化疗期间癌症患者认知症状的筛查：单项自我报告认知变化评分的敏感性和特异性。
Screening for cognitive symptoms among cancer patients during chemotherapy: Sensitivity and specificity of a single item self-report cognitive change score.
机构信息
Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
Western Sydney Youth Cancer Service, Westmead Hospital, Sydney, New South Wales, Australia.
出版信息
Psychooncology. 2022 Aug;31(8):1294-1301. doi: 10.1002/pon.5928. Epub 2022 Mar 30.
OBJECTIVES
Cognitive symptoms are commonly reported among cancer patients and survivors, yet guidance on when self-reported cognitive symptoms warrant follow-up is lacking. We sought to establish cut-off scores for identifying patients with perceived low cognitive functioning on widely used self-report measures of cognition and a novel single item Cognitive Change Score.
METHODS
Adult patients diagnosed with invasive cancer who had completed at least one cycle of chemotherapy completed a questionnaire containing the EORTC-Cognitive Function (CF) subscale, Functional Assessment of Cancer Therapy-Cognitive Function (FACT-COG) Perceived Cognitive Impairment (PCI) and our Cognitive Change Score (CCS). We used receiver operating characteristic analyses to establish the discriminative ability of these measures against the Patient's Assessment of Own Functioning Inventory (PAOFI) as our reference standard. We chose cut-off scores on each measure that maximised both sensitivity and specificity for identifying patients with self-reported low CF.
RESULTS
We recruited 294 participants (55.8% women, mean age 56.6 years) with mixed cancer diagnoses (25.5 months since diagnosis). On the CCS, 77.6% reported some cognitive change since starting chemotherapy. On the PAOFI 36% had low CF. The following cut-off scores identified cases of low CF: ≥28.5 on the CCS (75.5% sensitivity, 67.6% specificity); ≤75.0 on the European Organisation for Research and Treatment of Cancer, QLQ-C30 Cognitive Functioning scale (90.9% sensitivity, 57.1% specificity); ≤55.1 on the FACT-COG PCI-18 (84.8% sensitivity, 76.2% specificity), and ≤59.5 on the FACT-COG PCI-20 (78.8% sensitivity, 84.1% specificity).
CONCLUSIONS
We found a single item question asking about cognitive change has acceptable discrimination between patients with self-reported normal and low CF when compared to other more comprehensive self-report measures of cognitive symptoms. Further validation work is required.
目的
认知症状在癌症患者和幸存者中较为常见，但缺乏关于何时需要随访自我报告的认知症状的指导。我们试图为广泛使用的认知自我报告测量和新的单一认知变化评分确定识别感知认知功能低下的患者的截止分数。
方法
完成至少一个周期化疗的诊断为浸润性癌症的成年患者完成了一份问卷，其中包含欧洲癌症研究与治疗组织认知功能（CF）子量表、癌症治疗功能评估-认知功能（FACT-COG）感知认知障碍（PCI）和我们的认知变化评分（CCS）。我们使用接收者操作特征分析来确定这些测量与我们的参考标准患者自身功能评估量表（PAOFI）的区分能力。我们选择了每个测量的截止分数，这些分数可以最大化对自我报告 CF 低的患者的敏感性和特异性。
结果
我们招募了 294 名参与者（55.8%为女性，平均年龄为 56.6 岁），他们的癌症诊断种类繁多（诊断后 25.5 个月）。在 CCS 上，77.6%的人报告自化疗开始以来认知发生了变化。在 PAOFI 上，有 36%的人 CF 低。以下截止分数可识别 CF 低的病例：CCS 上的≥28.5（75.5%的敏感性，67.6%的特异性）；欧洲癌症研究与治疗组织，QLQ-C30 认知功能量表上的≤75.0（90.9%的敏感性，57.1%的特异性）；FACT-COG PCI-18 上的≤55.1（84.8%的敏感性，76.2%的特异性），FACT-COG PCI-20 上的≤59.5（78.8%的敏感性，84.1%的特异性）。
结论
我们发现，与其他更全面的认知症状自我报告测量相比，询问认知变化的单个项目问题在自我报告的正常和低 CF 患者之间具有可接受的区分能力。需要进一步的验证工作。
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