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Rapp SR, Dressler EV, Brown WM, Wade JL, Le-Lindqwister N, King D, Rowland KM, Weaver KE, Klepin HD, Shaw EG, Lesser GJ. Phase III Randomized, Placebo-Controlled Clinical Trial of Donepezil for Treatment of Cognitive Impairment in Breast Cancer Survivors After Adjuvant Chemotherapy (WF-97116). J Clin Oncol 2024:JCO2301100. [PMID: 38709986 DOI: 10.1200/jco.23.01100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 11/13/2023] [Accepted: 02/28/2024] [Indexed: 05/08/2024] Open
Abstract
PURPOSE To test efficacy of donepezil, a cognitive enhancer, to improve memory in breast cancer survivors who report cancer-related cognitive impairment 1-5 years postchemotherapy. PATIENTS AND METHODS Adult female BCS exposed to ≥4 cycles of adjuvant chemotherapy 1-5 years before enrollment who reported cancer-related cognitive impairment were eligible. Participants, enrolled at sites affiliated with the Wake Forest NCI Community Oncology Research Program (NCORP) Research Base, were randomly assigned to receive 5 mg of donepezil once daily for 6 weeks titrated to 10 mg once daily for 18 weeks or placebo. Cognition and self-report cognitive functioning was assessed at baseline, 12, 24 (end of intervention), and 36 (washout) weeks postrandomization. Mixed-effects repeated measures analysis of covariance models were used to assess treatment differences in immediate recall (primary outcome) on the Hopkins Verbal Learning Test-Revised (HVLT-R) and other cognitive domains (secondary outcomes) with covariates of treatment, time, time by treatment interaction, baseline outcome level, age stratification, and an unstructured covariance matrix to account for within participant correlation over time. RESULTS Two hundred seventy-six BCS from 87 NCORP practices (mean age, 57.1, standard deviation [SD], 10.5) who were at a mean of 29.6 months (SD, 14.2) postchemotherapy were randomly assigned to donepezil (n = 140) or placebo (n = 136). At 24 weeks, treatment groups did not differ on HVLT-R scores (donepezil mean = 25.98, placebo = 26.50, P = .32). There were no statistically significant differences between treatments at 12, 24, or 36 weeks for attention, executive function, verbal fluency, processing speed, or self-reported cognitive functioning. Endocrine therapy and menopausal status did not affect results. CONCLUSION BCS 1-5 years after completing chemotherapy with documented memory problems, randomly assigned to 24 weeks of 5-10 mg of donepezil once daily, did not perform differently at the end of treatment on tests of memory, other cognitive functions, or subjective functioning than those randomly assigned to placebo.
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Affiliation(s)
- Stephen R Rapp
- Department of Psychiatry & Behavioral Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
- Department of Social Sciences & Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Emily V Dressler
- Department of Biostatistics and Data Sciences, Wake Forest University School of Medicine, Winston-Salem, NC
| | - W Mark Brown
- Department of Biostatistics and Data Sciences, Wake Forest University School of Medicine, Winston-Salem, NC
| | - James L Wade
- Heartland Cancer Research NCORP, Cancer Care Specialists of Illinois-Decatur, Decatur, IL
| | | | - David King
- Metro Minnesota Community Oncology Research Consortium, Unity Hospital, Minneapolis-St Paul, MN
| | - Kendrith M Rowland
- Carle Cancer Center NCORP, Cancer Center at Illinois, University of Illinois Urbana-Champaign, Urbana-Champaign, IL
| | - Kathryn E Weaver
- Department of Social Sciences & Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Heidi D Klepin
- Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Edward G Shaw
- Department of Internal Medicine-Gerontology & Geriatrics Section, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Glenn J Lesser
- Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest University School of Medicine, Winston-Salem, NC
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Wang L, Ding Y, Zhang Y, Chen Y, Xue M, Wang X. The association between neuropsychological impairment, self-perceived cognitive deficit, symptoms, and health related quality of life in newly diagnosed ovarian cancer patients. Asia Pac J Oncol Nurs 2024; 11:100447. [PMID: 38798881 PMCID: PMC11127092 DOI: 10.1016/j.apjon.2024.100447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 03/18/2024] [Indexed: 05/29/2024] Open
Abstract
Objective To assess cognitive function in patients newly diagnosed with ovarian cancer (OC) before treatment and explore the relationship between neuropsychological impairment, self-perceived cognitive deficit, symptoms, and health-related quality of life in them. Methods From May 2021 to February 2022, 105 women newly diagnosed with OC were enrolled in the Cancer Center of Fudan University, Shanghai, China. Objective and subjective cognitive functions were assessed using the Montreal Cognitive Assessment (MoCA) scale and Perceptual Deficits Questionnaire (PDQ). Symptoms and quality of life were evaluated using the Memorial Symptom Assessment Scale (MSAS) and Functional Assessment of Cancer Therapy-Ovarian Cancer (FACT-O), respectively. Results This study included 105 newly diagnosed OC patients, with an average age of 49.73 (±8.48) years. Of these, 72.38% had impaired neuropsychological test scores, especially in delayed recall, abstraction, and visuospatial/executive function. Retrospective, and prospective memory were the most serious perceived deficits. The results of the MoCA test were not associated with PDQ (Rs = -0.180, P = 0.067) and significantly correlated with the distress index, physiological and total scores of the MSAS, and emotional well- being of the FACT-O. The PDQ positively correlated with all MSAS dimensions but not with the FACT-O. Conclusion The incidence of neuropsychological impairment in patients newly diagnosed with OC was high, with no association with self-perceived cognitive deficits. It is recommended that healthcare providers include cognitive impairment in symptom management in this population, who may benefit from early assessment, prevention, and intervention.
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Affiliation(s)
- Liying Wang
- School of Nursing, Fudan University, Shanghai, China
- Department of Nursing, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yan Ding
- School of Nursing, Fudan University, Shanghai, China
- Department of Nursing, Obstetrics & Gynecology Hospital of Fudan University, Shanghai, China
| | - Yi Zhang
- Department of Nursing, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yaqiong Chen
- Department of Nursing, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Mei Xue
- Department of Nursing, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xia Wang
- Department of Nursing, Obstetrics & Gynecology Hospital of Fudan University, Shanghai, China
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Naaktgeboren WR, Koevoets EW, Stuiver MM, van Harten WH, Aaronson NK, van der Wall E, Velthuis M, Sonke G, Schagen SB, Groen WG, May AM. Effects of physical exercise during adjuvant chemotherapy for breast cancer on long-term tested and perceived cognition: results of a pragmatic follow-up study. Breast Cancer Res Treat 2024; 205:75-86. [PMID: 38285111 PMCID: PMC11062992 DOI: 10.1007/s10549-023-07220-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 12/10/2023] [Indexed: 01/30/2024]
Abstract
PURPOSE Cancer-related cognitive impairment (CRCI) following chemotherapy is commonly reported in breast cancer survivors, even years after treatment. Data from preclinical studies suggest that exercise during chemotherapy may prevent or diminish cognitive problems; however, clinical data are scarce. METHODS This is a pragmatic follow-up study of two original randomized trials, which compares breast cancer patients randomized to exercise during chemotherapy to non-exercise controls 8.5 years post-treatment. Cognitive outcomes include an online neuropsychological test battery and self-reported cognitive complaints. Cognitive performance was compared to normative data and expressed as age-adjusted z-scores. RESULTS A total of 143 patients participated in the online cognitive testing. Overall, cognitive performance was mildly impaired on some, but not all, cognitive domains, with no significant differences between groups. Clinically relevant cognitive impairment was present in 25% to 40% of all participants, regardless of study group. We observed no statistically significant effect of exercise, or being physically active during chemotherapy, on long-term cognitive performance or self-reported cognition, except for the task reaction time, which favored the control group (β = -2.04, 95% confidence interval: -38.48; -2.38). We observed no significant association between self-reported higher physical activity levels during chemotherapy or at follow-up and better cognitive outcomes. CONCLUSION In this pragmatic follow-up study, exercising and being overall more physically active during or after adjuvant chemotherapy for breast cancer was not associated with better tested or self-reported cognitive functioning, on average, 8.5 years after treatment. Future prospective studies are needed to document the complex relationship between exercise and CRCI in cancer survivors.
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Affiliation(s)
- Willeke R Naaktgeboren
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Emmie W Koevoets
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Martijn M Stuiver
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Center for Quality of Life, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Wim H van Harten
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands
- Rijnstate Hospital, Arnhem, The Netherlands
| | - Neil K Aaronson
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Miranda Velthuis
- Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Gabe Sonke
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Sanne B Schagen
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Brain and Cognition Group, University of Amsterdam, Amsterdam, The Netherlands
| | - Wim G Groen
- Department of Medicine for Older People, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Aging & Later Life, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Ageing & Vitality, Rehabilitation & Development, Amsterdam, The Netherlands
| | - Anne M May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
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Lomeli N, Pearre DC, Cruz M, Di K, Ricks-Oddie JL, Bota DA. Cisplatin induces BDNF downregulation in middle-aged female rat model while BDNF enhancement attenuates cisplatin neurotoxicity. Exp Neurol 2024; 375:114717. [PMID: 38336286 PMCID: PMC11087041 DOI: 10.1016/j.expneurol.2024.114717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 01/04/2024] [Accepted: 02/06/2024] [Indexed: 02/12/2024]
Abstract
Cancer-related cognitive impairments (CRCI) are neurological complications associated with cancer treatment, and greatly affect cancer survivors' quality of life. Brain-derived neurotrophic factor (BDNF) plays an essential role in neurogenesis, learning and memory. The reduction of BDNF is associated with the decrease in cognitive function in various neurological disorders. Few pre-clinical studies have reported on the effects of chemotherapy and medical stress on BDNF levels and cognition. The present study aimed to compare the effects of medical stress and cisplatin on serum BDNF levels and cognitive function in 9-month-old female Sprague Dawley rats to age-matched controls. Serum BDNF levels were collected longitudinally during cisplatin treatment, and cognitive function was assessed by novel object recognition (NOR) 14 weeks post-cisplatin initiation. Terminal BDNF levels were collected 24 weeks after cisplatin initiation. In cultured hippocampal neurons, we screened three neuroprotective agents, riluzole (an approved treatment for amyotrophic lateral sclerosis), as well as the ampakines CX546 and CX1739. We assessed dendritic arborization by Sholl analysis and dendritic spine density by quantifying postsynaptic density-95 (PSD-95) puncta. Cisplatin and exposure to medical stress reduced serum BDNF levels and impaired object discrimination in NOR compared to age-matched controls. Pharmacological BDNF augmentation protected neurons against cisplatin-induced reductions in dendritic branching and PSD-95. Ampakines (CX546 and CX1739) and riluzole did not affect the antitumor efficacy of cisplatin in vitro. In conclusion, we established the first middle-aged rat model of cisplatin-induced CRCI, assessing the contribution of medical stress and longitudinal changes in BDNF levels on cognitive function, although future studies are warranted to assess the efficacy of BDNF enhancement in vivo on synaptic plasticity. Collectively, our results indicate that cancer treatment exerts long-lasting changes in BDNF levels, and support BDNF enhancement as a potential preventative approach to target CRCI with therapeutics that are FDA approved and/or in clinical study for other indications.
