■更多的人在诊断为血液恶性肿瘤(HMN)后长期存活,然而,关于HMN患者癌症相关认知障碍的数据有限.更好地了解老年人HMN后的认知结果对于患者咨询和管理很重要。
■模拟老年人HMN诊断前后的认知轨迹和认知下降率,并与匹配的非癌症队列进行比较。
■在这项基于人群的队列研究中,在1998年至2016年期间,65岁后被诊断为HMN的健康与退休研究(HRS)的老年人使用包含认知相关变量的倾向评分,与来自同一HRS波的无癌症参与者1:3进行匹配.用分段线性样条对认知轨迹进行建模,和以前认知能力下降的速度,during,并在诊断后对2组进行比较。数据从2022年4月到2024年4月进行了分析。
■通过医疗保险诊断代码进行HMN诊断。
■通过1992年至2020年的Langa-Weir认知汇总评分评估了认知功能。与认知相关的社会人口统计学和健康相关变量被纳入倾向得分。
■在基线时,HMN队列中有668名参与者(平均[SD]年龄,76.8[7.6]岁;男性343[51.3%];黑人72[10.8%],33[4.9%]西班牙裔,和585[87.6%]白人)和1994年对照组参与者(平均[SD]年龄,76.5[7.3]岁;男性1020[51.2%];黑人226[11.3%],91[4.6%]西班牙裔,和1726[86.6%]白色)。HMN队列主要由更惰性的诊断组成,只有96例患者(14.4%)接受化疗。在诊断之前和诊断前后的2年内,HMN和对照组的认知功能下降率相似.在诊断后1年及以后,与对照组(-0.24;95%CI-0.26-0.23)(P=.02)相比,HMN队列中认知下降的速度较慢(-0.18;95%CI-0.23-0.14),但在考虑了竞争性死亡风险后,这种差异不再显著(HMN组,-0.27;95%CI,-0.34至-0.19;对照组,-0.30;95%CI,-0.33至-0.27;P=.48)。
■在这项针对老年人的队列研究中,HMN和匹配的非癌症对照队列在之前有相似的认知下降率,during,并在考虑了竞争的死亡风险后进行诊断。
UNASSIGNED: More people are surviving long-term after diagnosis with hematologic malignant neoplasm (HMN), yet there are limited data on cancer-related cognitive impairment in people with HMN. Better understanding cognitive outcomes after HMN in older adults is important for patient counseling and management.
UNASSIGNED: To model cognitive trajectories and rates of cognitive decline before and after HMN diagnosis in older adults compared with a matched noncancer cohort.
UNASSIGNED: In this population-based cohort study, older adults from the Health and Retirement Study (HRS) diagnosed with HMN between 1998 and 2016 after age 65 years were matched 1:3 to participants without cancer from the same HRS wave using propensity scores incorporating variables relevant to cognition. Cognitive trajectories were modeled with piecewise linear splines, and rates of cognitive decline before, during, and after diagnosis were compared in the 2 groups. Data were analyzed from April 2022 to April 2024.
UNASSIGNED: HMN diagnosis by Medicare diagnosis codes.
UNASSIGNED: Cognitive function was assessed by the Langa-Weir cognitive summary score from 1992 to 2020. Sociodemographic and health-related variables relevant to cognition were incorporated into propensity scores.
UNASSIGNED: At baseline, there were 668 participants in the HMN cohort (mean [SD] age, 76.8 [7.6] years; 343 [51.3%] male; 72 [10.8%] Black, 33 [4.9%] Hispanic, and 585 [87.6%] White) and 1994 participants in the control cohort (mean [SD] age, 76.5 [7.3] years; 1020 [51.2%] male; 226 [11.3%] Black, 91 [4.6%] Hispanic, and 1726 [86.6%] White). The HMN cohort consisted predominantly of more indolent diagnoses, and only 96 patients (14.4%) received chemotherapy. Before and in the 2 years around the time of diagnosis, the HMN and control cohorts had similar rates of cognitive decline. At 1 year postdiagnosis and beyond, the rate of cognitive decline was slower in the HMN cohort (-0.18; 95% CI, -0.23 to -0.14) than in the control group (-0.24; 95% CI, -0.26 to -0.23) (P = .02), but this difference was no longer significant after accounting for the competing risk of death (HMN group, -0.27; 95% CI, -0.34 to -0.19; control group, -0.30; 95% CI, -0.33 to -0.27; P = .48).
UNASSIGNED: In this cohort study of older adults, the HMN and matched noncancer control cohorts had similar rates of cognitive decline before, during, and after diagnosis after accounting for the competing risk of death.