title: Vulnerabilities in Older Patients when Cancer Treatment is Initiated: Does a Cognitive Impairment Impact the Two-Year Survival?
abstract: BACKGROUND
  Dementia is a known predictor of shorter survival times in older cancer patients. However, no empirical evidence is available to determine how much a cognitive impairment shortens survival in older patients when cancer treatment is initiated.
  
  
  OBJECTIVE
  To longitudinally investigate how much a cognitive impairment detected at the initiation of cancer treatment influences survival of older patients during a two-year follow-up duration and to compare the predictive value of a cognitive impairment on patients survival with the predictive value of other vulnerabilities associated with older age.
  
  
  METHODS
  Three hundred and fifty-seven consecutive patients (≥65 years old) admitted for breast, prostate, or colorectal cancer surgeries were prospectively recruited. A cognitive impairment was assessed with the Montreal Cognitive Assessment (MoCA<26). Socio-demographic, disease-related, and geriatric vulnerabilities were assessed using validated tools. Univariate and subsequent multivariate Cox proportional hazards models stratified for diagnosis (breast/prostate cancer versus colorectal cancer) and disease status (metastatic versus non-metastatic) were used.
  
  
  RESULTS
  A cognitive impairment was detected in 46% (n = 163) of patients. Survival was significantly influenced by a cognitive impairment (HR = 6.13; 95% confidence interval [CI] = 2.07-18.09; p = 0.001), a loss in instrumental autonomy (IADL ≤7) (HR = 3.06; 95% CI = 1.31-7.11; p = 0.009) and fatigue (Mob-T<5) (HR = 5.98; 95% CI = 2.47-14.44; p <0.001).
  
  
  CONCLUSIONS
  During the two years following cancer treatment initiation, older patients with a cognitive impairment were up to six times more likely to die than patients without. Older patients should be screened for cognitive impairments at cancer treatment initiation to enable interventions to reduce morbidity and mortality. Further studies should address processes underlying the relationship between cognitive impairments and an increased risk of dying in older cancer patients.
authors.affiliation: Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Brussels, Belgium.|Université Libre de Bruxelles, Institut Jules Bordet, Brussels, Belgium.
authors.forename: Yves
authors.initials: Y
authors.lastname: Libert
authors.affiliation: Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Brussels, Belgium.|Université Libre de Bruxelles, Institut Jules Bordet, Brussels, Belgium.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Dubruille
authors.affiliation: Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Brussels, Belgium.|Université Libre de Bruxelles, Institut Jules Bordet, Brussels, Belgium.
authors.forename: Cindy
authors.initials: C
authors.lastname: Borghgraef
authors.affiliation: Université de Liège, Faculté des Sciences psychologiques et de l'Education, Liège, Belgium.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Etienne
authors.affiliation: Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Brussels, Belgium.|Université Libre de Bruxelles, Institut Jules Bordet, Brussels, Belgium.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Merckaert
authors.affiliation: Université Libre de Bruxelles, Institut Jules Bordet, Brussels, Belgium.
authors.forename: Marianne
authors.initials: M
authors.lastname: Paesmans
authors.affiliation: Université Catholique de Louvain, Service de Médecine Psychosomatique, Cliniques Universitaires de Mont-Godinne, Yvoir, Belgium.
authors.forename: Christine
authors.initials: C
authors.lastname: Reynaert
authors.affiliation: Université Libre de Bruxelles, Institut Jules Bordet, Brussels, Belgium.
authors.forename: Myriam
authors.initials: M
authors.lastname: Roos
authors.affiliation: Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Brussels, Belgium.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Slachmuylder
authors.affiliation: Université Libre de Bruxelles, Institut Jules Bordet, Brussels, Belgium.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Vandenbossche
authors.affiliation: Université Libre de Bruxelles, Institut Jules Bordet, Brussels, Belgium.
authors.forename: Dominique
authors.initials: D
authors.lastname: Bron
authors.affiliation: Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Brussels, Belgium.|Université Libre de Bruxelles, Institut Jules Bordet, Brussels, Belgium.
authors.forename: Darius
authors.initials: D
authors.lastname: Razavi
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D060825:Cognitive Dysfunction / Q000150:complications* / Q000175:diagnosis; D005221:Fatigue / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D009362:Neoplasm Metastasis; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000401:mortality*; D016016:Proportional Hazards Models