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Affiliation(s)
- Naomi Lomeli
- Department of Neurology, University of California Irvine, Irvine, CA, USA
| | - Diana C Pearre
- Gynecologic Oncology, Providence Specialty Medical Group, Burbank, CA, USA
| | - Maureen Cruz
- Department of Neurology, University of California Irvine, Irvine, CA, USA
| | - Kaijun Di
- Department of Neurology, University of California Irvine, Irvine, CA, USA
| | - Joni L Ricks-Oddie
- Center for Statistical Consulting, Department of Statistics, University of California Irvine, Irvine, CA, USA; Biostatistics, Epidemiology and Research Design Unit, Institute for Clinical and Translational Sciences, University of California Irvine, Irvine, CA, USA
| | - Daniela A Bota
- Department of Neurology, University of California Irvine, Irvine, CA, USA; Chao Family Comprehensive Cancer Center, University of California Irvine, Irvine, CA, USA.
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Hamilton S, Oxlad M, Sianis Y. Experiences of women with breast cancer disclosing cancer-related cognitive impairment symptoms to health professionals: a Systematic review and meta-synthesis. J Psychosoc Oncol 2024:1-21. [PMID: 38648500 DOI: 10.1080/07347332.2024.2342836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
OBJECTIVE Cancer-related cognitive impairment involves changes in cognitive domains among people diagnosed with cancer. This review aimed to explore and synthesize the experiences of women with breast cancer disclosing cancer-related cognitive impairment symptoms to health professionals. METHODS A systematic review and meta-synthesis was conducted to generate synthesized findings from existing literature. Six databases were searched from inception until mid-October 2022, with eligible studies appraised using the QualSyst Quality Assessment Checklist. RESULTS Three synthesized findings were generated from eight included studies. Findings highlight that women initiated conversations disclosing symptoms and frequently experienced dismissal or minimization from health professionals. Women rarely received information about cognitive impairment symptoms before treatment. Women reported that health professionals could be more involved in managing cognitive impairment symptoms. CONCLUSION This meta-synthesis highlights the importance of health professionals providing information before treatment and following up on cognitive impairment symptoms.
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Affiliation(s)
- Susan Hamilton
- School of Psychology, The University of Adelaide, Adelaide, Australia
| | - Melissa Oxlad
- School of Psychology, The University of Adelaide, Adelaide, Australia
| | - Yianni Sianis
- School of Psychology, The University of Adelaide, Adelaide, Australia
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Suzuki K, Morishita S, Nakano J, Okayama T, Inoue J, Tanaka T, Fukushima T. Association between quality of life and mortality risk in patients with breast cancer: a systematic review and meta-analysis. Breast Cancer 2024:10.1007/s12282-024-01581-7. [PMID: 38592636 DOI: 10.1007/s12282-024-01581-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 03/26/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Patients with breast cancer present with various problems that have an adverse effect on the quality of life (QOL). However, the association between the QOL and mortality among patients with breast cancer remains controversial. Therefore, this systematic review and meta-analysis aimed to determine whether QOL impacts prognosis in patients with breast cancer. METHODS The databases of CINAHL, Scopus, and PubMed databases were searched to retrieve observational studies that assessed the QOL and mortality risk in patients with breast cancer published before December 2022. RESULTS Among the 119,061 articles retrieved, six observational studies were included in the meta-analysis. Physical QOL (hazard ratio [HR]: 1.04, 95% confidence interval [CI]: 1.01-1.07, p = 0.003), emotional QOL (HR: 1.01, 95% CI: 1.00-1.03, p = 0.05), and role QOL (HR: 1.01, 95% CI: 1.00-1.01, p = 0.007) showed significant associations with mortality risk. In contrast, global QOL, cognitive QOL, and social QOL showed no associations with mortality risk. Subgroup analysis performed according to treatment time points revealed that the post-treatment physical QOL was associated with mortality risk. CONCLUSIONS Physical QOL, emotional QOL, and role QOL are associated with mortality risk in patients with breast cancer. Furthermore, post-treatment physical QOL showed a more significant association with prolonged survival than pre-treatment physical QOL.
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Affiliation(s)
- Katsuyoshi Suzuki
- Division of Rehabilitation Medicine, Shizuoka Cancer Center, Shizuoka, Japan
| | - Shinichiro Morishita
- Department of Physical Therapy, School of Health Sciences, Fukushima Medical University, Fukushima, Japan
| | - Jiro Nakano
- Faculty of Rehabilitation, Kansai Medical University, Osaka, Japan
| | - Taro Okayama
- Division of Rehabilitation Medicine, Shizuoka Cancer Center, Shizuoka, Japan
| | - Junichiro Inoue
- Division of Rehabilitation Medicine, Kobe University Hospital International Clinical Cancer Research Center, Kobe, Japan
| | - Takashi Tanaka
- Department of Rehabilitation, Hyogo Medical University Hospital, Nishinomiya, Japan
| | - Takuya Fukushima
- Faculty of Rehabilitation, Kansai Medical University, Osaka, Japan.
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Gates P, Dhillon HM, Krishnasamy M, Wilson C, Gough K. Cancer-related cognitive impairment and wellbeing in patients with newly diagnosed aggressive lymphoma compared to population norms and healthy controls: an exploratory study. Support Care Cancer 2024; 32:238. [PMID: 38512692 PMCID: PMC10957702 DOI: 10.1007/s00520-024-08441-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 03/15/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE There has been little dedicated research on cancer-related cognitive impairment in patients with aggressive lymphoma. We describe and compare patients' cognitive function with that of healthy controls and patients' wellbeing and distress with general population values. We also explore associations between patients' neuropsychological test performance and self-reported cognitive function and distress. METHODS Secondary analysis of data from a feasibility study of 30 patients with newly diagnosed aggressive lymphoma and 72 healthy controls. Patients completed neuropsychological tests and self-report measures before and 6-8 weeks after chemotherapy. Healthy controls completed neuropsychological tests and the FACT-Cog at enrolment and 6 months later. Mixed models were used to analyze neuropsychological test and FACT-Cog scores. One-sample t-tests were used to compare patients' self-reported wellbeing and distress with population norms. Associations were explored with Kendall's Tau b. RESULTS Patients and healthy controls were well matched on socio-demographics. Differences between neuropsychological test scores were mostly large-sized; on average, patients' scores on measures of information processing speed, executive function, and learning and memory were worse both before and after chemotherapy (all p ≤ 0.003). The same pattern was observed for impact of perceived cognitive impairment on quality-of-life (both p < 0.001). Patients' physical and emotional wellbeing scores were lower than population norms both before and after chemotherapy (all p ≤ 0.018). Associations between neuropsychological performance and other measures were mostly trivial (all p > 0.10). CONCLUSION For many patients with aggressive lymphoma, impaired neuropsychological test performance and impact of perceived impairments on quality-of-life precede chemotherapy and are sustained after chemotherapy. Findings support the need for large-scale longitudinal studies with this population to better understand targets for interventions to address cognitive impairments.
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Affiliation(s)
- Priscilla Gates
- Cognitive Neuroscience Lab, School of Psychology, Deakin University, Burwood, Victoria, Australia.
- Department of Clinical Haematology, Austin Health, Melbourne, Victoria, Australia.
- Department of Nursing, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.
- Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
| | - Haryana M Dhillon
- Faculty of Science, School of Psychology, Centre for Medical Psychology & Evidence-Based Decision-Making, The University of Sydney, Sydney, NSW, Australia
| | - Mei Krishnasamy
- Department of Nursing, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Carlene Wilson
- Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Melbourne, Victoria, Australia
- School of Psychology and Public Health, LaTrobe University, Melbourne, Victoria, Australia
- Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Karla Gough
- Department of Nursing, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Falahatpishe Z, Moradi A, Parhoon H, Parhoon K, Jobson L. Investigating executive functioning and episodic future thinking in Iranian women with breast cancer. J Psychosoc Oncol 2024:1-17. [PMID: 38459900 DOI: 10.1080/07347332.2024.2312970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2024]
Abstract
BACKGROUND This study examined executive functioning and episodic future thinking among Iranian women with breast cancer. METHOD We recruited 40 healthy female community volunteers and 80 females with breast cancer (either currently undergoing chemotherapy n = 40 or not undergoing chemotherapy n = 40). Participants were assessed using cognitive tasks that assessed executive functioning and episodic future thinking and a measure of cancer-related fatigue. RESULTS Both cancer groups had poorer performance than controls on all measures of executive functioning and episodic future thinking. Those undergoing chemotherapy had poorer performance on all measures of executive functioning than those not undergoing chemotherapy. Cross-sectional mediation analyses revealed cancer-related fatigue had a significant mediator role between cancer group and executive functioning and episodic future thinking. CONCLUSION Those with breast cancer, particularly those undergoing chemotherapy, may be experiencing cognitive difficulties. These cognitive concerns should be considered by health teams as addressing these impairments may assist in improving quality of life and treatment adherence.
