JNCI cancer spectrum · 2026
Prevalence of patient-reported and clinician-graded cognitive symptomatic adverse events in older patients with advanced cancer.
СтатьяМногоцентровое исследованиеРандомизированное исследованиеНазвание и аннотация: Перевод в очереди
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Alieldin Riham, Mohamed Mostafa, Li Chin-Shang, Janelsins Michelle C, Tylock Rachael, Mustian Karen M, Peppone Luke, Kamen Charles, Lin Po-Ju, Loh Kah Poh, Williams AnnaLynn M, Altman Brian J, Vertino Paula M, Sun Hongying, Gada Umang, Mohile Supriya G, Hopkins Judith O, Faller Bryan A, Vinciguerra Vincent, Magnuson Allison
Аннотация
PURPOSE: Cancer-related cognitive impairment is common in patients receiving cancer treatment but may be underdetected by clinician-graded adverse events (AEs) alone. Patient-reported outcomes and cognitive screening may improve identification of cognitive symptoms.
METHODS: We conducted a secondary analysis of the nationwide, multicenter GAP70+ trial of adults aged ≥70 years with advanced cancer starting systemic therapy. Cognitive symptoms were assessed longitudinally using patient-reported and clinician-graded cognitive AEs, and Mini-Cog screening at baseline, 4-6 weeks, 3 months, and 6 months. We examined prevalence, longitudinal trajectories, and associations with Mini-Cog impairment. Statistical significance was set at 2-sided P < .05.
RESULTS: Among 704 participants (mean age = 77.2 years; range = 70-96 years), patient-reported cognitive AEs were more prevalent than clinician-graded cognitive AEs at all time points: 19% vs 0.48% at 4-6 weeks, 18% vs 2.5% at 3 months, and 22% vs 0.44% at 6 months (all P < .001). Patient-reported cognitive AEs also fluctuated within patients over time. Impaired Mini-Cog was associated with higher patient-reported cognitive AEs at all post-baseline time points: 31% vs 15% at 4-6 weeks, 34% vs 14% at 3 months, and 49% vs 15% at 6 months (all P < .001). In contrast, associations with clinician-graded cognitive AEs were observed only at 3 months (P = .004) and 6 months (P = .04).
CONCLUSIONS: Cognitive symptomatic AEs are common and often underdetected by clinician grading alone in older adults with advanced cancer. Combining patient-reported AEs with brief cognitive screening may improve detection during treatment.
METHODS: We conducted a secondary analysis of the nationwide, multicenter GAP70+ trial of adults aged ≥70 years with advanced cancer starting systemic therapy. Cognitive symptoms were assessed longitudinally using patient-reported and clinician-graded cognitive AEs, and Mini-Cog screening at baseline, 4-6 weeks, 3 months, and 6 months. We examined prevalence, longitudinal trajectories, and associations with Mini-Cog impairment. Statistical significance was set at 2-sided P < .05.
RESULTS: Among 704 participants (mean age = 77.2 years; range = 70-96 years), patient-reported cognitive AEs were more prevalent than clinician-graded cognitive AEs at all time points: 19% vs 0.48% at 4-6 weeks, 18% vs 2.5% at 3 months, and 22% vs 0.44% at 6 months (all P < .001). Patient-reported cognitive AEs also fluctuated within patients over time. Impaired Mini-Cog was associated with higher patient-reported cognitive AEs at all post-baseline time points: 31% vs 15% at 4-6 weeks, 34% vs 14% at 3 months, and 49% vs 15% at 6 months (all P < .001). In contrast, associations with clinician-graded cognitive AEs were observed only at 3 months (P = .004) and 6 months (P = .04).
CONCLUSIONS: Cognitive symptomatic AEs are common and often underdetected by clinician grading alone in older adults with advanced cancer. Combining patient-reported AEs with brief cognitive screening may improve detection during treatment.