HOPA 2018 | Elderly patients and cognitive impairment caused by chemotherapy

The topic that I discussed at the HOPA meeting was focusing on cognition and chemotherapy related cognitive impairment. We had data that suggests that by the year 2030, around 7 out of 10 patients diagnosed with cancer are going to be older adults or older than age 65 and we also know that cognitive impairment is a condition of the aging as well. This is going to be an emerging topic because, while we have an increased rate of diagnosis of cancer in older adults, we’re also going to have to learn how to develop this risk of cognitive impairment, either patients that are presenting with cognitive impairment at baseline or patients with cancer that are going to be exposed to cancer therapies that can cause cognitive impairment. So, we want to make sure that oncology healthcare providers are knowledgeable about this area and also that they’re equipped to be able to manage these patients with these complex medical conditions.
The way I like to think about it is there are 2 pathways: we can have patients who are older, that can present with normal cognition, because they are able to perform activities of daily living, they are able to live independently, and those patients might not have cognitive impairment at baseline but they might have exposure to cancer treatments that can cause cognitive impairment, so the goal is, really, to be able to identify which of those cancer therapies are associated with this risk of chemotherapy-related cognitive impairment.
The other group of patients, or the other pathway would be patients who present with cognitive impairment at baseline, so at the time of cancer diagnosis, recognising the fact that those patients, although they might present with cognitive impairment at baseline, it might be subtle, it might be mild, those patients also might have exposure to cancer treatments that are known to potentially cause that baseline cognitive impairment to progress, and I think the goal is, really, being able to identify these patients early on, and to be able to have a periodic surveillance so that we’re able to identify how these therapies cause the progression of their cognitive impairment.
For the most part, pharmacists are not necessarily going to be performing the cognitive screenings for these patients. I think that when it comes to cancer care, cancer care is really an interprofessional care team model, and the role of the pharmacist is really to be able to look at what medications the patient is on at baseline, because we do know that outside of cancer therapies, there are certain medications that are classified as high-risk, that can cause cognitive impairment.

So, one classic example would be the pharmacologic class of medications known as benzodiazepines, those are going to be medications that patients can be using for anxiety, sometimes patients use those medications to help them sleep. So, at baseline, certainly we would be able to identify that the patient is already on these high-risk medications and that should also be part of the differential diagnosis to identify “are the patients already on pharmacologic therapies that could be causing some type of cognitive impairment at baseline?”