Williams Amy M, Lindholm Jamie, Siddiqui Farzan, Ghanem Tamer A, Chang Steven S
1 Henry Ford Health System, Department of Otolaryngology, Head and Neck Surgery, Detroit, Michigan, USA.
2 Henry Ford Health System, Department of Neurology, Division of Speech-Language Sciences and Disorders, Detroit, Michigan, USA.
Otolaryngol Head Neck Surg. 2017 Nov;157(5):808-815. doi: 10.1177/0194599817709235. Epub 2017 Jun 6.
Objective Identify the prevalence and clinical correlates of cognitive impairment in patients presenting for treatment of head and neck cancer (HNC) using brief screening within a multidisciplinary care team. Study Design A case series with planned data collection of cognitive function, quality of life (QoL), and psychosocial variables. Setting Urban Midwest academic medical center. Subjects and Methods In total, 209 consecutive patients with a diagnosis of HNC between August 2015 and September 2016 who had a pretreatment assessment with a clinical health psychologist. At pretreatment assessment, the Montreal Cognitive Assessment (MoCA), a brief screening tool for cognitive function, was administered along with a semistructured interview to gather information on psychiatric symptoms, social support, and substance use. Patient information, including demographics, clinical variables, and psychosocial variables, was extracted via chart review. A subset of patients with HNC completed the Functional Assessment of Cancer Therapy-Head and Neck Cancer at pretreatment assessment and was included in the QoL analyses. Results Cognitive impairment was associated with current alcohol use, past tobacco use and number of pack years, time in radiotherapy, and adherence to treatment recommendations. Social, emotional, and functional QoL scales were associated with cognitive impairment, including executive function, language, and memory. Conclusion Cognitive impairment is common in patients with HNC, and there are important associations between cognitive impairment and psychosocial, QoL, and treatment adherence variables. The results argue for the incorporation of cognitive screening as part of pretreatment assessment for patients, as well as further research into more direct, causal relationships via longitudinal, prospective studies.
目的 通过多学科护理团队内的简短筛查，确定头颈癌（HNC）患者认知障碍的患病率及其临床相关因素。研究设计 一项病例系列研究，计划收集认知功能、生活质量（QoL）和心理社会变量的数据。研究地点 美国中西部城市的学术医疗中心。研究对象和方法 2015年8月至2016年9月期间，共有209例连续诊断为HNC的患者接受了临床健康心理学家的预处理评估。在预处理评估时，使用蒙特利尔认知评估量表（MoCA）这一认知功能简短筛查工具，并进行半结构化访谈，以收集有关精神症状、社会支持和物质使用的信息。通过病历审查提取患者信息，包括人口统计学、临床变量和心理社会变量。一部分HNC患者在预处理评估时完成了癌症治疗功能评估-头颈癌量表，并纳入生活质量分析。结果 认知障碍与当前饮酒、既往吸烟及吸烟包年数、放疗时间和对治疗建议的依从性有关。社会、情感和功能生活质量量表与认知障碍有关，包括执行功能、语言和记忆。结论 认知障碍在HNC患者中很常见，认知障碍与心理社会、生活质量和治疗依从性变量之间存在重要关联。研究结果支持将认知筛查纳入患者预处理评估的一部分，并通过纵向前瞻性研究进一步探究更直接的因果关系。
