Cancer-related cognitive impairment and associated factors in a sample of older male oral-digestive cancer survivors

Assessing neurocognitive outcomes in PTSD: a multilevel meta-analytical approach

Background: Evidence supporting the association between posttraumatic stress disorder (PTSD) and cognitive impairment is accumulating. However, less is known about which factors influence this association.Objective: The aims of this meta-analysis were to (1) elucidate the association between PTSD and a broad spectrum of cognitive impairment, including the risk of developing neurocognitive disorder (NCD) later in life, using a multilevel meta-analytic approach, and (2) identify potential moderating factors of this association by examining the effects of age (20-39, 40-59, 60+), study design (cross-sectional or longitudinal), study population (war-exposed populations/veterans or the general population), neurocognitive outcome assessed (i.e. a diagnosis of NCD or type of cognitive domain as classified according to A Compendium of Neuropsychological tests), gender (≥50% women or <50% women), study quality (high vs low), type of PTSD measure (self-report or clinical diagnosis), as well as the presence of comorbidities such as traumatic brain injury (TBI), depression, and substance use (all coded as either present or absent).Method: Peer-reviewed studies on this topic were extracted from PubMed and Web of Science with predetermined keywords and criteria. In total, 53 articles met the criteria. Hedge's g effect sizes were calculated for each study and a three-level random effect meta-analysis conducted.Results: After accounting for publication bias, the results suggested a significant association between PTSD and cognitive impairment, g = 0.13 (95% CI: 0.10-0.17), indicating a small effect. This association was consistent across all examined moderators, including various neurocognitive outcomes, age, gender, study design, study population, study quality, type of PTSD measure, and comorbidities such as depression, substance use, and TBI.Conclusions: These findings collectively suggest that PTSD is associated with both cognitive impairment and NCD. This emphasizes the need for early intervention (including prevention strategies) of PTSD, alongside monitoring cognitive function in affected individuals.International Prospective Register of Systematic Reviews (PROSPERO) registration number: CRD42021219189, date of registration: 02.01.2021.

Prevalence and trends of cancer-related daily life limitations among gastrointestinal cancer survivors

PURPOSE

The number of gastrointestinal (GI) cancer survivors has increased substantially due to improvements in early detection and treatment, yet long-term functional patient outcomes remain poorly characterized. We sought to quantify the burden of activity limitations (AL) and functional limitations (FL) among GI cancer survivors compared with non-GI cancer survivors and the general U.S. population, as well as identify key predictors of cancer-related limitations.

METHODS

The National Health Interview Survey (NHIS), a nationally representative dataset (1997-2023), was queried to examine the prevalence and trends of cancer-related limitations among GI cancer survivors, non-GI cancer survivors, and the general U.S.

POPULATION

Multivariable logistic regression analyses identified independent predictors of AL and FL, adjusting for demographic and socioeconomic variables.

RESULTS

Among 5,513 GI cancer and 39,887 non-GI cancer survivors, 50.2% (Relative Risk [RR]: 1.23, 95% CI: 1.19-1.27) and 70.7% (RR: 1.07, 95% CI: 1.05-1.09) of GI cancer survivors reported AL and FL, respectively, compared with non-GI cancer survivors. The general U.S. population had a markedly lower prevalence of AL (13.5%; RR: 0.33, 95% CI: 0.33-0.34) and FL (35.7%; RR: 0.54, 95% CI: 0.53-0.54). GI cancer survivors were older (mean age: 69.1 vs. 65.3 vs. 36.1 years), more often single (8.8% vs. 8.6% vs. 28.3%), and more frequently received public insurance (75.1% vs. 68.9% vs. 27.4%) compared with non-GI cancer survivors and the general population (p < 0.05). In multivariable analysis, GI cancer survivors had 21% higher odds of AL (OR: 1.21, 95% CI: 1.11-1.32, p < 0.001) and 11% higher odds of FL (OR: 1.11, 95% CI: 1.00-1.19, p = 0.049).

CONCLUSIONS

GI cancer survivors face a significantly higher burden of functional limitations, influenced by demographic and socioeconomic factors.

