1
|
Pembroke L, Sherman KA, Francis H, Dhillon HM, Gurney H, Gillatt D. Psychosocial Factors Associated with Cognitive Function in Prostate Cancer Survivors on Hormonal Treatments: A Systematic Review. Neuropsychol Rev 2024:10.1007/s11065-024-09639-1. [PMID: 38642173 DOI: 10.1007/s11065-024-09639-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 03/07/2024] [Indexed: 04/22/2024]
Abstract
Hormonal treatments (HT) for prostate cancer (e.g., androgen deprivation therapy) yield clinical and survival benefits, yet adverse cognitive changes may be a side effect. Since psychosocial factors are largely modifiable, interventions targeting these factors may help mitigate these adverse cognitive effects. This systematic review aimed to identify a range of psychosocial factors associated with cognitive function in individuals with prostate cancer undergoing HT and to determine whether these factors mitigate or exacerbate this effect. Applying PRISMA guidelines, a comprehensive search of relevant databases conducted in September 2023 using terms related to prostate cancer, hormone therapy, and cognitive outcomes was undertaken. The search yielded 694 unique abstracts, with 11 studies included for analysis examining the relationship between cognitive function and the following psychosocial factors: psychological distress, fatigue, insomnia, and coping processes. Findings were mixed with only two studies reporting significant associations between cognitive performance with fatigue and depression. Three studies that included measures of perceived cognitive function identified associations with depression, anxiety, fatigue, insomnia, illness threat appraisals, and coping styles. However, no studies found evidence for an association between self-reported and objective measures of cognitive functioning. Evidence regarding the association of interpersonal factors is lacking. Moreover, whether these factors mitigate or exacerbate the effect of HT on cognitive function still needs to be determined. Overall, the research exploring the association between psychosocial factors and cognitive function in prostate cancer survivors undergoing HT is still in its infancy. Further research is required to optimize the implementation of neuropsychological interventions for prostate cancer survivors.
Collapse
Affiliation(s)
- Lorna Pembroke
- Lifespan Health and Wellbeing Research Centre, Macquarie University, Macquarie Park, NSW, 2109, Australia
- School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University & Macquarie University Hospital, Macquarie Park, NSW, 2109, Australia
| | - Kerry A Sherman
- Lifespan Health and Wellbeing Research Centre, Macquarie University, Macquarie Park, NSW, 2109, Australia.
- School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University & Macquarie University Hospital, Macquarie Park, NSW, 2109, Australia.
| | - Heather Francis
- School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University & Macquarie University Hospital, Macquarie Park, NSW, 2109, Australia
| | - Haryana M Dhillon
- Centre for Medical Psychology and Evidence-based Decision-making, School of Psychology, Faculty of Science, University of Sydney, Camperdown, NSW, 2006, Australia
- Psycho-Oncology Cooperative Research Group, School of Psychology, Faculty of Science, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Howard Gurney
- Faculty of Medicine, Health and Health Sciences, Macquarie University Clinical Trials Unit (CTU), Macquarie University & Macquarie University Hospital, Macquarie Park, NSW, 2109, Australia
| | - David Gillatt
- Faculty of Medicine, Health and Health Sciences, Macquarie, Macquarie University Urology Clinic, University & Macquarie University Hospital, Macquarie Park, NSW, 2109, Australia
| |
Collapse
|
2
|
Pilarska A, Pieczyńska A, Hojan K. Neuropsychological monitoring of cognitive function and ICF–based mental components in patients with malignant brain tumours. Front Psychol 2023; 14:1033185. [PMID: 37063555 PMCID: PMC10102367 DOI: 10.3389/fpsyg.2023.1033185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 03/13/2023] [Indexed: 04/03/2023] Open
Abstract
BackgroundCognitive deficits are one of the important clinical features of patients with brain tumours, which can affect up to 30–90% of patients before treatment. The consequence is a significant and rapid degradation of the patient’s intellectual functioning, seizures, paralysis and other symptoms that prevent independent functioning. This results in a reduced quality of life and a psychological crisis not only for the patient but also for their relatives. Maintaining the patient’s function at the highest level for as long as possible is particularly important, given that long-term remission or a cure is unlikely or accompanied by significant disability.PurposeThis paper aims to provide a narrative review to the neuropsychological procedure for monitoring cognitive function in patients with brain tumours, which may be helpful in developing adequate clinical practice and appropriate management procedures.MethodsA narrative review was applied to search broadly across disciplines, retrieving literature from several databases (PubMed, Web of Science, and EBSCOhost).Results(1) discussing the methodological aspects of neuropsychological tools for monitoring cognitive function in brain tumour patients, (2) identifying the most commonly used tools and (3) their practical applicability according to the cognitive function components of the International Classification of Functioning, Disability and Health (ICF).ConclusionThis article points to the need to systematise research tools or develop new ones, adapted to diagnostic needs with high psychometric characteristics, with particular attention to memory processes and learning effect. Rehabilitation of patients is also an important issue, which requires the use of adequate tools to assess functional disability. The International Classification of Functioning, Disability and Health (ICF) seems to be useful in this respect. The ICF has the advantage of targeting actions to improve the condition of the individual and to keep them as long as possible in a state of well-being that allows them to function effectively in society or to return to work. This is particularly important in view of the ageing population and the increasing number of diagnoses related to brain tumours.
Collapse
Affiliation(s)
- Agnieszka Pilarska
- Department of Rehabilitation, Greater Poland Cancer Centre, Poznan, Poland
- *Correspondence: Agnieszka Pilarska,
| | - Anna Pieczyńska
- Department of Rehabilitation, Greater Poland Cancer Centre, Poznan, Poland
- Department of Occupational Therapy, Poznan University of Medical Sciences, Poznan, Poland
| | - Katarzyna Hojan
- Department of Rehabilitation, Greater Poland Cancer Centre, Poznan, Poland
- Department of Occupational Therapy, Poznan University of Medical Sciences, Poznan, Poland
| |
Collapse
|
3
|
Kirkman MA, Day J, Gehring K, Zienius K, Grosshans D, Taphoorn M, Li J, Brown PD. Interventions for preventing and ameliorating cognitive deficits in adults treated with cranial irradiation. Cochrane Database Syst Rev 2022; 11:CD011335. [PMID: 36427235 PMCID: PMC9697842 DOI: 10.1002/14651858.cd011335.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cognitive deficits are common in people who have received cranial irradiation and have a serious impact on daily functioning and quality of life. The benefit of pharmacological and non-pharmacological treatment of cognitive deficits in this population is unclear. This is an updated version of the original Cochrane Review published in Issue 12, 2014. OBJECTIVES To assess the effectiveness of interventions for preventing or ameliorating cognitive deficits in adults treated with cranial irradiation. SEARCH METHODS For this review update we searched the Cochrane Register of Controlled Trials (CENTRAL), MEDLINE via Ovid, Embase via Ovid, and PsycInfo via Ovid to 12 September 2022. SELECTION CRITERIA We included randomised controlled (RCTs) trials that evaluated pharmacological or non-pharmacological interventions in cranial irradiated adults, with objective cognitive functioning as a primary or secondary outcome measure. DATA COLLECTION AND ANALYSIS Two review authors (MK, JD) independently extracted data from selected studies and carried out a risk of bias assessment. Cognitive function, fatigue and mood outcomes were reported. No data were pooled. MAIN RESULTS Eight studies met the inclusion criteria and were included in this updated review. Six were from the original version of the review, and two more were added when the search was updated. Nineteen further studies were assessed as part of this update but did not fulfil the inclusion criteria. Of the eight included studies, four studies investigated "prevention" of cognitive problems (during radiotherapy and follow-up) and four studies investigated "amelioration" (interventions to treat cognitive impairment as a late complication of radiotherapy). There were five pharmacological studies (two studies on prevention and three in amelioration) and three non-pharmacological studies (two on prevention and one in amelioration). Due to differences between studies in the interventions being evaluated, a meta-analysis was not possible. Studies in early radiotherapy treatment phase (five studies) Pharmacological studies in the "early radiotherapy treatment phase" were designed to prevent or ameliorate cognitive deficits and included drugs used in dementia (memantine) and fatigue (d-threo-methylphenidate hydrochloride). Non-pharmacological studies in the "early radiotherapy treatment phase" included a ketogenic diet and a two-week cognitive rehabilitation and problem-solving programme. In the memantine study, the primary cognitive outcome of memory at six months did not reach significance, but there was significant improvement in overall cognitive function compared to placebo, with similar adverse events across groups. The d-threo-methylphenidate hydrochloride study found no statistically significant difference between arms, with few adverse events. The study of a calorie-restricted ketogenic diet found no effect, although a lower than expected calorie intake in the control group complicates interpretation of the results. The study investigating the utility of a rehabilitation program did not carry out a statistical comparison of cognitive performance between groups. Studies in delayed radiation or late effect phase (four studies) The "amelioration" pharmacological studies to treat cognitive complications of radiotherapy included drugs used in dementia (donepezil) or psychostimulants (methylphenidate and modafinil). Non-pharmacological measures included cognitive rehabilitation and problem solving (Goal Management Training). These studies included patients with cognitive problems at entry who had "stable" brain cancer. The donepezil study did not find an improvement in the primary cognitive outcome of overall cognitive performance, but did find improvement in an individual test of memory, compared to placebo; adverse events were not reported. A study comparing methylphenidate with modafinil found improvements in cognitive function in both the methylphenidate and modafinil arms; few adverse events were reported. Another study comparing two different doses of modafinil combined treatment arms and found improvements across all cognitive tests, however, a number of adverse events were reported. Both studies were limited by a small sample size. The Goal Management Training study suggested a benefit of the intervention, a behavioural intervention that combined mindfulness and strategy training, on executive function and processing speed. There were a number of limitations across studies and few were without high risks of bias. AUTHORS' CONCLUSIONS In this update, limited additional evidence was found for the treatment or amelioration of cognitive deficits in adults treated with cranial irradiation. As concluded in the original review, there is supportive evidence that memantine may help prevent cognitive deficits for adults with brain metastases receiving cranial irradiation. There is supportive evidence that donepezil, methylphenidate and modafinil may have a role in treating cognitive deficits in adults with brain tumours who have been treated with cranial irradiation; patient withdrawal affected the statistical power of these studies. Further research that tries to minimise the withdrawal of consent, and subsequently reduce the requirement for imputation procedures, may offer a higher certainty of evidence. There is evidence from only a single small study to support non-pharmacological interventions in the amelioration of cognitive deficits. Further research is required.
Collapse
Affiliation(s)
- Matthew A Kirkman
- Department of Neurosurgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Julia Day
- Community Rehabilitation and Brain Injury Service (CRABIS), Strathbrock Partnership Centre, West Lothian, UK
| | - Karin Gehring
- Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, Netherlands
- Department of Cognitive Neuropsychology, Tilburg University, Tilburg, Netherlands
| | - Karolis Zienius
- Edinburgh Centre for Neuro-Oncology (ECNO), Western General Hospital, Edinburgh, UK
| | - David Grosshans
- Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Martin Taphoorn
- Department of Neurology, Haaglanden Medical Center, PO Box 432, Netherlands
| | - Jing Li
- Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Paul D Brown
- Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
4
|
Pertz M, Kowalski T, Jetschke K, Schmieder K, Schlegel U, Miller D. Pre- and postoperative self-reported and objectively assessed neurocognitive functioning in lower grade glioma patients. J Clin Neurosci 2022; 106:185-193. [DOI: 10.1016/j.jocn.2022.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/03/2022] [Accepted: 10/28/2022] [Indexed: 11/09/2022]
|
5
|
Gaynor AM, Ahles TA, Ryan E, Schofield E, Li Y, Patel SK, McNeal K, Traina T, Root JC. Initial encoding deficits with intact memory retention in older long-term breast cancer survivors. J Cancer Surviv 2022; 16:940-947. [PMID: 34357556 PMCID: PMC10321572 DOI: 10.1007/s11764-021-01086-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 07/09/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Cancer survivors frequently report significant forgetfulness, but standard neuropsychological tests often fail to detect primary memory deficits. Past research has suggested survivors may misattribute forgetfulness to memory decay rather than impairments in initial encoding, but no studies have tested whether this pattern is evident in older survivors, who are more vulnerable to age-related memory difficulties. We examined whether long-term breast cancer survivors treated in older adulthood demonstrate deficits in initial encoding, as opposed to increased rates of memory decay, relative to non-cancer controls. METHODS Three hundred twenty-eight breast cancer survivors age 60 and above, 5-15 years post-treatment, and 162 age-matched non-cancer controls completed list learning and narrative memory assessments at four time-points over 2 years. Performance on learning trials and delayed recall was analyzed at each time-point to assess group differences in memory encoding, and memory decay was assessed by analyzing changes in performance across delays. RESULTS Univariate ANCOVAs correcting for age and education showed that survivors had worse initial encoding performance across multiple time-points, which were compensated for with multiple learning trials to produce recall performance comparable to controls. There were no significant group differences in memory decay. CONCLUSIONS Older long-term breast cancer survivors exhibit a consistent pattern of initial encoding deficits, but memory retention was comparable to controls. Future research should consider the role of encoding deficits and age-related factors when evaluating cognitive function in older survivors. IMPLICATIONS FOR CANCER SURVIVORS Commonly reported memory problems may stem from encoding deficits in older long-term cancer survivors.
