Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.
Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
JAMA Netw Open. 2024 Aug 1;7(8):e2430833. doi: 10.1001/jamanetworkopen.2024.30833.
Psychosocial health services for adults with cancer should include support for cognitive symptoms and symptom clusters.
To characterize the frequency and severity of cognitive symptoms and to identify demographic and clinical risk factors associated with moderate to severe cognitive symptoms among outpatient adults with cancer seeking psychosocial support.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study analyzed data from routine patient-reported symptom screening during clinic appointments at the Princess Margaret Cancer Centre in Toronto, Canada, between January 1, 2013, and December 31, 2019. Participants were outpatient adults (aged ≥18 years) with diverse cancer diagnoses who endorsed interest in receiving psychosocial support from a health care team member. Data analysis was performed from April 2020 to June 2024.
The presence and severity of cognitive symptoms as self-rated by participants were characterized across 12 cancer types: brain or central nervous system (CNS), breast, gastrointestinal, head and neck, gynecological, thyroid, lung and bronchus, sarcoma, genitourinary, melanoma, hematological, and all other cancers. Multivariable logistic regression was used to explore the associations between demographic, clinical, and symptom factors and moderate to severe cognitive symptoms.
Across the sample of 5078 respondents (2820 females [55.5%]; mean [SD] age at time of survey, 56.0 [14.1] years) requesting psychosocial support, 3480 (68.5%) reported cognitive symptoms of any severity, ranging from 59.5% in sarcoma to 86.5% in brain or CNS cancer. Moderate to severe cognitive symptoms were reported by 1544 patients (30.4%), with the proportions being 51.3% for patients with brain or CNS, 37.0% for breast, 36.2% for thyroid, 30.9% for melanoma, 29.6% for head and neck, 28.3% for gastrointestinal, 28.2% for hematological, 28.1% for gynecological, 24.9% for lung and bronchus, 24.9% for sarcoma, 21.0% for genitourinary, and 26.8% for all other cancers. Across the entire sample, moderate to severe cognitive symptoms were associated with recurrence or progression involving the CNS (odds ratio [OR], 2.62; 95% CI, 1.80-3.81), depression (OR, 1.92; 95% CI, 1.59-2.31), tiredness (OR, 1.82; 95% CI, 1.52-2.19), drowsiness (OR, 1.64; 95% CI, 1.39-1.93), anxiety (OR, 1.57; 95% CI, 1.30-1.89), shortness of breath (OR, 1.38; 95% CI, 1.16-1.61), female sex (OR, 1.33; 95% CI, 1.14-1.56), first-line chemotherapy received (OR, 1.22; 95% CI, 1.05-1.41), and metastatic disease at diagnosis (OR, 0.74; 95% CI, 0.61-0.89). Within individual cancer types, tiredness and depression were consistently associated with moderate to severe cognitive symptoms.
This cross-sectional study found that cognitive symptoms were frequently reported by patients across a wide range of cancer types; higher severity of cognitive symptoms was consistently associated with higher symptom burden. The findings could be used to inform decision-making regarding access to cognitive screening, assessment, and supportive care in outpatient oncology clinics.
成人癌症患者的心理社会健康服务应包括对认知症状和症状群的支持。
描述认知症状的频率和严重程度，并确定与寻求心理社会支持的门诊癌症成人中中度至重度认知症状相关的人口统计学和临床风险因素。
设计、地点和参与者：这项横断面研究分析了 2013 年 1 月 1 日至 2019 年 12 月 31 日期间在加拿大多伦多玛格丽特公主癌症中心就诊时通过常规患者报告症状筛查获得的数据。参与者为年龄≥18 岁、患有各种癌症诊断且表示有兴趣接受医疗团队成员提供心理社会支持的门诊成年人。数据分析于 2020 年 4 月至 2024 年 6 月进行。
通过参与者自我报告的认知症状的存在和严重程度来描述 12 种癌症类型：脑或中枢神经系统（CNS）、乳房、胃肠道、头颈部、妇科、甲状腺、肺和支气管、肉瘤、泌尿生殖、黑色素瘤、血液学和所有其他癌症。多变量逻辑回归用于探讨人口统计学、临床和症状因素与中度至重度认知症状之间的关联。
在请求心理社会支持的 5078 名受访者（2820 名女性[55.5%]；调查时的平均[SD]年龄，56.0[14.1]岁）的样本中，3480 名（68.5%）报告了任何严重程度的认知症状，范围从肉瘤的 59.5%到脑或 CNS 癌症的 86.5%。1544 名患者（30.4%）报告了中度至重度认知症状，其中脑或 CNS 的比例为 51.3%、乳房为 37.0%、甲状腺为 36.2%、黑色素瘤为 30.9%、头颈部为 29.6%、胃肠道为 28.3%、血液学为 28.2%、妇科为 28.1%、肺和支气管为 24.9%、肉瘤为 24.9%、泌尿生殖为 21.0%、其他所有癌症为 26.8%。在整个样本中，中度至重度认知症状与涉及中枢神经系统的复发或进展（比值比[OR]，2.62；95%置信区间[CI]，1.80-3.81）、抑郁（OR，1.92；95%CI，1.59-2.31）、疲劳（OR，1.82；95%CI，1.52-2.19）、困倦（OR，1.64；95%CI，1.39-1.93）、焦虑（OR，1.57；95%CI，1.30-1.89）、呼吸急促（OR，1.38；95%CI，1.16-1.61）、女性（OR，1.33；95%CI，1.14-1.56）、接受一线化疗（OR，1.22；95%CI，1.05-1.41）和诊断时的转移性疾病（OR，0.74；95%CI，0.61-0.89）相关。在个别癌症类型中，疲劳和抑郁与中度至重度认知症状始终相关。
这项横断面研究发现，认知症状在广泛的癌症类型中经常被患者报告；认知症状的严重程度越高，与更高的症状负担一致。研究结果可用于为门诊肿瘤诊所的认知筛查、评估和支持性护理的决策提供信息。