IMPLICATIONS FOR CANCER SURVIVORS

Addressing functional disparities through targeted rehabilitation and support services may improve long-term outcomes.

Interaction effects between serum 25(OH)D and CRP status on cancer related mortality in adult cancer survivors

Vitamin D deficiency and elevated CRP (C-reactive protein) levels are independent indicators of risk for mortality in cancer survivors; however, their combined association with mortality has not been examined. This study included adult cancer survivors from four NHANES cycles (2003-2010), utilizing a multistage survey design. CRP levels were measured using a latex-enhanced turbidimetric assay, and serum 25(OH)D levels were assessed using RIA and LC-MS/MS methods. Mortality data were linked with the National Death Index up to 2019. The restricted cubic spline model was used to explore the nonlinear associations with mortality. Kaplan-Meier analysis was used to examine survival curve differences. Cox analysis was employed to assess mortality risk after adjusting for confounding factors, and interaction analysis was conducted. Of the 1619 adult cancer survivors (56.9% female; weighted age 64.91 ± 0.44 years), 762 deaths were recorded during the 17-year follow-up. Higher CRP and lower 25(OH)D levels were associated with increased risks of all-cause and cancer mortality. Joint analysis revealed the High CRP and Low VID group had the highest all-cause (HR 2.40, 95% CI 1.82-3.17) and cancer (HR 5.23, 95% CI 3.15-8.70) mortality risk compared to Low CRP and High VID group. Additionally, a multiplicative interaction between serum 25(OH)D and CRP factors on cancer mortality was observed (P = 0.049), indicating a synergistic effect of these two factors on cancer mortality. Sex and ethnicity subgroup analyses revealed that the High CRP and Low VID group exhibits the highest risk for all-cause and cancer mortality, findings that are consistent with those observed in the overall population. In cancer survivors, an elevated risk of cancer and all-cause mortality is linked to vitamin D deficiency and elevated levels of CRP. In particular, the interaction between these factors may impact cancer survivors' mortality related to cancers. Consequently, the risks may be significantly reduced through the use of anti-inflammatory medications as well as adequate intake of vitamin D.

Cancer-Related Cognitive Impairments (CRCIs) in Non-Central Nervous System Adult Patients: Outcome Measures and Methodology of Assessment: A Literature Review

BACKGROUND

Cancer-related cognitive impairment (CRCI) represents one of the most common and debilitating effects in patients surviving after cancer treatments. Neurocognitive deficits are important causes of disability and burden in cancer survivors. The true magnitude of CRCI is difficult to define due to significant heterogeneity of literature data. At present, there is no agreement on the gold standard for detection and grading of CRCI in clinical trials, and there is a lack of clear knowledge of its pathophysiology.

OBJECTIVES

In this review, we aim to discuss some perspectives for future research to pursue in order to cover the gaps in knowledge in the CRCI field.

METHODS

We focused our literature research on the following relevant issues: neuroradiological correlates of CRCI; objective neuropsychological evaluation and subjective complaint assessment and their correlation with objective measures; timing of assessment; and possible treatments.

RESULTS

The correct methodology for evaluating cognitive deficits induced by anti-tumor treatments still requires a definition based on quality scientific evidence, and literature data are currently scarce.

CONCLUSIONS

This review highlights the need for further research to understand the causes and consequences of cancer-related cognitive impairment using standardized and sensitive measures of cognitive functions and the long-term effects of chemotherapy on cognitive functions and to develop effective interventions.

A scoping review evaluating physical and cognitive functional outcomes in cancer survivors treated with chemotherapy: charting progress since the 2018 NCI think tank on cancer and aging phenotypes

PURPOSE

The primary goal of this scoping review was to summarize the literature published after the 2018 National Cancer Institute think tank, "Measuring Aging and Identifying Aging Phenotypes in Cancer Survivors," on physical and cognitive functional outcomes among cancer survivors treated with chemotherapy. We focused on the influence of chemotherapy on aging-related outcomes (i.e., physical functional outcomes, cognitive functional outcomes, and frailty), given the known associations between chemotherapy and biologic mechanisms that affect aging-related physiologic processes.