Collapse
Affiliation(s)
- Alexandra M Gaynor
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, 7th Floor, New York, NY, USA.
| | - Tim A Ahles
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, 7th Floor, New York, NY, USA
| | - Elizabeth Ryan
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, 7th Floor, New York, NY, USA
| | - Elizabeth Schofield
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, 7th Floor, New York, NY, USA
| | - Yuelin Li
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, 7th Floor, New York, NY, USA
| | - Sunita K Patel
- Departments of Population Science and Supportive Care Medicine, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Katrazyna McNeal
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, 7th Floor, New York, NY, USA
| | - Tiffany Traina
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - James C Root
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, 7th Floor, New York, NY, USA
| |
Collapse
|
6
|
Sahu K, Singh S, Devi B, Singh C, Singh A. A review on the neuroprotective effect of berberine against chemotherapy-induced cognitive impairment. Curr Drug Targets 2022; 23:913-923. [PMID: 35240956 DOI: 10.2174/1389450123666220303094752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 12/02/2021] [Accepted: 01/06/2022] [Indexed: 11/22/2022]
Abstract
Chemobrain is one of the major side effects of chemotherapy, despite increased research, the mechanisms underlying chemotherapy-induced cognitive changes remain unknown. Though, several possibly important candidate mechanisms have been identified and will be studied further in the future. Chemobrain is characterized by memory loss, cognitive impairment, difficulty in language, concentration, acceleration, and learning. The major characteristic of chemobrain is oxidative stress, mitochondrial dysfunction, immune dysregulation, hormonal alteration, white matter abnormalities, and DNA damage. Berberine (BBR) is an isoquinoline alkaloid extracted from various berberine species. BBR is a small chemical that easily passes the blood-brain barrier (BBB), making it useful for treating neurodegenerative diseases. Many studies on the pharmacology of BBR have been reported in the past. Furthermore, several clinical and experimental research indicates that BBR has a variety of pharmacological effects. So, in this review, we explore the pathogenesis of chemobrain and the neuroprotective potential of BBR against chemobrain. We also introduced the therapeutic role of BBR in various neurodegenerative and neurological diseases such as Alzheimer's, Parkinson's disease, mental depression, schizophrenia, anxiety, and also some stroke.
Collapse
Affiliation(s)
- Kuleshwar Sahu
- Department of Pharmacology, ISF College of Pharmacy, Moga-142001, Punjab India
| | - Sukhdev Singh
- Department of Pharmacology, ISF College of Pharmacy, Moga-142001, Punjab India
| | - Bhawna Devi
- Department of Pharmacology, ISF College of Pharmacy, Moga-142001, Punjab India
| | - Charan Singh
- Affiliated to IK Gujral Punjab Technical University, Jalandhar, Punjab-144603, India
| | - Arti Singh
- Department of Pharmacology, ISF College of Pharmacy, Moga-142001, Punjab India
| |
Collapse
|
7
|
Sahu K, Langeh U, Singh C, Singh A. Crosstalk between anticancer drugs and mitochondrial functions. Curr Res Pharmacol Drug Discov 2021; 2:100047. [PMID: 34909674 PMCID: PMC8663961 DOI: 10.1016/j.crphar.2021.100047] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/12/2021] [Accepted: 08/17/2021] [Indexed: 01/12/2023] Open
Abstract
Chemotherapy is an important component of cancer treatment, which has side effects like vomiting, peripheral neuropathy, and numerous organ toxicity but the most significant outcomes of chemotherapy are cognitive impairment, which is mainly referred to as chemobrain or CICI (chemotherapy-induced cognitive impairment). It is characterized by difficulty with language, concentrating, processing speed, learning, and memory, as it affects the hippocampus areas of the brain. Mitochondrial dysfunction and oxidative stress are one of the major mechanisms causing chemobrain. The generation of reactive oxygen species (byproducts of oxidative phosphorylation) mainly occurs in mitochondria that play a prominent role in the induction of oxidative stress. The homeostasis of ROS in the mitochondria is maintained by mitochondrial antioxidant mechanism via enzymes like catalase, glutathione, and superoxide dismutase. Lungs and breast cancer are the two most common types of cancer, which are the most leading cancers in the world with about 4.18 million cases. In this review we exposed the current knowledge regarding chemotherapy-induced oxidative stress and mitochondrial dysfunction to cause cognitive impairment.We especially focused on the antineoplastic agent (ADRIAMYCIN, CYCLOPHOSPHAMIDE), platinum group agent CISPLATIN, antimetabolite agents (METHOTREXATE), and nitrogen mustard agent (CARMUSTINE) which increase oxidative stress and inflammatory markers in the PNS (peripheral nervous system) as well as the central nervous system. We also highlight the behavioural and functional changes in the brain.
Collapse
Affiliation(s)
- Kuleshwar Sahu
- Department of Pharmacology, ISF College of Pharmacy, Moga, 142001, Punjab, India
| | - Urvashi Langeh
- Department of Pharmacology, ISF College of Pharmacy, Moga, 142001, Punjab, India
| | - Charan Singh
- Department of Pharmaceutics, ISF College of Pharmacy, Moga, 142001, Punjab, India
| | - Arti Singh
- Department of Pharmacology, ISF College of Pharmacy, Moga, 142001, Punjab, India
| |
Collapse
|
8
|
Dias-Carvalho A, Ferreira M, Ferreira R, Bastos MDL, Sá SI, Capela JP, Carvalho F, Costa VM. Four decades of chemotherapy-induced cognitive dysfunction: comprehensive review of clinical, animal and in vitro studies, and insights of key initiating events. Arch Toxicol 2021; 96:11-78. [PMID: 34725718 DOI: 10.1007/s00204-021-03171-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 09/23/2021] [Indexed: 01/22/2023]
Abstract
Cognitive dysfunction has been one of the most reported and studied adverse effects of cancer treatment, but, for many years, it was overlooked by the medical community. Nevertheless, the medical and scientific communities have now recognized that the cognitive deficits caused by chemotherapy have a strong impact on the morbidity of cancer treated patients. In fact, chemotherapy-induced cognitive dysfunction or 'chemobrain' (also named also chemofog) is at present a well-recognized effect of chemotherapy that could affect up to 78% of treated patients. Nonetheless, its underlying neurotoxic mechanism is still not fully elucidated. Therefore, this work aimed to provide a comprehensive review using PubMed as a database to assess the studies published on the field and, therefore, highlight the clinical manifestations of chemobrain and the putative neurotoxicity mechanisms.In the last two decades, a great number of papers was published on the topic, mainly with clinical observations. Chemotherapy-treated patients showed that the cognitive domains most often impaired were verbal memory, psychomotor function, visual memory, visuospatial and verbal learning, memory function and attention. Chemotherapy alters the brain's metabolism, white and grey matter and functional connectivity of brain areas. Several mechanisms have been proposed to cause chemobrain but increase of proinflammatory cytokines with oxidative stress seem more relevant, not excluding the action on neurotransmission and cellular death or impaired hippocampal neurogenesis. The interplay between these mechanisms and susceptible factors makes the clinical management of chemobrain even more difficult. New studies, mainly referring to the underlying mechanisms of chemobrain and protective measures, are important in the future, as it is expected that chemobrain will have more clinical impact in the coming years, since the number of cancer survivors is steadily increasing.
Collapse
Affiliation(s)
- Ana Dias-Carvalho
- Associate Laboratory i4HB-Institute for Health and Bioeconomy, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313, Porto, Portugal. .,UCIBIO-Applied Molecular Biosciences Unit, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313, Porto, Portugal.
| | - Mariana Ferreira
- Associate Laboratory i4HB-Institute for Health and Bioeconomy, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313, Porto, Portugal.,UCIBIO-Applied Molecular Biosciences Unit, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313, Porto, Portugal.,LAQV/REQUIMTE, Department of Chemistry, University of Aveiro, Aveiro, Portugal
| | - Rita Ferreira
- LAQV/REQUIMTE, Department of Chemistry, University of Aveiro, Aveiro, Portugal
| | - Maria de Lourdes Bastos
- Associate Laboratory i4HB-Institute for Health and Bioeconomy, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313, Porto, Portugal.,UCIBIO-Applied Molecular Biosciences Unit, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313, Porto, Portugal
| | - Susana Isabel Sá
- Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal.,Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - João Paulo Capela
- Associate Laboratory i4HB-Institute for Health and Bioeconomy, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313, Porto, Portugal.,UCIBIO-Applied Molecular Biosciences Unit, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313, Porto, Portugal.,Faculdade de Ciências da Saúde, Universidade Fernando Pessoa, Porto, Portugal
| | - Félix Carvalho
- Associate Laboratory i4HB-Institute for Health and Bioeconomy, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313, Porto, Portugal.,UCIBIO-Applied Molecular Biosciences Unit, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313, Porto, Portugal
| | - Vera Marisa Costa
- Associate Laboratory i4HB-Institute for Health and Bioeconomy, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313, Porto, Portugal. .,UCIBIO-Applied Molecular Biosciences Unit, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313, Porto, Portugal.
| |
Collapse
|
9
|
Lee J, Kim JS, Kim Y. Atorvastatin-mediated rescue of cancer-related cognitive changes in combined anticancer therapies. PLoS Comput Biol 2021; 17:e1009457. [PMID: 34669701 DOI: 10.1371/journal.pcbi.1009457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 11/01/2021] [Accepted: 09/17/2021] [Indexed: 11/19/2022] Open
Abstract
Acute administration of trastuzumab (TZB) may induce various forms of cognitive impairment. These cancer-related cognitive changes (CRCC) are regulated by an adverse biological process involving cancer stem cells (CSCs) and IL-6. Recent studies have reported that atorvastatin (ATV) may change the dynamic of cognitive impairment in a combination (TZB+ATV) therapy. In this study, we investigate the mutual interactions between cancer stem cells and the tumor cells that facilitate cognitive impairment during long term TZB therapy by developing a mathematical model that involves IL-6 and the key apoptotic regulation. These include the densities of tumor cells and CSCs, and the concentrations of intracellular signaling molecules (NFκB, Bcl-2, BAX). We apply the mathematical model to a single or combination (ATV+TZB) therapy used in the experiments to demonstrate that the CSCs can enhance CRCC by secreting IL-6 and ATV may interfere the whole regulation. We show that the model can both reproduce the major experimental observation on onset and prevention of CRCC, and suggest several important predictions to guide future experiments with the goal of the development of new anti-tumor and anti-CRCC strategies. Moreover, using this model, we investigate the fundamental mechanism of onset of cognitive impairment in TZB-treated patients and the impact of alternating therapies on the anti-tumor efficacy and intracellular response to different treatment schedules. A conventional drug, trastuzumab (TZB), was shown to be an effective weapon in killing cancer cells in brain. However, long term treatment of TZB increases the proportion of cancer stem cells (CSCs) in the tumour microenvironment (TME) and induces up-regulation of pro-tumoral molecules such as IL-6 in TME. These cancer cells then become more resistant to this chemotherapy through the IL-mediated up-regulation of NFκB and CSCs. More importantly, these changes in TME result in a serious side effect, cognitive impairment called cancer-related cognitive changes (CRCC). The detailed mechanism of CRCC is still poorly understood. However, cancer patients with chemotherapy-induced cognitive impairment can have long-term or delayed mental changes. In this study, we investigated the fundamental mechanism of CRCC in cancer patients based on experiments and a mathematical model that describes how tumor cells interact with CSCs in response to chemo drugs. In particular, we investigate how TZB-induced CSCs with modified IL-6 landscapes shape the cognitive functions in cancer patients. We showed that the combination treatment with another drug, atorvastatin (ATV), can abrogate the TZB-induced CRCC and enhance the survival probability of cancer patients by synergistic anti-tumor effect. We demonstrate that the cognitive functions and survival rates in cancer patients depend on the apoptotic signaling pathways via the critical communication and IL-6 landscapes of stimulated CTCs.
Collapse
|
10
|
Khadrawy YA, Hosny EN, Mohammed HS. Protective effect of nanocurcumin against neurotoxicity induced by doxorubicin in rat's brain. Neurotoxicology 2021; 85:1-9. [PMID: 33882267 DOI: 10.1016/j.neuro.2021.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/07/2021] [Accepted: 04/10/2021] [Indexed: 02/07/2023]
Abstract
Cognitive impairment is one of the serious side effects that cancer-treated patients suffer from after treatment by doxorubicin (DOX). Investigating the mechanisms underlying this impairment is crucial for its treatment or prevention. The current study investigates the cortical and hippocampal neurochemical changes induced by an acute dose of DOX (20 mg/kg, i.p.) and evaluates the neuroprotective effect of nanocurcumin (NC) (50 mg/kg, p.o.) against these changes. Animals were randomly divided into four groups, control, rats treated with either NC or DOX, and the fourth group treated with NC prior to DOX. Cortical dopamine level has significantly increased (71.88 %) after DOX injection. This was associated with a significant rise in the levels of lipid peroxidation (183.99 %, 201.4 %) and nitric oxide (36.54 %, 55 %) and a significant reduction in reduced glutathione (13 %, 21.44 %) in the cortex and hippocampus, respectively. In addition, DOX inhibited the cortical and hippocampal activities of acetylcholinesterase (94.82 %, 62.75 %) and monoamine oxidase (64.40 %, 68.84 %), respectively. Protection with NC mitigates the changes induced in the oxidative stress parameters by DOX. However, the effect on the activities of AchE and MAO was insignificant. This was reflected in the level of dopamine that showed non-significant changes in comparison to control and DOX-treated rats. The present findings indicate that oxidative stress, inhibition in AchE, MAO, and the subsequent elevation in dopamine could have a crucial role in mediating the chemo-brain adverse effects induced by DOX. In addition, protection with NC mitigated some of these adverse effects thus rendering DOX more tolerable.