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Affiliation(s)
| | - Alireza Moradi
- Kharazmi University and Institute for Cognitive Science Studies, Tehran, Iran
| | - Hadi Parhoon
- Department of Psychology, Razi University, Kermanshah, Iran
| | - Kamal Parhoon
- Postdoc Researcher in Cognitive Psychology, Kharazmi University, Tehran, Iran
| | - Laura Jobson
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
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Jan N, Sofi S, Qayoom H, Shabir A, Haq BU, Macha MA, Almilaibary A, Mir MA. Metronomic chemotherapy and drug repurposing: A paradigm shift in oncology. Heliyon 2024; 10:e24670. [PMID: 38314272 PMCID: PMC10837507 DOI: 10.1016/j.heliyon.2024.e24670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/03/2023] [Accepted: 01/11/2024] [Indexed: 02/06/2024] Open
Abstract
Cancer represents a significant global health and economic burden due to its high mortality rates. While effective in some instances, traditional chemotherapy often falls short of entirely eradicating various types of cancer. It can cause severe side effects due to harm to healthy cells. Two therapeutic approaches have risen to the forefront to address these limitations: metronomic chemotherapy (MCT) and drug repurposing. Metronomic chemotherapy is an innovative approach that breaks from traditional models. It involves the administration of chemotherapeutic regimens at lower doses, without long drug-free intervals that have previously been a hallmark of such treatments. This method offers a significant reduction in side effects and improved disease management. Simultaneously, drug repurposing has gained considerable attraction in cancer treatment. This approach involves utilizing existing drugs, initially developed for other therapeutic purposes, as potential cancer treatments. The application of known drugs in a new context accelerates the timeline from laboratory to patient due to pre-existing safety and dosage data. The intersection of these two strategies gives rise to a novel therapeutic approach named 'Metronomics.' This approach encapsulates the benefits of both MCT and drug repurposing, leading to reduced toxicity, potential for oral administration, improved patient quality of life, accelerated clinical implementation, and enhanced affordability. Numerous clinical studies have endorsed the efficacy of metronomic chemotherapy with tolerable side effects, underlining the potential of Metronomics in better cancer management, particularly in low- and middle-income countries. This review underscores the benefits and applications of metronomic chemotherapy and drug repurposing, specifically in the context of breast cancer, showcasing the promising results of pre-clinical and clinical studies. However, we acknowledge the necessity of additional clinical investigations to definitively establish the role of metronomic chemotherapy in conjunction with other treatments in comprehensive cancer management.
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Affiliation(s)
- Nusrat Jan
- Department of Bioresources, School of Biological Sciences, University of Kashmir, Srinagar-190006, India
| | - Shazia Sofi
- Department of Bioresources, School of Biological Sciences, University of Kashmir, Srinagar-190006, India
| | - Hina Qayoom
- Department of Bioresources, School of Biological Sciences, University of Kashmir, Srinagar-190006, India
| | - Aisha Shabir
- Department of Bioresources, School of Biological Sciences, University of Kashmir, Srinagar-190006, India
| | - Burhan Ul Haq
- Department of Bioresources, School of Biological Sciences, University of Kashmir, Srinagar-190006, India
| | - Muzaffar A Macha
- Watson-Crick Centre for Molecular Medicine, Islamic University of Science and Technology, Pulwama, India
| | - Abdullah Almilaibary
- Department of Family and Community Medicine, Faculty of Medicine, Al Baha University, Saudi Arabia
| | - Manzoor Ahmad Mir
- Department of Bioresources, School of Biological Sciences, University of Kashmir, Srinagar-190006, India
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Kuil LE, Varkevisser TMCK, Huisman MH, Jansen M, Bunt J, Compter A, Ket H, Schagen SB, Meeteren AYNSV, Partanen M. Artificial and natural interventions for chemotherapy- and / or radiotherapy-induced cognitive impairment: A systematic review of animal studies. Neurosci Biobehav Rev 2024; 157:105514. [PMID: 38135266 DOI: 10.1016/j.neubiorev.2023.105514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Cancer survivors frequently experience cognitive impairments. This systematic review assessed animal literature to identify artificial (pharmaceutical) or natural interventions (plant/endogenously-derived) to reduce treatment-related cognitive impairments. METHODS PubMed, EMBASE, PsycINFO, Web of Science, and Scopus were searched and SYRCLE's tool was used for risk of bias assessment of the 134 included articles. RESULTS High variability was observed and risk of bias analysis showed overall poor quality of reporting. Results generally showed positive effects in the intervention group versus cancer-therapy only group (67% of 156 cognitive measures), with only 15 (7%) measures reporting cognitive impairment despite intervention. Both artificial (61%) and natural (75%) interventions prevented cognitive impairment. Artificial interventions involving GSK3B inhibitors, PLX5622, and NMDA receptor antagonists, and natural interventions utilizing melatonin, curcumin, and N-acetylcysteine, showed most consistent outcomes. CONCLUSIONS Both artificial and natural interventions may prevent cognitive impairment in rodents, which merit consideration in future clinical trials. Greater consistency in design is needed to enhance the generalizability across studies, including timing of cognitive tests and description of treatments and interventions.
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Affiliation(s)
- L E Kuil
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands; Division of Pharmacology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
| | - T M C K Varkevisser
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, the Netherlands
| | - M H Huisman
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, the Netherlands
| | - M Jansen
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, the Netherlands
| | - J Bunt
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, the Netherlands
| | - A Compter
- Department of Neuro-Oncology, the Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
| | - H Ket
- Universiteitsbibliotheek, Vrije Universiteit Amsterdam, de Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
| | - S B Schagen
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
| | | | - M Partanen
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, the Netherlands.
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11
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Amani O, Mazaheri MA, Moghani MM, Zarani F, Choolabi RH. Chemotherapy-induced cognitive impairment in breast cancer survivors: A systematic review of studies from 2000 to 2021. Cancer Rep (Hoboken) 2024; 7:e1989. [PMID: 38351543 PMCID: PMC10864736 DOI: 10.1002/cnr2.1989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 11/27/2023] [Accepted: 01/15/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Studies have indicated that apart from enhancing patient survival, chemotherapy has adverse side effects on the psychological, social, and cognitive functions of breast cancer survivors. AIMS This study was conducted to understand chemotherapy's impact on breast cancer survivors' cognitive functions. METHODS AND RESULTS Our study is a systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We searched English databases, including PubMed/MEDLINE, PsycINFO, and Web of Science, and Persian databases, such as Irandoc and Elmnet, using Persian keywords of cancer, breast cancer, chemotherapy, cognitive functions, executive functions, and neuropsychological functions. Two reviewers independently evaluated the full text of the articles according to predefined criteria. Among the 937 available studies, 26 were selected based on the inclusion and exclusion criteria, of which 17 (65%) were longitudinal and 9 (35%) were cross-sectional. The findings indicated a significant relationship between the use of chemotherapy and cognitive impairments, most notably attention, working and short-term memory, and executive functions. However, the studies differed in their findings regarding the long-term persistence of cancer-related cognitive impairment (CRCI), which could be due to the wide range of tools used, different methods to measure cognitive functions, and the difference in the sample size of the studies. CONCLUSION Chemotherapy, affecting cortical and subcortical brain structures, causes a set of cognitive impairments that can lead to impairments in social responsibility acceptance, daily functioning, and quality of life of women. Therefore, rigorous and extensive research design is required to understand the causes and consequences of CRCI using standardized and sensitive measures of cognitive functions. Specifically, studies comparing the effects of different chemotherapy regimens on cognition and potential mechanisms and/or moderators of CRCI would be instrumental in designing more effective therapy regimens and evaluating the efficacy and cost-effectiveness of cognitive rehabilitation and supportive care programs.
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Affiliation(s)
- Omid Amani
- Department of PsychologyShahid Beheshti UniversityTehranIran
| | | | | | - Fariba Zarani
- Department of PsychologyShahid Beheshti UniversityTehranIran
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12
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Seitzman BA, Reynoso FJ, Mitchell TJ, Bice AR, Jarang A, Wang X, Mpoy C, Strong L, Rogers BE, Yuede CM, Rubin JB, Perkins SM, Bauer AQ. Functional network disorganization and cognitive decline following fractionated whole-brain radiation in mice. GeroScience 2024; 46:543-562. [PMID: 37749370 PMCID: PMC10828348 DOI: 10.1007/s11357-023-00944-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 09/11/2023] [Indexed: 09/27/2023] Open
Abstract
Cognitive dysfunction following radiotherapy (RT) is one of the most common complications associated with RT delivered to the brain, but the precise mechanisms behind this dysfunction are not well understood, and to date, there are no preventative measures or effective treatments. To improve patient outcomes, a better understanding of the effects of radiation on the brain's functional systems is required. Functional magnetic resonance imaging (fMRI) has shown promise in this regard, however, compared to neural activity, hemodynamic measures of brain function are slow and indirect. Understanding how RT acutely and chronically affects functional brain organization requires more direct examination of temporally evolving neural dynamics as they relate to cerebral hemodynamics for bridging with human studies. In order to adequately study the underlying mechanisms of RT-induced cognitive dysfunction, the development of clinically mimetic RT protocols in animal models is needed. To address these challenges, we developed a fractionated whole-brain RT protocol (3Gy/day for 10 days) and applied longitudinal wide field optical imaging (WFOI) of neural and hemodynamic brain activity at 1, 2, and 3 months post RT. At each time point, mice were subject to repeated behavioral testing across a variety of sensorimotor and cognitive domains. Disruptions in cortical neuronal and hemodynamic activity observed 1 month post RT were significantly worsened by 3 months. While broad changes were observed in functional brain organization post RT, brain regions most impacted by RT occurred within those overlapping with the mouse default mode network and other association areas similar to prior reports in human subjects. Further, significant cognitive deficits were observed following tests of novel object investigation and responses to auditory and contextual cues after fear conditioning. Our results fill a much-needed gap in understanding the effects of whole-brain RT on systems level brain organization and how RT affects neuronal versus hemodynamic signaling in the cortex. Having established a clinically-relevant injury model, future studies can examine therapeutic interventions designed to reduce neuroinflammation-based injury following RT. Given the overlap of sequelae that occur following RT with and without chemotherapy, these tools can also be easily incorporated to examine chemotherapy-related cognitive impairment.
