The role of depression in the relationship between cognitive decline and quality of life among breast cancer patients

NYHA classification deterioration and quality of life in heart failure inpatients: A chain mediation analysis of cognitive impairment and depression

BACKGROUND

Health-related quality of life (HRQoL) is a key indicator of the prognosis of heart failure (HF) patients. Although the association between the New York Heart Association (NYHA) class and HRQoL has been widely recognized, the underlying mechanisms of this association have not been fully elucidated.

OBJECTIVES

This study aimed to investigate the mediating role of cognitive impairment and depressive symptoms in NYHA class and HRQoL in HF patients.

METHODS

We used a convenience sampling method to select HF patients hospitalized between December 2023 and April 2024 in China. General information, NYHA class, cognitive function, depressive symptoms, and HRQoL were assessed. We conducted mediated effects analyses using the "Bruce" package in the R software.

RESULTS

A total of 313 HF patients were included in this study. The HRQoL scores of the patients were 62.60 ± 13.94. NYHA class, cognitive impairment, and depressive symptoms were positively correlated with the HRQoL scores. Mediation effect analysis showed that the mediation effects of cognitive impairment, depressive symptoms, and the combination of the two between NYHA class and HRQoL were 0.059, 0.119, and 0.044, accounting for 9.08 %, 18.30 %, and 6.77 % of the total effect, respectively.

CONCLUSION

NYHA class in HF patients directly and indirectly impacts HRQoL through cognitive impairment and depressive symptoms. Healthcare providers should prioritize joint assessment of cognitive function and depression symptoms, implementing comprehensive interventions to mitigate NYHA class effects on HRQoL.

Altered Brain Functional Networks in Patients With Breast Cancer After Different Cycles of Neoadjuvant Chemotherapy

BACKGROUND

Cancer-related cognitive impairment (CRCI) impacts breast cancer (BC) patients' quality of life after chemotherapy. While recent studies have explored its neural correlates, single time-point designs cannot capture how these changes evolve over time.

PURPOSE

To investigate changes in the brain connectome of BC patients at several time points during neoadjuvant chemotherapy (NAC).

STUDY TYPE

Longitudinal.

SUBJECTS

55 participants with BC underwent clinical assessments and fMRI at baseline (TP1), the first cycle of NAC (TP2, 30 days later), and the end (TP3, 140 days later). Two matched female healthy control (HCs, n = 20 and n = 18) groups received the same assessments. FIELD STRENGTH/SEQUENCE: rs-fMRI (gradient-echo EPI) and 3D T1-weighted magnetization-prepared rapid gradient echo sequence at 3.0 T.

ASSESSMENT

Brain functional networks were analyzed using graph theory approaches. We analyzed changes in brain connectome metrics and explored the relationship between these changes and clinical scales (including emotion and cognitive test). Patients were divided into subgroups according to clinical classification, chemotherapy regimen, and menopausal status. Longitudinal analysis was performed at three time points for each subgroup.

STATISTICAL TESTS

An independent sample t-test for patient-HC comparison at TP1. Analysis of variance and paired t-test for longitudinal changes. Regression analysis for relations between network measurements changes and clinical symptom scores changes. Significance was defined as p < 0.05.

RESULTS

Post-NAC, BC patients showed increased global efficiency (TP2-TP1 = 0.087, TP3-TP1 = 0.078), decreased characteristic path length (TP2-TP1 = -0.413, TP3-TP1 = -0.312), and altered nodal centralities mainly in the frontal-limbic system and cerebellar cortex. These abnormalities expanded with chemotherapy progression significantly (TP2 vs. TP3). Topological parameters changes were also correlated with clinical scales changes significantly. No differences were found within or between HC groups (p = 0.490-0.989) or BC subgroups (p = 0.053-0.988) at TP1.

DATA CONCLUSIONS

NAC affects the brain functional connectome of BC patients at TP2, and these changes persist and further intensify at TP3.

LEVEL OF EVIDENCE: 2

TECHNICAL EFFICACY

Stage 5.

Chronic stress enhances glycolysis and promotes tumorigenesis

Depression is a well-known risk factor for tumors, but the mechanisms other than inflammation are unclear. Aerobic glycolysis is considered to be a critical element in the reprogramming of energy metabolism in malignant tumors, and impaired glycolysis has been reported in the brains of chronic stress mice. Therefore, this study aimed to explore the role of glycolysis in which depression promotes tumorigenesis. We examined the impacts of chronic unpredictable mild stress (CUMS) on the growth and metastasis of breast cancer (BC) and lung cancer (LC). CUMS was used to construct a mouse depression model, BALB/c mice were injected with 4T1-Luc cells in the right subcutaneous mammary fat pad, and C57BL/6 mice were injected with Lewis-Luc cells in the tail vein. The experiments were conducted through behavioral experiments, live imaging techniques of small animals, Western blot, Glycolytic metabolites measurement, Hematoxylin and eosin staining (H&E staining), Nissl staining, and immunohistochemical (IHC) tests. The findings showed that both CUMS and tumors induced depressive-like behavior, neuronal damage, and impaired synaptic plasticity in mice, while CUMS also enhanced tumor development and metastasis in both BC and LC. In the brain, both CUMS and tumor alone and in combination less influence glycolytic products and enzyme levels. However, CUMS significantly enhanced the levels of aerobic glycolytic products and enzymes in tumor tissue. Collectively, our results provide insights into how glycolysis is regulated in the brain, leading to depression-like behavior, and how depression, in turn, enhanced glycolysis and promoted tumorigenesis.