Collapse
|
11
|
Mariegaard J, Wenstrup J, Lim KZM, Bidstrup PE, von Heymann A, Johansen C, Knudsen GM, Law I, Specht L, Stenbæk DS. Prevalence of cognitive impairment and its relation to mental health in Danish lymphoma survivors. Support Care Cancer 2020; 29:3319-3328. [PMID: 33118105 DOI: 10.1007/s00520-020-05857-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/23/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE This study sought to investigate the prevalence of self-reported cognitive impairment and its relation to illness and treatment characteristics and mental health in Hodgkin lymphoma (HL) and diffuse large B cell lymphoma (DLBCL) survivors as cancer-related cognitive impairment has not been extensively studied in lymphoma survivors. METHODS One hundred fifteen HL and DLBCL survivors (mean age = 40.3 years, mean months since completed treatment = 29.6) completed questionnaires on executive function and mental health. We examined the prevalence of executive impairment and compared illness and treatment characteristics and mental health across survivors reporting impaired and non-impaired executive functioning using chi-square, Cochran-Armitage, and Mann-Whitney U tests. RESULTS We found that 39% reported executive impairment. Survivors reporting impaired executive functioning reported worse mental health (ps < .001) than survivors reporting non-impaired executive functioning. A larger proportion of the impaired group had received a high chemo dose compared to the non-impaired group although this result fell short of significance after adjustment for multiple comparisons (p = .017). CONCLUSIONS Self-reported cognitive impairment is prevalent in HL and DLBCL survivors and is associated with worse mental health and possibly high chemo dose. Future studies should investigate objective impairment and the possible dose-response relationship between chemo dose and cognitive impairment in lymphoma survivors.
Collapse
Affiliation(s)
- Johanna Mariegaard
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, DK-2100, Copenhagen, Denmark
| | - Jonathan Wenstrup
- Department of Oncology, Copenhagen University Hospital Rigshospitalet, DK-2100, Copenhagen, Denmark.,Psychological Aspects of Cancer, Survivorship Unit, Danish Cancer Society Research Center, DK-2100, Copenhagen, Denmark.,Department of Neurology, Bispebjerg-Frederiksberg Hospital, DK-2400, Copenhagen, Denmark
| | - Kevin Zi Ming Lim
- Psychological Aspects of Cancer, Survivorship Unit, Danish Cancer Society Research Center, DK-2100, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, DK-2100, Copenhagen, Denmark
| | - Pernille Envold Bidstrup
- Psychological Aspects of Cancer, Survivorship Unit, Danish Cancer Society Research Center, DK-2100, Copenhagen, Denmark
| | - Annika von Heymann
- CASTLE Cancer Late Effects Research Unit, Department of Oncology, Copenhagen University Hospital Rigshospitalet, DK-2100, Copenhagen, Denmark
| | - Christoffer Johansen
- CASTLE Cancer Late Effects Research Unit, Department of Oncology, Copenhagen University Hospital Rigshospitalet, DK-2100, Copenhagen, Denmark
| | - Gitte Moos Knudsen
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, DK-2100, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, DK-2100, Copenhagen, Denmark
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine & PET, Copenhagen University Hospital Rigshospitalet, DK-2100, Copenhagen, Denmark
| | - Lena Specht
- Department of Oncology, Copenhagen University Hospital Rigshospitalet, DK-2100, Copenhagen, Denmark
| | - Dea Siggaard Stenbæk
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, DK-2100, Copenhagen, Denmark.
| |
Collapse
|
12
|
Pertz M, Popkirov S, Schlegel U, Thoma P. Research on cognitive and sociocognitive functions in patients with brain tumours: a bibliometric analysis and visualization of the scientific landscape. Neurol Sci 2020; 41:1437-1449. [PMID: 32052308 PMCID: PMC8266703 DOI: 10.1007/s10072-020-04276-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 02/02/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Many patients with brain tumours exhibit mild to severe (neuro)cognitive impairments at some point during the course of the disease. Social cognition, as an instance of higher-order cognitive functioning, specifically enables initiation and maintenance of appropriate social interactions. For individuals being confronted with the diagnosis of a brain tumour, impairment of social function represents an additional burden, since those patients deeply depend on support and empathy provided by family, friends and caregivers. METHODS The present study explores the scientific landscape on (socio)cognitive functioning in brain tumour patients by conducting a comprehensive bibliometric analysis using VOSviewer. The Web of Science Core Collection database was examined to identify relevant documents published between 1945 and 2019. RESULTS A total of 664 English titles on (socio)cognitive functions in patients with brain tumours was retrieved. Automated textual analysis revealed that the data available so far focus on three major topics in brain tumour patients: cognitive functions in general and in paediatric cases, as well as psychological factors and their influence on quality of life. The focus of research has gradually moved from clinical studies with cognitive functions as one of the outcome measures to investigations of interactions between cognitive functions and psychological constructs such as anxiety, depression or fatigue. Medical, neurological and neuropsychological journals, in particular neuro-oncological journals published most of the relevant articles authored by a relatively small network of well interconnected researchers in the field. CONCLUSION The bibliometric analysis highlights the necessity of more research on social cognition in brain tumour patients.
Collapse
Affiliation(s)
- Milena Pertz
- Department of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr-University Bochum, In der Schornau 23-25, D-44892, Bochum, Germany.
| | - Stoyan Popkirov
- Department of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr-University Bochum, In der Schornau 23-25, D-44892, Bochum, Germany
| | - Uwe Schlegel
- Department of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr-University Bochum, In der Schornau 23-25, D-44892, Bochum, Germany
| | - Patrizia Thoma
- Neuropsychological Therapy Centre (NTC)/Clinical Neuropsychology, Faculty of Psychology, Ruhr-University Bochum, Universitätsstraße 150, D-44780, Bochum, Germany
| |
Collapse
|
13
|
Wolyniec K, Sharp J, Lazarakis S, Mileshkin L, Schofield P. Understanding and information needs of cancer patients regarding treatment‐focused genomic testing: A systematic review. Psychooncology 2020; 29:632-638. [DOI: 10.1002/pon.5351] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/28/2020] [Accepted: 02/02/2020] [Indexed: 01/09/2023]
Affiliation(s)
- Kamil Wolyniec
- Department of Psychological SciencesSwinburne University of Technology Hawthorn Victoria Australia
- Department of Cancer Experiences ResearchPeter MacCallum Cancer Centre Melbourne Victoria Australia
| | - Jessica Sharp
- Department of Statistics Data Science and EpidemiologySwinburne University of Technology Hawthorn Victoria Australia
| | - Smaro Lazarakis
- Health Sciences LibraryRoyal Melbourne Hospital Melbourne Victoria Australia
| | - Linda Mileshkin
- Sir Peter MacCallum Department of OncologyUniversity of Melbourne Melbourne Victoria Australia
| | - Penelope Schofield
- Department of Psychological SciencesSwinburne University of Technology Hawthorn Victoria Australia
- Department of Cancer Experiences ResearchPeter MacCallum Cancer Centre Melbourne Victoria Australia
- Sir Peter MacCallum Department of OncologyUniversity of Melbourne Melbourne Victoria Australia
| |
Collapse
|
14
|
Shadick NA, Katz P, Iannaccone CI, Maica G, Coblyn J, Weinblatt ME, Cui J. The Impact of Exercise, Lifestyle, and Clinical Factors on Perceived Cognitive Function in Patients with Rheumatoid Arthritis: Results from a Prospective Cohort Study. ACR Open Rheumatol 2019; 1:620-626. [PMID: 31872183 PMCID: PMC6917307 DOI: 10.1002/acr2.11088] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 09/05/2019] [Indexed: 12/22/2022] Open
Abstract
Objective Lifestyle factors, such as inactivity and obesity, contribute to cognitive decline in the general population, but little is known about how these factors may affect individuals with a chronic inflammatory condition such as rheumatoid arthritis (RA). We studied the clinical and functional risk factors related to a worsening of perceived cognitive function in patients with RA. Methods We collected clinical and functional questionnaire data over 10 years in a prospective RA cohort including yearly self‐reported memory, concentration, and word‐finding difficulties graded from “never” to “often.” Generalized estimating equation models examined the role of exercise (defined as those meeting the Department of Health and Human Services physical activity guidelines of 75 minutes of vigorous or 150 minutes of moderate aerobic activity per week), body mass index (BMI), sleep, depression (Mental Health Index‐Depression), Disease Activity Score (DAS)28–c‐reactive protein (CRP)3 score, disease‐modifying antirheumatic drug, and corticosteroid use from the previous year as predictors of cognitive complaints that progressed to “often” compared with the previous year (the first year (Ti) progressed to “often” 1 year later (Ti+1)). Results Of 1219 RA subjects, 127 (10.4%) described either poor memory, concentration, or word‐finding difficulties as affecting them “often” at study entry. RA patients (n = 1092, mean age = 56.5 years, 82% female, 58% college educated) were less likely to report word‐finding difficulties, poor memory, and concentration as “often” if they were physically active (p = 0.0001, P = 0.01, P < 0.0001, respectively). Female RA patients developed more concentration complaints compared with males (P = 0.03); patients taking an anti–tumor necrosis factor therapy were less likely to complain of poor memory (P = 0.01). Sleep, BMI, fatigue, depression, DAS28‐CRP3, methotrexate, and corticosteroid use were not independently associated with a worsening of any cognitive complaints. Conclusion RA patients who are physically active are less likely to report cognitive difficulties. Our study suggests potential modifiable risk factors for the prevention of cognitive dysfunction in RA.
Collapse
Affiliation(s)
- Nancy A Shadick
- Division of Rheumatology, Immunology & Allergy, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, 02115
| | - Patricia Katz
- Division of Rheumatology, UCSF Medical Center, San Francisco, CA, 94118
| | - Christine I Iannaccone
- Division of Rheumatology, Immunology & Allergy, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, 02115
| | - Gabriela Maica
- Division of Rheumatology, Immunology & Allergy, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, 02115
| | - Jonathan Coblyn
- Division of Rheumatology, Immunology & Allergy, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, 02115
| | - Michael E Weinblatt
- Division of Rheumatology, Immunology & Allergy, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, 02115
| | - Jing Cui
- Division of Rheumatology, Immunology & Allergy, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, 02115
| |
Collapse
|
15
|
Bras L, Driessen DAJJ, de Vries J, Festen S, van der Laan BFAM, van Leeuwen BL, de Bock GH, Halmos GB. Patients with head and neck cancer: Are they frailer than patients with other solid malignancies? Eur J Cancer Care (Engl) 2019; 29:e13170. [PMID: 31571340 PMCID: PMC7063690 DOI: 10.1111/ecc.13170] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 08/06/2019] [Accepted: 09/04/2019] [Indexed: 12/16/2022]
Abstract
Objective We aimed to compare frailty status between patients with head and neck cancer (HNC) and other solid malignancies. Methods Data collection was prospective, and the following were compared between cohorts at baseline: patient and tumour characteristics, Charlson Comorbidity Index (CCI), Groningen Frailty Indicator (GFI), Mini Mental State Examination (MMSE), Activities of Daily Living (ADLs), Instrumental ADLs (IADLs), Timed Up and Go (TUG) and Quality of Life (QoL). Univariate and multivariate logistic regression analyses were performed, and odds ratios (ORs) with their 95% confidence intervals (95% CIs) were estimated. Results In total, 242 patients with HNC and 180 with other oncology diagnoses were enrolled, of whom 32.6% and 21.8% were frail according to the GFI respectively. Comorbidity scores were not significantly different between the cohorts (7.4% vs. 13.1%; OR 0.54; 95% CI 0.28–1.02). In the univariate analysis, the GFI was significantly worse in the HNC cohort (OR 1.74; 95% CI 1.11–2.71). However, in the multivariate analysis, the MMSE, TUG and global QoL were significantly worse in the HNC cohort, with ORs of 20.03 (95% CI 2.44–164.31), 11.56 (95% CI 1.86–71.68) and 0.98 (95% CI 0.97–1.00) respectively. Conclusion Patients with HNC appear to be frailer than patients with other solid malignancies despite comparable levels of comorbidity.