METHODS

A search was conducted across electronic databases, including PubMed, Scopus, and Web of Science, for manuscripts published between August 2018 and July 2023. Eligible studies: 1) included physical function, cognitive function, and/or frailty as outcomes; 2) included cancer survivors (as either the whole sample or a subgroup); 3) reported on physical or cognitive functional outcomes and/or frailty related to chemotherapy treatment (as either the whole sample or a subgroup); and 4) were observational in study design.

RESULTS

The search yielded 989 potentially relevant articles, of which 65 met the eligibility criteria. Of the 65 studies, 49 were longitudinal, and 16 were cross-sectional; 30 studies (46%) focused on breast cancer, 20 studies (31%) focused on the age group 60 + years, and 17 (26%) focused on childhood cancer survivors. With regards to outcomes, 82% of 23 studies reporting on physical function showed reduced physical function, 74% of 39 studies reporting on cognitive functional outcomes found reduced cognitive function, and 80% of 15 studies reporting on frailty found increasing frailty among cancer survivors treated with chemotherapy over time and/or compared to individuals not treated with chemotherapy. Fourteen studies (22%) evaluated biologic mechanisms and their relationship to aging-related outcomes. Inflammation was consistently associated with worsening physical and cognitive functional outcomes and epigenetic age increases. Further, DNA damage was consistently associated with worse aging-related outcomes.

CONCLUSION

Chemotherapy is associated with reduced physical function, reduced cognitive function, and an increase in frailty in cancer survivors; these associations were demonstrated in longitudinal and cross-sectional studies. Inflammation and epigenetic age acceleration are associated with worse physical and cognitive function; prospective observational studies with multiple time points are needed to confirm these findings.

IMPLICATIONS FOR CANCER SURVIVORS

This scoping review highlights the need for interventions to prevent declines in physical and cognitive function in cancer survivors who have received chemotherapy.

Validity and screening capacity of the FCR-1r for fear of cancer recurrence in long-term colorectal cancer survivors

PURPOSE

Existing fear of cancer recurrence (FCR) screening measures is being shortened to facilitate clinical use. This study aimed to evaluate the validity and screening capacity of a single-item FCR screening measure (FCR-1r) in long-term colorectal cancer (CRC) survivors with no recurrence and assess whether it performs as well in older as in younger survivors.

METHODS

All Danish CRC survivors above 18, diagnosed and treated with curative intent between 2014 and 2018, were located through a national patient registry. A questionnaire including the FCR-1r, which measures FCR on a 0-10 visual analog scale, alongside the validated Fear of Cancer Recurrence Inventory Short Form (FCRI-SF) as a reference standard was distributed between November 2021 and May 2023. Screening capacity and cut-offs were evaluated with a receiver-operating characteristic analysis (ROC) in older (≥ 65 years) compared to younger (< 65 years) CRC survivors. Hypotheses regarding associations with other psychological variables were tested as indicators of convergent and divergent validity.

RESULTS

Of the CRC survivors, 2,128/4,483 (47.5%) responded; 1,654 (36.9%) questionnaires were eligible for analyses (median age 76 (range 38-98), 47% female). Of the responders, 85.2% were aged ≥ 65. Ninety-two participants (5.6%) reported FCRI-SF scores ≥ 22 indicating clinically significant FCR. A FCR-1r cut-off ≥ 5/10 had 93.5% sensitivity and 80.4% specificity for detecting clinically significant FCR (AUC = 0.93, 95% CI 0.91-0.94) in the overall sample. The discrimination ability was significantly better in older (AUC = 0.93, 95% CI 0.91-0.95) compared to younger (0.87, 95% (0.82-0.92), p = 0.04) CRC survivors. The FCR-1r demonstrated concurrent validity against the FCRI-SF (r = 0.71, p < 0.0001) and convergent validity against the short-versions of the Symptom Checklist-90-R subscales for anxiety (r = 0.38, p < 0.0001), depression (r = 0.27, p < 0.0001), and emotional distress (r = 0.37, p < 0.0001). The FCR-1r correlated weakly with employment status (r =  - 0.09, p < 0.0001) and not with marital status (r = 0.01, p = 0.66) indicating divergent validity.