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Affiliation(s)
- Benjamin A Seitzman
- Department of Radiation Oncology, School of Medicine, Washington University in St. Louis, 4921 Parkview Place, Campus Box 8224, St. Louis, MO, 63110, USA
| | - Francisco J Reynoso
- Department of Radiation Oncology, School of Medicine, Washington University in St. Louis, 4921 Parkview Place, Campus Box 8224, St. Louis, MO, 63110, USA
| | - Timothy J Mitchell
- Department of Radiation Oncology, School of Medicine, Washington University in St. Louis, 4921 Parkview Place, Campus Box 8224, St. Louis, MO, 63110, USA
| | - Annie R Bice
- Mallinckrodt Institute of Radiology, School of Medicine, Washington University in St. Louis, 660 S. Euclid Ave, Campus Box 8225, St. Louis, MO, 63110, USA
| | - Anmol Jarang
- Mallinckrodt Institute of Radiology, School of Medicine, Washington University in St. Louis, 660 S. Euclid Ave, Campus Box 8225, St. Louis, MO, 63110, USA
| | - Xiaodan Wang
- Mallinckrodt Institute of Radiology, School of Medicine, Washington University in St. Louis, 660 S. Euclid Ave, Campus Box 8225, St. Louis, MO, 63110, USA
- Department of Biomedical Engineering, McKelvey School of Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Cedric Mpoy
- Department of Radiation Oncology, School of Medicine, Washington University in St. Louis, 4921 Parkview Place, Campus Box 8224, St. Louis, MO, 63110, USA
| | - Lori Strong
- Department of Radiation Oncology, School of Medicine, Washington University in St. Louis, 4921 Parkview Place, Campus Box 8224, St. Louis, MO, 63110, USA
| | - Buck E Rogers
- Department of Radiation Oncology, School of Medicine, Washington University in St. Louis, 4921 Parkview Place, Campus Box 8224, St. Louis, MO, 63110, USA
| | - Carla M Yuede
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Joshua B Rubin
- Department of Pediatrics, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Stephanie M Perkins
- Department of Radiation Oncology, School of Medicine, Washington University in St. Louis, 4921 Parkview Place, Campus Box 8224, St. Louis, MO, 63110, USA.
| | - Adam Q Bauer
- Mallinckrodt Institute of Radiology, School of Medicine, Washington University in St. Louis, 660 S. Euclid Ave, Campus Box 8225, St. Louis, MO, 63110, USA.
- Department of Biomedical Engineering, McKelvey School of Engineering, Washington University in St. Louis, St. Louis, MO, USA.
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13
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Muhammad Khir S, Wan Mohd Yunus WMA, Mahmud N, Wang R, Panatik SA, Mohd Sukor MS, Nordin NA. Efficacy of Progressive Muscle Relaxation in Adults for Stress, Anxiety, and Depression: A Systematic Review. Psychol Res Behav Manag 2024; 17:345-365. [PMID: 38322293 PMCID: PMC10844009 DOI: 10.2147/prbm.s437277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 01/15/2024] [Indexed: 02/08/2024] Open
Abstract
Background The rise in the prevalence of mental health problems among adults worldwide has raised concerns, highlighting the critical need for evidence-based mental health interventions that are accessible, comprehensive, and effective. Previous research suggests that Progressive Muscle Relaxation (PMR) is a promising intervention widely used to reduce mental health problems. Nevertheless, the current literature on the efficacy of PMR among adults globally is fragmented, indicating a potential gap in this research area. Hence, this paper aims to systematically compile the research evidence on the efficacy of PMR in adults for stress, anxiety, and depression. Methods The Scopus, Web of Sciences, PubMed, PsycINFO, and Cochrane Central Register of Controlled Trials were searched from the earliest available evidence to 28th March 2023. The PRISMA (Preferred Reporting Items of Systematic Reviews and Meta-analyses) guidelines were followed, and the protocol was registered on the Open Science Framework. Joanna Briggs Institute (JBI) Critical Appraisal Tools were used to assess the quality of the included studies. Results A total of forty-six (46) publications from sixteen (16) countries covering more than 3402 adults were included in the review. The results show that PMR are effective in reducing stress, anxiety, and depression in adults. When PMR is combined with other interventions, the combined techniques have also consistently exhibited enhanced efficacy. Moreover, findings also indicate that the efficacy of PMR is heightened when implemented in conjunction with other interventions, surpassing its standalone efficacy. Funding and Registration This research was supported/funded by the Ministry of Higher Education (MoHE) under the Fundamental Research Grant Scheme (FRGS) (FRGS/1/2020/SS0/UTM/02/23). The review was registered on Open Science Framework (OSF) on the 7th of March 2023; DOI: https://doi.org/10.17605/OSF.IO/U2HZP.
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Affiliation(s)
- Syazwina Muhammad Khir
- Department of Psychology, School of Human Resource Development and Psychology, Faculty of Social Sciences and Humanities, Universiti Teknologi Malaysia, Johor, Malaysia
| | - Wan Mohd Azam Wan Mohd Yunus
- Department of Psychology, School of Human Resource Development and Psychology, Faculty of Social Sciences and Humanities, Universiti Teknologi Malaysia, Johor, Malaysia
- INVEST Research Flagship, University of Turku, Turku, Finland
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
| | - Norashikin Mahmud
- Department of Psychology, School of Human Resource Development and Psychology, Faculty of Social Sciences and Humanities, Universiti Teknologi Malaysia, Johor, Malaysia
| | - Rui Wang
- Department of Psychology, School of Human Resource Development and Psychology, Faculty of Social Sciences and Humanities, Universiti Teknologi Malaysia, Johor, Malaysia
| | - Siti Aisyah Panatik
- Department of Psychology, School of Human Resource Development and Psychology, Faculty of Social Sciences and Humanities, Universiti Teknologi Malaysia, Johor, Malaysia
| | - Mohammad Saipol Mohd Sukor
- Department of Psychology, School of Human Resource Development and Psychology, Faculty of Social Sciences and Humanities, Universiti Teknologi Malaysia, Johor, Malaysia
| | - Nor Akmar Nordin
- Department of Psychology, School of Human Resource Development and Psychology, Faculty of Social Sciences and Humanities, Universiti Teknologi Malaysia, Johor, Malaysia
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McGranahan TM, Figuracion KC, Goldberg M, Sheppard DP. Neurologic Complications in Adult Cancer Survivorship. Semin Neurol 2024; 44:90-101. [PMID: 38183974 DOI: 10.1055/s-0043-1777424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2024]
Abstract
Over the past decade, the improvement in cancer diagnostics and therapeutics has extended the overall survival of patients diagnosed with cancer including brain cancer. However, despite these unprecedented medical successes, patients continue to experience numerous neurologic complications after treatment that interfere with their independence, functionality, and overall quality of life. These include, among others, cognitive impairment, endocrinopathies, peripheral and cranial neuropathies, and vasculopathy. This article describes the long-term neurologic complications cancer survivors commonly experience to increase awareness of these complications and discuss treatments when available. Further research is necessary to understanding of mechanisms of neurologic injury and advance diagnosis and treatment. Effective patient education, monitoring, and managing neurologic issues after cancer treatment may improve independence, functionality, and quality of life during survivorship.
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Affiliation(s)
| | | | - Myron Goldberg
- Department of Rehabilitation Medicine, University of Washington Medical Center, Seattle, Washington
| | - David P Sheppard
- Department of Rehabilitation Medicine, University of Washington Medical Center, Seattle, Washington
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15
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Klaver KM, Duijts SFA, Geusgens CAV, Kieffer JM, Agelink van Rentergem J, Hendriks MP, Nuver J, Marsman HA, Poppema BJ, Oostergo T, Doeksen A, Aarts MJB, Ponds RWHM, van der Beek AJ, Schagen SB. Internet-based cognitive rehabilitation for working cancer survivors: results of a multicenter randomized controlled trial. JNCI Cancer Spectr 2024; 8:pkad110. [PMID: 38273712 PMCID: PMC10868395 DOI: 10.1093/jncics/pkad110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/11/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Cognitive problems contribute to decline in work performance. We evaluated (1) the effectiveness of basic self-management and extensive therapist-guided online cognitive rehabilitation on attainment of individually predetermined work-related goals among occupationally active cancer survivors, and (2) whether effectiveness of the programs differed for survivors with and without formal cognitive impairment. METHODS In a 3-arm randomized controlled trial (NCT03900806), 279 non-central nervous system cancer survivors with cognitive complaints were assigned to the basic program (n = 93), the extensive program (n = 93), or a waiting-list control group (n = 93). Participants completed measurements pre-randomization (T0), 12 weeks post-randomization upon program completion (T1), and 26 weeks post-randomization (T2). Mixed-effects modeling was used to compare intervention groups with the control group on goal attainment, and on self-perceived cognitive problems, work ability, and health-related quality of life. RESULTS Participants in the extensive program achieved their predetermined goals better than those in the control group, at short- and long-term follow-up (effect size [ES] = .49; P < .001; ES = .34; P = .014). They also had fewer recovery needs after work (ES = -.21; P = .011), more vitality (ES = .20; P = .018), and better physical role functioning (ES = .0.43 P = .015) than controls. At long-term follow-up, this finding persisted for physical role functioning (ES = .42; P = .034). The basic program elicited a small positive nonsignificant short-term (not long-term) effect on goal attainment for those with adequate adherence (ES = .28, P = .053). Effectiveness of the programs did not differ for patients with or without cognitive impairment. CONCLUSIONS Internet-based therapist-guided extensive cognitive rehabilitation improves work-related goal attainment. Considering the prevalence of cognitive problems in survivors, it is desirable to implement this program.
