Assessment of Cancer-Related Cognitive Decline in an Inpatient Oncology Population

Cancer related cognitive decline (CRCD) can negatively affect participation in activities of daily living and overall quality of life, however CRCD is not well characterized (Jean Pierre & McDonald, 2016). Evidence for CRCD in the common non–central nervous system (non-CNS) cancers has significantly expanded the issue, with research suggesting that cognitive changes are caused by multiple factors. In light of this, research has shifted toward addressing the impact of factors correlated to long-term cognitive decline, include pain, anxiety, depression, and physical function in oncology patients (Matuoka, Kurita, Nordly, Sjøgren, & de Mattos-Pimenta, 2019). Systematic cognitive assessment is not routine in clinical practice, possibly due to the lack of easily applied assessment tools as well as the subtlety of symptoms. One clinically applicable tool is the Trail Making Test Part B (TMTB), which has been identified as specific, sensitive, and reliable in the oncology population (Kurita et al., 2018). Normative data for the TMTB has also been established and stratified by age, increasing the clinical utility of this tool (Tombaugh, 2004). Correlational factors can be measured using the EQ-5D-5L Health Questionnaire (EQ-5D-5L) and Visual Analog Scale (VAS), due to their subjective nature and clinical utility. In order to broaden the clinical understanding of CRCD, the objectives of this project were twofold: (i) to identify the prevalence of cancer related cognitive decline (CRCD) in an inpatient hospital using the Trail Making Test Part B (TMTB), and (ii) to identify quantitative differences between individuals experiencing CRCD and those scoring within normal limits (WNL). Participants were drawn from a convenience sample on multiple oncology units in a 750 bed urban academic medical center, and were included if they were alert and oriented x4 and following simple commands. Participants were excluded if: they had baseline vision/hearing deficits; English was not their primary language; had known neurotoxicity or documented CNS involvement. Participants were evaluated by one of two OTs using the TMTB, EQ-5D-5L, and VAS. TMTB scores were recorded and compared to age stratified norms to determine clinically relevant differences. Participants were classified as within normal limits (WNL), or impaired, based on these norms. Averages were calculated to determine differences in length of stay, and an unpaired t test was conducted to compare differences between the WNL group and the impaired group on EQ-5D-5L and VAS scores. Of the 50 participants (27 female, age range 24-80), 4 terminated TMTB testing; 3 expired prior to discharge from the acute hospital setting. Of those completing the TMTB, 70% (n = 32) scored outside of their age stratified norms (BNL group). Only 53.33% of the BNL group received post-acute care services (PAC) at discharge as compared to 35.71% in the WNL group. Differences between WNL and beyond normal limits (BNL) were compared by averaging scores on the EQ-5D-5L in 33 participants, gleaning the following data: EQ-5D-5L VAS WNL = 62, BNL = 67.32; mobility WNL = 1.20, BNL = 1.61; self-care WNL = 1.20, BNL = 1.26; usual activity WNL = 1.70, BNL = 2.26; pain WNL = 1.60, BNL = 2.26; anxiety WNL = 1.70, BNL = 1.74. No significant differences were appreciated between BNL and WNL in EQ-5D-5L scores. This project demonstrates the prevalence of CRCD in a hospitalized oncology population, despite minimal reported differences in pain, anxiety, and physical function. The majority of patients with documented CRCD discharged home without additional therapy services. This project offers OT evaluation methods for cognitive dysfunction and related factors, as well as discharge trends in an inpatient oncology population.

References

Jean-Pierre, P., & McDonald, B. C. (2016). In Aminoff M. J., Boller F. and Swaab D. F. (Eds.), Chapter 17 - neuroepidemiology of cancer and treatment-related neurocognitive dysfunction in adult-onset cancer patients and survivors Elsevier. https://doi.org///doi.org/10.1016/B978-0-12-802973-2.00017-3

Kurita, G. P., Sandvad, M., Lundorff, L., De Mattos-Pimenta, C. A., Hojsted, J., & Sjogren, P. (2018). Assessment of cognitive function in patients with metastatic cancer: Are we using the right tools? Palliative & Supportive Care, 16(1), 80-89. https://doi.org/10.1017/S1478951517000694 [doi]

Matuoka, J. Y., Kurita, G. P., Nordly, M., Sjøgren, P., & de Mattos-Pimenta, C. A. (2019). Validation of a battery of neuropsychological tests for patients with metastatic cancer. Clinical Nursing Research, https://doi.org/10.1177/1054773819831210

Tombaugh, T. N. (2004). Trail making test A and B: Normative data stratified by age and education. Archives of Clinical Neuropsychology: The Official Journal of the National Academy of Neuropsychologists, 19(2), 203-214. https://doi.org/10.1016/S0887-6177(03)00039-8 [doi]