Downstream consequences of abnormal cognitive screening in older adults seen pretreatment in a geriatric oncology clinic. Issue 5 (June 2020)

• Record Type: Journal Article
• Authors: Malik, Uzair; Alam, Zuhair; Loucks, Allison; Jin, Rana; Yokom, Daniel; Watt, Sarah; Berger, Arielle; Romanovsky, Lindy; Puts, Martine; Alibhai, Shabbir M.H.
• Is Part Of: Journal of geriatric oncology. Volume 11:Issue 5(2020)
• Page Start: 784
• Page End: 789
• Publication Date: 2020-06
• Subjects: Cognitive impairment -- Comprehensive geriatric assessment -- Geriatric oncology -- Geriatric oncology clinic -- Treatment decision-making; Geriatric oncology -- Periodicals; Neoplasms -- Periodicals; Aged -- Periodicals; Geriatric oncology; Electronic journals; Periodicals; 618.976994005
• DOI: 10.1016/j.jgo.2019.10.022
• Languages: English
• ISSNs: 1879-4068

Abstract

Abstract: Introduction: Although screening for cognitive impairment (CI) is an important part of a comprehensive geriatric assessment (CGA), little is known about the downstream work-up of abnormal screening or its impact on cancer treatment. We characterized the downstream workup in diagnosing CI and its impact on cancer treatment decision-making. Methods: Patients who underwent a pre-treatment CGA at an academic Geriatric Oncology (GO) clinic between July 2015 and June 2018 and had a positive Mini-Cog (≤ 3 out of 5) screen were included. Data were collected from medical charts and database review. Analyses were primarily descriptive. Results: Of 82 patients seen in the pre-treatment setting, 46 (56.1%) had a positive Mini-Cog screen. Of those, 12 (26.1%) were diagnosed with dementia, 8 (17.4%) were diagnosed with mild cognitive impairment and 10 (21.7%) had CI not otherwise specified. Although 46 patients had a positive screen, only 30 patients (65.2%) were classified as cognitively "abnormal" in the GO team final assessment. Change to oncologic treatment due to CI was seen in 12 (40.0%) cases. Increased delirium risk was identified in 9 (75.0%) of 12 surgical cases; however, delirium prevention was only recommended in 5 cases (55.6%). Strategies to optimize patients with CI included targeting falls prevention ( n = 13), home/personal safety ( n = 7), medication safety (n = 7), and nutrition ( n = 6). Pharmacotherapy for cognition was not recommended in any case. Conclusion: Undiagnosed CI is prevalent in the GO setting and influenced treatment in 40.0% of cases. Gaps were identified in clinician and patient/caregiver education around delirium risk. Addressing these issues may improve patient care.