Screening for cognitive impairment in routine clinical oncology practice: a pilot study using Patient Reported Outcome Measures and online cognitive testing in melanoma and breast cancer patients

Abstract Purpose This pilot study aimed to identify patients with cognitive impairment by a stepped-care use of Patient Reported Outcome Measures (PROMs) and online cognitive tests implemented in routine clinical practice. Methods Self-reported cognitive functioning was measured in breast cancer or melanoma patients, six months after start of treatment, with two items of the EORTC QLQ-C30. Scores below a predefined threshold of 75 indicated clinically relevant cognitive impairment. Subsequent objective cognitive functioning was assessed with an online test battery, consisting of 7 tests that measure learning and memory, attention and working memory, information processing, executive functioning, and psychomotor speed. Impaired cognitive functioning was defined as a z-score of ≤ − 1.5 on 2 or more tests, a z-score of ≤ − 2 on one single test, or both. Results In total, 261 patients completed PROMs six months after start treatment; 38/154 (25%) melanoma and 43/107 (40%) breast cancer patients reported clinically relevant cognitive impairment. Of them, 12/38 (32%) melanoma and 15/43 (35%) breast cancer patients opted for online cognitive testing. Of those completing formal tests, cognitive impairment was identified in 4/12 (33%) melanoma and 10/15 (67%) breast cancer patients. Conclusion A significant number of patients report cognitive problems six months after starting treamtment. Only 32–35% was able and/or expressed the need for further diagnostics. Among those who are formally tested, 33–67% had cognitive impairment, which is 3–9% of the total group that completed PROMs in routine care. Implications for Cancer Survivors: This pilot study suggests that a stepped care pathway for cognitive problems is relevant and also mangable in terms of clinical care.