| Objective:To explore the prevalence of cognitive impairment in cancer patients.Based on Ahles’ prediction model of cognitive change of cancer patients,the relationship between sociodemographic factors,cognitive reserve,disease characteristics,physiological factors,psychological factors,lifestyle and the risk of cognitive impairment of cancer patients was explored.Methods:From July 2020 to November 2020,cancer patients were recruited from two wards of the department of radiotherapy and chemotherapy of a Grade A hospital in Jinan City,Shandong Province.The subscales of Functional Assessment of Cancer Therapy-Cognitive Function(FACT-cog Versions3),Patient Health Questionnaire(PHQ-9),7-item Generalized Anxiety Disorder Scale(GAD-7),Functional Assessment of Chronic Illness Therapy-Fatigue(FACIT-F Version 4),Pittsburgh sleep quality index(PSQI)were used to assess cognitive impairment,depression,anxiety,fatigue and sleep quality,respectively.In addition,the sociodemographic data and disease characteristic of cancer patients were collected by self-administered questionnaire.SPSS26.0 was used for statistical description,chi-square test and logistic regression analysis.R 4.0.3 was used to draw a Nomogram graph to present the risk prediction model for cognitive impairment in cancer patients,and the model was verified.Results:1.General demographic characteristics of cancer patients are as follow.The average age of the participants was 59.5±9.2 years.Most of them were male(70.8%).30.7%of participants had cancer of the respiratory system(lung cancer),50.4%of participants had cancer of the digestive system(esophageal cancer,stomach cancer,rectal cancer,colon cancer,etc.),and 18.6%of participants had other kinds of cancer(endometrial cancer,nasopharyngeal cancer,etc.);77.6%of the cancer patients with tumor stage Ⅲ-Ⅳ;27.1%of cancer patients were complicated with cardiovascular disease,and 5.3%of cancer patients were complicated with diabetes.2.28.3%of cancer patients reported cognitive impairment.Univariate analysis results showed that cancer patients with or without cognitive impairment had inter-group differences in whether they had cardiovascular disease(P=0.001),different educational reserve(P=0.027),depression symptoms(P<0.001),anxiety symptoms(P<0.001),fatigue symptoms(P<0.001),and sleep problems(P=0.002).3.Multivariate logistic regression results showed that patients with cardiovascular disease had a 2.627-fold risk of cognitive impairment than those without cardiovascular disease(OR=2.627,95%CI=-1.495-4.618,P=0.001).Cancer patients with low educational reserve had a 2.078-fold risk of cognitive impairment compared with those with high educational reserve(OR=2.078,95%CI=1.191-3.627,P=0.010).Cancer patients with depressive symptoms had a 2.890-fold risk of cognitive impairment compared with patients without depressive symptoms(OR=2.890,95%CI=1.608-5.195,P<0.001);Cancer patients with fatigue were 4.479-fold more likely to develop cognitive impairment than those without fatigue symptoms(OR=4.479,95%CI=2.197-9.131,P<0.001).4.Based on the multi-factor logistic regression results,a Nomogram model was built and repeated 1000 times by Bootstrap self-sampling method for internal verification.The C-index was 0.757(95%CI=0.703-0.811),and the area under the ROC curve was 0.757,which proved that the model had good accuracy and differentiation.The calibration curve of the model is close to the standard line,which indicates that the model has good concordance.Conclusion:1.The high incidence of cognitive impairments in cancer patients deserves attention.2.Low educational reserve,depressive symptoms,fatigue symptoms,and sleep problems were independent risk factors for cancer patients with cognitive impairments.3.This study establishes a simple and intuitive Nomogram model with good differentiation and calibration,which can directly and accurately assess the risk of cognitive impairments in cancer patients.However,its applicability needs to be further verified in a large sample longitudinal study. |
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