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Affiliation(s)
- Kete M Klaver
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Public and Occupational Health, Amsterdam University Medical Center location Vrije Universiteit, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Societal Participation and Health, Amsterdam, the Netherlands
| | - Saskia F A Duijts
- Department of Public and Occupational Health, Amsterdam University Medical Center location Vrije Universiteit, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Societal Participation and Health, Amsterdam, the Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
- Department of Medical Psychology, Amsterdam University Medical Center location Vrije Universiteit, Amsterdam, Amsterdam, the Netherlands
| | - Chantal A V Geusgens
- Department of Medical Psychology, Zuyderland Medical Center, Sittard, the Netherlands
| | - Jacobien M Kieffer
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Joost Agelink van Rentergem
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Mathijs P Hendriks
- Department of Medical Oncology, Northwest Clinics, Alkmaar, the Netherlands
| | - Janine Nuver
- Department of Medical Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Boelo J Poppema
- Department of Medical Oncology, Ommelander Hospital Group, Groningen, the Netherlands
| | - Tanja Oostergo
- Department of Medical Oncology, Diakonessenhuis Utrecht, Utrecht, the Netherlands
| | - Annemiek Doeksen
- Department of Surgery, St Antonius Hospital, Utrecht, the Netherlands
| | - Maureen J B Aarts
- Department of Medical Oncology, GROW-School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Rudolf W H M Ponds
- Department of Medical Psychology, Amsterdam University Medical Center location Vrije Universiteit, Amsterdam, Amsterdam, the Netherlands
| | - Allard J van der Beek
- Department of Public and Occupational Health, Amsterdam University Medical Center location Vrije Universiteit, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Societal Participation and Health, Amsterdam, the Netherlands
| | - Sanne B Schagen
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
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16
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Hinojosa-Gonzalez DE, Zafar A, Saffati G, Kronstedt S, Zlatev DV, Khera M. Androgen deprivation therapy for prostate cancer and neurocognitive disorders: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis 2024:10.1038/s41391-023-00785-w. [PMID: 38167924 DOI: 10.1038/s41391-023-00785-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/29/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Prostate cancer is a prevalent disease that urgently needs to address its treatment-related complications. By examining existing evidence on the association between Androgen Deprivation Therapy (ADT) and dementia, this study contributes to the understanding of potential risks. We sought to analyze the currently available evidence regarding the risk of dementia, Alzheimer's disease (AD), vascular dementia, and Parkinson's disease (PD) in patients undergoing ADT. METHODS A systematic search of PubMed, EMBASE, Scopus, and Google Scholar was performed to identify studies published from the databases' inception to April 2023. Studies were identified through systematic review to facilitate comparisons between studies with and without some degree of controls for biases affecting distinctions between ADT receivers and non-ADT receivers. This review identified 305 studies, with 28 meeting the inclusion criteria. Heterogeneity was assessed using Higgins I2%. Variables with an I2 over 50% were considered heterogeneous and analyzed using a Random-Effects model. Otherwise, a Fixed-Effects model was employed. RESULTS A total of 28 studies were included for analysis. Out of these, only 1 study did not report the number of patients. From the remaining 27 studies, there were a total of 2,543,483 patients, including 900,994 with prostate cancer who received ADT, 1,262,905 with prostate cancer who did not receive ADT, and 334,682 patients without prostate cancer who did not receive ADT. This analysis revealed significantly increased Hazard Ratios (HR) of 1.20 [1.11, 1.29], p < 0.00001 for dementia, HR 1.26 [1.10, 1.43], p = 0.0007 for Alzheimer's Disease, HR 1.66 [1.40, 1.97], p < 0.00001 for depression, and HR 1.57 [1.31, 1.88], p < 0.00001 for Parkinson's Disease. The risk of vascular dementia was HR 1.30 [0.97, 1.73], p < 0.00001. CONCLUSION Based on the analysis of the currently available evidence, it suggests that ADT significantly increases the risk of dementia, AD, PD, and depression.
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Affiliation(s)
- David E Hinojosa-Gonzalez
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB 1102, Boston, MA, 02114, USA.
| | - Affan Zafar
- Scott Department of Urology, Baylor College of Medicine, 7200 Cambridge Street, Houston, TX, 77030, USA
| | - Gal Saffati
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB 1102, Boston, MA, 02114, USA
| | - Shane Kronstedt
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB 1102, Boston, MA, 02114, USA
| | - Dimitar V Zlatev
- Scott Department of Urology, Baylor College of Medicine, 7200 Cambridge Street, Houston, TX, 77030, USA
| | - Mohit Khera
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB 1102, Boston, MA, 02114, USA
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Ding H, Xiang R, Jia Y, Ye J, Xia Z. Cyclosporin A-mediated translocation of HuR improves MTX-induced cognitive impairment in a mouse model via NCOA4-mediated ferritinophagy. Aging (Albany NY) 2023; 15:12537-12550. [PMID: 37950727 PMCID: PMC10683624 DOI: 10.18632/aging.205195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/12/2023] [Indexed: 11/13/2023]
Abstract
Chemotherapy-induced cognitive impairment (CICI) is a subject that requires critical solutions in neuroscience and oncology. However, its potential mechanism of action remains ambiguous. The aim of this study was to investigate the vital role of HuR in the neuroprotection of cyclosporin A (CsA) during methotrexate (MTX)-induced cognitive impairment. A series of Hu-antigen R (HuR) gain and loss experiments were used to examine cyclosporin A (CsA)-mediated translocation of HuR's ability to improve MTX-induced cognitive impairment through NCOA4-mediated ferritinophagy in vitro and in vivo. Obtained results show that the administration of CsA alleviated MTX-induced cognitive impairment in mice. The presence of MTX promoted the shuttling of HuR from the cytoplasm to the nucleus, whereas treatment with CsA increased cytoplasmic HuR expression levels and the levels of ferritinophagy-related proteins, such as NCOA4 and LC3II, compared to the MTX group. However, applying KH-3, an inhibitor of HuR, reversed CsA's impact on the expression of ferritinophagy-related proteins in the hippocampus and in vitro. Also, treatment with CsA attenuated microglial activation by altering Iba-1 expression and decreased TNF-α and IL-1β levels in mice hippocampi. Moreover, KH-3 neutralized CsA's effects on the expression of both Iba-1 and HuR in vivo and in vitro. In summary, CsA was confirmed to have a neuroprotective role in CICI. Its possible underlying mechanisms may be involved in the translocation of HuR. Mediating the translocation of HuR during CICI could mitigate neruoinflammation and neuronal apoptosis via NCOA4-mediated ferritinophagy and, thus, alleviate cognitive impairment in mice with CICI.
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Affiliation(s)
- Huang Ding
- Department of Pain, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, People’s Republic of China
| | - Rong Xiang
- Department of Otolaryngology-Head and Neck Surgery, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, People’s Republic of China
| | - Yifan Jia
- Department of Pain, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, People’s Republic of China
| | - Jishi Ye
- Department of Pain, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, People’s Republic of China
| | - Zhongyuan Xia
- Department of Pain, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, People’s Republic of China
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Tesfay N, Hailu G, Habtetsion M, Woldeyohannes F. Birth prevalence and risk factors of neural tube defects in Ethiopia: a systematic review and meta-analysis. BMJ Open 2023; 13:e077685. [PMID: 37940152 PMCID: PMC10632862 DOI: 10.1136/bmjopen-2023-077685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/19/2023] [Indexed: 11/10/2023] Open
Abstract
OBJECTIVE This study aims to estimate the prevalence of neural tube defects (NTDs) and to identify potential risk factors in the Ethiopian context. STUDY DESIGN Systematic review and meta-analysis. STUDY PARTICIPANTS A total of 611 064 participants were included in the review obtained from 42 studies. METHODS PubMed (Medline), Embase and Cochrane Library databases in combination with other potential sources of literature were systematically searched, whereby studies conducted between January 2010 and December 2022 were targeted in the review process. All observational studies were included and heterogeneity between studies was verified using Cochrane Q test statistics and I2 test statistics. Small study effects were checked using Egger's statistical test at a 5% significance level. RESULT The pooled prevalence of all NTDs per 10 000 births in Ethiopia was 71.48 (95% CI 57.80 to 86.58). The between-study heterogeneity was high (I2= 97.49%, p<0.0001). Birth prevalence of spina bifida (33.99 per 10 000) was higher than anencephaly (23.70 per 10 000), and encephalocele (4.22 per 10 000). Unbooked antenatal care (AOR 2.26, 95% CI (1.30 to 3.94)), preconception intake of folic acid (AOR 0.41, 95% CI (0.26 to 0.66)), having chronic medical illness (AOR 2.06, 95% CI (1.42 to 2.99)), drinking alcohol (AOR 2.70, 95% CI (1.89 to 3.85)), smoking cigarette (AOR 2.49, 95% CI (1.51 to 4.11)), chewing khat (AOR 3.30, 95% CI (1.88 to 5.80)), exposure to pesticides (AOR 3.87, 95% CI (2.63 to 5.71)), maternal age ≥35 (AOR 1.90, 95% CI (1.13 to 3.25)), maternal low educational status (AOR 1.60, 95% CI (1.13 to 2.24)), residing in urban areas (AOR 0.75, 95% CI (0.58 to 0.97))and family history of NTDs (AOR 2.51, 95% CI (1.36 to 4.62)) were associated with NTD cases. CONCLUSION The prevalence of NTDs in Ethiopia is seven times as high as in other Western countries where prevention measures are put in place. Heredity, maternal and environmental factors are associated with a high prevalence of NTDs. Mandatory fortification of staple food with folic acid should be taken as a priority intervention to curb the burden of NTDs. To smoothen and overlook the pace of implementation of mass fortification, screening, and monitoring surveillance systems should be in place along with awareness-raising measures. PROSPERO REGISTRATION NUMBER CRD42023413490.
