Abstract
Cancer-related cognitive decline is not well understood in the oncology population, and evaluation for cognitive dysfunction while inpatient is not routine. The aims of this project are to: (1) identify the prevalence of CRCD in an inpatient hospital utilizing the Trail Making Test Part B, and (2) identify differences between individuals experiencing CRCD and those scoring within normal limits.
Primary Author and Speaker: Erika Dobson
Additional Authors and Speakers: Malarie Molinari
Cancer related cognitive decline (CRCD) can negatively affect participation in routine 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 patients with metastatic cancer (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, thus 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 and related factors, 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 over the course of 9 months, and were included if they were alert and oriented x4 and were able to follow 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 in order to determine clinically relevant differences. Of the 50 participants (23 males, age range 24-80), 4 terminated TMTB testing due to reports of increased anxiety, and 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), requiring an average of 43.87 seconds longer. 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 35 participants, gleaning the following data: EQ-5D-5L VAS WNL= 63.94, BNL= 63.66; mobility WNL= 1.63, BNL = 1.69; self-care WNL= 1.38, BNL = 1.38; usual activity WNL =2.22, BNL = 2.17; pain WNL = 2.10, BNL = 2.17; anxiety WNL = 1.81, BNL = 1.76. 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 observable differences in factors related to cognition including 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 highlights the underutilization of occupational therapy services in the oncology population.
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