Collapse
Affiliation(s)
- Linda Bras
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Daphne A J J Driessen
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Julius de Vries
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Suzanne Festen
- University Center for Geriatric Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Bernard F A M van der Laan
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Barbara L van Leeuwen
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Geertruida H de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gyorgy B Halmos
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
16
|
Busson R, van der Kaaij M, Mounier N, Aleman BMP, Thiéblemont C, Stamatoullas A, Ribrag V, Tilly H, Haioun C, Casasnovas RO, Kluin-Nelemans HC, Henry-Amar M. Fatigue level changes with time in long-term Hodgkin and non-Hodgkin lymphoma survivors: a joint EORTC-LYSA cross-sectional study. Health Qual Life Outcomes 2019; 17:115. [PMID: 31266501 PMCID: PMC6604328 DOI: 10.1186/s12955-019-1186-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 06/23/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Long-term lymphoma survivors often complain of persistent fatigue that remains unexplained. While largely reported in Hodgkin lymphoma (HL), long-term fatigue is poorly documented in non-Hodgkin lymphomas (NHL). Data collected in two cohort studies were used to illustrate the fatigue level changes with time in the two populations. METHODS Two cross-sectional studies were conducted in 2009-2010 (HL) and in 2015 (NHL) in survivors enrolled in European Organisation for Research and Treatment of Cancer (EORTC) Lymphoma Group and Lymphoma Study Association (LYSA) trials. The same protocol and questionnaires were used in both studies including the Multidimensional Fatigue Inventory (MFI) tool to assess fatigue and a checklist of health disorders. Multivariate linear regression models were used in the two populations separately to assess the influence of time since diagnosis and primary treatment, age, gender, education level, cohabitation status, obesity and health disorders on fatigue level changes. Fatigue level changes were compared to general population data. RESULTS Overall, data of 2023 HL and 1619 NHL survivors with fatigue assessment available (99 and 97% of cases, respectively) were analyzed. Crude levels of fatigue were similar in the two populations. Individuals who reported health disorders (61% of HL and 64% of NHL) displayed higher levels of fatigue than those who did not (P < 0.001). HL survivors showed increasing fatigue level with age while in NHL survivors mean fatigue level remained constant until age 70 and increased beyond. HL survivors showed fatigue changes with age higher than those of the general population with health disorders while NHL survivors were in between those of the general population with and without health disorders. CONCLUSIONS Among lymphoma survivors progressive increase of fatigue level with time since treatment completion is a distinctive feature of HL. Our data suggest that changes in fatigue level are unlikely to only depend on treatment complications and health disorders. Investigations should be undertaken to identify which factors including biologic mechanisms could explain why a substantial proportion of survivors develop high level of fatigue.
Collapse
Affiliation(s)
- Raphaël Busson
- École Doctorale MIIS, University of Caen-Normandie, 14032, Caen, France
- Centre de Traitement des Données du Cancéropôle Nord-Ouest, Plateforme de Recherche Clinique Ligue Contre le Cancer, Centre François Baclesse, 3 Avenue Général Harris, 14076, Caen, Cedex 5, France
| | - Marleen van der Kaaij
- Department of Internal Medicine, Leiden University Medical Centre, Albinusdreef 2, 2333, ZA, Leiden, the Netherlands
| | - Nicolas Mounier
- Service d'Onco-hématologie, Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Hôpital l'Archet 2, 151 Route Saint-Antoine de Ginestière, BP 3079, 06202, Nice, Cedex 3, France
| | - Berthe M P Aleman
- Department of Radiotherapy, The Netherlands Cancer Institute, Plesmanlaan 121, 1066, CX, Amsterdam, the Netherlands
| | - Catherine Thiéblemont
- Service d'Hématologie, AP-HP CHU Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Aspasia Stamatoullas
- Service d'Hématologie, Centre Henri Becquerel, Rue d'Amiens, 76000, Rouen, France
| | - Vincent Ribrag
- Service d'Hématologie, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94805, Villejuif, Cedex, France
| | - Hervé Tilly
- Service d'Hématologie, Centre Henri Becquerel, Rue d'Amiens, 76000, Rouen, France
| | - Corinne Haioun
- Service d'Hématologie, AP-HP CHU Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - René-Olivier Casasnovas
- Service d'Hématologie, CHRU de Dijon Bourgogne, Hôpital Le Bocage, 2 Boulevard Maréchal de Lattre of Tassigny, 21000, Dijon, France
| | - Hanneke C Kluin-Nelemans
- Department of Haematology, University Medical Centre Groningen, University of Groningen, PO Box 30.001, 9700, RB, Groningen, the Netherlands
| | - Michel Henry-Amar
- Centre de Traitement des Données du Cancéropôle Nord-Ouest, Plateforme de Recherche Clinique Ligue Contre le Cancer, Centre François Baclesse, 3 Avenue Général Harris, 14076, Caen, Cedex 5, France.
| |
Collapse
|
17
|
Alhowail AH, Bloemer J, Majrashi M, Pinky PD, Bhattacharya S, Yongli Z, Bhattacharya D, Eggert M, Woodie L, Buabeid MA, Johnson N, Broadwater A, Smith B, Dhanasekaran M, Arnold RD, Suppiramaniam V. Doxorubicin-induced neurotoxicity is associated with acute alterations in synaptic plasticity, apoptosis, and lipid peroxidation. Toxicol Mech Methods 2019; 29:457-466. [PMID: 31010378 DOI: 10.1080/15376516.2019.1600086] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Cognitive deficits are commonly reported by patients following treatment with chemotherapeutic agents. Anthracycline-containing chemotherapy regimens are associated with cognitive impairment and reductions in neuronal connectivity in cancer survivors, and doxorubicin (Dox) is a commonly used anthracycline. Although it has been reported that Dox distribution to the central nervous system (CNS) is limited, considerable Dox concentrations are observed in the brain with co-administration of certain medications. Additionally, pro-inflammatory cytokines, which are overproduced in cancer or in response to chemotherapy, can reduce the integrity of the blood-brain barrier (BBB). Therefore, the aim of this study was to evaluate the acute neurotoxic effects of Dox on hippocampal neurons. In this study, we utilized a hippocampal cell line (H19-7/IGF-IR) along with rodent hippocampal slices to evaluate the acute neurotoxic effects of Dox. Hippocampal slices were used to measure long-term potentiation (LTP), and expression of proteins was determined by immunoblotting. Cellular assays for mitochondrial complex activity and lipid peroxidation were also utilized. We observed reduction in LTP in hippocampal slices with Dox. In addition, lipid peroxidation was increased as measured by thiobarbituric acid reactive substances content indicating oxidative stress. Caspase-3 expression was increased indicating an increased propensity for cell death. Finally, the phosphorylation of signaling molecules which modulate LTP including extracellular signal-regulated kinase 1/2 (ERK1/2), p38 mitogen-activated protein kinase, and Akt were increased. This data indicates that acute Dox exposure dose-dependently impairs synaptic processes associated with hippocampal neurotransmission, induces apoptosis, and increases lipid peroxidation leading to neurotoxicity.
Collapse
Affiliation(s)
- Ahmad H Alhowail
- a Department of Drug Discovery and Development , Auburn University , Auburn , AL , USA
| | - Jenna Bloemer
- a Department of Drug Discovery and Development , Auburn University , Auburn , AL , USA
| | - Mohammed Majrashi
- a Department of Drug Discovery and Development , Auburn University , Auburn , AL , USA
| | - Priyanka D Pinky
- a Department of Drug Discovery and Development , Auburn University , Auburn , AL , USA
| | | | - Zhang Yongli
- a Department of Drug Discovery and Development , Auburn University , Auburn , AL , USA.,b Tianjin Huanhu Hospital , Tianjin , PR China
| | - Dwipayan Bhattacharya
- a Department of Drug Discovery and Development , Auburn University , Auburn , AL , USA
| | - Matthew Eggert
- a Department of Drug Discovery and Development , Auburn University , Auburn , AL , USA
| | - Lauren Woodie
- c Department of Nutrition, Dietetics and Hospitality Management , College of Human Sciences, Auburn University , Auburn , AL , USA
| | - Manal A Buabeid
- d College of Pharmacy and Health Sciences , Ajman University , Ajman , UAE
| | - Nathaniel Johnson
- a Department of Drug Discovery and Development , Auburn University , Auburn , AL , USA
| | - Alyssa Broadwater
- a Department of Drug Discovery and Development , Auburn University , Auburn , AL , USA
| | - Bruce Smith
- e Department of Anatomy, Physiology and Pharmacology , College of Veterinary Medicine, Auburn University , Auburn , AL , USA
| | | | - Robert D Arnold
- a Department of Drug Discovery and Development , Auburn University , Auburn , AL , USA
| | - Vishnu Suppiramaniam
- a Department of Drug Discovery and Development , Auburn University , Auburn , AL , USA
| |
Collapse
|
18
|
Ha Y, Hwang S, Chon YE, Kim MN, Lee JH, Hwang SG. Validation of the Liver Disease Quality of Life Instrument 1.0 in Patients with Chronic Hepatitis B: A Prospective Study. J Clin Med 2019; 8:jcm8050656. [PMID: 31083480 PMCID: PMC6572606 DOI: 10.3390/jcm8050656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/07/2019] [Accepted: 05/07/2019] [Indexed: 12/05/2022] Open
Abstract
The purpose of this study was to report on the clinical usefulness of the Liver Disease Quality of Life Instrument (LDQOL) 1.0, which was prospectively measured in chronic hepatitis B patients. We regularly followed up with patients with chronic hepatitis B between 2008 and 2010 who were enrolled in the study, and the LDQOL 1.0 was filled out until 2015. The reliability and construct validity were evaluated by Cronbach’s α values and analysis of variance. Cox proportional hazards models were used to identify questionnaire components associated with death and decompensation. The LDQOL 1.0 scores were compared between groups of patients with different clinical characteristics. A total of 192 patients (27.1% with cirrhosis) were enrolled. The LDQOL 1.0 was reliable with high internal consistency based on the Cronbach’s α value. Most of each component was significantly associated with liver disease-related parameters, such as disability days, self-rated severity of liver disease symptoms, and Child-Pugh class. The change in concentration score between the first and last visit significantly predicted death (hazard ratio (HR), 0.44) and decompensation (HR, 0.97; p < 0.05 for both). Patients who achieved complete viral suppression did not show better scores than those who did not. In conclusion, the LDQOL 1.0 was prospectively validated in patients with chronic hepatitis B. Complete viral suppression did not influence the improvement of quality of life scores. The change in concentration scores over time was predictive of death and decompensation.
Collapse
Affiliation(s)
- Yeonjung Ha
- Department of Gastroenterology, CHA Bundang Medical Center, CHA University, 59 Yatap-ro,Bundang-gu, Seongnam-si, Gyeonggi-do 13496, Korea.
| | - Sohyun Hwang
- Department of Pathology, CHA Bundang Medical Center, CHA University, 59 Yatap-ro,Bundang-gu, Seongnam-si, Gyeonggi-do 13496, Korea.
| | - Young Eun Chon
- Department of Gastroenterology, CHA Bundang Medical Center, CHA University, 59 Yatap-ro,Bundang-gu, Seongnam-si, Gyeonggi-do 13496, Korea.
| | - Mi Na Kim
- Department of Gastroenterology, CHA Bundang Medical Center, CHA University, 59 Yatap-ro,Bundang-gu, Seongnam-si, Gyeonggi-do 13496, Korea.
| | - Joo Ho Lee
- Department of Gastroenterology, CHA Bundang Medical Center, CHA University, 59 Yatap-ro,Bundang-gu, Seongnam-si, Gyeonggi-do 13496, Korea.
| | - Seong Gyu Hwang
- Department of Gastroenterology, CHA Bundang Medical Center, CHA University, 59 Yatap-ro,Bundang-gu, Seongnam-si, Gyeonggi-do 13496, Korea.
| |
Collapse
|
19
|
Seo EJ, Klauck SM, Efferth T, Panossian A. Adaptogens in chemobrain (Part II): Effect of plant extracts on chemotherapy-induced cytotoxicity in neuroglia cells. Phytomedicine 2019; 58:152743. [PMID: 30901664 DOI: 10.1016/j.phymed.2018.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 11/02/2018] [Accepted: 11/05/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Cancer chemotherapy-induced cognitive impairments are apparently associated with harmful effects on physiological functions of brain cells. Adaptogens, are known to exhibit neuroprotective effects and to increase cognitive functions in clinical studies. In our previous study (Seo et al., 2018), we demonstrated that selected adaptogenic extracts significantly attenuate cytostatic-induced regulation of more than 100 genes involved in the activation of neuronal death and inhibiting neurogenesis. Neuroprotective and cytoprotective activities of adaptogens rise the question about their possible impact on cytostatic effects of a chemotherapeutic combination of 5-fluorouracil, epirubicin and cyclophosphamide (FEC). AIM The aim of this study was to assess the effects of selected adaptogenic herbal extracts, namely of andrographolide (AND), Herba Andrographidis (AP), Radix Eleutherococci (ES) genuine extracts, their fixed combination (AE), and the combination of three adaptogenic herbs, Rhodiola Radix, Shisandra Fructus and Eleutherococci Radix (RSE) on the cytotoxicity of a fixed combination of 5-fluorouracil, epirubicin and cyclophosphamide (FEC) on neuroglia cells. METHODS Cytotoxicity of FEC, adaptogenic extracts and their combination with FEC was tested on isolated T98G cells in a wide range of concentrations of all tested compounds. RESULTS FEC reproducibly inhibited the proliferation of T98G cells by 50% at concentrations of 5 × 10-1 µg/ml epirubicin, 500 × 10-1 µg/ml 5-fluorouracil and 20 × 10-1 µg/ml 4-hydroperoxycyclophosphamide after 24 h incubation of cells. These concentrations were subsequently used for experiments with adaptogenic extracts. The cytotoxic activity of FEC was not significantly changed in the presence of AND, ES and AE. Furthermore, it was potentiated by AP extract and RSE in concentrations of 0.06-6 µg/ml and 17.6-26.4 µg/ml. CONCLUSION The neuroprotective effect of adaptogens did not attenuate the cytotoxic activity of FEC. Application of cytostatic drugs in combination with adaptogenic plant extracts likely have no impact in cytotoxic effect of FEC. Furthermore, AP and RSE potentiated the cytotoxic effects of FEC.