Effectiveness of Acceptance and Commitment Therapy (ACT) on disease acceptance for breast cancer patients: Study protocol of a randomized controlled trial

BACKGROUND

Breast cancer patients face significant psychological challenges, including difficulties in accepting the diagnosis, treatment, and long-term impact of the disease. Acceptance and Commitment Therapy (ACT) has shown promise in enhancing acceptance and psychological flexibility in various populations. This study aims to investigate the effectiveness of ACT in promoting disease acceptance among breast cancer patients through a randomized controlled trial.

METHODS

This study will recruit 90 breast cancer patients and randomly allocate them to an ACT intervention or control group. The ACT intervention, focusing on acceptance, mindfulness, value clarification, and committed action, will be delivered over 4 weeks. Meanwhile, the control group will receive standard care with non-therapeutic intervention. The study's primary outcome is disease acceptance, while secondary outcomes include depression, anxiety, social support, quality of life (QoL), and psychological inflexibility. Data will be collected at three points: baseline, post-intervention, and three-month follow-up. Statistical analysis will compare outcomes between groups to evaluate the effectiveness and mechanism of this intervention using covariance and mediation analysis.

DISCUSSION

This study evaluates the effectiveness of ACT in promoting disease acceptance among breast cancer patients. It hypothesizes that the ACT group will show higher disease acceptance and improvements in social support, QoL, and psychological flexibility compared to the control group. The findings will contribute to research on psychological interventions and demonstrate ACT's effectiveness in enhancing disease acceptance.

TRIAL REGISTRATION

The research project is registered in the ClinicalTrials (NCT05327153).

The mechanism of cancer-depression comorbidity

Cancer and depression are closely interrelated, particularly in patients with advanced cancer, who often present with comorbid anxiety and depression for various reasons. Recently, there has been a growing interest in the study of depression in cancer patients, with the aim of assessing the possible triggers, predictors, adverse events, and possible treatment options for depression in several common cancers. The objective of this narrative review is to synthesize the extant literature on the relationship between the occurrence and progression of depression in several common patient categories. The authors conducted a comprehensive review of 75 articles published in PubMed over the past five years. This review was further evaluated in the present paper. Ultimately, it was determined that depression is a prevalent and detrimental phenomenon among cancer patients, particularly those with advanced disease. Consequently, there is a pressing need to prioritize research and interventions aimed at improving the quality of life and psychosocial well-being of cancer patients, including those with advanced disease. The relationship between cancer and depression has been evolving dynamically in recent times. The current research findings indicate a strong association between cancer and depression. However, the direction of causality remains unclear. Focusing on depression in cancer patients may, therefore, be beneficial for these patients.

Association between cognitive functioning and health-related quality of life and its mediation by depressive symptoms in older patients with kidney failure

BACKGROUND

Impaired cognition, poor health-related quality of life (HRQoL) and depressive symptoms are common in older patients with kidney failure. Understanding what influences HRQoL is important, as older patients regard HRQoL as a health priority. This study examines whether cognitive functioning is associated with HRQoL and whether depressive symptoms mediate this effect in older patients with kidney failure.

METHODS

Outpatients aged ≥ 65 years from 35 Dutch and Belgian hospitals with eGFR 20-10 mL/min/1.73 m2 were included from the ongoing DIALOGICA study. Cognitive functioning was assessed using the Montreal Cognitive Assessment. Depressive symptoms were screened with 2 Whooley Questions and thereafter assessed with the 15-item Geriatric Depression Scale. HRQoL was assessed using the 12-item Short-Form Health Survey. To assess whether cognitive functioning is associated with HRQoL, cross-sectional multivariable linear regression analyses were performed. Subsequent mediation analyses were performed with PROCESS using the product method.

RESULTS

In total, 403 patients were included, with a mean age of 76.5 years (SD 5.8) and estimated glomerular filtration rate (eGFR) of 14.5 mL/min/1.73 m2 (SD 3.0). Cognitive functioning was associated with mental HRQoL (adjusted β 0.30, 95% CI 0.05;0.55) but not physical HRQoL (adjusted β 0.18, 95% CI -0.09;0.44). This effect is mediated by depressive symptoms (adjusted β 0.14, 95% CI 0.04;0.25).

CONCLUSION

Lower cognitive functioning was negatively associated with mental HRQoL, which was mediated by depressive symptoms in older patients with kidney failure. Future research should explore whether cognitive interventions and treatment of depression improve HRQoL in this vulnerable patient population.

