Prognostic impact of neurocognitive disorders in older patients with cancer: the ELCAPA prospective cohort study

Catherine Conti; Elena Paillaud; Marie Laurent; Johanne Poisson; Pascaline Boudou-Rouquette; Maxime Frelaut; Pierre Gay; Johanna Canovas; Philippe Caillet; Soraya Mebarki; Amaury Broussier; Florence Canouï-Poitrine

doi:10.1016/j.jnha.2024.100215

Prognostic impact of neurocognitive disorders in older patients with cancer: the ELCAPA prospective cohort study

J Nutr Health Aging. 2024 Mar 21;28(5):100215. doi: 10.1016/j.jnha.2024.100215. Online ahead of print.

Affiliations

¹ AP-HP, Paris Cancer Institute CARPEM, Hôpital Européen Georges Pompidou, Department of Geriatrics, F-75015 Paris, France; Université Paris-Est, Inserm, 7376- IMRB, F-94000 Créteil, France. Electronic address: catherine.conti@aphp.fr.
² AP-HP, Paris Cancer Institute CARPEM, Hôpital Européen Georges Pompidou, Department of Geriatrics, F-75015 Paris, France; Université Paris-Est, Inserm, 7376- IMRB, F-94000 Créteil, France.
³ Université Paris-Est, Inserm, 7376- IMRB, F-94000 Créteil, France; AP-HP, Hopital Henri-Mondor, Department of Internal Medicine and Geriatrics, F-94010 Creteil, France.
⁴ AP-HP, Paris Cancer Institute CARPEM, Hôpital Européen Georges Pompidou, Department of Geriatrics, F-75015 Paris, France; Université Paris-Cité, Center for Research on Inflammation, Inserm U1149, F-75018 Paris, France.
⁵ AP-HP, Hôpital Cochin - Port-Royal, Department of Oncology, F-75014 Paris, France.
⁶ Gustave Roussy Cancer Campus, F-94076 Villejuif, France.
⁷ AP-HP, Paris Cancer Institute CARPEM, Hôpital Européen Georges Pompidou, Department of Geriatrics, F-75015 Paris, France.
⁸ Université Paris-Est, Inserm, 7376- IMRB, F-94000 Créteil, France; AP-HP, Hôpitaux Henri-Mondor/Emile Roux, Department of Geriatrics, F-94456 Limeil-Brevannes, F-94000 Créteil, France.
⁹ Université Paris-Est, Inserm, 7376- IMRB, F-94000 Créteil, France; AP-HP, Hopital Henri-Mondor, Public Health Departement, F-94010 Creteil, France.

PMID: 38518539
DOI: 10.1016/j.jnha.2024.100215

Abstract

Objective: To assess the prognostic value of neurocognitive disorder (NCD) for 12 month-overall mortality in patients aged 70 or more with a solid cancer.

Design: prospective, observational, multicenter cohort.

Setting and participants: We analyzed data from the ELCAPA longitudinal multicenter observational cohort of patients aged 70 or over, referred for a geriatric assessment (GA) before a new cancer treatment modality between January 31st, 2007, and December 29th, 2017. We defined the baseline NCD in four classes: no NCD, mild NCD, moderate NCD, and major NCD, based on the Mini-Mental State Examination (MMSE) score, memory complaint, and the Instrumental Activities of Daily Living (IADL) score.

Statistical methods: We compared the baseline characteristics of patients according to NCD classes, globally and by pairs (with Bonferroni' correction). Prognosis value of NCD classes were analysed by using univariable and then multivariable 12 month survival analysis with age as time-variable and with and without adjustement for the treatment strategy (curative, palliative or exclusive supportive care).

Results: 2784 patients with solid-cancer were included, with a median [interquartile range] age of 82 [78;86]. 36% of the patients were free of NCD, 34% had a mild NCD, 17% had a moderate NCD, and 13% had a major NCD. We identified the following independent prognostic factors for 12 month-overall mortality: NCD (adjusted hazard ratio (aHR) [95% confidence interval (CI)] for a major NCD = 1.54 [1.19-1.98] (p < 0.001), type of cancer, metastatic status, inpatient consultation, poor general health (assessed as the level of fatigue and Eastern Cooperative Oncology Group performance status [ECOG-PS]), greater weight loss, palliative treatment, and exclusive supportive care. Additional adjustment for the treatment strategy did not greatly change the strength of the association of a major NCD with 12 month-overall mortality (HR [95%CI] = 1.78 [1.39-2.29] (p < 0.001).

Conclusion: Our results suggest that the presence of a major NCD has direct prognostic value (independently of other geriatric factors, the type of cancer and the treatment strategy) in older patients with a solid cancer.

Keywords: Cancer; Mortality; Neurocognitive disorder; Older adult; Prognostic value.