Collapse
Affiliation(s)
- Ean-Jeong Seo
- Department of Pharmaceutical Biology, Institute of Pharmacy and Biochemistry, Johannes Gutenberg University, Mainz, Germany
| | - Sabine M Klauck
- Division of Cancer Genome Research, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 460, 69120 Heidelberg, Germany
| | - Thomas Efferth
- Department of Pharmaceutical Biology, Institute of Pharmacy and Biochemistry, Johannes Gutenberg University, Mainz, Germany.
| | - Alexander Panossian
- Phytomed AB, Vaxtorp, Halland, Sweden; EuroPharma USA Inc., 955 Challenger Dr., Green Bay, WI 54311, USA.
| |
Collapse
|
20
|
Immanuel A, Hunt J, McCarthy H, van Teijlingen E, Sheppard ZA. Quality of life in survivors of adult haematological malignancy. Eur J Cancer Care (Engl) 2019; 28:e13067. [PMID: 31020751 DOI: 10.1111/ecc.13067] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 12/13/2018] [Accepted: 03/25/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Survivors of haematological malignancies endure long-term effects of both treatment and disease. This paper examines factors that influence their quality of life through reporting on the results of a survey. METHODS Survey using previously validated quality of life questionnaires for use in cancer management. Participants were adults aged 18 and over who had completed treatment for a haematological malignancy and were between 1 and 5 years post-treatment. FINDINGS A total of 131 participants, median age of 66, completed questionnaires (66% response rate). Significant associations were found between age, global quality of life, physical and role functioning. Men reported better physical functioning and lower symptom scores than women. Employed participants reported better quality of life. Increasing age was associated with lowest quality of life. Best role functioning was also noted in participants who lived beyond 2.5 years following treatment completion. The survey suggested a gender difference with men reporting better physical functioning, fewer symptoms of pain and less loss of sleep compared with women. CONCLUSION This study contributes to the underdeveloped area of care for and research into adult haematological cancer survivors. Knowledge and understanding of the factors that affect the quality of life of such adults may provide an insight into implementation measures.
Collapse
Affiliation(s)
- Anita Immanuel
- Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, UK
| | - Jane Hunt
- Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, UK
| | | | - Edwin van Teijlingen
- Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, UK.,MMIHS, Tribhuvan University, Kirtipur, Nepal.,Nobel College, Pokhara University, Lekhnath, Nepal
| | - Zoë A Sheppard
- Research and Innovation, Dorset County Hospital, Dorchester, UK
| |
Collapse
|
21
|
Affiliation(s)
- Daniel S J Costa
- 1 Royal North Shore Hospital, St Leonards, NSW, Australia.,2 University of Sydney, Sydney, NSW, Australia
| | - Joanna E Fardell
- 3 University of New South Wales, Sydney, NSW, Australia.,4 Sydney Children's Hospital, Sydney, NSW, Australia
| |
Collapse
|
22
|
Seo EJ, Klauck SM, Efferth T, Panossian A. Adaptogens in chemobrain (Part I): Plant extracts attenuate cancer chemotherapy-induced cognitive impairment - Transcriptome-wide microarray profiles of neuroglia cells. Phytomedicine 2019; 55:80-91. [PMID: 30668446 DOI: 10.1016/j.phymed.2018.10.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 10/17/2018] [Accepted: 10/18/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Cancer chemotherapy-induced cognitive impairments are presumably associated with undesirable effects of chemotherapy on physiological functions of brain cells. Adaptogens are natural compounds or plant extracts increasing an organism's adaptability and survival in stress. They exhibited neuroprotective effects and increased cognitive functions in clinical studies in human beings. HYPOTHESIS We hypothesized that selected adaptogenic plant extracts attenuate or prevent cancer chemotherapy-induced cognitive impairments. AIM We assessed the effects of selected adaptogenic herbal extracts on FEC (fixed combination 5-fluorouracil, epirubicin and cyclophosphamide) induced changes in transcriptome-wide RNA microarray profiles of neuroglia cells. The aim of the study was to predict potential effects of andrographolide, Andrographis herb, Eleutherococcus root genuine extracts, their fixed combination (AE) and the combination of Rhodiola roots, Schisandra berries and Eleutherococcus roots (RSE) on cellular and physiological, mostly cognitive functions. METHODS Gene expression profiling was performed by transcriptome-wide mRNA microarray in the human T98G neuroglia cells after treatment with adaptogens. Interactive pathways downstream analysis was performed with data sets of significantly up- or down-regulated genes and predicted effects on cellular functions and diseases were identified by Ingenuity IPA database software. RESULTS FEC deregulated 67 genes involved in decrease of neuronal development, 37 genes involved in development of the sensory system, 12 genes in extension of axons, and 3 genes in migration of neurons. Co-incubation with Andrographis paniculata (AP) suppressed FEC-induced deregulation of a large number of genes involved in predicted activation of neuronal death and inhibition of neurogenesis, and 16 genes related to inhibition of several functions in the nervous system. Co-incubation with AE suppressed FEC-induced deregulation of a number of genes involved in predicted inhibition of axon extension, migration of T98G neuroglia cells, conduction of nerves and other genes related to regulations of some other functions in the nervous system. CONCLUSION Application of cytostatic drugs in combination with apoptogenic plant extracts induced significant changes in transcriptome-wide mRNA microarray profiles of neuroglial cells. These changes indicate on potential beneficial effects on neuronal functions associated with mild cognitive impairments in cancer chemotherapy.
Collapse
Affiliation(s)
- Ean-Jeong Seo
- Department of Pharmaceutical Biology, Institute of Pharmacy and Biochemistry, Johannes Gutenberg University, Staudinger Weg 5, Mainz 55128, Germany
| | - Sabine M Klauck
- Division of Cancer Genome Research, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 460 Heidelberg 69120, Germany
| | - Thomas Efferth
- Department of Pharmaceutical Biology, Institute of Pharmacy and Biochemistry, Johannes Gutenberg University, Staudinger Weg 5, Mainz 55128, Germany.
| | - Alexander Panossian
- EuroPharma USA Inc., 955 Challenger Dr., Green Bay, Wisconsin 54311 United States; Phytomed AB, Vaxtorp, Sweden.
| |
Collapse
|
23
|
Abstract
OBJECTIVES To address the estimated rates of incidence, potential underlying etiologies, and cognitive domains affected from diagnosis and treatment. To describe potential cognitive function interventions. DATA SOURCES PubMed. CONCLUSION Adults with gliomas report that the most distressing, persistent, and greatest negative impact on their lives relates to the cognitive impairment they experience. However, there are several potential interventions that may prevent cognitive decline during treatment or maintain cognitive function long term. IMPLICATIONS FOR NURSING PRACTICE Awareness of cognitive sequela that adults with gliomas face can lead to early identification, full neurocognitive profiling, and implementation of evidence-based interventions for those experiencing cognitive impairments following cancer treatment.
Collapse
|
24
|
Abstract
As the population of cancer survivors has grown into the millions, there has been increasing emphasis on understanding how the late effects of treatment affect survivors' ability to return to work/school, their capacity to function and live independently, and their overall quality of life. This review focuses on cognitive change associated with cancer and cancer treatments. Research in this area has progressed from a pharmacotoxicology perspective to a view of the cognitive change as a complex interaction of aspects of the treatment, vulnerability factors that increase risk for posttreatment cognitive decline, cancer biology, and the biology of aging. Methodological advances include the development of (a) measurement approaches that assess more fine-grained subcomponents of cognition based on cognitive neuroscience and (b) advanced statistical approaches. Conceptual issues that arise from this multidimensional perspective are described in relation to future directions, understanding of mechanisms, and development of innovative interventions.
Collapse
Affiliation(s)
- Tim A Ahles
- Neurocognitive Research Lab, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA; ,
| | - James C Root
- Neurocognitive Research Lab, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA; ,
| |
Collapse
|
25
|
Abstract
Personalized medicine is expected to positively change the treatment of cancer, but early identification of patients who are most likely to benefit requires an integrated effort from interprofessional care providers. Centering care around a patient's needs is the main task for a nurse coordinator, who is considered the core person for communication among all interprofessional care providers. This article describes a perspective on the nurse coordinator role as implemented in the lung cancer clinic at King Abdulaziz Medical City in Riyadh, Saudi Arabia.
.
Collapse
|
26
|
Verma T, Mallik SB, Ramalingayya GV, Nayak PG, Kishore A, Pai KSR, Nandakumar K. Sodium valproate enhances doxorubicin-induced cognitive dysfunction in Wistar rats. Biomed Pharmacother 2017; 96:736-741. [PMID: 29049976 DOI: 10.1016/j.biopha.2017.09.150] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 09/11/2017] [Accepted: 09/18/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Increasing number of scientific reports have highlighted the role of histone acetylation/deacetylation in neurodegenerative conditions, including chemotherapy-induced cognitive dysfunction (also known as chemobrain). Multiple sources state that increased activity of histone deacetylases (HDACs) play a detrimental role in chemobrain. In the present study, sodium valproate, a well-known HDAC inhibitor, was explored for its neuroprotective potential against chemobrain development. METHODS Doxorubicin (DOX), a chemotherapeutic agent, was used to induce chemobrain in experimental animals while treating with sodium valproate simultaneously. The animals were subjected to novel object recognition test (NORT) in order to assess their cognitive status and further, brain antioxidant levels were estimated. The animal body weights and survival were noted throughout the period of the study. Blood parameters such as red blood cell count, white blood cell count and haemoglobin levels were also measured. RESULTS Our findings are in contradiction to the known neuroprotective properties of valproic acid. We observed that sodium valproate failed to prevent chemobrain development in DOX treated animals. In fact, treatment with sodium valproate dose dependently worsened cognitive status in DOX treated animals including their brain antioxidant status, possibly leading to neuronal damage through free radical induced toxicity. CONCLUSION The present study highlights the caution that needs to be exercised in projecting HDAC inhibitors as in vivo neuroprotective agents, due to the complexity of existing neurological pathways and the diverse roles of histone deacetylases.
Collapse
Affiliation(s)
- Thaneshwar Verma
- Department of Pharmacology, Manipal College of Pharmaceutical Sciences, Manipal University, Manipal, Karnataka, 576104, India
| | - Sanchari Basu Mallik
- Department of Pharmacology, Manipal College of Pharmaceutical Sciences, Manipal University, Manipal, Karnataka, 576104, India
| | - G V Ramalingayya
- Department of Pharmacology, Manipal College of Pharmaceutical Sciences, Manipal University, Manipal, Karnataka, 576104, India; Discovery Biology, Suven Life Sciences Limited, Hyderabad, Telangana, 502307, India
| | - Pawan G Nayak
- Department of Pharmacology, Manipal College of Pharmaceutical Sciences, Manipal University, Manipal, Karnataka, 576104, India
| | - Anoop Kishore
- Department of Pharmacology, Manipal College of Pharmaceutical Sciences, Manipal University, Manipal, Karnataka, 576104, India
| | - K Sreedhara R Pai
- Department of Pharmacology, Manipal College of Pharmaceutical Sciences, Manipal University, Manipal, Karnataka, 576104, India
| | - Krishnadas Nandakumar
- Department of Pharmacology, Manipal College of Pharmaceutical Sciences, Manipal University, Manipal, Karnataka, 576104, India.
| |
Collapse
|
27
|
Yoon BY, Lee JH, Shin SY. Discrepancy between subjective and objective measures of cognitive impairment in patients with rheumatoid arthritis. Rheumatol Int 2017; 37:1635-41. [PMID: 28871379 DOI: 10.1007/s00296-017-3806-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 08/21/2017] [Indexed: 10/18/2022]
Abstract
This study explored the discrepancy between perceived cognitive dysfunction and computerized neuropsychological test performance in Korean patients with RA. Individuals with RA were recruited by their rheumatologists during follow-up visits at one hospital in Korea. After getting signed consents, a trained research nurse assessed participants with a range of physical, psychosocial, and biological metrics. Subjective cognitive dysfunction was assessed using the Perceived Deficits Questionnaire (PDQ; range 0-20). Objective cognitive impairment was assessed using a set of 6 computerized neurocognitive tests yielding 12 indices covering a range of cognitive domains. Subjects were classified as 'impaired' if they performed 1 SD below age-based population norms on each test. A total cognitive function score was calculated by summing the transformed scores (range 0-12). Multiple linear regression analyses determined the relationship of total cognitive function score with PDQ score, controlling for disease activity, functional limitations, and psychological factors. Forty subjects (mean ± SD age: 63.1 ± 11.4 years) were included. Mean ± SD scores of total cognitive function and PDQ were 7.3 ± 2.7 (2-12) and 11.8 ± 5.1 (5-25), respectively. In multivariate analysis, there was no significant relationship between total cognitive function score and PDQ score. However, depression and sleep quality (β = 0.37, p = 0.025; β = 0.17, p = 0.034) were significantly associated with PDQ score. The findings emphasize the gap between subjective and objective measures of cognitive impairment and the importance of considering psychological factors within the context of cognitive complaints in clinical settings.
