All ETDs from UAB

Advisory Committee Chair

Nicole C Wright

Advisory Committee Members

Marguerite R Irvin

Richard E Kennedy

Gabrielle B Rocque

Kristen Triebel

Document Type

Dissertation

Date of Award

2021

Degree Name by School

Doctor of Philosophy (PhD) School of Public Health

Abstract

Cancer and dementia are common aging-related diseases. Cancer and itstreatments are associated with cognitive impairment referred to as cancer-related cognitive impairment (CRCI). Dementias demonstrate similar impairment. Only one study has examined the longitudinal association between cancer and dementia. This dissertation goes beyond limitations of the prior study and has three aims: 1.) to evaluate dementia progression by prior cancer diagnosis, 2.) to evaluate progression of all-cause dementia by cancer treatments, and 3.) to evaluate patterns and predictors of care among dementia patients by cancer history. This study uses EHR data to evaluate cognitive progression by cancer history /cancer treatment characteristics, and proportion of specialty care visits and predictors of such visits compared to visits in other locations by cancer history among dementia patients. Results indicate participants with any cancer history have higher baselinecognition than those without cancer history (b: 1.49, 95% CI: 0.91-2.07), and progress slower (β: 0.40, 95% CI: 0.08-0.71). However, adjusting for health behaviors and comorbidities attenuated this association. Although non-Hispanic blacks had lower cognition at baseline compared to the other race and ethnic groups, the only race/ethnic differences we observed was that people of Other race/ethnic groups had a different cognitive progression than non-Hispanic whites and non-Hispanic blacks. Immunotherapies result in lower mean baseline cognition (15.20 vs. Chemotherapy:18.40; Hormone therapy: 19.29; Two or more: 20.06) and slower mean progression per year than those on other therapies and two or more therapies (3.35 vs. Chemotherapy: 0.23; Hormone therapy: 0.18; Two or more: -1.52). Finally, those with cancer history are less likely to utilize specialty care than those without on (11.3% vs. 17.1%) or after dementia diagnosis (13.5% vs. 19.2%). Age at dementia diagnosis, Black race, anticholinergic burden, socioeconomic status, and vascular risk predict lower odds of specialty care. This work supports hypotheses of many underlying mechanisms for cancer’seffect on dementia. Studies are needed to explore causes of racial disparities and to assess cancer treatments in a larger sample with ability to control for cancer staging and evaluate disparities in this association. Finally, studies are needed to evaluate causes of differences in specialty care utilization between those with and without cancer history.

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