama at Birmingham (UAB) Cancer and Aging Resilience Evaluation (CARE) study—a prospective registry enrolling older adults (≥60 years) undergoing cancer treatment at UAB Hospitals and Clinics. 18 , 19 We chose 60 years of age as criteria for enrollment in this registry given recognition of the uncertainty of the “right” age cutoff and to allow for meaningful age-related sub-analyses such as the current study. 20 For the current report, we included patients completing GA at the time of initial consultation to the UAB medical oncology clinic between 9/2017 and 10/2019.…”

“…All participants completed patient-reported GA as previously published ( Supplementary Table S1 ). 18 , 19 Briefly, CARE GA is a modified version of the Cancer and Aging Research Group GA 24 and includes the following domains 25 , 26 : functional status, 27 , 28 comorbidity, 27 , 29 , 30 cognition, mood disorders, 31–33 nutrition, 34 social support, 35 and HRQoL 33 , consistent with recommendations from the International Society of Geriatric Oncology. 25 , 26 …”

Association Between Chronologic Age and Geriatric Assessment–Identified Impairments: Findings From the CARE Registry

“…Using participants from the University of Alabama at Birmingham (UAB) Cancer and Aging Resilience Evaluation (CARE) Study, an ongoing prospective registry enrolling older adults ($60 years old) undergoing cancer care at UAB Hospitals and Clinics, 19,20 we identified patients diagnosed with a gastrointestinal malignancy presenting to our medical oncology clinic for an initial consultation. We chose 60 years of age as a criterion for enrollment in this registry given the uncertainty surrounding the "right" age cutoff and to allow for meaningful age-related subanalyses, such as the current study.…”

“…We conducted patient-reported GAs as previously described (supplemental eTable 1; available with this article at JNCCN.org). 19,20 Our GA comprised the following domains: functional status, comorbidity, cognition, mental health status, nutrition, social support, and health-related quality of life, consistent with recommendations from the International Society of Geriatric Oncology (SIOG). 3 We assessed functional status using the Older Americans Resources and Services (OARS) instrumental activities of daily living (IADLs), 22 OARS activities of daily living (ADLs), 22 patient-reported ECOG PS, 23 and number of falls within the last 6 months.…”

Patient‐reported geriatric assessment‐based frailty index among older adults with gastrointestinal malignancies

“…a Other race includes Black (146) and Hispanics(12). b Other GI includes Hepatobiliary (104), Gastroesophageal (60), Anal cancer(13), Appendiceal Cancer(7), Gastrointestinal stromal tumor(17), Neuroendocrine carcinoma (51), and GI not otherwise specified(5).T A B L E 3Abbreviations: CI, confidence interval; GI, gastrointestinal.a Functional decline. b Other race includes Black (146) and Hispanics (12).c…”