Radboud University Medical Center, Donders Centre for Medical Neuroscience, Department of Medical Psychology, Nijmegen, the Netherlands.
Radboud University, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognition, Nijmegen, the Netherlands.
JAMA Otolaryngol Head Neck Surg. 2019 Mar 1;145(3):251-257. doi: 10.1001/jamaoto.2018.3981.
Head and neck cancer (HNC) and its treatment may negatively alter neurocognitive and speech functioning. However, the prevalence of neurocognitive impairment among patients with HNC before treatment is poorly studied, and the association between neurocognitive and speech functioning is unknown, which hampers good interpretability of the effect of HNC treatment on neurocognitive and speech function.
To document neurocognitive functioning in patients with HNC before treatment and to investigate the association between neurocognitive and speech functioning.
DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study of newly diagnosed patients with HNC before treatment using a large sample obtained in a nationwide, multicenter setting (Netherlands Quality of Life and Biomedical Cohort Study in Head and Neck Cancer [NET-QUBIC] project).
Objective neuropsychological measures of delayed recall, letter fluency, and executive functioning, as well as patient-reported outcome measures on neurocognitive speech and functioning, were collected before treatment.
In total, 254 patients with HNC participated (71.7% male), with a mean (SD) age of 62 (10) years. The response rate ranged from 81.9% (208 of 254) to 84.6% (215 of 254). Objective neurocognitive measures indicated that 4.7% (10 of 212) to 15.0% (32 of 214) of patients were initially seen with moderate to severe cognitive impairment. Mild to moderate impairment was found in 12.3% (26 of 212) to 26.2% (56 of 214) of patients. The most altered domains were delayed recall and letter fluency. Seven percent (15 of 208) of the patients reported high levels of everyday neurocognitive failure, and 42.6% (89 of 209) reported speech problems. Objective neurocognitive function was not significantly associated with patient-reported neurocognitive or speech functioning, but the results from patient-reported outcome measures were significantly correlated.
Results of this study demonstrate a high prevalence of impaired speech functioning among patients with HNC before treatment, which is in line with previous findings. A novel finding is that neurocognitive impairment is also highly prevalent as objectively measured and as self-perceived. Understanding the reason why patients with HNC are initially seen with neurocognitive impairment before the start of treatment is important because this impairment may complicate patient-clinician interaction and alter treatment adherence and because treatment itself may further worsen cognitive functioning. In addition, low self-perceived neurocognitive and speech functioning before treatment may decrease a patient's confidence in communicative participation and perceived quality of life. Disentangling the associations between objective and patient-reported neurocognitive and speech functions is an important area for future research.
头颈部癌症（HNC）及其治疗可能会对神经认知和言语功能产生负面影响。然而，治疗前 HNC 患者神经认知障碍的患病率研究甚少，且神经认知和言语功能之间的关联也不清楚，这阻碍了对 HNC 治疗对神经认知和言语功能影响的良好解释。
在治疗前记录 HNC 患者的神经认知功能，并研究神经认知和言语功能之间的关系。
设计、地点和参与者：这是一项在全国多中心环境中（荷兰头颈部癌症生活质量和生物医学队列研究[NET-QUBIC]项目）使用大样本进行的新诊断 HNC 患者治疗前的前瞻性队列研究。
在治疗前收集了延迟回忆、字母流畅性和执行功能等客观神经心理学测量结果，以及患者报告的神经认知言语和功能的结果测量。
共有 254 例 HNC 患者（71.7%为男性）参与，平均（SD）年龄为 62（10）岁。应答率范围为 81.9%（208/254）至 84.6%（215/254）。客观神经认知测量结果表明，4.7%（10/212）至 15.0%（32/214）的患者最初表现出中度至重度认知障碍。12.3%（26/212）至 26.2%（56/214）的患者存在轻度至中度损害。改变最明显的领域是延迟回忆和字母流畅性。7%（15/208）的患者报告有较高水平的日常神经认知失败，42.6%（89/209）的患者报告有言语问题。客观神经认知功能与患者报告的神经认知或言语功能无显著相关性，但患者报告的结果测量结果显著相关。
本研究结果表明，治疗前 HNC 患者的言语功能障碍患病率较高，这与之前的研究结果一致。一个新发现是，神经认知障碍也像客观测量和自我感知一样普遍存在。了解为什么 HNC 患者在开始治疗前就出现神经认知障碍的原因很重要，因为这种障碍可能会使患者与临床医生的互动复杂化，并改变治疗的依从性，而且治疗本身也可能进一步恶化认知功能。此外，治疗前患者自我感知的神经认知和言语功能较差可能会降低患者对交流参与和感知生活质量的信心。阐明客观和患者报告的神经认知和言语功能之间的关联是未来研究的一个重要领域。
