Cognitive Factors Linked to Treatment Adherence in Elderly Patients With Cancer

Cognitive factors such as working memory dysfunction and depression may be predictors of non-adherence in patients with cancer, especially among the elderly, according to a study presented at the European Society for Medical Oncology (ESMO) 2016 Congress (October 7-11; Copenhagen, Denmark).
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Oral anticancer therapies play a significant role in helping patients manage symptoms and achieve better outcomes. Therefore, while it is not always intentional, non-adherence to prescribed treatment regimens can negatively impact therapeutic success and patient survival. In their study presented at ESMO 2016, researchers led by Melanie Dos Santos, Centre Francois Baclesse (Caen, France), assessed the relationship between cognitive functions and oral medication adherence in order to identify patient profiles that are more likely to be non-adherents. They focused particularly on the elderly population.

Prior to initiation of treatment, the researchers performed standardized neuropsychological tests and assessments of patient autonomy, depression, and anxiety. Two self-assessment questionnaires and an observance sheet were then used to evaluate adherence to oral therapy at 1 and 3 months after the start of treatment.

Of 126 patients enrolled in the study, 88% (n = 111) completed the adherence questionnaires. At 1 month, the adherence rate was 90% with a median age at baseline of 70 years. Fifty percent of patients exhibited some degree of cognitive impairment, however, with working memory disorders and depression the two factor associated most significantly with non-adherence. In addition, age and Montreal Cognitive Assessment scores both had an effect on working memory impairment. 

From these results researchers concluded that working memory dysfunction and depression are predictors of non-adherence. Therefore, cognitive assessment for these patients should be performed and considered when planning treatment regimens for elderly patients with cancer.