Patterns of care and survival in cancer patients with cognitive impairment

BACKGROUND: Incidence of both cancer and cognitive impairments from various origins increases with age. As the population ages, physicians will be increasingly confronted with malignancies occurring in patients with cognitive impairment. Research has indicated cognitively-impaired cancer patients may not receive comparable treatment as non-cognitively impaired patients, thereby negatively affecting survival. The purpose of this study was to examine survival in a group of cognitively-impaired older cancer patients (MMSE ≤ 24) compared to a non-impaired control group (MMSE ≥ 25), where both groups received similar treatment. METHODS: The sample was drawn from patients in a senior adult oncology program (SAOP) at an NCI-designated Comprehensive Cancer Center. Baseline data and patterns of care were abstracted from patient charts and the cancer registry. Key end points were survival and patterns of treatment. RESULTS: A sample consisted of 86 cognitively impaired patients (mean age 79.1 years) and 172 non-impaired patients (mean age 75.4). Despite similar treatment patterns, results showed significantly greater survival (values p < .001) in the non-impaired control group, after adjusting for age, sex, performance status, ADLs/IADLs and comorbidity. Median survival for the control group was 72.6 months compared to 23.0 months in the cognitively-impaired cases. Similar results occurred in analyses by age group and site. CONCLUSIONS: Across tumor types and stages, cognitively impaired patients have approximately one-third the median survival of the control group, even when receiving similar treatment. However, in early stages, this survival can still be a significant number of years, and treatment guidelines need to be developed.