CONCLUSIONS

The FCR-1r is a valid tool for FCR screening in CRC survivors with excellent ability to discriminate between clinical and non-clinical FCR, particularly in older CRC survivors.

Cancer survivorship at heart: a multidisciplinary cardio-oncology roadmap for healthcare professionals

In cancer, a patient is considered a survivor from the time of initial diagnosis until the end of life. With improvements in early diagnosis and treatment, the number of cancer survivors (CS) has grown considerably and includes: (1) Patients cured and free from cancer who may be at risk of late-onset cancer therapy-related cardiovascular toxicity (CTR-CVT); (2) Patients with long-term control of not-curable cancers in whom CTR-CVT may need to be addressed. This paper highlights the importance of the cancer care continuum, of a patient-centered approach and of a prevention-oriented policy. The ultimate goal is a personalized care of CS, achievable only through a multidisciplinary-guided survivorship care plan, one that replaces the fragmented management of current healthcare systems. Collaboration between oncologists and cardiologists is the pillar of a framework in which primary care providers and other specialists must be engaged and in which familial, social and environmental factors are also taken into account.

Higher Stress in Oncology Patients is Associated With Cognitive and Evening Physical Fatigue Severity

CONTEXT

Cognitive and physical fatigue are common symptoms experienced by oncology patients. Exposure to stressful life events (SLE), cancer-related stressors, coping styles, and levels of resilience may influence the severity of both dimensions of fatigue.

OBJECTIVES

Evaluate for differences in global, cancer-specific, and cumulative life stress, as well as resilience and coping in oncology patients (n=1332) with distinct cognitive fatigue AND evening physical fatigue profiles.

METHODS

Latent profile analysis, which combined the two symptom scores, identified three subgroups of patients with distinct cognitive fatigue AND evening physical fatigue profiles (i.e., Low, Moderate, High). Patients completed measures of global, cancer-specific, and cumulative life stress as well measures of resilience and coping. Differences among the latent classes in the various measures were evaluated using parametric and nonparametric tests.

RESULTS

Compared to Low class, the other two classes reported higher global and cancer-specific stress. In addition, they reported higher occurrence rates for sexual harassment and being forced to touch prior to 16 years of age. Compared to the other two classes, High class reported lower resilience scores and higher use of denial, substance use, and behavioral disengagement.

CONCLUSION

To decrease both cognitive and evening physical fatigue, clinicians need to assess for relevant stressors and initiate interventions to increase resilience and the use of engagement coping strategies. Additional research is warranted on the relative contribution of various social determinants of health to both cognitive and physical fatigue in oncology patients receiving chemotherapy.

A Systematic Review on the Potential Acceleration of Neurocognitive Aging in Older Cancer Survivors

As survival rates increase, more emphasis has gone to possible cognitive sequelae in older cancer patients, which could be explained by accelerated brain aging. In this review, we provide a complete overview of studies investigating neuroimaging, neurocognitive, and neurodegenerative disorders in older cancer survivors (>65 years), based on three databases (Pubmed, Web of Science and Medline). Ninety-six studies were included. Evidence was found for functional and structural brain changes (frontal regions, basal ganglia, gray and white matter), compared to healthy controls. Cognitive decline was mainly found in memory functioning. Anti-hormonal treatments were repeatedly associated with cognitive decline (tamoxifen) and sometimes with an increased risk of Alzheimer's disease (androgen deprivation therapy). Chemotherapy was inconsistently associated with later development of cognitive changes or dementia. Radiotherapy was not associated with cognition in patients with non-central nervous system cancer but can play a role in patients with central nervous system cancer, while neurosurgery seemed to improve their cognition in the short-term. Individual risk factors included cancer subtypes (e.g., brain cancer, hormone-related cancers), treatment (e.g., anti-hormonal therapy, chemotherapy, cranial radiation), genetic predisposition (e.g., APOE, COMT, BDNF), age, comorbidities (e.g., frailty, cognitive reserve), and psychological (e.g., depression, (post-traumatic) distress, sleep, fatigue) and social factors (e.g., loneliness, limited caregiver support, low SES). More research on accelerated aging is required to guide intervention studies.

