Kurita Geana Paula, Benthien Kirstine Skov, Sjøgren Per, Kaasa Stein, Hjermstad Marianne Jensen
Palliative Research Group, Department of Oncology, Rigshospitalet-Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark.
Multidisciplinary Pain Centre, Department of Neuroanaesthesiology, Rigshospitalet-Copenhagen University Hospital, Copenhagen, Denmark.
Support Care Cancer. 2017 Mar;25(3):941-949. doi: 10.1007/s00520-016-3485-7. Epub 2016 Nov 10.
Studies with neuropsychological assessments in patients with cancer are sparse, and the evidence is very limited regarding their status of cognitive function over time. This study aimed at assessing the prevalence and predictors of cognitive impairment in patients with cancer in palliative care.
Prospective longitudinal investigation derived from the European Palliative Care Cancer Symptom study (2011-2013) including patients with cancer in palliative care, ≥18 years, and with at least one assessment post-inclusion. For cognitive assessment, a 4-item version of the Mini Mental State Examination was applied at inclusion and after 4 to 16 weeks. Logistic regression model with multiple imputations was applied.
The sample consisted of 1568 patients (50% male, mean age 65.5, 42% with 10-12 years schooling, mean Karnofsky Performance Status-KPS 68%). Longitudinal analysis of the patients with complete MMSE at both assessments (n = 801) showed that 64.5% were not impaired, 12.5% remained cognitively impaired, 11.4% developed impairment, and 11.6% improved. Those who improved cognitively also reported reduced pain intensity and increased appetite. The predictive model (n = 1351) showed that those with low KPS (OR = 1.6, 95% CI 1.0-2.5) most often developed cognitive impairment, while patients with breast cancer (OR = 0.4, 95% CI 0.2-0.7) had lower odds for impairment.
During palliative care, a substantial number of patients remained cognitively impaired or developed cognitive impairment; however, it is noteworthy that improvement was also observed. Physical performance and cancer type may predict cognitive impairment.
针对癌症患者进行神经心理学评估的研究较少，关于其认知功能随时间变化状况的证据非常有限。本研究旨在评估姑息治疗中癌症患者认知障碍的患病率及预测因素。
该前瞻性纵向研究源自欧洲姑息治疗癌症症状研究（2011 - 2013年），纳入了处于姑息治疗阶段、年龄≥18岁且纳入后至少有一次评估的癌症患者。认知评估采用简易精神状态检查表的4项版本，在纳入时及4至16周后进行。应用多重填补的逻辑回归模型。
样本包括1568名患者（50%为男性，平均年龄65.5岁，42%接受过10 - 12年教育，卡氏功能状态评分平均为68%）。对两次评估时MMSE完整的患者（n = 801）进行纵向分析显示，64.5%无认知障碍，12.5%仍存在认知障碍，11.4%出现认知障碍，11.6%有所改善。认知功能改善的患者还报告疼痛强度降低且食欲增加。预测模型（n = 1351）显示，卡氏功能状态评分低的患者（比值比=1.6，95%置信区间1.0 - 2.5）最常出现认知障碍，而乳腺癌患者（比值比=0.4，95%置信区间0.2 - 0.7）出现认知障碍的几率较低。
在姑息治疗期间，相当数量的患者仍存在认知障碍或出现认知障碍；然而，值得注意的是也观察到了改善情况。身体状况和癌症类型可能预测认知障碍。