A Structural Equation Model for Understanding the Relationship between Cognitive Reserve, Autonomy, Depression and Quality of Life in Aging

In recent years, aging has become a focal point of scientific research and health policies due to the growing demographic trend of an aging worldwide population. Understanding the protective and risk factors that influence aging trajectories is crucial for designing targeted interventions that support healthy aging and improve people's quality of life. The aim of this study was to explore the relationships between variables of aging. A total of 103 Italian participants (55-75 years old) underwent multidimensional assessments that covered cognitive, functional, emotional, and quality of life dimensions. Structural equation modeling was used to analyze the data and elucidate the relationships between depression, quality of life, cognitive reserve, executive functions, and daily autonomy. The findings revealed that a higher quality of life was associated with reduced depressive symptoms. In addition, cognitive reserve emerged as a protective factor positively correlated with both quality of life and daily autonomy. In this study, quality of life was determined using physical health, psychological, social relationships, and environmental domains. Identifying the significant relationships between these variables in a sample of late adults and young-aged people has given us useful elements for designing psycho-educational interventions that can be aimed at preventing frailty in later old age or supporting healthy longevity.

Quality-adjusted life years for HER2-positive, early-stage breast cancer using trastuzumab-containing regimens in the context of cost-effectiveness studies: a systematic review

INTRODUCTION

This study aims to provide a comprehensive assessment of economic and health-related quality of life (HRQoL) outcomes for human epidermal growth factor receptor 2 (HER2)-positive, early-stage breast cancer patients treated with trastuzumab-containing regimens, by focusing on both Incremental Cost-Effectiveness Ratios (ICERs) and quality-adjusted life years (QALYs).

METHODS

A systematic search was conducted across PubMed, Embase, and Scopus databases without language or publication year restrictions. Two independent reviewers screened eligible studies, extracted data, and assessed methodology and reporting quality using the Drummond checklist and Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022), respectively. Costs were converted to US dollars (US$) for 2023 for cross-study comparison.

RESULTS

Twenty-two articles, primarily from high-income countries (HICs), were included, with ICERs ranging from US$13,176/QALY to US$254,510/QALY, falling within country-specific cost-effectiveness thresholds. A notable association was observed between higher QALYs and lower ICERs, indicating a favorable cost-effectiveness and health outcome relationship. EQ-5D was the most utilized instrument for assessing health state utility values, with diverse targeted populations.

CONCLUSIONS

Studies reporting higher QALYs tend to have lower ICERs, indicating a positive relationship between cost-effectiveness and health outcomes. However, challenges such as methodological heterogeneity and transparency in utility valuation persist, underscoring the need for standardized guidelines and collaborative efforts among stakeholders.

REGISTRATION

PROSPERO ID: CRD42021259826.

Construction and validation of a risk-prediction model for chemotherapy-related cognitive impairment in patients with breast cancer

PURPOSE

To identify risk factors of chemotherapy-related cognitive impairment (CRCI) and construct and validate a visual prediction model of such for patients with breast cancer.

METHODS

A multicenter, descriptive, and cross-sectional design was adopted. Data were collected from ten public tertiary hospitals in China. Cognitive function was assessed by using Functional Assessment of Cancer Therapy-cognitive function. Socio-demographic, clinical, psychological, and physical indicators were also assessed. The logistic prediction model was constructed by fivefold cross-validation. Then, a nomogram was utilized to visualize the prediction model, which was also evaluated via discrimination, calibration, and decision curve analysis.

RESULTS

A total of 71 breast cancer patients had CRCI with a prevalence of 9.58%. This visual prediction model was constructed based on education background, exercise frequency, chemotherapy times, and fatigue and demonstrated good discrimination, with an area under the receiver operating characteristic curve of 0.882. The calibration curve indicated good agreement between experimental and projected values, and the decision curve proved good clinical applicability.

CONCLUSION

Education background, exercise frequency, chemotherapy times, and fatigue were associated with high incidence of CRCI. The prediction model exhibits superior performance and has promise as a useful instrument for assessing the likelihood of CRCI in breast cancer patients.

IMPLICATIONS FOR CANCER SURVIVORS

Our findings could provide breast cancer survivors with risk screening based on CRCI predictors to implement prevention and early intervention, and help patients integrate into society and achieve comprehensive recovery.

Cognitive appraisal and depression in cancer patients undergoing chemotherapy: mediation by perceived stress and self-efficacy

PURPOSE

Cancer patients undergoing chemotherapy are prone to suffering a higher incidence rate of depression, leading to poor quality of life. However, how cancer affects depression is unclear. This study aimed to examine whether the relationship between cognitive appraisal and depression is mediated by perceived stress and self-efficacy in cancer patients undergoing chemotherapy.

METHODS

A total of 421 cancer patients undergoing chemotherapy participated in this cross-sectional survey. Cognitive appraisal of cancer, perceived stress, self-efficacy, and depression were measured with the Perceived Life Threat Scale, Perceived Stress Scale, General Self-efficacy Scale and Hospital Anxiety, and Depression Scale-Depression Scale, respectively. Path analysis was performed to analyze the mediating effects of perceived stress and self-efficacy on the relationship between cognitive appraisal of cancer and depression.

RESULTS

Cognitive appraisal of cancer exerted direct (b = 0.066, SE = 0.020, p < 0.001, bias-corrected 95% CI = [0.027, 0.106]) and indirect (mediated by depression and insomnia) (b = 0.136, SE = 0.015, p < 0.001, bias-corrected 95% CI = [0.107, 0.167]) effects on depression. Perceived stress and self-efficacy were significant in mediating the relationship between cognitive appraisal of cancer and depression (b = 0.101, SE = 0.014, p < 0.001, bias-corrected 95% CI = [0.074, 0.132]; b = 0.021, SE = 0.006, p < 0.001, bias-corrected 95% CI = [0.006, 0.028], respectively). Additionally, a sequential mediating effect of perceived stress via self-efficacy was found, and the mediating effect size was 0.014 (p < 0.01, bias-corrected 95% CI = [0.010,0.034]).

