Background: Cognitive functioning has been found to be related to substance abuse, depression, anxiety, and quality of life (QoL), as well as treatment adherence for rehabilitation and outcomes in patients with cancer. Previous longitudinal research has found that cognitive impairment significantly contributes to quality of life in patients with head and neck cancer. Additionally, both cognitive impairment and poorer quality of life have been associated with decreased overall survival in patients with head and neck cancers.
Objective: The current study seeks to examine the relationships between psychosocial variables, cognitive function, and QoL in patients with oropharyngeal cancer prior to initiating cancer treatment. Additionally, it will determine if pre-treatment variables are associated with treatment adherence markers (i.e., time in radiation therapy, adherence to Tumor Board recommendations).
Methods: Seventy-one patients with oropharyngeal cancer completed the FACT-H&N, the Montreal Cognitive Assessment (MoCA), and a semistructured psychiatric interview with a Clinical Health Psychologist as part of pre-treatment assessment. Patient demographics, diagnosis, and treatment were extracted via chart review.
Results: As would be expected, the number of depressive symptoms was negatively associated with QoL on the total FACT-H&N score (r=-.56, p<.001) and each of the FACT-H&N subscales (r=-.29 to -.58, p<.01). The total FACT-H&N score was positively associated with scores on delayed recall (r=.32, p<.01). Social wellbeing scores were positively associated with scores on the language and delayed recall subscales, and the overall MoCA score (r=.24, .28, and .24, p<.05, respectively). Emotional wellbeing and functional wellbeing subscales were positively associated with delayed recall scores (r=.24 and .39, p<.05, respectively). There were no significant associations between the physical wellbeing or the head and neck symptoms subscales and the subscales or overall score on the MoCA.
Lower MoCA scores were associated with not following Tumor Board recommendations (t = -3.08, p<.01), indicating that patients with lower MoCA scores were less likely to engage in treatment recommended by the Tumor Board following NCCN guidelines. In particular, lower scores on attention/concentration (t = -3.05, p<.01) and language (t = -2.68, p<.01) were associated with not following Tumor Board recommendations. Neither the QoL subscales nor the total score were associated with Tumor Board adherence. Patients score on delayed recall was negatively associated with the length of time in primary radiotherapy (r=-.30, p<.05). Lower scores on the total QoL score was associated with longer time in primary radiotherapy (r=-.45, p<.05). Neither cognitive function nor QoL scores were associated with adjuvant radiotherapy lengths.
Conclusions: Pre-treatment QoL and cognitive functioning are related at baseline. Additionally, these variables are associated with important treatment adherence makers, such as time in radiation therapy and adherence to Tumor Board recommendations. These adherence markers may indicate less treatment adherence and a negative prognostic value. Future research should examine mediating factors and the development of intervention to aid in adherence. Further, the current results argue for the importance of assessing for cognitive functioning and quality of life prior to treatment to aid in treatment planning and resource management for patients.