Certain Patients May Be at Higher Risk of Cancer-Related Cognitive Impairment, Stress, Anxiety

Cancer-related cognitive impairment and stress may be more common in some patients with cancer than others, highlighting the need for patients and providers to discuss the individual patient’s risk, according to research presented at the 47th Annual Oncology Nursing Society Congress.

Kate Oppegaard, a second-year PhD student at the University of California San Francisco School of Nursing, explained that previous research has demonstrated a relationship between changes in cognitive function and anxiety; however, the interaction of the two is not often studied as such.

“We know that both cognitive impairment and anxiety occur in a significant percentage of patients with cancer. And both of these symptoms lead to decrements in quality of life for patients,” Oppegaard said during the presentation. “However, these two symptoms are evaluated independently rather than together. Therefore, the purpose of this study is to identify groups of patients with distinct co-occurring cancer-related cognitive impairment and anxiety profiles, and then evaluated for differences in demographic, clinical and stress characteristics among these groups.”

The study included 1,332 outpatients with cancer during their first or second cycle of chemotherapy. Patients completed a demographic questionnaire, a performance status scale, a self-administered comorbidity questionnaire and their toxicity from chemotherapy was rated.

Compared to patients with high cognitive function and low anxiety (57%) — the lowest level of symptom burden — patients with moderate cognitive function and moderate anxiety (34%) were more likely: to be younger, female, Hispanic, living alone, unemployed and report childcare or elder care responsibilities, back pain and depression, and have a lower functional status and household income. Additionally, they were less likely to be married or have a partner.

Patients with low cognitive function and high anxiety (8%) — those with the most symptom burden — were more likely to be: younger, Hispanic, unemployed and report stomach disease or ulcers, as well as back pain and depression. These patients were less likely to be married or have a partner and exercise on a regular basis. They also had lower functional status and household income.

When evaluating perceived stress, there was a significant difference among the three groups of patients. Those with a higher symptom burden reported significantly higher levels of perceived global stress and cancer-related stress. Patients in the two higher symptoms burden groups met criteria for either post-traumatic symptomatology or post-traumatic stress disorder.

The final measure was to evaluate how a person felt that they could handle adversity, which is measured on a scale of zero to 40 with higher scores indicating a higher self-perceived resilience — the average score in the general population is 31.8, Oppegaard explained. The results demonstrated that patients with higher symptom burden had lower scores, meaning they had lower self-perceived resilience and were below the general population.

Oppegaard said that these results may help nurses and other clinicians identify patients who may be at higher risk of developing cancer-related cognitive impairment and stress.

“Many factors can contribute to cancer related cognitive impairment and anxiety in patients with cancer. And future research is needed to understand how unrelieved stress may contribute to the co-occurrence of these two symptoms,” she concluded.

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