Worse Outcomes in Cancer Patients With Cognitive Impairment

A new study published by researchers from the University of Georgia and the Moffitt Cancer Center in Tampa, Fla., has found that cancer patients with dementia have a dramatically lower survival rate than patients with cancer alone, even after controlling for factors such as age, tumor type, and tumor stage.

But the study, published in Critical Reviews in Oncology/Hematology, also argues that a diagnosis of dementia shouldn't discourage the use of cancer screenings and appropriate cancer treatments.

"As the population ages and as treatments improve, we're going to see more patients with both dementia and cancer," says lead author Claire Robb, PhD, MPH, an assistant professor in the university's College of Public Health. "And right now there are no guidelines for oncologists as to how to treat these patients."

Robb and her coauthors in the Senior Adult Oncology Program at Moffitt compared the outcomes of 86 cancer patients with cognitive impairment to a control group of 172 patients with cancer alone. They found that cancer patients with dementia survived an average of four fewer years.

Robb says that the reason for the disparity is unclear. She notes that the patients in both groups received similar treatment and that the survival gap persists even after controlling for age, tumor type, and tumor stage.

But Robb points out that within the cognitively impaired group, there was a dramatic difference in survival time between those with mild cognitive impairment and those with moderate to severe impairment. The researchers found that while patients with moderate to severe dementia had an average survival time of eight months, those with mild dementia had an average survival time of nearly four and a half years.

"Some people would argue against treating patients with mild cognitive impairment because they're going to have a shorter survival," Robb says. "But, you know, 53 months—almost 4 and a half years—is a pretty significant amount of time to live."

Robb emphasizes that she does not advocate overly aggressive treatment for patients who are in the late stages of dementia, but urges the creation of guidelines to help ensure that cognitively impaired cancer patients receive appropriate treatment.

"People have thought about the impact of the aging population on rates of cancer and dementia, but not much attention has been paid to what happens when the diseases coincide," Robb says. "We're going to be seeing more cases like these, and, if anything, I hope our research raises awareness of this situation."

— Source: University of Georgia