Cognitive impairment ups risk of severe chemotherapy toxicities in elderly cancer patients

Cognitive impairment in elderly cancer patients appear to increase the risk of severe toxicities related to chemotherapy, reports a recent study.

Accessing the Cancer and Aging Research Group (CARG) Chemotherapy Toxicity Risk tool, researchers retrieved data of 703 elderly cancer patients (aged ≥65 years; 56.6 percent female). The Blessed Orientation-Memory-Concentration (BOMC) test was used to assess cognition, and scores in the range of 5–10 were considered as putative cognitive impairment.

Of the participants, 36 percent (n=250) had potential cognitive impairment, while evidence of severe chemotherapy toxicity was reported in 54.8 percent (n=385). Toxicity was significantly more common among patients with potential cognitive impairment (61.6 percent vs 51.0 percent; p<0.01).

Univariate logistic regression analysis found a statistically significant increase in risk of severe toxicity associated with cognitive impairment (odds ratio [OR], 1.54; p<0.01). Adjusting for the CARG tool, however, attenuated this relationship (OR, 1.35, p=0.08).

The effect of cognitive impairment on toxicity was especially strong in participants who only had a high school education or lower (OR, 1.87, p=0.03). No interactions with race and ethnicity were reported.

In the present study, majority of the participants had stage III or IV cancers (81.1 percent) and most had at least a college or advanced degree (63.2 percent). The mean BOMC score was 3.9±3.3, which was slightly but significantly higher in those with severe chemotherapy toxicities (4.1±3.4 vs 3.6±3.1; p=0.05).

“These results support screening for cognitive impairment in older adults with cancer and lower education level before receiving chemotherapy,” said researchers. “Future studies are needed to validate these findings, as well as evaluate potential interventions to address cognitive deficits.”