Do Cognitively Impaired Elderly Patients with Cancer Respond Differently on Self-reported Symptom Scores? A 5-Year Retrospective Analysis

Abstract

Objectives: An increasing number of elderly subjects with cancer were admitted to the palliative care unit and they have suffered both distressing symptoms and cognitive impairment. We aim to identify the prevalence of cognitive impairment among elderly cancer patients receiving in-patient palliative care and to examine any difference between patients with cognitive impairment on self-reported symptoms. Materials and Methods: Subjects' age ≥65 admitted to a palliative care unit from 01 September 2015 to 31 August 2020 was included in the study. Exclusion criteria were those with an impaired conscious state, severe cognitive impairment, or language problems that were non-communicable. Variables collected included baseline demographics, cancer diagnosis, cancer stage, mobility state using the modified Barthel index (mBI), and performance status as measured by the palliative performance scale. Cognitive impairment was defined by abbreviated mental test ≤6. Self-reported symptoms scales were measured by the Chinese version of MD Anderson Symptom Inventory and EORTC QLQ C-30 (European Organisation for Research and Treatment of Cancer, Quality of Life Core Questionnaire 30). Results: Nine hundred and ninety-one subjects with 1174 admissions were retrieved. Eight hundred and seventy-three admission episodes were included in this study. Three hundred and eight (35%) have cognitive impairment. Cognitively impaired subjects were older, showed worse physical function and performance status, and more often residing in old age homes. Independent predictors of cognitive impairment were age (OR 1.09), mBI (OR 0.96), chair/bed bound state (OR 1.79), and presence of brain metastasis (OR 2.63). They reported lower scores in pain (P < 0.001), distress (P < 0.001), sleep disturbance (P < 0.001) and nausea and vomiting (P = 0.012) in the self-reported symptoms scale. Conclusion: Elderly cancer patients with cognitive impairment were older with poorer performance status. They have reported a lower level of pain, distress, and sleep disturbance. Clinicians should be alerted to this phenomenon to tackle the unmet concomitant symptoms.