Age-related differences in self-report and objective measures of cognitive function in older patients prior to chemotherapy

Early Telephone-Based Frailty Screening With the Vulnerable Elders Survey in Adults Aged 75 Years and Older With Lung and Gynecological Cancer

BACKGROUND

The International Society of Geriatric Oncology recommends that all older people with cancer have a geriatric evaluation before beginning treatment.

OBJECTIVE

To determine the prevalence of frailty in people 75 years and older diagnosed with lung or gynecological cancer and evaluate the adaptation of standard therapeutic strategies based on frailty, following the implementation of telephone-based frailty screening with the Vulnerable Elders Survey (VES-13).

INTERVENTIONS/METHODS

We performed a retrospective observational study in 362 people screened by an advanced practice nurse before their first oncology appointment. We collected secondary data from electronic medical records. The main variables were degree of frailty (according to VES-13 and comprehensive geriatric assessment), type of cancer treatment (standard and prescribed), treatment completion, sociodemographic characteristics, and comorbidities.

RESULTS

The VES-13 detected 186 people (51.4%) at risk of health deterioration, and the comprehensive geriatric assessment confirmed some degree of frailty in 157 people (43.4%), with a κ coefficient of 0.84. People with more comorbidities, greater frailty, and more geriatric syndromes were more likely to need treatment readjustment ( P < .001).

CONCLUSIONS

Telephone-based frailty screening by an advanced practice nurse showed high applicability, with very good agreement between the proportion of people classified as frail before the initial visit and in the subsequent geriatric assessment.

IMPLICATIONS FOR PRACTICE

A protocol for establishing frailty risk through telephone screening by an advanced practice nurse facilitates the care process and helps clinicians adapt therapeutic decision-making to the needs of each patient and their family.

Changes in Subjective Measures of Cognitive Function in Older Adults From the Initiation Through 12 Months After the Receipt of Chemotherapy

BACKGROUND

Cognitive impairment has a negative impact on older patients with cancer.

OBJECTIVES

The aim of this study was to evaluate for interindividual differences in 2 subjective measures of cognitive function in older patients (n = 112), as well as determine which demographic, clinical, and symptom characteristics, and levels of physical function, were associated with initial levels and with the trajectory of each of these 2 measures.

METHODS

Cognitive function was assessed using the cognitive function scale from the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 and the Attentional Function Index at the initiation of chemotherapy and at 1, 3, 6, 9, and 12 months after its initiation. Hierarchical linear modeling was used to assess for interindividual differences in and characteristics associated with initial levels and changes in cognitive function.

RESULTS

Characteristics associated with decreases in Quality of Life Questionnaire Core 30 scores at the initiation of chemotherapy were longer time since the cancer diagnosis and higher depression scores. Characteristics associated with poorer Attentional Function Index scores at enrollment were lower levels of education and higher depression scores. No characteristics were associated with worse trajectories of either cognitive function measure.

CONCLUSION

Some older patients undergoing chemotherapy experience decrements in cognitive function.

IMPLICATIONS FOR PRACTICE

Our findings suggest that clinicians need to assess for depressive symptoms in older patients before the initiation of chemotherapy. Evidence-based interventions (eg, cognitive stimulation, increased physical activity) can be recommended to maintain and increase cognitive function in older oncology patients.

Characteristics associated with decrements in objective measures of physical function in older patients with cancer during chemotherapy

PURPOSE

Study purposes were to evaluate for inter-individual variability in the trajectories of three objective measures of physical function (PF) in older patients receiving chemotherapy (n = 112) and determine which characteristics were associated with worse PF.

METHODS

Balance, gait speed, and chair-stand test were evaluated at initiation and 1, 3, 6, 9, and 12 months following chemotherapy. Hierarchical linear modeling was used to assess inter-individual variability in the trajectories of the three tests. Demographic, clinical, and symptom characteristics, and levels of cognitive function associated with initial levels and changes over time in each of the tests were determined.

RESULTS

Gait speed and chair-stand tests improved over time. Balance declined until month 6, then increased. Characteristics associated with decreases in balance scores at initiation of chemotherapy were lower level of education and lower Karnofsky Performance Status (KPS) score. For initial levels of poorer gait speed, older age, poorer Trail Making Test B (TMTB), and worse Attentional Function Index scores were the associated characteristics. Lower KPS scores, higher body mass index, and poorer TMTB scores were associated with poorer chair-stand times at initiation of chemotherapy. Worse trajectories of chair-stand times were associated with poorer chair-stand time at enrollment. Characteristic associated with lower initial levels and improved trajectories of balance was older age at enrollment.

CONCLUSIONS

Determination of characteristics associated with decrements in balance, gait speed, and chair-stand can assist clinicians to identify older oncology patients at risk for decrements in PF. Interventions to maintain and improve PF need to be implemented with higher risk patients.