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Affiliation(s)
- Neamin Tesfay
- Centre of Public Health Emergency Management, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Girmay Hailu
- Centre of Public Health Emergency Management, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Medhanye Habtetsion
- Centre of Public Health Emergency Management, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Fistum Woldeyohannes
- Health Financing Program, Clinton Health Access Initiative, Addis Ababa, Ethiopia
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Aran KR, Gupta GD, Singh S. Cladribine induces apoptosis, neuroinflammation, mitochondrial oxidative stress, tau phosphorylation and Aβ (1-42) pathway in the hippocampus: An in vivo approach. J Chem Neuroanat 2023; 133:102340. [PMID: 37708945 DOI: 10.1016/j.jchemneu.2023.102340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 09/08/2023] [Accepted: 09/11/2023] [Indexed: 09/16/2023]
Abstract
Cladribine is a purine nucleoside found to enhance toxic amyloid protein and cause memory impairment. Patients following chemotherapy treatment commonly suffer from cognitive deficits more prevalent in the elderly than adults. A previous research study revealed that cladribine has a high affinity to the brain, increases the level of amyloid precursor protein, and results in learning deficits. The study was designed to validate an animal model of cladribine administration to rats through mitochondrial oxidative stress, inflammation, apoptosis, tau phosphorylation, and amyloid-β (1-42) accumulation. In this study, all rats were orally given cladribine (0.5 and 1 mg/kg) for 28 days, resulting in impaired spatial memory confirmed by behavioural activity. On day 29, all rats were euthanized, and the hippocampal tissues were isolated and used for the estimation of neuroinflammatory markers, biochemicals parameters (glutathione, catalase, lipid peroxidation, and nitrite), amyloid-β (1-42) level, neurotransmitters, and nuclear factor kappa B analysis. Cladribine administration significantly elevated cytokines release, dysbalanced neurotransmitter concentration, and promoted the Aβ accumulation and hyperphosphorylation of tau protein. Our study outcome confirmed that cladribine produces cognitive impairment via activation of Nuclear factor kappa B, mitochondrial oxidative stress and dysbalanced of the endogenous antioxidant defence system.
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Affiliation(s)
- Khadga Raj Aran
- Neuroscience Division, Department of Pharmacology, ISF College of Pharmacy (An Autonomous College), Moga, Punjab 142001, India; I. K. Gujral Punjab Technical University, Jalandhar, India
| | - G D Gupta
- Department of Pharmaceutics, ISF College of Pharmacy (An Autonomous College), Moga, Punjab, 142001, India
| | - Shamsher Singh
- Neuroscience Division, Department of Pharmacology, ISF College of Pharmacy (An Autonomous College), Moga, Punjab 142001, India.
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Jesús OJ, Luis CP, Matilde MF. Effects of exercise on cancer-related cognitive impairment in breast cancer survivors: a scoping review. Breast Cancer 2023; 30:885-909. [PMID: 37480454 PMCID: PMC10587261 DOI: 10.1007/s12282-023-01484-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 07/09/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND Cancer-related cognitive impairment (CRCI) is one of the major long-term concerns reported by breast cancer survivors after overcoming the disease. The present study undertakes a scoping review of relevant research publications to explore the effect of increasing physical activity (PA) levels or the use of exercise (EX)-based programs on CRCI in female breast cancer survivors; who have completed neo/adjuvant chemotherapy treatment and are awaiting or receiving hormonal therapy. METHODS An electronic search of Pubmed, Embase, Scopus, WOS, and Cochrane databases has been conducted to identify published literature from January 2000 to December 2021. RESULTS Of 1129 articles, twenty met the inclusion criteria. The majority of the included observational studies (90%) reported cross-sectional design; meanwhile, 72% of experimental research reported randomized controlled trials (RCTs) or randomized crossover trials. 15 neuropsychological batteries and tests, and 5 self-reported validated questionnaires were employed. Only 27% of the included articles used a combination of the previously mentioned methods. The recorder of moderate-vigorous PA (MVPA), defined as more than 3 METs, or represented as average daily minutes spent (≥ 1952 counts/min) was the most analyzed variable in cross-sectional studies, and EX programs based on aerobic training (AT) were the most proposed by RCTs. CONCLUSIONS The exploratory approach of this review demonstrates modest but increasingly promising evidence regarding exercise's potential to improve brain health among breast cancer survivors although these findings highlight the importance of addressing methodological heterogeneity in the same direction with the view of using exercise within the clinic area.
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Affiliation(s)
| | - Carrasco-Páez Luis
- Departamento de Educación Física y Deporte, Universidad de Sevilla, España, Pirotecnia St., 41013, Sevilla, Spain.
| | - Mora-Fernández Matilde
- Departamento de Motricidad Humana y Rendimiento Deportivo, Universidad de Sevilla, España, Pirotecnia St., 41013, Sevilla, Spain
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21
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Rocha ECLD, Sousa KHJF, Lucchesi PADO, Faria MGDA, Balbinotti MAA, Rebustini F, Ferretti-Rebustini REDL, Gallasch CH. Content validity evidence of the Brazilian version of the Cognitive Symptom Checklist-Work-21. Rev Bras Enferm 2023; 76:e20220453. [PMID: 37672463 PMCID: PMC10476516 DOI: 10.1590/0034-7167-2022-0453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 02/15/2023] [Indexed: 09/08/2023] Open
Abstract
OBJECTIVE to cross-culturally adapt and assess the content validity evidence of the Cognitive Symptom Checklist-Work-21 for the Brazilian context. METHOD a psychometric study of cross-cultural adaptation, covering the stages of translation, reconciliation, back-translation, intercultural equivalence assessment and content validity evidence analysis, considering Content Validity Ratio parameters in breast cancer survivors. RESULTS the translations were equivalent to the original version. Colloquial expressions were modified, tense, verbal adjusted, and two items containing multiple commands were separated. The final version now contains 22 items, presenting semantic, conceptual, idiomatic and experimental equivalences. The pre-test indicated good understanding and ease in the response process. CONCLUSION the final version was defined as "Lista de verificação de sintomas cognitivos relacionados ao trabalho - 22 itens", showing good linguistic equivalence and strong evidence of content validity in the Brazilian context.
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22
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Madison AA, Andridge R, Kantaras AH, Renna ME, Bennett JM, Alfano CM, Povoski SP, Agnese DM, Lustberg M, Wesolowski R, Carson WE, Williams NO, Reinbolt RE, Sardesai SD, Noonan AM, Stover DG, Cherian MA, Malarkey WB, Kiecolt-Glaser JK. Depression, Inflammation, and Intestinal Permeability: Associations with Subjective and Objective Cognitive Functioning throughout Breast Cancer Survivorship. Cancers (Basel) 2023; 15:4414. [PMID: 37686689 PMCID: PMC10487080 DOI: 10.3390/cancers15174414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/22/2023] [Accepted: 08/26/2023] [Indexed: 09/10/2023] Open
Abstract
About one-in-three breast cancer survivors have lingering cognitive complaints and objective cognitive impairment. Chronic inflammation and intestinal permeability (i.e., leaky gut), two risk factors for cognitive decline, can also fuel depression-another vulnerability for cognitive decline. The current study tested whether depression accompanied by high levels of inflammation or intestinal permeability predicted lower subjective and objective cognitive function in breast cancer survivors. We combined data from four breast cancer survivor studies (n = 613); some had repeated measurements for a total of 1015 study visits. All participants had a blood draw to obtain baseline measures of lipopolysaccharide binding protein-a measure of intestinal permeability, as well as three inflammatory markers that were incorporated into an inflammatory index: C-reactive protein, interleukin-6, and tumor necrosis factor-α. They reported depressive symptoms on the Center for Epidemiological Studies depression scale (CES-D), and a binary variable indicated clinically significant depressive symptoms (CES-D ≥ 16). The Kohli (749 observations) and the Breast Cancer Prevention Trial (591 observations) scales assessed subjective cognitive function. Objective cognitive function tests included the trail-making test, Hopkins verbal learning test, Conners continuous performance test, n-back test, FAS test, and animal-naming test (239-246 observations). Adjusting for education, age, BMI, cancer treatment type, time since treatment, study visit, and fatigue, women who had clinically elevated depressive symptoms accompanied by heightened inflammation or intestinal permeability reported poorer focus and marginally poorer memory. However, poorer performance across objective cognitive measures was not specific to inflammation-associated depression. Rather, there was some evidence of lower verbal fluency; poorer attention, verbal learning and memory, and working memory; and difficulties with visuospatial search among depressed survivors, regardless of inflammation. By themselves, inflammation and intestinal permeability less consistently predicted subjective or objective cognitive function. Breast cancer survivors with clinically significant depressive symptoms accompanied by either elevated inflammation or intestinal permeability may perceive greater cognitive difficulty, even though depression-related objective cognitive deficits may not be specific to inflammation- or leaky-gut-associated depression.
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Affiliation(s)
- Annelise A Madison
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Department of Psychology, The Ohio State University, Columbus, OH 43210, USA
| | - Rebecca Andridge
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Division of Biostatistics, The Ohio State University, Columbus, OH 43210, USA
| | - Anthony H Kantaras
- Department of Neuroscience, The Ohio State University, Columbus, OH 43210, USA
| | - Megan E Renna
- School of Psychology, University of Southern Mississippi, Hattiesburg, MS 39406, USA
| | - Jeanette M Bennett
- Department of Psychological Science, University of North Carolina at Charlotte, Charlotte, NC 28213, USA
| | | | - Stephen P Povoski
- The Ohio State University Comprehensive Cancer Center, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Division of Surgical Oncology, Department of Surgery, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Doreen M Agnese
- The Ohio State University Comprehensive Cancer Center, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Division of Surgical Oncology, Department of Surgery, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Maryam Lustberg
- Center for Breast Cancer, Yale Cancer Center, Yale University, New Haven, CT 06519, USA
| | - Robert Wesolowski
- The Ohio State University Comprehensive Cancer Center, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Department of Internal Medicine, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - William E Carson
- The Ohio State University Comprehensive Cancer Center, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Division of Surgical Oncology, Department of Surgery, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Nicole O Williams
- The Ohio State University Comprehensive Cancer Center, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Department of Internal Medicine, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Raquel E Reinbolt
- The Ohio State University Comprehensive Cancer Center, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Department of Internal Medicine, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Sagar D Sardesai
- The Ohio State University Comprehensive Cancer Center, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Department of Internal Medicine, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Anne M Noonan
- The Ohio State University Comprehensive Cancer Center, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Department of Internal Medicine, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Daniel G Stover
- The Ohio State University Comprehensive Cancer Center, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Department of Internal Medicine, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Mathew A Cherian
- The Ohio State University Comprehensive Cancer Center, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Department of Internal Medicine, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - William B Malarkey
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Department of Internal Medicine, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Janice K Kiecolt-Glaser
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
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Melis M, Schroyen G, Blommaert J, Leenaerts N, Smeets A, Van Der Gucht K, Sunaert S, Deprez S. The Impact of Mindfulness on Functional Brain Connectivity and Peripheral Inflammation in Breast Cancer Survivors with Cognitive Complaints. Cancers (Basel) 2023; 15:3632. [PMID: 37509292 PMCID: PMC10377401 DOI: 10.3390/cancers15143632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/06/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Cancer-related cognitive impairment (CRCI) has been linked to functional brain changes and inflammatory processes. Hence, interventions targeting these underlying mechanisms are needed. In this study, we investigated the effects of a mindfulness-based intervention on brain function and inflammatory profiles in breast cancer survivors with CRCI. METHODS Female breast cancer survivors reporting cognitive complaints (n = 117) were randomly assigned to a mindfulness-based intervention (n = 43), physical training (n = 36), or waitlist control condition (n = 38). Region-of-interest (ROI) and graph theory analyses of resting state functional MRI data were performed to study longitudinal group differences in functional connectivity and organization in the default mode, dorsal attention, salience, and frontoparietal network. Additionally, bead-based immunoassays were used to investigate the differences in inflammatory profiles on serum samples. Measures were collected before, immediately after and three months post-intervention. RESULTS No ROI-to-ROI functional connectivity changes were identified. Compared to no intervention, graph analysis showed a larger decrease in clustering coefficient after mindfulness and physical training. Additionally, a larger increase in global efficiency after physical training was identified. Furthermore, the physical training group showed a larger decrease in an inflammatory profile compared to no intervention (IL-12p70, IFN-γ, IL-1β, and IL-8). CONCLUSION Both mindfulness and physical training induced changes in the functional organization of networks related to attention, emotion processing, and executive functioning. While both interventions reduced functional segregation, only physical training increased functional integration of the neural network. In conclusion, physical training had the most pronounced effects on functional network organization and biomarkers of inflammation, two mechanisms that might be involved in CRCI.