CONCLUSIONS

This study suggests that medical staff could prevent or relieve depression through improving self-efficacy or reducing perceived stress in cancer patients undergoing chemotherapy.

Predictors of quality of life among adults with self-reported cancer related cognitive impairment

OBJECTIVE

The purpose of the current study was to examine the unique contribution of personal and medical factors, objective and subjective cognition, and self-efficacy to the explained variance of quality of life (QoL) among survivors with self-reported cancer related cognitive impairment (CRCI).

METHOD

Seventy-three cancer survivors (non-central nervous system) with CRCI (mean age: 50.85 ± 10.82 years old, mean years post-treatment: 3 ± 2.7) participated in this cross-sectional study. QoL was assessed using the Functional Assessment of Cancer Therapy (FACT)-GP, while the cognitive function was assessed both objectively using tests of attentional control, speed of processing and sustained attention, and subjectively using the FACT-Cognition perceived cognitive impairments (FACTcog-PCI) subscale. Self-efficacy was assessed using the New General Self-Efficacy Scale (NGSE).

RESULTS

A hierarchical multiple linear regression analysis revealed that sustained attention, perceived cognitive impairment and self-efficacy, accounted for 54% of the variance of QoL (R² = 0.543, p < 0.000), each providing a unique contribution to the explained variance (15-20% each) after controlling for age and gender.

CONCLUSIONS

Considering that these variables may be amenable to change, this model can serve as a conceptual framework for designing effective cognitive treatment options for CRCI. Clinical Trial Registration: ClinicalTrials.gov NCTImplication for rehabilitationCancer related cognitive impairment is characterized by difficulties in the speed of processing performance, severe perceived cognitive impairments, and relatively low general self-efficacy.Multi-dimensional assessments including subjective and objective cognition as well as self-efficacy should be administered to cancer survivors with cognitive complaints to understand the underlying mechanisms of their QoL.Integrative cognitive rehabilitation interventions that aim to improve QoL among people with cancer-related cognitive impairment should target sustained attention, perceived cognitive impairment, and self-efficacy.

The Relationship Between Self-reported Cognitive Abilities and Psychological Symptoms in Breast Cancer Survivors

BACKGROUND

Many breast cancer survivors (BCSs) report numerous symptoms following cancer treatment, including cognitive concerns and psychological symptoms (anxiety and depression). However, the association among these symptoms is not well understood.

OBJECTIVES

The objectives were to, primarily, examine the relationship between self-reported cognitive ability and psychological symptoms (anxiety and depressive symptoms) controlling for potential confounders of age, education, and time posttreatment and, secondarily, examine the relationship between self-reported cognitive domains (attention, language, visuoperception, visual memory, and verbal memory) and psychological symptoms.

METHODS

This secondary data analysis pooled data from 2 theoretically and conceptually congruent, institutional review board-approved studies of BCSs. Breast cancer survivors completed the Multiple Ability Self-report Questionnaire (cognitive ability), Spielberger State Trait Anxiety Inventory-State (anxiety), and Center for Epidemiological Studies-Depression Scale (depressive symptoms). Data were analyzed using descriptive statistics, Pearson correlations, and separate linear regression.

RESULTS

One hundred fifty-five BCSs who were on average 54.8 (SD, 8.9) years of age, approximately 5 years (mean, 5.2 [SD, 3.8] years) posttreatment, and well-educated (mean, 15.2 [SD, 2.2] years) completed questionnaires. In bivariate correlations, higher anxiety and depressive symptoms were significantly related to cognitive abilities in all domains ( P = <.01). In the regression model, increased anxiety was associated with poorer cognitive abilities in all domains ( P < .01).

CONCLUSIONS

Anxiety and depressive symptoms were associated with decrements in self-reported cognitive abilities among BCSs.

IMPLICATIONS FOR PRACTICE

With increasing numbers of BCSs, more research is needed to address psychological symptoms, which correlate with cognitive function. Findings from this analysis can inform clinical BCS survivorship care planning and future interventional research, focused on comprehensive symptom management.

Health-related quality of life in Her2-positive early breast cancer woman using trastuzumab: A systematic review and meta-analysis

