2584 - Associations between Cognitive Ability and Changes in Quality of Life among Older Adults with Metastatic Cancer Undergoing Palliative Radiation Therapy

A. Osei¹, M. Jain², E. Moshier², L. Jonsson¹, and K. V. Dharmarajan¹; ¹Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, ²Icahn School of Medicine at Mount Sinai, Department of Population Health Science & Policy, New York, NY

Purpose/Objective(s): Older adults may be more susceptible to poor outcomes from radiation therapy, yet the relationship between geriatric conditions such as cognitive impairment (CI) and outcomes such as quality of life (QOL) are not well understood. While validated tools exist in the field of medical oncology that aid clinicians in understanding how a geriatric patient fitting a certain profile may tolerate systemic treatment, more is to be learned regarding this question in radiation oncology. The objective of this study is to estimate associations between pre-radiation therapy cognitive ability and one-month post-radiation QOL changes in older adults with metastatic disease. Materials/

Methods: This study is situated within a large prospective cohort study comprising patients 65 and older with metastatic cancer undergoing palliative radiation treatment at single urban, academic institution. Cognitive ability was assessed through the Blessed-Orientation-Memory-Concentration Test (BOMC), a screening tool for signs of CI. We assessed patient-reported QOL through the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-30) at baseline before radiation and one month post-radiation. Data was collected in the data collection web application. Linear mixed effects modeling was used to assess the differences in EORTC-QLQ-30 subscale change scores between pre- and post-radiation therapy assessments in patients grouped by cognitive status (unimpaired and impaired). Patient characteristics were compared using Fisher’s exact test for categorical distributions and the Wilcoxon rank-sum test for continuous distributions.
Results: 32 patients were enrolled, with 26 in the unimpaired group and 6 in the impaired group. Role functioning, someone’s ability to perform tasks within their social role, worsened significantly more over time for those with CI compared to those without impairment (p=0.0491), and the burden of nausea/vomiting worsened significantly for those with CI (p=0.0392).
Conclusion: Our data demonstrates that role functioning and burden of nausea/vomiting worsen significantly within a month after radiation for individuals with CI. Analysis with a larger study population and adjusted multivariate analysis is necessary to further elucidate the relationship between cognitive ability and QOL in older adults undergoing radiation therapy to guide clinicians on best care practices for radiation patients with CI.