Prevalence of Patient-Reported and Clinician-Graded cognitive symptomatic adverse events in older patients with advanced cancer

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PURPOSE: Cancer-related cognitive impairment is common in patients receiving cancer treatment but may be under detected by clinician-graded adverse events (AEs) alone. Patient-reported outcomes and cognitive screening may improve identification of cognitive symptoms. METHODS: We conducted a secondary analysis of the nationwide, multicenter GAP70+ trial of adults aged ≥70 years with advanced cancer starting systemic therapy. Cognitive symptoms were assessed longitudinally using patient-reported and clinician-graded cognitive AEs, and Mini-Cog screening at baseline, 4-6 weeks, 3 months, and 6 months. We examined prevalence, longitudinal trajectories, and associations with Mini-Cog impairment. Statistical significance was set at two-sided p< 0.05. RESULTS: Among 704 participants (mean age, 77.2 years; range, 70 to 96 years), patient-reported cognitive AEs were more prevalent than clinician-graded cognitive AEs at all timepoints: 19% vs 0.48% at 4 to 6 weeks, 18% vs 2.5% at 3 months, and 22% vs 0.44% at 6 months at 6 months (all p < 0.001). Patient-reported cognitive AEs also fluctuated within patients over time. Impaired Mini-Cog was associated with higher patient-reported cognitive AEs at all post-baseline timepoints: 31% vs 15% at 4 to 6 weeks, 34% vs 14% at 3 months, and 49% vs 15%at 6 months (all p < 0.001). In contrast, associations with clinician-graded cognitive AEs were observed only at 3 months (p = 0.004) and 6 months (p = 0.04). CONCLUSIONS: Cognitive symptomatic AEs are common and often under detected by clinician grading alone in older adults with advanced cancer. Combining patient-reported AEs with brief cognitive screening may improve detection during treatment.

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