Background: Despite the benefits of trastuzumab in many trials, evidence of its impact on health-related quality of life (HRQoL) in early treatment has not been summarized. This study explored the effects of trastuzumab treatment on HRQoL, including pooled meta-analysis, in an effort to provide an integrated assessment of HRQoL for Her2-positive early breast cancer patients. Methods: A comprehensive literature review to February 2023 using three databases, focusing on treatment using trastuzumab during the early stage, was performed. The mean changes from baseline during and after treatment were extracted from the included randomized control trials (RCTs) papers and total HRQoL scores were obtained from cross-sectional studies included. Mean difference (MD) and 95% confidence intervals were assessed by a random effect or fixed effect model based on heterogeneity (I²). Results: A total of ten studies were identified and reviewed, consisting of seven RCTs and three cross-sectional studies. The pooled analysis of the mean change from baseline during treatment resulted in an MD of 1.92 (95% CI = 1.59 to 2.25, p < 0.05, I² = 0%), favoring the trastuzumab group. A non-significant result of the mean change from baseline after treatment appeared in the analysis of 12-month follow-up. In the cross-sectional studies, pooled analyses of HRQoL showed that trastuzumab meaningfully demonstrated an improved HRQoL profile (MD = 9.29, 95% CI = 1.31 to 17.27, p = 0.02, I² = 0%). Conclusion: Trastuzumab as a targeted therapy resulted in a favorable effect on HRQoL in the early stages of Her2-positive breast cancer. The findings of significant improvements in patients' HRQoL and less clinically meaningful deterioration in side effects of trastuzumab-containing regimen during treatment were supported by prolonged survival.

Clinical and genetic factors associated with self-reported cognitive deficits in women with breast cancer: the "CAGE-Cog" study

Background

Breast cancer patients undergoing chemotherapy treatment are at particular risk of experiencing acute cognitive impairment leading to daily challenges in decision-making and reduced quality of life and functional autonomy. The aim was to assess the relationship between clinical and genetic factors and cognitive function in a sample of patients with breast cancer undergoing chemotherapy.

Methods

A cross-sectional study was carried out between November 2017 and June 2019 on women (N = 112) treated for breast cancer by intravenous chemotherapy at the oncology outpatient unit of Hôtel-Dieu de France Hospital, Beirut. Patients were evaluated with the 37-item Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog). Other validated scales were also used to assess depression, anxiety, sleep disorders, pain, and fatigue. DNA was obtained by a buccal swab (FTA®technology) for genotyping of different genes (ABCB1, COMT, DRD2, OPRM1, CLOCK, CRY2, and PER2) using the Lightcycler®(Roche).

Results

The mean age of participants was 56.04 years. Multivariable analysis, taking the four FACT-Cog subscores as the dependent variables, showed that the mean cognitive score decreased with higher depression, anxiety, and insomnia scores. Patients with university education levels had better perceived cognitive abilities than those with primary education. Moreover, carrying the G allele for the OPRM1 polymorphism (c.118A > G;rs197791) was significantly associated with a better cognitive function compared to AA patients (B = 2.05; p = 0.038).

Conclusions

A comprehensive oncological care plan should include a personalized assessment of all factors related to cognitive functioning in cancer patients, particularly anxiety and depression, to achieve an optimal patient outcome.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12885-022-10077-6.

Fatigue among post-hematopoietic stem cell transplant patients in Jordan: prevalence and associated factors

BACKGROUND

During hematopoietic stem cell transplant (HSCT), patients underwent various serious prolonged treatments, including conditioning and immunosuppressive drugs, resulting in several symptoms and alterations in the patient's functioning. One of the most commonly reported symptoms is fatigue.

AIM

To assess fatigue levels and associated factors during the first 100 days post-HSCT among Jordanian patients.

METHODS

A descriptive cross-sectional design assessed fatigue and associated factors during the first 100 days post-HSCT among Jordanian patients. A convenient sample was used to recruit post-HSCT patients. Data were collected using the demographic survey and the Brief Fatigue Inventory (BFI) scale.

RESULTS

The findings of this study demonstrated that 40.5% of the participants had severe total fatigue scores, while the mean BFI intensity average score was 5.01 and the mean interference of fatigue with patients' daily life was 5.06. In terms of fatigue interference with daily activities, the highest interference was with the patient's mood and normal work, while the lowest interference was with the walking ability. The analysis revealed a strong positive correlation between the fatigue intensity and its interference with the daily activities (r = .98, p ˂.001). Besides, a significantly strong negative correlation was found between the number of days post-HSCT and fatigue scores (r =  - .92, p ˂.001).

CONCLUSION

Post-transplant, patients experienced increased fatigue intensity, reduced physical activity, interference with the patient's mood, and diminished functional capacity. Patients who have HSCT require a significant nursing care immediately post-transplant.

Comparing Disease-Specific and Generic Quality of Life in Korean Breast Cancer Survivors Using the FACT-B and QLI: The Importance of Instrument Selection

BACKGROUND

Quality of life (QOL) has become an important indicator for evaluating patients' symptoms and their overall satisfaction with life. Thus, examining QOL is essential for fully understanding the life satisfaction of breast cancer survivors (BCS). However, selecting the appropriate instrument for QOL measurement is challenging, and few studies have compared disease-specific and generic QOL measures and how they reflect the impact of cancer-related symptoms on QOL in BCS. We examined QOL in BCS using both disease-specific and generic instruments and compared their representation of the QOL impacts of anxiety, depression, sleep, fatigability, and posttraumatic growth.

METHODS

This study involved analysis of follow-up data for an exercise intervention called the BLESS (Better Life after cancer, Energy, Strength, and Support) program, which included 40 BCS treated at 1 medical center in South Korea. Their QOL was assessed using both the Functional Assessment of Cancer Therapy-Breast (FACT-B) and Quality of Life Index (QLI).

