Assessing cognitive function in cancer patients.
OBJECTIVE
Some patients with cancer suffer cognitive impairment after chemotherapy. A brief, sensitive instrument is required to screen patients for cognitive impairment. In this study, we compare three possible screening instruments.


METHODS
Cancer patients (n=31) who had received adjuvant chemotherapy within 2 years underwent cognitive evaluation on three occasions. Fluent English speakers (n=20) completed the High Sensitivity Cognitive Screen (HSCS), the computer-based Headminder and CogHealth, and the Functional Assessment of Cancer Therapy-cognitive function (FACT-COG) questionnaire. Patients not fluent in English (NESB) (n=11) performed CogHealth and Headminder.


RESULTS
The patients were aged 31-65 years, and 94% were women with breast cancer. At baseline, 6 of 20 (30%) had moderate-severe cognitive impairment on HSCS, 17 of 31 (55%) had scores greater than one standard deviation (SD) below the mean for normative data in one to two of three domains on Headminder, and on CogHealth, 8 of 31 (26%) were greater than one SD below the mean in at least two of six domains. A large practice effect was seen for the HSCS, with moderate-severe cognitive impairment decreasing from 30 to 5% between the first and second assessment. On FACT-COG, 9 of 19 patients (47%) rated their cognition as greater than one SD below that of a pre-chemotherapy breast cancer control group, with impact on quality of life greater than one SD below for 10 of 19 (53%) patients. No correlation was seen between objective cognitive testing and the FACT-COG.


CONCLUSIONS
CogHealth and Headminder were suitable for NESB patients. The HSCS is not recommended for longitudinal studies with short intervals between testing due to practice effect. There is poor correlation between the patients' perception of their cognitive impairment and the objective tests.
Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada. janette.vardy@uhn.on.ca
Janette
J
Vardy
Karen
K
Wong
Qi-Long
QL
Yi
Alison
A
Park
Paul
P
Maruff
Lynne
L
Wagner
Ian F
IF
Tannock
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects; D001943:Breast Neoplasms / Q000188:drug therapy / Q000523:psychology*; D016022:Case-Control Studies; D017024:Chemotherapy, Adjuvant; D003071:Cognition / Q000187:drug effects; D003072:Cognition Disorders / Q000139:chemically induced / Q000523:psychology; D015179:Colorectal Neoplasms / Q000188:drug therapy / Q000523:psychology*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008182:Luria-Nebraska Neuropsychological Battery; D008297:Male; D008875:Middle Aged; D010465:Perception / Q000187:drug effects; D011788:Quality of Life; D012107:Research Design; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D000970:Antineoplastic Agents