Cancer patients may experience a decrease in cognitive functioning before, during and after cancer treatment. So far, the Quality of Life Group of the European Organisation for Research and Treatment ...of Cancer (EORTC QLG) developed an item bank to assess self-reported memory and attention within a single, cognitive functioning scale (CF) using computerized adaptive testing (EORTC CAT Core CF item bank). However, the distinction between different cognitive functions might be important to assess the patients' functional status appropriately and to determine treatment impact. To allow for such assessment, the aim of this study was to develop and psychometrically evaluate separate item banks for memory and attention based on the EORTC CAT Core CF item bank. In a multistep process including an expert-based content analysis, we assigned 44 items from the EORTC CAT Core CF item bank to the memory or attention domain. Then, we conducted psychometric analyses based on a sample used within the development of the EORTC CAT Core CF item bank. The sample consisted of 1030 cancer patients from Denmark, France, Poland, and the United Kingdom. We evaluated measurement properties of the newly developed item banks using confirmatory factor analysis (CFA) and item response theory model calibration. Item assignment resulted in 31 memory and 13 attention items. Conducted CFAs suggested good fit to a 1-factor model for each domain and no violations of monotonicity or indications of differential item functioning. Evaluation of CATs for both memory and attention confirmed well-functioning item banks with increased power/reduced sample size requirements (for CATs greater than or equal to 4 items and up to 40% reduction in sample size requirements in comparison to non-CAT format). Two well-functioning and psychometrically robust item banks for memory and attention were formed from the existing EORTC CAT Core CF item bank. These findings could support further research on self-reported cognitive functioning in cancer patients in clinical trials as well as for real-word-evidence. A more precise assessment of attention and memory deficits in cancer patients will strengthen the evidence on the effects of cancer treatment for different cancer entities, and therefore contribute to shared and informed clinical decision-making.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
INTRODUCTION: Stereotactic radiotherapy (SRT) is the current treatment of choice in patients with one to three brain metastases. Although survival rates are assumed to be similar, SRT is expected to ...have a less detrimental effect on cognition and health-related quality of life (HRQoL) than whole-brain radiotherapy (WBRT). OBJECTIVE: To prospectively study the impact of SRT on HRQoL and cognitive functioning in patients with brain metastatic disease. METHODS: A total of 97 patients were included prior to SRT treatment. Cognitive functioning and HRQoL were measured at baseline, 3 and 6 months follow-up. Cognition was measured with tests covering 4 domains (verbal and working memory, information processing speed and attention) and compared to matched healthy controls. HRQoL was assessed with the EORTC-QLQC30 and BN20. Seven scales were analysed: physical, cognitive, emotional and role functioning, global quality of life, motor and communication deficits. Fatigue was assessed with the Fatigue Severity Scale. Survival analysis was performed and effect of total volume of brain metastases and Karnofsky Performance Status (KPS) (both categorized) on overall survival (OS) was examined. Linear mixed models were used to analyse cognition and HRQoL over time, also separately for KPS and tumour volume. RESULTS: Mean age of patients was 63 years, median OS was 7.7 months. Six months survival rate was 60%. Median OS was significantly shorter for KPS < 90 compared to KPS greater than or equal to 90 (5.5 vs 11.1 months) and for large compared to smaller tumour volume (4.5 vs 9.3 months). Prior to SRT, 3 out of 4 cognitive domains (verbal and working memory, attention) were worse compared to controls, and all HRQoL scores were lower than of the general population. On group level, patients worsened in physical functioning (-14; p = 0.03) and fatigue (10; p = 0.001) after 6 months follow-up, while other HRQoL scales did not significantly change over time. Cognitive domain scores did not change over 6 months. Mean HRQoL scores over 6 months time were significantly lower for patients with baseline KPS <90 compared to patients with KPS greater than or equal to 90 for physical (54 vs 74; p < 0.001), cognitive (75 vs 85; p = 0.03) and role functioning (46 vs 70; p < 0.001), motor dysfunction (21 vs 8; p = 0.006) and fatigue (37 vs 29; p = 0.02). Mean physical and cognitive functioning over time were lower for large than for smaller tumour volumes. Information processing speed over time was worse for patients with KPS <90 than KPS greater than or equal to 90 (-0.6 vs 0.5; p = 0.002), and for large tumour volume compared to small or medium volumes (-1.1 vs 0.2 vs 0.3; p = 0.02). CONCLUSION: Before SRT, cognitive functioning and HRQoL are moderately impaired in patients with brain metastases. Low KPS and large tumour volume are associated with shorter survival and worse cognitive functioning and HRQoL. Over time, SRT does not have a detrimental effect on cognition and HRQoL, suggesting that SRT should be preferred over WBRT.
INTRODUCTION: Cognition is often affected in patients with brain tumors. Apart from language function, direct tumor effects on discrete cognitive functions have barely been studied. In this study, we ...quantify baseline functioning in seven cognitive domains and identify brain locations involved in these cognitive domains using tumor localization maps (TLMs), which is a new approach. METHODS: Adult patients with glioma treated at the VU University Medical Center between 2006-2011 with available preoperative neuropsychological assessment were included. Cognition was tested for verbal memory, visuospatial memory, working memory, attention, executive functioning, information processing speed, and visuoconstructive abilities. Cognitive performance was compared to healthy controls, matched for age, sex, and educational level. Tumor volumes for TLMs were segmented on MRI fluid attenuated inversion recovery (FLAIR) hyperintense signal abnormality for low-grade gliomas, and MRI T1 contrast-enhanced abnormality for high-grade gliomas. For each cognitive domain, we applied TLMs to link cognitive performance with location throughout the brain at 1 mm resolution. Considerations for spatial dependence and multiple comparisons were taken into account. PRELIMINARY RESULTS: Seventy-four patients (7 with WHO grade I, 43 with grade II, 12 with grade III, and 10 with grade IV glioma, and 2 with other histology) were included so far. Mean age of patients was 40 years. Preoperative cognitive functioning was significantly impaired in five of seven domains compared to healthy controls. Most frequently affected were attentional function and working memory capacity (30% and 21% of patients, respectively). No differences in cognitive domain scores were observed between patients with low-grade and high-grade glioma. Tumor localization maps are currently being processed and statistically compared voxel-wise for each of the seven cognitive domains. Preliminary results of the TLMs demonstrate that performance in specific cognitive domains is associated with specific brain tumor locations. CONCLUSION: Empirical evidence on location of cognition can be used for optimizing brain tumor surgery and be integrated in counseling and cognitive rehabilitation for patients with newly-diagnosed glioma.
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