RESULTS

Both FACT-B and QLI total scores revealed that Korean BCS had low levels of QOL. Furthermore, both FACT-B and QLI total scores were significantly related to anxiety, depression, sleep, fatigability, and posttraumatic growth in the participants. Notably, multivariate regression analysis of FACT-B and QLI total scores showed different predictors for QOL: with the FACT-B, depression was the only significant predictor, while with the QLI, posttraumatic growth was the only significant predictor.

CONCLUSION

The selection of a given QOL instrument may affect the overall findings and interpretation of the impacts of related symptoms. The FACT-B should be considered for studies of symptoms such as depression, while the QLI is more appropriate for examining overall QOL and posttraumatic growth.

Determinants of quality of life in women immediately following the completion of primary treatment of breast cancer: A cross-sectional study

Backgrounds

Many breast cancer patients experience significant distress immediately following the completion of primary treatment. Women who report low levels of quality of life (QOL) early in this phase of transitional survivorship tend to experience diminished long-term adjustment. However, since most of the prior studies on survivors were conducted on patients at various times, studies on QOL of women during the end of primary treatment have been insufficient. This study aimed to identify determinants of QOL in women with breast cancer immediately following the completion of treatment.

Methods

A cross-sectional study was conducted on 140 disease-free breast cancer patients who had completed therapy in the past 1 month at university hospitals. Functional Assessment of Cancer Therapy-Breast (FACT-B), Memorial Symptom Assessment Scale-Short Form (MSAS-SF), Self-Efficacy Scale for Self-Management of Breast Cancer (SESSM-B), and Interpersonal Support Evaluation List-12 (ISEL-12) scales were used to assess predictors and QOL. The data were analyzed using the Pearson correlation, t-test, ANOVA, and hierarchical multiple regression.

Results

The mean score of QOL for breast cancer survivors was 97.23 (±20.01). Chemotherapy and perceived economic status were significantly associated with QOL in terms of sociodemographic and disease/treatment-related characteristics. Physical and psychological symptoms and social support had a significant association with QOL. The regression analyses showed that physical and psychological symptoms and belonging support were statistically significant in predicting the QOL of breast cancer survivors.

Conclusions

The variables of symptom experience and social support must be acknowledged when improving women’s QOL immediately after their completion of primary breast cancer treatment. Greater focus on the reduction of symptom distress and increasing a sense of belonging could improve QOL among breast cancer survivors.

Cognitive effects of chemotherapy: An integrative review

PURPOSE

An estimated 18.1 million new cancer cases (excluding nonmelanoma skin cancers) were diagnosed worldwide in 2020. Despite a rising incidence of cancers worldwide, in developed countries with strong healthcare systems, survival rates are improving as a result of early detection, improved treatments and survivorship care (World Health Organisation (WHO), 2021). Whilst living longer, cancer survivors are often living with side effects of treatment, including chemotherapy related cognitive impairment, often termed "chemobrain".

METHOD

An integrative review of contemporary literature answering the research question how does chemotherapy affect cognitive function? was undertaken utilising three computerised databases CINAHL, Medline and PUBMED, between 2015 and 2021. Data was thematically analysed to identify themes within published literature.

RESULTS

Thematic analysis identified four broad themes within the literature regarding chemotherapy induced cognitive impairment. Identified themes included; cognition as part of a complex scenario, proof of existence and searching for the cause, learning to play the game and timing of cognitive impairment.

CONCLUSIONS

Aggressive treatment with chemotherapy in the adjuvant setting has drastically improved the survival of cancer patients. Subsequent to aggressive treatments, side effects such as cognitive impairment have presented, which may persist in the long term. Despite the exact aetiology of chemotherapy induced cognitive impairment being largely unknown, the consequences of the condition are impacting cancer survivors and their quality of life.

A serial multiple mediator model of sense of coherence, coping strategies, depression, and quality of life among gynecologic cancer patients undergoing chemotherapy

PURPOSE

This study evaluated whether coping strategies (positive reframing, planning, and active coping) and depression mediate the relationship between sense of coherence (SOC) and quality of life (QoL) using a serial multiple mediator model in patients with gynecologic cancer who are undergoing chemotherapy.

METHODS

A sample of 148 participants, with a mean age of 52.17 years (range 20-75) and diagnosed with gynecological cancer (e.g., cervix, ovary and endometrium) was surveyed in a cross-sectional study. Data were collected using a structured self-reporting questionnaire. A serial multiple mediator model was analyzed to explain sequential causality among two mediators (coping strategy and depression) and to investigate the direct and indirect effects of the mediator model in SPSSWIN 26.0 and PROCESS macro program.

RESULTS

The conceptual serial mediation model of SOC, positive reframing, depression, and QoL revealed a significant positive total effect (coefficient c = 13.099, SE = 1.647, p < 0.001). The path through single mediation of positive reframing (Effect = 0.925) and depression (Effect = 5.942) and that through both mediators (Effect = 1.161) were statistically significant. The total indirect effect was also statistically significant (Effect = 8.028). Moreover, the conceptual serial mediation model on SOC, planning, depression, and QoL revealed a significant positive total effect (coefficient c = 13.099, SE = 1.647, p < 0.001). The path through both mediation of planning and depression (Effect = 1.162) and the total indirect effect were statistically significant (Effect = 8.172).

CONCLUSIONS

Helping patients with gynecologic cancer undergoing chemotherapy to strengthen SOC may improve QoL by equipping them with efficient positive reframing or planning strategies to reduce depression.