Challenges of Survivorship for Older Adults Diagnosed with Cancer

Purpose of Review

The purpose of this brief review is to highlight significant recent developments in survivorship research and care of older adults following cancer treatment. The aim is to provide insight into care and support needs of older adults during cancer survivorship as well as directions for future research.

Recent Findings

The numbers of older adult cancer survivors are increasing globally. Increased attention to the interaction between age-related and cancer-related concerns before, during, and after cancer treatment is needed to optimize outcomes and quality of life among older adult survivors. Issues of concern to older survivors, and ones associated with quality of life, include physical and cognitive functioning and emotional well-being. Maintaining activities of daily living, given limitations imposed by cancer treatment and other comorbidities, is of primary importance to older survivors. Evidence concerning the influence of income and rurality, experiences in care coordination and accessing services, and effectiveness of interventions remains scant for older adults during survivorship.

Summary

There is a clear need for further research relating to tailored intervention and health care provider knowledge and education. Emerging issues, such as the use of medical assistance in dying, must be considered in this population.

Investigating the Short-Term Effects of Cold Stress on Metabolite Responses and Metabolic Pathways in Inner-Mongolia Sanhe Cattle

Simple Summary

Cold stress is a major environmental stressor affecting cattle performance in temperate regions, which causes impaired welfare and economic losses to cattle producers. The identification of biological mechanisms associated with cold stress response is paramount for developing effective mitigation strategies, such as genomic selection. In this study, we assessed the short-term effects of hyper-cold stress on metabolite responses and metabolic pathways in the serum of Inner-Mongolia Sanhe cattle. Moreover, 19 differential metabolites were found, mainly involved in amino acid metabolism. A further integration of metabolome results and gene expression highlighted the regulation of metabolic changes and related pathways in severe cold exposure, such as “aminoacyl-tRNA biosynthesis” and “valine, leucine, and isoleucine degradation”. In summary, we presented new insights on the short-term effects of severe cold stress as well as metabolites and metabolic pathways associated with cold stress response in Inner-Mongolia Sanhe cattle.

Abstract

Inner-Mongolia Sanhe cattle are well-adapted to low-temperature conditions, but the metabolic mechanisms underlying their climatic resilience are still unknown. Based on the ¹H Nuclear Magnetic Resonance platform, 41 metabolites were identified and quantified in the serum of 10 heifers under thermal neutrality (5 °C), and subsequent exposure to hyper-cold temperature (−32 °C) for 3 h. Subsequently, 28 metabolites were pre-filtrated, and they provided better performance in multivariate analysis than that of using 41 metabolites. This indicated the need for pre-filtering of the metabolome data in a paired experimental design. In response to the cold exposure challenge, 19 metabolites associated with cold stress response were identified, mainly enriched in “aminoacyl-tRNA biosynthesis” and “valine, leucine, and isoleucine degradation”. A further integration of metabolome and gene expression highlighted the functional roles of the DLD (dihydrolipoamide dehydrogenase), WARS (tryptophanyl-tRNA synthetase), and RARS (arginyl-tRNA synthetase) genes in metabolic pathways of valine and leucine. Furthermore, the essential regulations of SLC30A6 (solute carrier family 30 (zinc transporter), member 6) in metabolic transportation for propionate, acetate, valine, and leucine under severe cold exposure were observed. Our findings presented a comprehensive characterization of the serum metabolome of Inner-Mongolia Sanhe cattle, and contributed to a better understanding of the crucial roles of regulations in metabolites and metabolic pathways during cold stress events in cattle.

Embracing the complexity: Older adults with cancer-related cognitive decline-A Young International Society of Geriatric Oncology position paper

Cancer-related cognitive decline (CRCD) may have particularly significant consequences for older adults, impacting their functional and physical abilities, level of independence, ability to make decisions, treatment adherence, overall quality of life, and ultimately survival. In honor of Dr. Hurria's work we explore and examine multiple types of screening, assessment and non-pharmacologic treatments for CRCD. We then suggest future research and clinical practice questions to holistically appreciate the complexity of older adults with cancer's experiences and fully integrate the team-based approach to best serve this population.