CANCER-RELATED COGNITIVE IMPAIRMENT IN OLDER ADULTS WITH ACUTE MYELOID LEUKEMIA RECEIVING CHEMOTHERAPY: PERSPECTIVES FROM PATIENTS AND THEIR CAREGIVERS

Abstract

Acute Myeloid Leukemia (AML), an aggressive cancer of blood and bone marrow, is a disease of older adults, with a median diagnosis age of 68 years. Chemotherapy is the standard treatment for AML. Unfortunately, chemotherapy may impact cognitive function, also known as cancer-related cognitive impairment (CRCI), which impacts survivors across illness journey. Current literature on CRCI focuses mainly on survivors with a solid tumor diagnosis; consequently a knowledge gap exists for older adults with AML. Hence, this dissertation aims to 1) systematically explore current literature on cognitive function in adults with AML; 2) examine trajectory of CRCI and identify its correlates from 1st to 4th cycle of chemotherapy in older adults with AML; and 3) describe CRCI experiences of older adults with AML and their caregivers up to 4th cycle of chemotherapy.This dissertation is guided by the Dynamic Symptoms Model. Chapter 2 systematically examines cognitive function literature in adults with AML treated with chemotherapy. Chapter 3 and Chapter 4 are based on a prospective, longitudinal study. Chapter 3 presents the quantitative data of 14 older adults with AML. The findings show that cognitive function remain stable over time; however, 63.64% and 75% of older adults with AML experience subjective and cognitive impairment respectively after initiating chemotherapy. In particular, impaired verbal learning/memory and executive function are found in a greater number of older adults with AML. Additionally, potential correlates of cognitive function include: disease burden, insomnia, emotional distress, and hemoglobin. Chapter 4 presents the qualitative data from 11 older adults with AML and 8 caregivers. The findings show: 1) CRCI symptom experience, such as memory, language, and concentration; 2) impact of CRCI on emotion and the disruption of life; 3) CRCI problem-solving and emotional coping strategies; and 4) perceived demographic, physical/clinical, psychological, environmental, and other risk factors of CRCI. Findings from this dissertation provide an in-depth and comprehensive preliminary understanding of CRCI in older adults with AML, which provides fundamental knowledge for future sufficiently-powered quantitative studies. Additionally, understanding caregivers’ experiences provides a critical foundation for future intervention development to involve caregivers in managing CRCI in older adults with cancer.Doctor of Philosoph