Clinical Assessment of Cognitive Function in Patients with Head and Neck Cancer: Prevalence and Correlates

Objective Identify the prevalence and clinical correlates of cognitive impairment in patients presenting for treatment of head and neck cancer (HNC) using brief screening within a multidisciplinary care team. Study Design A case series with planned data collection of cognitive function, quality of life (QoL), and psychosocial variables. Setting Urban Midwest academic medical center. Subjects and Methods In total, 209 consecutive patients with a diagnosis of HNC between August 2015 and September 2016 who had a pretreatment assessment with a clinical health psychologist. At pretreatment assessment, the Montreal Cognitive Assessment (MoCA), a brief screening tool for cognitive function, was administered along with a semistructured interview to gather information on psychiatric symptoms, social support, and substance use. Patient information, including demographics, clinical variables, and psychosocial variables, was extracted via chart review. A subset of patients with HNC completed the Functional Assessment of Cancer Therapy-Head and Neck Cancer at pretreatment assessment and was included in the QoL analyses. Results Cognitive impairment was associated with current alcohol use, past tobacco use and number of pack years, time in radiotherapy, and adherence to treatment recommendations. Social, emotional, and functional QoL scales were associated with cognitive impairment, including executive function, language, and memory. Conclusion Cognitive impairment is common in patients with HNC, and there are important associations between cognitive impairment and psychosocial, QoL, and treatment adherence variables. The results argue for the incorporation of cognitive screening as part of pretreatment assessment for patients, as well as further research into more direct, causal relationships via longitudinal, prospective studies.