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abstract
Highlights
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- 60% of women with gynecologic cancers have decreased cognition by MoCa screening.
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- Age, race, education, cancer site and pain were associated with decreased cognition.
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- Decreased cognition was associated with pain > 5, but not with opioid use.
Abstract
Objective
Cognitive
impairment has implications in counseling, treatment, and survivorship
for women with gynecologic malignancies. The purpose of our study was to
evaluate the prevalence and risk factors associated with cognition in
women with gynecologic malignancies.
Methods
After
Institutional Review Board approval, 165 women at an urban ambulatory
gynecologic oncology facility were queried using a Montreal Cognitive
Assessment (MoCA), Wong–Baker pain scale, neuropathy scale, Patient
Health Questionnaire 9 (PHQ-9) Depression Scale, and Generalized Anxiety
Disorder Scale (GAD 7). Univariate and multivariate analyses were
utilized to evaluate the association of cognitive deficit with age,
education, race/ethnicity, disease site, stage, treatment, pain,
neuropathy, anxiety, and depression.
Results
The
mean MoCA score for the entire cohort was 24.1 (range 13–30.) 24% of
patients had MoCA scores less than 22. Low scores (< 22) were
associated with older age, non-white race/ethnicity, lower education
level, uterine and vulvar cancers, and pain ≥ 5 (p < 0.05). There was
a trend toward lower cognition scores for women treated with both
chemotherapy and radiation (p = 0.10). While clinically significant pain
was associated with low cognition, there was no association with use of
opioid pain medication and low cognition scores.
Conclusions
There
was a high prevalence of cognitive deficit in women with gynecologic
malignancies. The association of low cognition with report of clinically
significant pain, but not with use of opioid pain medications, should
be further explored. Research is needed to evaluate the impact of
cognitive deficits on treatment adherence and outcomes for women with
gynecologic malignancies.
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