Older Patients, Cognitive Impairment, and Cancer: An Increasingly Frequent Triad

Author:
Martine Extermann University of South Florida, Senior Adult Oncology Program, H. Lee Moffitt Cancer Center, Tampa, Florida

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Volume/Issue:
Volume 3: Issue 4
Online Publication Date:
Jul 2005
DOI:
https://doi.org/10.6004/jnccn.2005.0033
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The incidence of both cancer and cognitive impairments from various origins increases with age. Oncologists are increasingly being confronted with cancers occurring in patients with cognitive impairment, yet very few studies have addressed the problem. Cognitive impairment affects a patients' survival to an extent similar to an average cancer, and this can be an important thing to consider, especially in the adjuvant setting. Cognitive impairment also predisposes patients to delirium in the surgery setting or during hospitalization. Because effective preventive measures exist, careful attention should be paid to identifying patients at risk. Cognitive impairment does not automatically mean inability to consent, but particular precautions should be taken. For outpatient treatments such as chemotherapy, a comprehensive multidisciplinary approach is key for a good outcome. Proper caregiver support should be ensured upfront, and aggressive supportive care should be used. In the setting of an experienced geriatric oncology team, patients with cognitive impairment appear more likely to receive standard oncologic therapies. Cancer patients with cognitive impairment are at high risk of concomitant depression.

Correspondence: Martine Extermann, MD, Departments of Oncology and Medicine, University of South Florida, and Senior Adult Oncology Program, H. Lee Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612. E-mail: extermann@moffitt.usf.edu
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Print ISSN:
1540-1405
Online ISSN:
1540-1413
Publisher:
National Comprehensive Cancer Network
Cover Journal of the National Comprehensive Cancer Network
  • 1

    Extermann M, Aapro M. Assessment of the older cancer patient. Hematol Oncol Clin North Am 2000;14:63–78.

  • 2

    Nguyen HT, Black SA, Ray LA et al.. Cognitive impairment and mortality in older Mexican Americans. J Am Geriatr Soc 2003;51:178–183.

  • 3

    Callen L, Vranas P, Overcash J et al.. Survival and patterns of care in older patients with cognitive impairment. 5th meeting of the International Society of Geriatric Oncology, San Francisco, October 15–16, 2004.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Chodosh J, Petitti DB, Elliott M et al.. Physician recognition of cognitive impairment: evaluating the need for improvement. J Am Geriatr Soc 2004;52:1051–1059.

  • 5

    Reuben DB, Herr KA, Pacala JT et al.. Geriatrics at your Fingertips, 6th ed. New York: American Geriatrics Society; 2004.

  • 6

    Folstein MF, Folstein SE, McHugh PR: Mini Mental State: a practical method for grading the cognitive status of patients for the clinician. J Psychiat Res 1975;12:189–198.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Lorentz WJ, Scanlan JM, Borson S. Brief screening instruments for dementia. Can J Psychiatry 2002;47,723–733.

  • 8

    Salmon DP, Thal LJ, Butters N, Heindel WC. Longitudinal evaluation of dementia of the Alzheimer type: a comparison of 3 standardized mental status examinations. Neurology 1990;l40:1225–1230.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Esteban-Santillan C, Praditsuwan R, Ueda H, Geldmacher DS. Clock drawing test in very mild Alzheimer's disease. J Am Geriatr Soc 1998;46:1266–1269.

  • 10

    Borson S, Scanlan J, Brush M et al.. The mini-cog: a cognitive ‘vital signs’ measure for dementia screening in multilingual elderly. Int J Geriatr Psychiatry. 2000;15:1021–1027.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Duff Canning SJ, Leach L, Stuss D et al.. Diagnostic utility of abbreviated fluency measures in Alzheimer disease and vascular dementia. Neurology 2004;62:556–562.

  • 12

    Gupta SK, Lamont EB. Patterns of presentation, diagnosis, and treatment in older patients with colon cancer and comorbid dementia. J Am Geriatr Soc 2004;52:1681–1687.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Marcantonio ER, Goldman L, Mangione CM et al.. A clinical prediction rule for delirium after elective noncardiac surgery. JAMA 1994;271:134–139.

  • 14

    Inouye SK, Viscoli CM, Horwitz RI et al.. A predictive model for delirium in hospitalized elderly medical patients based on admission characteristics. Ann Intern Med 1993;119:474–481.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Inouye SK, Bogardus ST Jr, Charpentier PA et al.. A multi-component intervention to prevent delirium in hospitalized older patients. N Engl J Med 1999;340:669–676.

  • 16

    Keller SM, Markovitz LJ, Wilder JR et al.. Emergency and elective surgery in patients over age 70. Am Surg 1987;53:636.

  • 17

    Balducci L, Lyman GH. Patients aged > or = 70 are at high risk for neutropenic infection and should receive hemopoietic growth factors when treated with moderately toxic chemotherapy. J Clin Oncol 2001;19:1583–1585.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Aldemir M, Ozen S, Kara IH, Sir A, Bac B. Predisposing factors for delirium in the surgical intensive care unit. Crit Care 2001;5:265–270.

  • 19

    Matsui K, Masuda N, Uchida Y et al.. Determinants of myelosuppression in the treatment of non-small cell lung cancer with cisplatin-containing chemotherapy. Jpn J Cancer Res 1996;87:781–786.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Extermann M, Chen H, Cantor AB et al.. Predictors of tolerance to chemotherapy in older cancer patients: a prospective pilot study. Eur J Cancer 2002;38:1466–1473.

Copyright:
Copyright © 2005 by the National Comprehensive Cancer Network 2005
Page Numbers:
4
Article Category:
Research Article
Received:
07 May 2005
Accepted:
17 Jun 2005
Print Publication Date:
01 Jul 2005
Online Publication Date:
Jul 2005
Keywords:
Carcinoma; aged; cognitive impairment; dementia; decision making; cancer treatment; delirium; dementia screening; informed consent

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