Work

Pre-Transplant Cognitive Dysfunction in Hematologic Cancers, Predictors and Associated Outcomes

Year: 2018

Type: article

Abstract: Background: Patients presenting for treatment of hematologic cancers may be at increased risk for cognitive dysfunction before allogenic hematopoietic stem cell transplantation (HSCT). Potentially significant risk factors include advanced age, treatment with multiple chemotherapy agents prior to transplant, physical deconditioning, and fatigue. Potential cognitive dysfunction or frank impairment may affect treatment decision-making or ability to recall and/or follow post-HSCT treatment-plan recommendations, which may impact medication and treatment adherence post-discharge, and thus overall survival (OS). As such, clarification of potential pre-HSCT cognitive dysfunction is an important goal to guide treatment planning, to potentially enlist care-givers for compensatory support, for provision of cognitive rehabilitation, and to enhance monitoring post-discharge. Methods: We assessed 420 patients admitted for planned HSCT from 2012-2016 who were screened by occupational therapy with the Montreal Cognitive Assessment (MOCA) screening measure to characterize cognitive function within 5 days of admission. We examined select predictor variables, including age, Karnofsky Performance Status (KPS), gender, disease type, and psychotropic medication use. We additionally examined select outcome variables, including 100-day OS and non-relapse mortality (NRM), to assess the relationship of cognitive dysfunction with treatment outcomes. Results: Prior to transplant, 36.4% of patients met criteria for cognitive dysfunction as indicated by a MOCA total score <26. Significant predictors of cognitive dysfunction included increasing age (P = .003) and trend significant association with KPS score (P = .09). No effects of gender, disease type, or psychotropic medication use were found. With regard to outcomes, no significant association was found between cognitive dysfunction and 100-day OS post-discharge or NRM. Conclusion: Results of this study indicate that a significant proportion of patients awaiting transplant present upon admission with cognitive dysfunction and that older patients or patients with reduced KPS score may be at greater risk. Greater attention to potential cognitive dysfunction prior to transplant, and identification of those patients most at risk, may alert the treatment team to cases in which greater attention, oversight, and inclusion of caregivers in post-discharge care and recommendations for outpatient occupational therapy follow up is most required. Longitudinal follow-up studies are needed to clarify variables that increase risk for cognitive dysfunction and to track cognitive changes following transplant with reassessment.

Source: Transplantation and Cellular Therapy

DOI: 10.1016/j.bbmt.2017.12.354