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Original Investigation
January 24, 2019

Assessment of Neurocognitive Impairment and Speech Functioning Before Head and Neck Cancer Treatment

Author Affiliations
  • 1Radboud University Medical Center, Donders Centre for Medical Neuroscience, Department of Medical Psychology, Nijmegen, the Netherlands
  • 2Radboud University, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognition, Nijmegen, the Netherlands
  • 3Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Medical Psychology, Nijmegen, the Netherlands
  • 4Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Otolaryngology–Head and Neck Surgery, Cancer Center Amsterdam, Amsterdam, the Netherlands
  • 5Vrije Universiteit, Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
  • 6Department of Radiotherapy, University Medical Center, Utrecht, the Netherlands
  • 7Department of Radiation Oncology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
  • 8Department of Otolaryngology and Head and Neck Surgery, Erasmus Cancer Institute, Erasmus Medical Center, Rotterdam, the Netherlands
  • 9Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Public Health, Amsterdam, the Netherlands
  • 10Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Otorhinolaryngology and Head and Neck Surgery, Nijmegen, the Netherlands
JAMA Otolaryngol Head Neck Surg. 2019;145(3):251-257. doi:10.1001/jamaoto.2018.3981
Key Points

Question  What is pretreatment neurocognitive function in patients with head and neck cancer and what is the association between neurocognitive and speech functioning?

Findings  In a cohort study of 254 newly diagnosed patients with head and neck cancer, pretreatment objective neurocognitive measures indicated 12.3% to 26.2% mild to moderate impairment and 4.7% to 15.0% moderate to severe impairment. Self-perceived neurocognitive functioning was significantly associated with speech function.

Meaning  Results of this study suggest that pretreatment neurocognitive impairment is frequently present in patients with head and neck cancer, and low self-perceived neurocognitive and speech functioning may alter communicative participation and perceived quality of life.

Abstract

Importance  Head and neck cancer (HNC) and its treatment may negatively alter neurocognitive and speech functioning. However, the prevalence of neurocognitive impairment among patients with HNC before treatment is poorly studied, and the association between neurocognitive and speech functioning is unknown, which hampers good interpretability of the effect of HNC treatment on neurocognitive and speech function.

Objectives  To document neurocognitive functioning in patients with HNC before treatment and to investigate the association between neurocognitive and speech functioning.

Design, Setting, and Participants  Prospective cohort study of newly diagnosed patients with HNC before treatment using a large sample obtained in a nationwide, multicenter setting (Netherlands Quality of Life and Biomedical Cohort Study in Head and Neck Cancer [NET-QUBIC] project).

Main Outcome and Measures  Objective neuropsychological measures of delayed recall, letter fluency, and executive functioning, as well as patient-reported outcome measures on neurocognitive speech and functioning, were collected before treatment.

Results  In total, 254 patients with HNC participated (71.7% male), with a mean (SD) age of 62 (10) years. The response rate ranged from 81.9% (208 of 254) to 84.6% (215 of 254). Objective neurocognitive measures indicated that 4.7% (10 of 212) to 15.0% (32 of 214) of patients were initially seen with moderate to severe cognitive impairment. Mild to moderate impairment was found in 12.3% (26 of 212) to 26.2% (56 of 214) of patients. The most altered domains were delayed recall and letter fluency. Seven percent (15 of 208) of the patients reported high levels of everyday neurocognitive failure, and 42.6% (89 of 209) reported speech problems. Objective neurocognitive function was not significantly associated with patient-reported neurocognitive or speech functioning, but the results from patient-reported outcome measures were significantly correlated.

Conclusions and Relevance  Results of this study demonstrate a high prevalence of impaired speech functioning among patients with HNC before treatment, which is in line with previous findings. A novel finding is that neurocognitive impairment is also highly prevalent as objectively measured and as self-perceived. Understanding the reason why patients with HNC are initially seen with neurocognitive impairment before the start of treatment is important because this impairment may complicate patient-clinician interaction and alter treatment adherence and because treatment itself may further worsen cognitive functioning. In addition, low self-perceived neurocognitive and speech functioning before treatment may decrease a patient’s confidence in communicative participation and perceived quality of life. Disentangling the associations between objective and patient-reported neurocognitive and speech functions is an important area for future research.

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