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Affiliation(s)
- Michelle Melis
- Department of Imaging and Pathology, Translational MRI, Catholic University Leuven, 1000 Brussels, Belgium
- Research Foundation Flanders (FWO), 1000 Brussels, Belgium
- Leuven Brain Institute, Catholic University Leuven, 3000 Leuven, Belgium
- Leuven Cancer Institute, Catholic University Leuven, 3000 Leuven, Belgium
| | - Gwen Schroyen
- Department of Imaging and Pathology, Translational MRI, Catholic University Leuven, 1000 Brussels, Belgium
- Leuven Brain Institute, Catholic University Leuven, 3000 Leuven, Belgium
- Leuven Cancer Institute, Catholic University Leuven, 3000 Leuven, Belgium
| | - Jeroen Blommaert
- Leuven Brain Institute, Catholic University Leuven, 3000 Leuven, Belgium
- Leuven Cancer Institute, Catholic University Leuven, 3000 Leuven, Belgium
- Department of Oncology, Gynecological Oncology, Catholic University Leuven, 3000 Leuven, Belgium
| | - Nicolas Leenaerts
- Leuven Brain Institute, Catholic University Leuven, 3000 Leuven, Belgium
- Department of Neurosciences, Mind-Body Research, Catholic University Leuven, 3000 Leuven, Belgium
| | - Ann Smeets
- Leuven Cancer Institute, Catholic University Leuven, 3000 Leuven, Belgium
- Department of Oncology, Surgical Oncology, Catholic University Leuven, 3000 Leuven, Belgium
- Department of Surgical Oncology, Multidisciplinary Breast Center, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Katleen Van Der Gucht
- Tilburg School of Social and Behavioral Sciences, Tilburg University, 5037 AB Tilburg, The Netherlands
- Leuven Mindfulness Centre, Faculty of Psychology and Educational Sciences, Catholic University Leuven, 3000 Leuven, Belgium
- Neuromodulation Laboratory, Biomedical Sciences Group, Department of Rehabilitation Sciences, Catholic University Leuven, 3000 Leuven, Belgium
| | - Stefan Sunaert
- Department of Imaging and Pathology, Translational MRI, Catholic University Leuven, 1000 Brussels, Belgium
- Leuven Brain Institute, Catholic University Leuven, 3000 Leuven, Belgium
- Department of Radiology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Sabine Deprez
- Department of Imaging and Pathology, Translational MRI, Catholic University Leuven, 1000 Brussels, Belgium
- Leuven Brain Institute, Catholic University Leuven, 3000 Leuven, Belgium
- Leuven Cancer Institute, Catholic University Leuven, 3000 Leuven, Belgium
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Alsikhan RS, Aldubayan MA, Almami IS, Alhowail AH. Protective Effect of Galantamine against Doxorubicin-Induced Neurotoxicity. Brain Sci 2023; 13:971. [PMID: 37371449 DOI: 10.3390/brainsci13060971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND AND AIMS Doxorubicin (DOX) causes cognitive impairment (chemobrain) in patients with cancer. While DOX damages the cholinergic system, few studies have focused on the protective effects of cholinergic function on chemobrain. The acetylcholinesterase inhibitor galantamine (GAL) demonstrates neuroprotective properties. We investigated the mechanisms associated with DOX-induced cognitive impairments and the potential protective role of GAL in preventing chemobrain. MAIN METHODS Female Wistar rats were divided into control, DOX, GAL, and DOX + GAL groups. The rats in the DOX group were administered DOX (5 mg/kg intraperitoneally twice weekly for two weeks), while those in the GAL group were orally administered GAL (2.5 mg/kg) via oral gavage once daily for 15 days. The combination group (DOX + GAL) received GAL (once daily) and DOX (two times per week) concurrently. The body weights and survival rates were monitored daily. The animals were subjected to behavioral tests to assess the memory function followed by the biochemical estimation of inflammatory markers, including tumor necrosis factor-α (TNF-α), interleukine-1β (IL-1β), and interleukine-6 (IL-6) in rat brain tissue and RT-qPCR. KEY FINDINGS DOX caused a reduction in the body weight and survival rate, which was alleviated by GAL concomitant treatment with DOX (DOX + GAL). These groups had reduced body weights and survival rates. DOX-treated animals exhibited an impairment of short-term spatial working memory, manifested as a behavioral alteration in the Y-maze test, the novel object recognition (NOR) test, and the elevated plus-maze (EPM) test. Concurrent treatment with GAL (DOX + GAL) showed improved memory function, as evidenced by an increase in the number of entries and time spent in the novel arm, the time spent exploring the novel object, and the transfer latency in the Y-maze, NOR test, and EPM test, respectively. These findings were also supported by biochemical observations showing the reversal of DOX-induced changes in IL-1β, IL-6, and TNF-α, as well as their relative expression of mRNA in brain tissue following concurrent GAL treatment. CONCLUSION GAL appeared to be a neuroprotective agent against neuroinflammation caused by DOX by reducing inflammatory markers in the brain.
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Affiliation(s)
- Rawan S Alsikhan
- Department of Pharmacology and Toxicology, College of Pharmacy, Qassim University, Buraydah 51452, Saudi Arabia
- Department of Pharmacology and Toxicology, Unaizah College of Pharmacy, Qassim University, Unaizah 51911, Saudi Arabia
| | - Maha A Aldubayan
- Department of Pharmacology and Toxicology, College of Pharmacy, Qassim University, Buraydah 51452, Saudi Arabia
| | - Ibtesam S Almami
- Department of Biology, College of Science, Qassim University, Buraydah 51452, Saudi Arabia
| | - Ahmad H Alhowail
- Department of Pharmacology and Toxicology, College of Pharmacy, Qassim University, Buraydah 51452, Saudi Arabia
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25
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Yang Y, Gorka SM, Pennell ML, Weinhold K, Orchard T. Intolerance of Uncertainty and Cognition in Breast Cancer Survivors: The Mediating Role of Anxiety. Cancers (Basel) 2023; 15:3105. [PMID: 37370715 DOI: 10.3390/cancers15123105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 05/31/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
Cancer-related cognitive impairment (CRCI) is one of the most prevalent symptoms that breast cancer survivors experience. While cancer treatments are established contributors to CRCI, inter-individual differences in CRCI are not well understood. Individual differences in sensitivity to uncertainty are potential contributors to CRCI; however, no prior studies have attempted to examine this link in the context of breast cancer. To address the gap, we used preliminary findings from an ongoing cross-sectional study. A total of 38 women with stage I-III breast cancer (1-4 years post-treatment) were included in this study. Intolerance of uncertainty (IU) was assessed using the Intolerance of Uncertainty Scale. Self-reported cognitive function was assessed with the Neuro-QoL questionnaire. Anxiety was assessed using the Patient-Reported Outcomes Measurement System Bank. From this study, we found that anxiety mediates the association between IU and cognitive function of survivors. In other words, among post-menopausal breast cancer survivors, those with higher IU showed higher anxiety and consequently had lower cognitive function. This finding suggests that assessing IU may help predict the risk of CRCI. This study expands the current knowledge that addresses the importance of IU as a factor associated with cognitive health.
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Affiliation(s)
- Yesol Yang
- Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center-James, 406 W 10th Avenue, Columbus, OH 43210, USA
| | - Stephanie M Gorka
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, 370 W 9th Avenue, Columbus, OH 43210, USA
- Institute for Behavioral Medicine Research, The Ohio State University, 460 Medical Center Drive, Columbus, OH 43210, USA
| | - Michael L Pennell
- Division of Biostatistics, College of Public Health, The Ohio State University, 1841 Neil Ave., Columbus, OH 43210, USA
| | - Kellie Weinhold
- Human Nutrition Program, Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, Columbus, OH 43210, USA
| | - Tonya Orchard
- Human Nutrition Program, Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, Columbus, OH 43210, USA
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26
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Rayner R, Shaw J, Hunt C. Development and user testing of a patient decision aid for cancer patients considering treatment for anxiety or depression. BMC Med Inform Decis Mak 2023; 23:65. [PMID: 37024880 PMCID: PMC10080801 DOI: 10.1186/s12911-023-02146-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 03/15/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Despite high rates of mental health disorders among cancer patients, uptake of referral to psycho-oncology services remains low. This study aims to develop and seek clinician and patient feedback on a patient decision aid (PDA) for cancer patients making decisions about treatment for anxiety and/or depression. METHODS Development was informed by the International Patient Decision Aid Standards and the Ottawa Decision Support Framework. Psycho-oncology professionals provided feedback on the clinical accuracy, acceptability, and usability of a prototype PDA. Cognitive interviews with 21 cancer patients/survivors assessed comprehensibility, acceptability, and usefulness. Interviews were thematically analysed using Framework Analysis. RESULTS Clinicians and patients strongly endorsed the PDA. Clinicians suggested minor amendments to improve clarity and increase engagement. Patient feedback focused on clarifying the purpose of the PDA and improving the clarity of the values clarification exercises (VCEs). CONCLUSIONS The PDA, the first of its kind for psycho-oncology, was acceptable to clinicians and patients. Valuable feedback was obtained for the revision of the PDA and VCEs.
