Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri.
Program in Occupational Therapy & Department of Neurology, Washington University School of Medicine in St Louis, St Louis, Missouri.
JAMA Otolaryngol Head Neck Surg. 2018 Nov 1;144(11):978-987. doi: 10.1001/jamaoto.2018.0283.
Cognitive dysfunction (CD) is recognized by the American Cancer Society as a treatment effect in head and neck cancer, but the extent of this problem at baseline in oropharyngeal cancer (OPC), the most common subsite in current practice, to our knowledge has never been studied.
To assess the baseline cognition of patients with OPC using National Institutes of Health (NIH)-sponsored instruments of Patient-Reported Outcomes Measurement Information System (PROMIS) and NIH Toolbox Cognitive Battery (NIHTB-CB).
DESIGN, SETTING, AND PARTICIPANTS: This was a prospective cohort study conducted at a tertiary academic center. Of 83 consecutive patients, newly diagnosed as having OPC from September 2016 to May 2017, 16 were ineligible, 8 refused to participate, and 3 were lost to follow-up after screening, resulting in 56 study participants.
Self-perceived and objective cognition with PROMIS and NIHTB-CB standardized T scores, respectively, were main outcomes. Impairment was defined as (1) T scores less than 0.5 SD for PROMIS; (2) T score less than 1.5 SD in at least 1 cognitive domain or less than 1 SD in 2 or more domains for NIHTB-CB total cognition; and (3) T score per previously published criteria for NIHTB-CB intelligence-stratified cognition.
Of the 56 study participants (52 men, 4 women; median age, 59 years [range, 42-77 years]), 19 (34%) had a college degree, and 20 (36%) had a professional or technical occupation. Thirty (about 53%) were never-smokers, 26 (46%) were never-drinkers, 29 (52%) were obese, 13 (23%) had a moderate to severe comorbidity, 3 (5%) used antidepressants, and 25 (52%) had hearing loss. Impaired self-reported, NIHTB-CB total, and intelligence-stratified cognition scores were observed in 6 (11%), 18 (32%), and 12 (21%), respectively. Among all variables, objective impairment was more common in men (23% vs 0%) and those with p16-negative OPC (33% vs 20%), moderate to severe comorbidity (31% vs 18%), and hearing loss (31% vs 12%).
Impaired objective cognition was more common at baseline than self-reported, and was more frequent in men, participants with p16-negative OPC, moderate to severe comorbidity, and hearing loss. NIHTB-CB allowed immediate scoring of demographically adjusted cognitive function. In clinical practice, these scores can be used to identify patients with impaired cognition at baseline who may be susceptible to developing further impairment after treatment. Identification of impairment at baseline will help to institute early cognitive interventions, which may lead to an improved posttreatment quality of life.
重要性：美国癌症协会将认知功能障碍（CD）视为头颈部癌症的一种治疗效果，但目前在口腔癌（OPC）中，这一问题在基线时的严重程度我们并不清楚。OPC 是目前最常见的亚部位。
目的：使用美国国立卫生研究院（NIH）赞助的患者报告的结果测量信息系统（PROMIS）和 NIH 工具包认知电池（NIHTB-CB）评估 OPC 患者的基线认知能力。
设计、地点和参与者：这是一项在三级学术中心进行的前瞻性队列研究。2016 年 9 月至 2017 年 5 月，83 例新诊断为 OPC 的连续患者中，有 16 例不合格，8 例拒绝参与，3 例在筛选后失访，最终有 56 例研究参与者。
主要结局和测量：自我感知和客观认知分别采用 PROMIS 和 NIHTB-CB 标准化 T 分数表示，是主要结局。损害定义为：（1）PROMIS 中 T 分数低于 0.5 个标准差；（2）NIHTB-CB 总认知中至少 1 个认知域的 T 分数低于 1.5 个标准差或 2 个或更多域的 T 分数低于 1 个标准差；（3）根据之前发表的 NIHTB-CB 智力分层认知标准的 T 分数。
结果：在 56 名研究参与者（52 名男性，4 名女性；中位年龄 59 岁[范围，42-77 岁]）中，19 名（34%）具有大学学历，20 名（36%）具有专业或技术职业。约 53%的人从不吸烟，46%的人从不饮酒，52%的人肥胖，23%的人有中度至重度合并症，3%的人使用抗抑郁药，52%的人有听力损失。分别有 6 名（11%）、18 名（32%）和 12 名（21%）患者出现自我报告、NIHTB-CB 总认知和智力分层认知评分受损。在所有变量中，男性（23%比 0%）和 p16 阴性 OPC（33%比 20%）、中度至重度合并症（31%比 18%）和听力损失（31%比 12%）患者的客观损害更常见。
结论和相关性：与自我报告相比，基线时的客观认知障碍更为常见，且在男性、p16 阴性 OPC、中度至重度合并症和听力损失患者中更为常见。NIHTB-CB 允许对人口统计学调整后的认知功能进行即时评分。在临床实践中，这些分数可用于识别基线时认知受损的患者，这些患者在治疗后可能更容易进一步受损。在基线时识别到损害有助于早期实施认知干预，从而可能改善治疗后的生活质量。