Collapse
|
28
|
Jo MW, Lee HJ, Kim SY, Kim SH, Chang H, Ahn J, Ock M. Development and Validation of a Novel Generic Health-related Quality of Life Instrument With 20 Items (HINT-20). J Prev Med Public Health 2017; 50:38-59. [PMID: 28173686 PMCID: PMC5327678 DOI: 10.3961/jpmph.16.081] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 12/23/2016] [Indexed: 11/29/2022] Open
Abstract
Objectives Few attempts have been made to develop a generic health-related quality of life (HRQoL) instrument and to examine its validity and reliability in Korea. We aimed to do this in our present study. Methods After a literature review of existing generic HRQoL instruments, a focus group discussion, in-depth interviews, and expert consultations, we selected 30 tentative items for a new HRQoL measure. These items were evaluated by assessing their ceiling effects, difficulty, and redundancy in the first survey. To validate the HRQoL instrument that was developed, known-groups validity and convergent/discriminant validity were evaluated and its test-retest reliability was examined in the second survey. Results Of the 30 items originally assessed for the HRQoL instrument, four were excluded due to high ceiling effects and six were removed due to redundancy. We ultimately developed a HRQoL instrument with a reduced number of 20 items, known as the Health-related Quality of Life Instrument with 20 items (HINT-20), incorporating physical, mental, social, and positive health dimensions. The results of the HINT-20 for known-groups validity were poorer in women, the elderly, and those with a low income. For convergent/discriminant validity, the correlation coefficients of items (except vitality) in the physical health dimension with the physical component summary of the Short Form 36 version 2 (SF-36v2) were generally higher than the correlations of those items with the mental component summary of the SF-36v2, and vice versa. Regarding test-retest reliability, the intraclass correlation coefficient of the total HINT-20 score was 0.813 (p<0.001). Conclusions A novel generic HRQoL instrument, the HINT-20, was developed for the Korean general population and showed acceptable validity and reliability.
Collapse
Affiliation(s)
- Min-Woo Jo
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyeon-Jeong Lee
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Soo Young Kim
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Seon-Ha Kim
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyejung Chang
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeonghoon Ahn
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Minsu Ock
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
29
|
Redmond KJ, Hales RK, Anderson-Keightly H, Zhou XC, Kummerlowe M, Sair HI, Duhon M, Kleinberg L, Rosner GL, Vannorsdall T. Prospective Study of Hippocampal-Sparing Prophylactic Cranial Irradiation in Limited-Stage Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2017; 98:603-611. [PMID: 28581401 DOI: 10.1016/j.ijrobp.2017.03.009] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 02/21/2017] [Accepted: 03/07/2017] [Indexed: 12/12/2022]
Abstract
PURPOSE To prospectively evaluate cognitive function and intracranial failure patterns after hippocampal-sparing prophylactic cranial irradiation (PCI) for limited-stage small cell lung cancer (SCLC). METHODS AND MATERIALS Adults with limited-stage SCLC, achieving a complete response to chemoradiotherapy and no brain metastases, were eligible. Patients received PCI 25 Gy/10 fractions, with a mean hippocampal dose limited to <8 Gy and ≥90% of the brain receiving 90% of the prescription. A diverse battery of neuropsychological testing was performed at baseline and 6 and 12 months after PCI. Brain MRI scans were performed at baseline and 6, 12, 18, and 24 months. The primary endpoint was memory measured by the Hopkins Verbal Learning Test-Revised Delayed Recall at 6 months after PCI. The 25-Gy arm of Radiation Therapy Oncology Group protocol 0212 was used as a reference of potential efficacy. Development of intracranial metastases was recorded. Overall survival and progression-free survival were estimated using the Kaplan-Meier method. RESULTS Eight men and 12 women with a median age of 61 years enrolled. Two-year overall survival was 88% (95% confidence interval 68%-100%). There was no significant decline in performance between baseline and 6 or 12 months for any of the tests. The association between baseline intelligence quotient and change in performance on testing was not significant. Magnetic resonance imaging revealed asymptomatic brain metastases at a cumulative rate of 20%, with no concurrent extracranial progression. Two patients developed a metastasis in the under-dosed region. Neither involved the dentate gyrus, but 1 involved the avoidance region. Both patients concurrently developed additional metastasis in fully treated brain regions. There were 2 neurologic deaths. CONCLUSIONS This prospective study suggests a potential benefit of hippocampal sparing in limiting the neuropsychological sequelae of brain radiation, but with a risk of failures in the spared region. These data strongly support continued enrollment on ongoing cooperative group randomized trials. Clinical Trials registration number: NCT01797159.
Collapse
Affiliation(s)
- Kristin J Redmond
- Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University, Baltimore, Maryland.
| | - Russell K Hales
- Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University, Baltimore, Maryland
| | - Heather Anderson-Keightly
- Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University, Baltimore, Maryland
| | - Xian C Zhou
- Division of Biostatistics and Bioinformatics, Department of Oncology, The Johns Hopkins University, Baltimore, Maryland
| | - Megan Kummerlowe
- Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University, Baltimore, Maryland
| | - Haris I Sair
- Department of Radiology, The Johns Hopkins University, Baltimore, Maryland
| | - Mario Duhon
- Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University, Baltimore, Maryland
| | - Lawrence Kleinberg
- Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University, Baltimore, Maryland
| | - Gary L Rosner
- Division of Biostatistics and Bioinformatics, Department of Oncology, The Johns Hopkins University, Baltimore, Maryland
| | - Tracy Vannorsdall
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University, Baltimore, Maryland; Department of Neurology, The Johns Hopkins University, Baltimore, Maryland
| |
Collapse
|
30
|
Oh PJ, Kim J. The Effects of Nonpharmacologic Interventions on Cognitive Function in Patients With Cancer: A Meta-Analysis. Oncol Nurs Forum 2016; 43:E205-17. [DOI: 10.1188/16.onf.e205-e217] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
31
|
|
32
|
Root JC, Andreotti C, Tsu L, Ellmore TM, Ahles TA. Learning and memory performance in breast cancer survivors 2 to 6 years post-treatment: the role of encoding versus forgetting. J Cancer Surviv 2016; 10:593-9. [PMID: 26658913 PMCID: PMC4864094 DOI: 10.1007/s11764-015-0505-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 11/25/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE Our previous retrospective analysis of clinically referred breast cancer survivors' performance on learning and memory measures found a primary weakness in initial encoding of information into working memory with intact retention and recall of this same information at a delay. This suggests that survivors may misinterpret cognitive lapses as being due to forgetting when, in actuality, they were not able to properly encode this information at the time of initial exposure. Our objective in this study was to replicate and extend this pattern of performance to a research sample to increase the generalizability of this finding in a sample in which subjects were not clinically referred for cognitive issues. METHODS We contrasted learning and memory performance between breast cancer survivors on endocrine therapy 2 to 6 years post-treatment with age- and education-matched healthy controls. We then stratified lower- and higher-performing breast cancer survivors to examine specific patterns of learning and memory performance. Contrasts were generated for four aggregate visual and verbal memory variables from the California Verbal Learning Test-2 (CVLT-2) and the Brown Location Test (BLT): Single-trial Learning: Trial 1 performance, Multiple-trial Learning: Trial 5 performance, Delayed Recall: Long-delay Recall performance, and Memory Errors: False-positive errors. RESULTS As predicted, breast cancer survivors' performance as a whole was significantly lower on Single-trial Learning than the healthy control group but exhibited no significant difference in Delayed Recall. In the secondary analysis contrasting lower- and higher-performing survivors on cognitive measures, the same pattern of lower Single-trial Learning performance was exhibited in both groups, with the additional finding of significantly weaker Multiple-trial Learning performance in the lower-performing breast cancer group and intact Delayed Recall performance in both groups. CONCLUSIONS As with our earlier finding of weaker initial encoding with intact recall in a cohort of clinically referred breast cancer survivors, our results indicate this same profile in a research sample of breast cancer survivors. Further, when the breast cancer group was stratified by lower and higher performance, both groups exhibited significantly lower performance on initial encoding, with more pronounced encoding weakness in the lower-performing group. As in our previous research, survivors did not lose successfully encoded information over longer delays, either in the lower- or higher-performing group, again arguing against memory decay in survivors. The finding of weaker initial encoding of information together with intact delayed recall in survivors points to specific treatment interventions in rehabilitation of cognitive dysfunction. IMPLICATIONS FOR CANCER SURVIVORS The finding of weaker initial encoding of information together with intact delayed recall in survivors points to specific treatment interventions in rehabilitation of cognitive dysfunction and is discussed.
Collapse
Affiliation(s)
- James C Root
- Neurocognitive Research Laboratory, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th Floor, New York, NY, 10022, USA.
- Weill Cornell Medical College, New York, NY, USA.
| | - Charissa Andreotti
- Neurocognitive Research Laboratory, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th Floor, New York, NY, 10022, USA
| | - Loretta Tsu
- Department of Psychology, Program in Behavioral and Cognitive Neuroscience, The Graduate Center, City University of New York, The City College of the City University of New York, New York, NY, USA
| | - Timothy M Ellmore
- Department of Psychology, Program in Behavioral and Cognitive Neuroscience, The Graduate Center, City University of New York, The City College of the City University of New York, New York, NY, USA
| | - Tim A Ahles
- Neurocognitive Research Laboratory, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th Floor, New York, NY, 10022, USA
- Weill Cornell Medical College, New York, NY, USA
| |
Collapse
|
33
|
Li Y, Root JC, Atkinson TM, Ahles TA. Examining the Association between Patient-Reported Symptoms of Attention and Memory Dysfunction with Objective Cognitive Performance: A Latent Regression Rasch Model Approach. Arch Clin Neuropsychol 2016; 31:365-77. [PMID: 27193366 DOI: 10.1093/arclin/acw017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2016] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Patient-reported cognition generally exhibits poor concordance with objectively assessed cognitive performance. In this article, we introduce latent regression Rasch modeling and provide a step-by-step tutorial for applying Rasch methods as an alternative to traditional correlation to better clarify the relationship of self-report and objective cognitive performance. An example analysis using these methods is also included. METHOD Introduction to latent regression Rasch modeling is provided together with a tutorial on implementing it using the JAGS programming language for the Bayesian posterior parameter estimates. In an example analysis, data from a longitudinal neurocognitive outcomes study of 132 breast cancer patients and 45 non-cancer matched controls that included self-report and objective performance measures pre- and post-treatment were analyzed using both conventional and latent regression Rasch model approaches. RESULTS Consistent with previous research, conventional analysis and correlations between neurocognitive decline and self-reported problems were generally near zero. In contrast, application of latent regression Rasch modeling found statistically reliable associations between objective attention and processing speed measures with self-reported Attention and Memory scores. CONCLUSIONS Latent regression Rasch modeling, together with correlation of specific self-reported cognitive domains with neurocognitive measures, helps to clarify the relationship of self-report with objective performance. While the majority of patients attribute their cognitive difficulties to memory decline, the Rash modeling suggests the importance of processing speed and initial learning. To encourage the use of this method, a step-by-step guide and programming language for implementation is provided. Implications of this method in cognitive outcomes research are discussed.
Collapse
Affiliation(s)
- Yuelin Li
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - James C Root
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Thomas M Atkinson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tim A Ahles
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| |
Collapse
|
34
|
Le Rhun E, Delbeuck X, Lefeuvre-Plesse C, Kramar A, Skrobala E, Pasquier F, Bonneterre J. A phase III randomized multicenter trial evaluating cognition in post-menopausal breast cancer patients receiving adjuvant hormonotherapy. Breast Cancer Res Treat 2015; 152:569-80. [DOI: 10.1007/s10549-015-3493-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 07/02/2015] [Indexed: 12/29/2022]
|
35
|
Allart-Vorelli P, Porro B, Baguet F, Michel A, Cousson-Gélie F. Haematological cancer and quality of life: a systematic literature review. Blood Cancer J 2015; 5:e305. [PMID: 25909835 PMCID: PMC4450328 DOI: 10.1038/bcj.2015.29] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 02/02/2015] [Indexed: 11/11/2022] Open
Abstract
The aim of this study is to examine the impact of haematological cancers on quality of life (QoL). A review of the international literature was conducted from the databases ‘PsycInfo' and 'Medline' using the keywords: 'haematological cancer', 'quality of life', 'physical', 'psychological', 'social', 'vocational', 'professional', 'economic', 'cognitive', and 'sexual'. Twenty-one reliable studies were analysed. Among these studies, 12 showed that haematological cancer altered overall QoL, 8 papers found a deterioration of physical dimension, 8 papers reported on functional and role dimensions, 11 papers reported on the psychological component and 9 on the social component. Moreover, one study and two manuscripts, respectively, reported deteriorated sexual and cognitive dimensions. Our review demonstrates that the different dimensions of QoL are deteriorated by haematological malignancies and, probably, by the side effects of treatment.
