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

Vitória Piai*, Judith B. Prins, Irma M. Verdonck-De Leeuw, C. René Leemans, Chris H.J. Terhaard, Johannes A. Langendijk, Robert J. Baatenburg De Jong, Johannes H. Smit, Robert P. Takes, Roy P.C. Kessels

*Corresponding author for this work

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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.

Original languageEnglish
Pages (from-to)251-257
Number of pages7
JournalJAMA Otolaryngology-Head and Neck Surgery
Volume145
Issue number3
Early online date24 Jan 2019
DOIs
Publication statusPublished - Mar 2019

Funding

the Netherlands (Langendijk); Department of Otolaryngology and Head and Neck Surgery, Erasmus Cancer Institute, Erasmus Medical Center, Rotterdam, the Netherlands (Baatenburg de Jong); Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Public Health, Amsterdam, the Netherlands (Smit); Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Otorhinolaryngology and Head and Neck Surgery, Nijmegen, the Netherlands (Takes). Author Contributions: Dr Piai had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: Prins, Verdonck-de Leeuw, Langendijk, Baatenburg de Jong, Smit, Takes. Study concept and design: Piai. Acquisition, analysis, or interpretation of data: Piai, Prins, Verdonck-de Leeuw, Leemans, Terhaard, Langendijk, Smit, Kessels. Drafting of the manuscript: Piai, Verdonck-de Leeuw, Smit, Kessels. Critical revision of the manuscript for important intellectual content: All authors. Statistical analysis: Piai, Smit, Kessels. Obtained funding: Terhaard. Administrative, technical, or material support: Verdonck-de Leeuw, Terhaard. Supervision: Prins, Verdonck-de Leeuw, Baatenburg de Jong, Takes, Kessels. Conflict of Interest Disclosures: Dr Verdonck-de Leeuw reported receiving grants from KWF Kankerbestrijding, ZonMw, Zilveren Kruis, Achmea, Fonds NutsOhra, Danone/Nutricia, Pink Ribbon, Bristol-Myers Squibb, Red-Kite, and CZ Zorgverzekering. Dr Terhaard reported receiving grants from KWF Kankerbestrijding. Dr Langendijk reported receiving personal fees from Ion Beam Applications and other support from Ion Beam Applications, RaySearch, and Mirada Medical. No other disclosures were reported. Funding/Support: This study was supported by the Dutch Cancer Society (KWF-Alpe d’HuZes) and by Language in Interaction from the Netherlands Organisation for Scientific Research. This study was carried out using the research infrastructure within the Netherlands Quality of Life and Biomedical Cohort Study in Head and Neck Cancer (NET-QUBIC) project sponsored by the Dutch Cancer Society (KWF-Alpe d’HuZes). Dr Piai was supported by Language in Interaction from the Netherlands Organisation for Scientific Research. Role of the Funder/Sponsor: The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Additional Contributions: Sanne B. Schagen, PhD (Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands; and Brain & Cognition, Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands), assisted with normative data for the verbal fluency task. No compensation was received. We thank all of the participating patients and their families.

FundersFunder number
Danone/Nutricia
Dutch Cancer Society
KWF-Alpe d’HuZes
Language in Interaction from the Netherlands Organisation for Scientific Research
ZonMw
Fonds NutsOhra
Nederlandse Organisatie voor Wetenschappelijk Onderzoek
KWF Kankerbestrijding

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