Division of Hematology/Oncology, Department of Medicine, San Francisco Veterans Affairs Medical Center, California.
Helen Diller Family Comprehensive Cancer Center, University of California San Francisco.
JAMA Netw Open. 2024 Aug 1;7(8):e2431057. doi: 10.1001/jamanetworkopen.2024.31057.
More people are surviving long-term after diagnosis with hematologic malignant neoplasm (HMN), yet there are limited data on cancer-related cognitive impairment in people with HMN. Better understanding cognitive outcomes after HMN in older adults is important for patient counseling and management.
To model cognitive trajectories and rates of cognitive decline before and after HMN diagnosis in older adults compared with a matched noncancer cohort.
DESIGN, SETTING, AND PARTICIPANTS: In this population-based cohort study, older adults from the Health and Retirement Study (HRS) diagnosed with HMN between 1998 and 2016 after age 65 years were matched 1:3 to participants without cancer from the same HRS wave using propensity scores incorporating variables relevant to cognition. Cognitive trajectories were modeled with piecewise linear splines, and rates of cognitive decline before, during, and after diagnosis were compared in the 2 groups. Data were analyzed from April 2022 to April 2024.
HMN diagnosis by Medicare diagnosis codes.
Cognitive function was assessed by the Langa-Weir cognitive summary score from 1992 to 2020. Sociodemographic and health-related variables relevant to cognition were incorporated into propensity scores.
At baseline, there were 668 participants in the HMN cohort (mean [SD] age, 76.8 [7.6] years; 343 [51.3%] male; 72 [10.8%] Black, 33 [4.9%] Hispanic, and 585 [87.6%] White) and 1994 participants in the control cohort (mean [SD] age, 76.5 [7.3] years; 1020 [51.2%] male; 226 [11.3%] Black, 91 [4.6%] Hispanic, and 1726 [86.6%] White). The HMN cohort consisted predominantly of more indolent diagnoses, and only 96 patients (14.4%) received chemotherapy. Before and in the 2 years around the time of diagnosis, the HMN and control cohorts had similar rates of cognitive decline. At 1 year postdiagnosis and beyond, the rate of cognitive decline was slower in the HMN cohort (-0.18; 95% CI, -0.23 to -0.14) than in the control group (-0.24; 95% CI, -0.26 to -0.23) (P = .02), but this difference was no longer significant after accounting for the competing risk of death (HMN group, -0.27; 95% CI, -0.34 to -0.19; control group, -0.30; 95% CI, -0.33 to -0.27; P = .48).
In this cohort study of older adults, the HMN and matched noncancer control cohorts had similar rates of cognitive decline before, during, and after diagnosis after accounting for the competing risk of death.
越来越多的人在诊断出血液恶性肿瘤（HMN）后能够长期存活，但关于 HMN 患者的癌症相关认知障碍的数据有限。更好地了解老年人 HMN 后的认知结果对于患者咨询和管理很重要。
在与癌症无关的匹配队列中，比较老年患者 HMN 诊断前后的认知轨迹和认知下降率。
设计、地点和参与者：在这项基于人群的队列研究中，年龄在 65 岁及以上、1998 年至 2016 年间被诊断患有 HMN 的 HRS 参与者与同一 HRS 波次中无癌症的参与者按倾向得分进行 1:3 匹配，该倾向得分纳入了与认知相关的变量。使用分段线性样条模型来建模认知轨迹，并比较两组在诊断前、诊断中和诊断后的认知下降率。数据分析于 2022 年 4 月至 2024 年 4 月进行。
医疗保险诊断代码诊断的 HMN。
认知功能通过 1992 年至 2020 年的 Langa-Weir 认知综合评分进行评估。将与认知相关的社会人口学和健康相关变量纳入倾向得分。
在基线时，HMN 队列中有 668 名参与者（平均[标准差]年龄，76.8[7.6]岁；343[51.3%]为男性；72[10.8%]为黑人，33[4.9%]为西班牙裔，585[87.6%]为白人），对照组中有 1994 名参与者（平均[标准差]年龄，76.5[7.3]岁；1020[51.2%]为男性；226[11.3%]为黑人，91[4.6%]为西班牙裔，1726[86.6%]为白人）。HMN 队列主要由惰性诊断组成，只有 96 名患者（14.4%）接受了化疗。在诊断前和诊断前后的 2 年中，HMN 和对照组的认知下降率相似。在诊断后 1 年及以后，HMN 队列的认知下降速度较慢（-0.18；95%CI，-0.23 至-0.14），而对照组的认知下降速度较快（-0.24；95%CI，-0.26 至-0.23）（P=0.02），但在考虑死亡的竞争风险后，这种差异不再显著（HMN 组，-0.27；95%CI，-0.34 至-0.19；对照组，-0.30；95%CI，-0.33 至-0.27；P=0.48）。
在这项针对老年人的队列研究中，在考虑死亡的竞争风险后，HMN 和匹配的非癌症对照组在诊断前、诊断中和诊断后具有相似的认知下降率。