Collapse
Affiliation(s)
- P Allart-Vorelli
- Laboratory of Psychology 'Health and Quality of Life' EA 4139, University Bordeaux Segalen, Bordeaux, France
| | - B Porro
- Department of Psychology, Epsylon EA 4556 Laboratory 'Dynamics of Human Abilities and Health Behaviors', University Paul Valéry Montpellier 3, Montpellier, France
| | - F Baguet
- 1] Department of Psychology, Epsylon EA 4556 Laboratory 'Dynamics of Human Abilities and Health Behaviors', University Paul Valéry Montpellier 3, Montpellier, France [2] ICM, Institut Régional du Cancer de Montpellier, Epidaure Prevention Unit - Rue des Apothicaires, Montpellier Cedex 5, France
| | - A Michel
- 1] Department of Psychology, Epsylon EA 4556 Laboratory 'Dynamics of Human Abilities and Health Behaviors', University Paul Valéry Montpellier 3, Montpellier, France [2] MIS, Montpellier Institut du Sein - 25 rue de Clémentville, Montpellier, France
| | - F Cousson-Gélie
- 1] Department of Psychology, Epsylon EA 4556 Laboratory 'Dynamics of Human Abilities and Health Behaviors', University Paul Valéry Montpellier 3, Montpellier, France [2] ICM, Institut Régional du Cancer de Montpellier, Epidaure Prevention Unit - Rue des Apothicaires, Montpellier Cedex 5, France
| |
Collapse
|
36
|
Von Ah D, Tallman EF. Perceived cognitive function in breast cancer survivors: evaluating relationships with objective cognitive performance and other symptoms using the functional assessment of cancer therapy-cognitive function instrument. J Pain Symptom Manage 2015; 49:697-706. [PMID: 25240787 DOI: 10.1016/j.jpainsymman.2014.08.012] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 08/07/2014] [Accepted: 08/14/2014] [Indexed: 11/19/2022]
Abstract
CONTEXT Perceived cognitive impairment (PCI) has been shown to be one of the most common symptoms after breast cancer treatment. However, this symptom does not always correlate with objective cognitive performance and is often highly associated with other patient-reported symptoms. OBJECTIVES Using a sample of breast cancer survivors (BCS), this study examined relationships among the Functional Assessment of Cancer Therapy-Cognitive (FACT-Cog) scale, a self-report questionnaire that measures PCI; impact on quality of life (QoL); comments from others (other); perceived cognitive ability (PCA); objective cognitive performance on tests of verbal memory, speed of processing, and executive functioning; and other symptoms (fatigue, depression, anxiety, and sleep disturbance). METHODS The BCS who were aged 40 years or older and at least one year post-chemotherapy treatment were enrolled. Participants completed questionnaires and a brief neuropsychological assessment. RESULTS A total of 88 BCS who were on average 56.7 (SD 8.5) years old and 5.3 (SD 4.1) years post-treatment participated; 94% reported clinically significant PCI. The PCI was significantly correlated with some objective measures of immediate and delayed verbal memory and executive function, whereas PCA was associated with all these measures. The PCI and PCA were both significantly associated with depressive symptoms, fatigue, and anxiety, but only PCI was related to poor global sleep quality. CONCLUSION The PCA was highly correlated with objective neuropsychological performance and may be clinically useful in identifying problems with verbal memory and executive functioning in BCS.
Collapse
Affiliation(s)
- Diane Von Ah
- Department of Adult Health, Indiana University School of Nursing, Indianapolis, Indiana, USA.
| | - Eileen F Tallman
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana, USA
| |
Collapse
|
37
|
King S, Green HJ. Psychological intervention for improving cognitive function in cancer survivors: a literature review and randomized controlled trial. Front Oncol 2015; 5:72. [PMID: 25859431 PMCID: PMC4373254 DOI: 10.3389/fonc.2015.00072] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 03/10/2015] [Indexed: 12/24/2022] Open
Abstract
Although the impact of cancer and associated treatments on cognitive functioning is becoming an increasingly recognized problem, there are few published studies that have investigated psychological interventions to address this issue. A waitlist randomized controlled trial methodology was used to assess the efficacy of a group cognitive rehabilitation intervention ("ReCog") that successfully targeted cancer-related cognitive decline in previously published pilot research. Participants were 29 cancer survivors who were randomly allocated to either the intervention group or a waitlist group who received the intervention at a later date, and 16 demographically matched community volunteers with no history of cancer (trial registration ACTRN12615000009516, available at http://www.ANZCTR.org.au/ACTRN12615000009516.aspx). The study was the first to include an adapted version of the Traumatic Brain Injury Self-Efficacy Scale to assess cognitive self-efficacy (CSE) in people who have experienced cancer. Results revealed participating in the intervention was associated with significantly faster performance on one objective cognitive task that measures processing speed and visual scanning. Significantly larger improvements for the intervention group were also found on measures of perceived cognitive impairments and CSE. There was some evidence to support the roles of CSE and illness perceptions as potential mechanisms of change for the intervention. Overall, the study provided additional evidence of feasibility and efficacy of group psychological intervention for targeting cancer-related cognitive decline.
Collapse
Affiliation(s)
- Summer King
- Menzies Health Institute Queensland and School of Applied Psychology, Griffith University, Gold Coast, QLD, Australia
| | - Heather Joy Green
- Menzies Health Institute Queensland and School of Applied Psychology, Griffith University, Gold Coast, QLD, Australia
| |
Collapse
|
38
|
Gehring K, Taphoorn MJB, Sitskoorn MM, Aaronson NK. Predictors of subjective versus objective cognitive functioning in patients with stable grades II and III glioma. Neurooncol Pract 2015; 2:20-31. [PMID: 26034638 DOI: 10.1093/nop/npu035] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Studies in cancer and noncancer populations demonstrate lower than expected correlations between subjective cognitive symptoms and cognitive functioning as determined by standardized neuropsychological tests. This paper systematically examines the association between subjective and objective cognitive functioning in patients with low-grade glioma and the associations of these indicators of cognitive function with clusters of sociodemographic, clinical, and self-reported physical and mental health factors. METHODS Multiple regression analyses with the subjective and 2 objective indicators of cognitive functioning as dependent variables and 4 clusters of predictor variables were conducted in 169 patients with predominantly low-grade glioma. RESULTS Correlations between the subjective and the 2 objective cognitive indicators were negligible (0.04) to low (0.24). Objective cognitive deficits were predominantly associated with sociodemographic (older age, lower education, male sex) and clinical (left hemisphere tumor) variables, while lower ratings of subjective cognitive function were more closely related to self-reported mental health symptoms (fatigue, lower mental well-being), physical (motor) dysfunction and female sex. Self-reported communication deficits were associated significantly with both subjective and objective dysfunction. CONCLUSIONS We recommend that both subjective and objective measures of cognitive functioning, together with a measure of psychological distress, be used for comprehensive neuropsychological assessments of patients with glioma to determine which areas are most affected and which specific intervention strategies are most appropriate.
Collapse
Affiliation(s)
- Karin Gehring
- Tilburg University, Department of Cognitive Neuropsychology , Tilburg , The Netherlands (K.G., M.M.S.); Medical Center Haaglanden, Department of Neurology , The Hague , The Netherlands (M.J.B.T.); VU University Medical Center, Department of Neurology , Amsterdam, The Netherlands (M.J.B.T.); The Netherlands Cancer Institute, Division of Psychosocial Research and Epidemiology , Amsterdam , The Netherlands (N.K.A.); Programme Group Clinical Psychology , University of Amsterdam , Amsterdam , The Netherlands (N.K.A.)
| | - Martin J B Taphoorn
- Tilburg University, Department of Cognitive Neuropsychology , Tilburg , The Netherlands (K.G., M.M.S.); Medical Center Haaglanden, Department of Neurology , The Hague , The Netherlands (M.J.B.T.); VU University Medical Center, Department of Neurology , Amsterdam, The Netherlands (M.J.B.T.); The Netherlands Cancer Institute, Division of Psychosocial Research and Epidemiology , Amsterdam , The Netherlands (N.K.A.); Programme Group Clinical Psychology , University of Amsterdam , Amsterdam , The Netherlands (N.K.A.)
| | - Margriet M Sitskoorn
- Tilburg University, Department of Cognitive Neuropsychology , Tilburg , The Netherlands (K.G., M.M.S.); Medical Center Haaglanden, Department of Neurology , The Hague , The Netherlands (M.J.B.T.); VU University Medical Center, Department of Neurology , Amsterdam, The Netherlands (M.J.B.T.); The Netherlands Cancer Institute, Division of Psychosocial Research and Epidemiology , Amsterdam , The Netherlands (N.K.A.); Programme Group Clinical Psychology , University of Amsterdam , Amsterdam , The Netherlands (N.K.A.)
| | - Neil K Aaronson
- Tilburg University, Department of Cognitive Neuropsychology , Tilburg , The Netherlands (K.G., M.M.S.); Medical Center Haaglanden, Department of Neurology , The Hague , The Netherlands (M.J.B.T.); VU University Medical Center, Department of Neurology , Amsterdam, The Netherlands (M.J.B.T.); The Netherlands Cancer Institute, Division of Psychosocial Research and Epidemiology , Amsterdam , The Netherlands (N.K.A.); Programme Group Clinical Psychology , University of Amsterdam , Amsterdam , The Netherlands (N.K.A.)
| |
Collapse
|
39
|
Wang XM, Walitt B, Saligan L, Tiwari AF, Cheung CW, Zhang ZJ. Chemobrain: a critical review and causal hypothesis of link between cytokines and epigenetic reprogramming associated with chemotherapy. Cytokine 2015; 72:86-96. [PMID: 25573802 DOI: 10.1016/j.cyto.2014.12.006] [Citation(s) in RCA: 126] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 10/29/2014] [Accepted: 12/08/2014] [Indexed: 01/21/2023]
Abstract
One consequence of modern cancer therapy is chemotherapy related cognitive dysfunction or "chemobrain", the subjective experience of cognitive deficits at any point during or following chemotherapy. Chemobrain, a well-established clinical syndrome, has become an increasing concern because the number of long-term cancer survivors is growing dramatically. There is strong evidence that correlates changes in peripheral cytokines with the development of chemobrain in commonly used chemotherapeutic drugs for different types of cancer. However, the mechanisms by which these cytokines elicit change in the central nervous system are still unclear. In this review, we hypothesize that the administration of chemotherapy agents initiates a cascade of biological changes, with short-lived alterations in the cytokine milieu inducing persistent epigenetic alterations. These epigenetic changes lead to changes in gene expression, alterations in metabolic activity and neuronal transmission that are responsible for generating the subjective experience of cognition. This speculative but testable hypothesis should help to gain a comprehensive understanding of the mechanism underlying cognitive dysfunction in cancer patients. Such knowledge is critical to identify pharmaceutical targets with the potential to prevent and treat cancer-treatment related cognitive dysfunction and similar disorders.
Collapse
|
40
|
Day J, Zienius K, Gehring K, Grosshans D, Taphoorn M, Grant R, Li J, Brown PD. Interventions for preventing and ameliorating cognitive deficits in adults treated with cranial irradiation. Cochrane Database Syst Rev 2014; 2014:CD011335. [PMID: 25519950 PMCID: PMC6457828 DOI: 10.1002/14651858.cd011335.pub2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Cognitive deficits are common in people who have received cranial irradiation and have a serious impact on daily functioning and quality of life. The benefit of pharmacological and non-pharmacological treatment of cognitive deficits in this population is unclear. OBJECTIVES To assess the effectiveness of interventions for preventing or ameliorating cognitive deficits in adult patients treated with cranial irradiation. SEARCH METHODS In August 2014. we searched the Cochrane Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and PsycINFO and checked the reference lists of included studies. We also searched for ongoing trials via ClinicalTrials.gov, the Physicians Data Query and the Meta Register of Controlled Trials. SELECTION CRITERIA We included randomised controlled trials (RCTs) that evaluated pharmacological or non-pharmacological interventions in cranial irradiated adults, with objective cognitive functioning as a primary or secondary outcome measure. DATA COLLECTION AND ANALYSIS Two review authors (JD, KZ) independently extracted data from selected studies and carried out a 'Risk of bias' assessment. Cognitive function, fatigue and mood outcomes were reported. No data were pooled. MAIN RESULTS Sixteen studies were identified for possible inclusion in the review, six of which were included. Three studies investigated prevention and three studies investigated amelioration. Due to differences between studies in the interventions being evaluated, a meta-analysis was not possible. Two studies investigated a pharmacological intervention for the prevention of cognitive deficits; memantine compared with placebo, and d-threo-methylphenidate HCL compared with placebo. In the first study the primary cognitive outcome of memory at six months did not reach significance, but there was significant improvement in overall cognitive function compared to placebo, with similar adverse events across groups. The second study found no statistically significant difference between arms, with few adverse events. The third study investigated a rehabilitation program for the prevention of cognitive deficits but did not carry out a statistical comparison of cognitive performance between groups.Three studies investigated the use of a pharmacological intervention for the treatment of cognitive deficits; methylphenidate compared with modafinil, two different doses of modafinil, and donepezil compared with placebo. The first study found improvements in cognitive function in both the methylphenidate and modafinil arms; few adverse events were reported. The second study combined treatment arms and found improvements across all cognitive tests, however, a number of adverse events were reported. Both studies were limited by a small sample size. The third study did not find an improvement in the primary cognitive outcome of overall performance, but did find improvement in an individual test of memory, compared to placebo; adverse events were not reported. No non-pharmacological studies for the amelioration of cognitive deficits were eligible. There were a number of limitations across studies but few without high risks of bias. AUTHORS' CONCLUSIONS There is supportive evidence that memantine may help prevent cognitive deficits for adults with brain metastases receiving cranial irradiation. There is supportive evidence that donepezil may have a role in treating cognitive deficits in adults with primary or metastatic brain tumours who have been treated with cranial irradiation. Patient withdrawal affected the statistical power of both studies. Further research that tries to minimise the withdrawal of consent, and subsequently reduce the requirement for imputation procedures, may offer a higher quality of evidence.There is no strong evidence to support any non-pharmacological interventions (medical or cognitive/behavioural) in the prevention or amelioration of cognitive deficits. Non-randomised studies appear promising but are as yet to be conclusive via translation into high quality evidence. Further research is required.