The Influence of Rehabilitation on Quality of Life in Breast Cancer Survivors: A Clinical Study

Background: Breast cancer survivors report negative impacts of cancer, augmented by specific vulnerabilities to body changes, negative self-assessment, and quality-of-life concerns. The main objective of our work was to test the effect of a rehabilitation program on breast cancer patients by evaluating the change in their physical well-being during an outpatient rehabilitation setting and, subsequently, in a home rehabilitation setting, considering the individual personality profile. Methods: Patients who underwent total mastectomy with breast prostheses or tissue expanders were enrolled. Outcome assessments (Pain, Quality of Life, Personality traits for the Minnesota Multiphasic Personality Inventory-2) before treatment (T0), at the end of the rehabilitative treatment (T1 = 10 sessions 2/week, one hour/each), and after two months of follow-up (T2) were performed. Results: The data of 38 included patients were analyzed. The quadratic trend of the Visual Analogue Scale can be explained by the fact that patients have a strong reduction in the perceived pain immediately after rehabilitation in the clinic. This reduction remains constant for the home period of the rehabilitation. The personality profiles of all the participants were substantially valid. Only three patients obtained scores higher than 65 points. Conclusions: The study evidenced that in the initial phase of the rehabilitation, psychological traits such as anxiety, depression, and preoccupation could have a strong association especially with the autonomous functions and the perceived physical symptoms. However, during the therapeutic process, this association decreased and these decrements were higher when patients performed their rehabilitation at home, in a more familiar and comfortable setting.

Chemotherapy-related subjective cognitive impairment in breast cancer patients in semi-rural South Africa

Background

Breast cancer is the most commonly diagnosed cancer amongst women worldwide. Whilst current evidence indicates the therapeutic benefits from the use of chemotherapy, self-perceived cognitive difficulties emerged as a frequent occurrence during and after chemotherapy treatment in breast cancer patients.

Aim

The current study sought to investigate self-perceived cognitive impairment in a group of breast cancer patients in semi-rural South Africa.

Setting

The patients were recruited from an outpatient oncology clinic at a semi-rural, tertiary academic hospital in Gauteng, South Africa.

Methods

In a randomised, quantitative, time-based series study, 30 female patients aged 21–60 years (mean age = 50 years) diagnosed with stages II and III breast cancer on CMF (cyclophosphamide, methotrexate, fluorouracil) (n = 10) and FAC (fluorouracil, adriamycin, cyclophosphamide) (n = 20) chemotherapy regimens, completed the self-reported Functional Assessment of Cancer Therapy-Cognition (Fact-Cog) test as a measure of subjective cognitive functioning at three points during the course of treatment (T₀, T₁, T₂).

Results

The results of the paired sample t-tests showed the scores on the Fact-Cog test confirmed significant cognitive decline for both treatment groups from baseline (T₀) to completion (T₂) of chemotherapy; CMF group, t (9) = 2.91, p = 0.017 and the FAC group t (19) = 4.66, p < 0.001.

Conclusion

This study confirms that self-reported subjective cognitive impairment is common in breast cancer patients who received chemotherapy in a sample of South African patients. The results have implications for the overall care of cancer patients.

Contribution

The context-based knowledge engendered by the current study is expected to augment the continuum of care for breast cancer patients.

The effect of fear of progression on quality of life among breast cancer patients: the mediating role of social support

Background

Women with breast cancer are prone to have mental stress and be stimulated by the fear of progression (FOP), then giving rise to a lower quality of life (QOL). The study aimed to examine the relationships between FOP, social support and QOL, and further explore whether social support mediates the association between FOP and QOL among Chinese patients with breast cancer.

Methods

The cross-sectional study was conducted from October 2019 to May 2020 at Anshan Cancer Hospital in Liaoning, China. 244 female breast cancer patients completed questionnaires including the Functional Assessment of Cancer Therapy for Breast (FACT-B), Multi-Dimensional Scale of Perceived Social Support (MSPSS), and Fear of Progression (FOP). Hierarchical multiple regression analysis was performed to assess the associations between FOP, social support and QOL. Asymptotic and resampling strategies were used to explore the mediating role of social support.

Results

The mean QOL score was 90.6 ± 17.0 among the patients with breast cancer. FOP was negatively correlated with QOL, while social support was positively related to QOL. Social support partly mediated the association between FOP and QOL, and the proportion of the mediating effect accounted for by social support was 25%.

Conclusions

Chinese breast cancer patients expressed low QOL. Social support could mediate the association between FOP and QOL. Medical staffs and cancer caregivers should alleviate patients’ FOP to improve their QOL by facilitating social support.

The Impact of AC and AC-T Chemotherapy's Toxicities on Quality of Life Among Women with Breast Cancer in Ethiopia: A Prospective Patient-Reported Outcomes Study

PURPOSE

The study aimed to evaluate the quality of life patterns and the effects of AC and AC-T chemotherapy's toxicities on QoL among Ethiopian women with breast cancer.

METHODS

QoL was measured at baseline and at every end of two cycles, for the median of 8 cycles among 146 breast cancer women on AC and AC-T chemotherapy, using EORTC QLQ-C30 and BR23 instruments. The effect of QoL score, socio-demographic, and clinical variables at baseline were adjusted for the effect of chemotherapy's toxicities on QoL.