Collapse
Affiliation(s)
- Julia Day
- Edinburgh Centre for Neuro-Oncology (ECNO),Western General Hospital,Crewe Road South, Edinburgh, Scotland, EH4 2XU, UK. .
| | | | | | | | | | | | | | | |
Collapse
|
41
|
Day J, Zienius K, Taphoorn M, Li J, Gehring K, Grosshans D, Grant R, Brown P. Interventions for preventing and ameliorating cognitive deficits in adults treated with cranial irradiation. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014. [DOI: 10.1002/14651858.cd011335] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
42
|
Bender CM, Merriman JD. Cancer- and treatment-related cognitive changes: what can we do now? What lies ahead? Oncology (Williston Park) 2014; 28:806-808. [PMID: 25224482 PMCID: PMC4261918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
|
43
|
Ercoli LM, Castellon SA, Hunter AM, Kwan L, Kahn-Mills BA, Cernin PA, Leuchter AF, Ganz PA. Assessment of the feasibility of a rehabilitation intervention program for breast cancer survivors with cognitive complaints. Brain Imaging Behav 2014; 7:543-53. [PMID: 23955490 DOI: 10.1007/s11682-013-9237-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
To assess the feasibility of a cognitive rehabilitation program in breast cancer survivors (BCS) with persistent post-treatment cognitive complaints. BCS with cognitive complaints, 18-months to 5-years post-treatment, were recruited for a once-weekly, five-week, group cognitive training intervention. Outcome measures included self-reported mood and cognitive function, and neurocognitive tests administered at pre-intervention, immediate-, two-month and four-month post-intervention. A sub-study in eight participants evaluated resting state quantitative electroencephalography (qEEG) changes from pre- to immediate post-intervention in relationship to post-intervention changes in cognitive complaints. Twenty-seven BCS completed the protocol and tolerated the intervention well. We observed significant reductions in total and memory-specific cognitive complaints from pre-intervention to immediate post-intervention (p = 0.031 and p = 0.009, respectively) and at four-months post-intervention (p < 0.0001 and p < 0.001, respectively). Significant improvement in neurocognitive tests were found for Symbol Digit, Stroop, and Trails A tests (df = 26, all p's <0.05). Effect sizes for changes from pre-intervention to immediate and to four-month post intervention ranged from 0.429 to 0.607, and from 0.439 to 0.741, respectively. Increase in qEEG absolute alpha power over the course of the intervention was associated with reduced complaints at immediate post-intervention (r = -0.78, p = 0.021), two-months (r range = -0.76 to -0.82, p-value range 0.004 to 0.03), and four-months (r = -0.71, p = 0.048). A five-week group cognitive training intervention is feasible and well tolerated. Cognitive complaints and neurocognitive test performances showed positive changes. qEEG may serve as a potential biomarker for improvement in self-reported complaints. A randomized clinical trial is underway to test the efficacy of the intervention.
Collapse
Affiliation(s)
- Linda M Ercoli
- Department of Psychiatry and Biobehavioral Sciences and Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA,
| | | | | | | | | | | | | | | |
Collapse
|
44
|
Eisenberg SA, Kurita K, Taylor-Ford M, Agus DB, Gross ME, Meyerowitz BE. Intolerance of uncertainty, cognitive complaints, and cancer-related distress in prostate cancer survivors. Psychooncology 2014; 24:228-35. [DOI: 10.1002/pon.3590] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 05/05/2014] [Accepted: 05/13/2014] [Indexed: 12/18/2022]
Affiliation(s)
- Stacy A. Eisenberg
- Department of Psychology; University of Southern California; Los Angeles CA USA
| | - Keiko Kurita
- Department of Psychology; University of Southern California; Los Angeles CA USA
| | - Megan Taylor-Ford
- Department of Psychology; University of Southern California; Los Angeles CA USA
| | - David B. Agus
- Keck School of Medicine; University of Southern California; Los Angeles CA USA
| | - Mitchell E. Gross
- Keck School of Medicine; University of Southern California; Los Angeles CA USA
| | - Beth E. Meyerowitz
- Department of Psychology; University of Southern California; Los Angeles CA USA
| |
Collapse
|
45
|
Abstract
The mental health of cancer survivors has not always been the primary emphasis of treatment protocols since physical health outcomes have taken precedence. Older cancer survivors experience a double jeopardy since they are at risk for memory impairments and mild cognitive impairment and because they are greater than 55 years of age. Of the 9.6 million cancer survivors in the US who have completed active treatment, many report cognitive difficulties, with labels such as "chemo brain," "not as sharp," "woolly-headedness," or the "mind does not work as quickly". To date, most of our knowledge of cognitive impairment in cancer survivors comes from female breast cancer survivors. Studies indicate that these survivors have diminished executive function, verbal memory, and motor function. Cancer survivors want to live independently in the community for as long as possible however, these cognitive deficits may prevent this desired lifestyle. To broaden our understanding this paper reviews the literature on the cognitive impairment and memory deficits experienced by three groups of cancer survivors breast, colorectal, and prostate cancer, that make up 60% of all survivors nationally. Even though mental health declined after a cancer diagnosis, the long-term outcomes of cancer survivors did not differ from persons without cancer in depression or cognitive function.
Collapse
Affiliation(s)
| | - JoAnn S Oliver
- The University of Alabama, Capstone College of Nursing, Tuscaloosa, AL
| | - Forrest Scogin
- The University of Alabama, Department of Psychology, Tuscaloosa, AL
| |
Collapse
|
46
|
Gehring K, Aaronson NK, Taphoorn MJ, Sitskoorn MM. Interventions for cognitive deficits in patients with a brain tumor: an update. Expert Rev Anticancer Ther 2014; 10:1779-95. [DOI: 10.1586/era.10.163] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
47
|
Le Fel J, Daireaux A, Vandenbosshe S, Heutte N, Rigal O, Rovira K, Joly F, Roy V. [Impact of cancer treatments on cognitive functions: the patients' view, their expectation and their interest in participating to cognitive rehabilitation workshops]. Bull Cancer 2013; 100:223-9. [PMID: 23501351 DOI: 10.1684/bdc.2013.1710] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Cancer and chemotherapy can have adverse effects on cognitive functions and quality of life of patients. We wanted to know the patients' view on these disorders, but also their expectations in terms of assessment and support. METHODS AND RESULTS A survey was conducted in day care hospital among 551 patients from three cancer centers. Most of the patients were between 40 and 74 years and suffered from breast cancer. Eighty-four percent were treated with chemotherapy. Forty-one percent of patients report memory problems, 26% were affected by specific concentration disorders, and 19% of the attention. On the whole, 52% of patients report at least one of the previous cognitive impairment. Among these patients, 80% evoked that the support of these problems was essential and 70% were willing to participate in "workshops" to deal with these disorders. CONCLUSION The cognitive impairment occurrence is a real problem for patients receiving chemotherapy and becomes a priority in the global management of their disease. Studies assessing a specific support of theses symptoms should be encouraged to help patients.
Collapse
|
48
|
Paquet L, Collins B, Song X, Chinneck A, Bedard M, Verma S. A pilot study of prospective memory functioning in early breast cancer survivors. Breast 2013; 22:455-61. [PMID: 23648279 DOI: 10.1016/j.breast.2013.04.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 03/17/2013] [Accepted: 04/03/2013] [Indexed: 01/06/2023] Open
Abstract
AIMS To evaluate prospective memory (PM) functioning in early breast cancer (BC) survivors and its association with fatigue and depression. METHODS The Memory for Intention Screening Test, the Center for Epidemiologic Studies Depression Scale and the Functional Assessment of Cancer Therapy-Fatigue subscale were administered to 80 patients and 80 aged-matched healthy controls. RESULTS Patients performed more poorly than controls on the memory test (p < 0.001) and had a higher rate of impairment (odds ratio = 5.5, p < 0.01). Fatigue mediated the relationship between Group membership and PM performance. CONCLUSIONS BC survivors exhibited a clear pattern of PM deficit and fatigue was a major contributor to this deficit. This suggests that a common mechanism may be involved in fatigue symptoms and memory disturbances experienced by patients. Further research is needed to evaluate the role of adjuvant therapy in PM deficits and to explore whether interventions targeted at improving fatigue may also improve memory functioning in BC survivors.
Collapse
Affiliation(s)
- Lise Paquet
- Carleton University, Ottawa, Ontario, Canada
| | | | | | | | | | | |
Collapse
|
49
|
Shin SY, Katz P, Julian L. Relationship between perceived cognitive dysfunction and objective neuropsychological performance in persons with rheumatoid arthritis. Arthritis Care Res (Hoboken) 2013; 65:481-6. [PMID: 22899659 DOI: 10.1002/acr.21814] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Accepted: 07/27/2012] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Research shows a gap between perceived cognitive dysfunction and objective neuropsychological performance in persons with chronic diseases. We explored this relationship in persons with rheumatoid arthritis (RA). METHODS Individuals from a longitudinal cohort study of RA participated in a study visit that included physical, psychosocial, cognitive, and biologic metrics. Subjective cognitive dysfunction was assessed using the Perceived Deficits Questionnaire (PDQ; range 0-20, where higher scores = greater perceived impairment). Objective cognitive impairment was assessed using a battery of 12 standardized neuropsychological measures yielding 16 indices. On each test, subjects were classified as impaired if they performed 1 SD below the age-based population norms. Total cognitive function scores were calculated by summing the transformed scores (range 0-16, where higher scores = greater impairment). Multiple linear regression analyses determined the relationship of the total cognitive function score with the PDQ score, controlling for sex, race, marital status, income, education, disease duration, disease severity, depression, and fatigue. RESULTS One hundred twenty subjects (mean ± SD age 58.5 ± 11.0 years) were included. Mean ± SD scores of total cognitive function and the PDQ were 2.5 ± 2.2 (range 0-10) and 5.8 ± 3.8 (range 0-16), respectively. In multivariate analysis, there was no significant relationship between the total cognitive function score and the PDQ score. However, depression and fatigue (β = 0.32, P < 0.001 and β = 0.31, P = 0.001, respectively) were significantly associated with the PDQ score. CONCLUSION The findings emphasize the gap between subjective and objective measures of cognitive impairment and the importance of considering psychological factors within the context of cognitive symptoms in clinical settings.
Collapse
|
50
|
Cheung YT, Shwe M, Tan EHJ, Chui WK, Ng R, Chan A. Acknowledging the relevance of cognitive changes in cancer patients: perspectives of oncology practitioners in Asia. J Cancer Surviv 2013; 7:146-54. [PMID: 23392850 DOI: 10.1007/s11764-012-0256-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Accepted: 11/09/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Previous studies have suggested that cognitive impairment can affect cancer patients' health-related quality of life (HRQoL) and daily functioning. This study investigated oncology practitioners' perceptions of the relevance, effects, and causes of such cognitive changes in cancer patients, and their awareness of coping strategies. METHODS Oncology practitioners completed a self-administered cross-sectional survey. Practitioners were recruited from four major cancer centers in Singapore and Thailand, and through a regional cancer meeting that took place in Singapore in September 2011. RESULTS The sample (n = 193) consisted of nurses (51.3 %), oncologists (35.2 %), and pharmacists (13.5 %). Cognitive changes were frequently observed among cancer patients, particularly in the domains of memory (77.1 %) and concentration (74.6 %). The majority (86.5 %) of respondents agreed that cognitive changes adversely effected patients' HRQoL. The majority (65.3 %) of the respondents also recognized the need to implement routine neuropsychological assessments in clinical settings. The following factors were perceived as contributing to cognitive changes: aging (77.6 %), cancer-related fatigue (65.2 %), and anxiety (61.2 %). Compared with other healthcare professionals, oncologists were less likely to agree that chemotherapy was a major contributing factor to cognitive changes (25.0 % vs. 9.8 %, p = 0.038). Psychosocial support and the use of complementary alternative medicines (CAM) were identified as coping strategies for cognitive changes. CONCLUSIONS Healthcare professionals do not perceive a uniform set of contributing factors to cognitive impairment among cancer patients, although they all acknowledge that cancer patients' experience of cognitive impairment is a relevant issue. IMPLICATIONS FOR CANCER SURVIVORS It is important to equip clinicians with the knowledge necessary for monitoring and managing the cognitive disturbances and psychological distress experienced by at risk patients in a clinical setting.
Collapse
Affiliation(s)
- Yin Ting Cheung
- Department of Pharmacy, National University of Singapore, 18 Science Drive, Block S4, Singapore, 117543, Singapore
| | | | | | | | | | | |
Collapse
|