RESULTS

Overall QoL, all functional scales (except cognitive functioning, body image, future perspectives, and sexual functioning) and symptom scales (except dyspnea, insomnia, pain score, arm, and breast symptoms) of EORTC QLQ-C30 and BR23 deteriorated significantly both clinically and statistically, in particular, during the first two cycles of chemotherapy. After the end of cycle 2 or 4, except for cognitive, social functioning, and financial difficulties of the patients, almost all other QoL dimensions were improved towards pretreatment score by the end of cycle 8. In addition to age, educational status, and tumor stage, the Global Health Status (-10.55≤B≤-7.71, P≤0.013), and the functional scales (-25.320≤B≤-6.351, P≤0.033) of EORTC QLQ-C30 and BR23 were significantly affected at least by one of the AC and AC-T chemotherapy's toxicity such as grade≥2 fatigue, dysgeusia, constipation, dry mouth, vomiting, oral mucositis, skin hyperpigmentation and/or peripheral neuropathy than their lower grade. Grade≥2 fatigue, dysgeusia, oral mucositis, constipation, peripheral neuropathy, anemia arthralgia/myalgia, dry mouth, diarrhea, constipation, and/or skin hyperpigmentation were positively predicted for the deterioration of symptoms scale of EORTC QLQ-C30 and BR23 (4.819≤B≤26.451, P≤0.043).

CONCLUSION

Quality of life among Ethiopian breast cancer patients on AC and AC-T regimens significantly deteriorated particularly during the first two cycles of chemotherapy. In addition to the age, tumor stage and educational status of the patients, grade≥2 fatigue, dysgeusia, constipation, oral mucositis, dry mouth, peripheral neuropathy, and skin hyperpigmentation due to AC and AC-T chemotherapy were frequently associated with deterioration of different scales/items QoL. Hence, devising different strategies to improve the deteriorated QoL due to chemotherapy's toxicities particularly during the first two cycles has paramount importance.

Cognitive and Psychological Impacts of Different Treatment Options for Prostate Cancer: A Critical Analysis

Objectives

Psychological morbidity as well as cognitive impairment are increasingly reported in prostate cancer (PCa) patients. However, despite growing numbers of PCa survivors and the well estimated negative impact of cognitive decline and emotional distress on survivors' quality of life, no study has assessed the whole range of cognitive and psychological sequelae as a response to treatment options for PCa. The objective of the present review was to systematically characterize the types and estimate the prevalence of the cognitive impairment and emotional burdens that were found in PCa survivors secondary to different treatment options.

Methods

Systematic, general reviews, meta-analysis, and overviews of review studies in English, that were published in PubMed during the last 10 years until l August 2019 and that reported psychological distress, anxiety, depression, cognitive decline, or dementia among individuals with PCa exposed to a particular treatment option were analyzed.

Results

A total of 21 articles were reviewed. Some of the studies described one or more cognitive or psychological consequences of only one therapeutic strategy while others compared the psychological impacts among different strategies. Most of these studies suggested that either radical prostatectomy or active surveillance and radiotherapy were well-tolerated treatments in terms of psychological modifications. However, many of these patients may require additional emotional support. There is also increasing evidence that androgen deprivation therapy may be associated with depression, while controversy surrounding the association between cognitive dysfunction, dementia, and androgen deprivation therapy remains ambivalent.

Conclusion

Emotional distress and cognitive decline may accompany every PCa treatment option to different degrees. Accurate information on the short- and long-term effect of treatments on cognitive and psychological aspects should be provided to patients during treatment decision-making. There is also a need to develop well-targeted psychological and neurological interventions that could help those experiencing ongoing post-treatment difficulties.

Changes in Attentional Function in Patients From Before Through 12 Months After Breast Cancer Surgery

CONTEXT

Although approximately 75% of patients with breast cancer report changes in attentional function, little is known about how demographic, clinical, symptom, and psychosocial adjustment (e.g., coping) characteristics influence changes in the trajectories of attentional function over time.

OBJECTIVES

This study evaluated interindividual variability in the trajectories of self-reported attentional function and determined which demographic, clinical, symptom, and psychosocial adjustment characteristics were associated with initial levels and with changes in attentional function from before through 12 months after breast cancer surgery.

METHODS

Before surgery, 396 women were enrolled. Attentional Function Index (AFI) was completed before and nine times within the first 12 months after surgery. Hierarchical linear modeling was used to determine which characteristics were associated with initial levels and trajectories of attentional function.

RESULTS

Given an estimated preoperative AFI score of 6.53, for each additional month, the estimated linear rate of change in AFI score was an increase of 0.054 (P < 0.001). Higher levels of comorbidity, receipt of adjuvant chemotherapy, higher levels of trait anxiety, fatigue, and sleep disturbance, and lower levels of energy and less sense of control were associated with lower levels of attentional function before surgery. Patients who had less improvements in attentional function over time were nonwhite, did not have a lymph node biopsy, had received hormonal therapy, and had less difficulty coping with their disease.

CONCLUSION

Findings can be used to identify patients with breast cancer at higher risk for impaired self-reported cognitive function and to guide the prescription of more personalized interventions.