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Affiliation(s)
- Rebecca Rayner
- School of Psychology, Faculty of Science, The University of Sydney, Chris O'Brien Lifehouse Level 6 (North), C39Z, 2006, Sydney, NSW, Australia
| | - Joanne Shaw
- Psycho-oncology Co-operative Research Group, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia.
| | - Caroline Hunt
- School of Psychology, Faculty of Science, The University of Sydney, Chris O'Brien Lifehouse Level 6 (North), C39Z, 2006, Sydney, NSW, Australia
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Pang L, Li W, Yao S, Jing Y, Yin X, Cheng H. Psychological distress is involved in CRCI in breast cancer survivors via mediating cytokine levels. Cancer Med 2023. [PMID: 36965094 DOI: 10.1002/cam4.5847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 02/28/2023] [Accepted: 03/12/2023] [Indexed: 03/27/2023] Open
Abstract
BACKGROUND Cancer-related cognitive impairment (CRCI) is a frequent consequence in breast cancer survivors after chemotherapy and lowers their quality of life (QOL). Psychological distress is frequently experienced by breast cancer survivors. There are currently few studies investigating the role of psychological distress in the genesis of CRCI. METHODS In total, 122 breast cancer survivors after standard chemotherapy within a year were recruited and assessed using the Psychological Distress Thermometer (DT). Sixty breast cancer survivors had non-psychological distress (NPD group) and sixty-two breast cancer survivors with psychological distress (PD group). The scores of the Mini-Mental State Examination (MMSE), prospective and retrospective memory (PM and RM) Questionnaire (PRMQ), and Functional Assessment of Cancer Therapy-General (FACT-G) and the levels of cytokines including interleukin-1 beta (IL-1β), tumor necrosis factor-alpha (TNF-α), and interleukin-4 (IL-4) were compared between the two groups. Using PROCESS, we investigated whether psychological distress predicted cognitive function based on MMSE through IL-1β, TNF-α, and IL-4. RESULTS The PD group had higher scores on RM, PM, and FACT-G and lower scores on MMSE than the NPD group (t = -11.357, t = -10.720, t = -15.419, t = 10.162, respectively; p < 0.05). Meanwhile, a higher level of IL-1β, TNF-α, and IL-4 was observed in the PD group than in the NPD group (t = -3.961, t = -3.396, t = -3.269, respectively; p < 0.05). The link between psychological distress and cognitive function as measured by the MMSE was also mediated by IL-1β, TNF-α, and IL-4 (effect size: 26%, 25%, and 24%). CONCLUSION Breast cancer patients with psychological distress displayed poor cognitive function, poor memory, and inferior quality of life, which was accompanied by higher cytokine levels of IL-1β, TNF-α, and IL-4. This study demonstrated IL-1β, TNF-α, and IL-4 as potential pathways to CRCI in response to ongoing psychological distress, which provided evidence for the involvement of psychological distress in CRCI in breast cancer survivors.
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Affiliation(s)
- Lulian Pang
- Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Wen Li
- Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Senbang Yao
- Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yanyan Jing
- Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Xiangxiang Yin
- Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Huaidong Cheng
- Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Department of Oncology, Shenzhen Hospital of Southern Medical University, Shenzhen, China
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28
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Fleming B, Edison P, Kenny L. Cognitive impairment after cancer treatment: mechanisms, clinical characterization, and management. BMJ 2023; 380:e071726. [PMID: 36921926 DOI: 10.1136/bmj-2022-071726] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Cognitive impairment is a debilitating side effect experienced by patients with cancer treated with systemically administered anticancer therapies. With around 19.3 million new cases of cancer worldwide in 2020 and the five year survival rate growing from 50% in 1970 to 67% in 2013, an urgent need exists to understand enduring side effects with severe implications for quality of life. Whereas cognitive impairment associated with chemotherapy is recognized in patients with breast cancer, researchers have started to identify cognitive impairment associated with other treatments such as immune, endocrine, and targeted therapies only recently. The underlying mechanisms are diverse and therapy specific, so further evaluation is needed to develop effective therapeutic interventions. Drug and non-drug management strategies are emerging that target mechanistic pathways or the cognitive deficits themselves, but they need to be rigorously evaluated. Clinically, consistent use of objective diagnostic tools is necessary for accurate diagnosis and clinical characterization of cognitive impairment in patients treated with anticancer therapies. This should be supplemented with clinical guidelines that could be implemented in daily practice. This review summarizes the recent advances in the mechanisms, clinical characterization, and novel management strategies of cognitive impairment associated with treatment of non-central nervous system cancers.
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Affiliation(s)
- Ben Fleming
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Paul Edison
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
- College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Laura Kenny
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
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29
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Tapia JL, Taberner-Bonastre MT, Collado-Martínez D, Pouptsis A, Núñez-Abad M, Duñabeitia JA. Effectiveness of a Computerized Home-Based Cognitive Stimulation Program for Treating Cancer-Related Cognitive Impairment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4953. [PMID: 36981862 PMCID: PMC10049401 DOI: 10.3390/ijerph20064953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 06/18/2023]
Abstract
Cancer patients assert that after chemotherapy their cognitive abilities have deteriorated. Cognitive stimulation is the clinical treatment of choice for reversing cognitive decline. The current study describes a computerized home-based cognitive stimulation program in patients who survived breast cancer. It aims to assess safety and effectiveness of cognitive stimulation in the oncology population. A series of 45-min training sessions was completed by the participants. A thorough assessment was performed both before and after the intervention. The mini-Mental Adjustment to Cancer Scale, the Cognitive Assessment for Chemo Fog Research, and the Functionality Assessment Instrument in Cancer Treatment-Cognitive Function served as the main assessment tools. The State-Trait Anxiety Inventory, Beck Depression Inventory, Brief Fatigue Inventory, and Measuring Quality of Life-The World Health Organization data were gathered as secondary outcomes. Home-based cognitive stimulation demonstrated beneficial effects in the oncology population, with no side effects being reported. Cognitive, physical, and emotional improvements were observed, along with decreased interference in daily life activities and a better overall quality of life.
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Affiliation(s)
- Jose L. Tapia
- Centro de Investigación Nebrija en Cognición (CINC), Universidad Nebrija, 28015 Madrid, Spain
| | | | - David Collado-Martínez
- Servicio de Oncología Médica, Hospital Universitario de la Ribera, 46600 Valencia, Spain
| | - Athanasios Pouptsis
- Servicio de Oncología Médica, Hospital Universitario de la Ribera, 46600 Valencia, Spain
| | - Martín Núñez-Abad
- Servicio de Oncología Médica, Hospital Universitario de la Ribera, 46600 Valencia, Spain
| | - Jon Andoni Duñabeitia
- Centro de Investigación Nebrija en Cognición (CINC), Universidad Nebrija, 28015 Madrid, Spain
- AcqVA Aurora Center, The Arctic University of Norway, 9019 Tromsø, Norway
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Giustiniani A, Danesin L, Pezzetta R, Masina F, Oliva G, Arcara G, Burgio F, Conte P. Use of Telemedicine to Improve Cognitive Functions and Psychological Well-Being in Patients with Breast Cancer: A Systematic Review of the Current Literature. Cancers (Basel) 2023; 15:cancers15041353. [PMID: 36831693 PMCID: PMC9954456 DOI: 10.3390/cancers15041353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/13/2023] [Accepted: 02/17/2023] [Indexed: 02/25/2023] Open
Abstract
The diagnosis and side effects of breast cancer (BC) treatments greatly affect the everyday lives of women suffering from this disease, with relevant psychological and cognitive consequences. Several studies have reported the psychological effects of receiving a diagnosis of BC. Moreover, women undergoing anticancer therapies may exhibit cognitive impairment as a side effect of the treatments. The access to cognitive rehabilitation and psychological treatment for these patients is often limited by resources; women of childbearing age often encounter difficulties in completing rehabilitation programs requiring access to care institutions. Telemedicine, which provides health services using information and communication technologies, is a useful tool to overcome these limitations. In particular, telemedicine may represent an optimal way to guarantee cognitive rehabilitation, psychological support, and recovery to BC patients. Previous studies have reviewed the use of telemedicine to improve psychological well-being in BC patients, and a few have investigated the effect of telerehabilitation on cognitive deficits. This study systematically reviewed the evidence on the cognitive and psychological effects of telemedicine in BC patients. Current evidence suggests that telemedicine may represent a promising tool for the management of some psychological problems experienced by breast cancer patients, but more controlled studies are needed to clarify its effectiveness, especially for cognitive deficits. The results are also discussed in light of the intervening and modulating factors that may mediate both side effect occurrence and the success of the interventions.
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Turcu-Stiolica A, Bogdan M, Dumitrescu EA, Zob DL, Gheorman V, Aldea M, Dinescu VC, Subtirelu MS, Stanculeanu DL, Sur D, Lungulescu CV. Diagnostic Accuracy of Machine-Learning Models on Predicting Chemo-Brain in Breast Cancer Survivors Previously Treated with Chemotherapy: A Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16832. [PMID: 36554712 PMCID: PMC9779296 DOI: 10.3390/ijerph192416832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/11/2022] [Accepted: 12/12/2022] [Indexed: 06/17/2023]
Abstract
We performed a meta-analysis of chemo-brain diagnostic, pooling sensitivities, and specificities in order to assess the accuracy of a machine-learning (ML) algorithm in breast cancer survivors previously treated with chemotherapy. We searched PubMed, Web of Science, and Scopus for eligible articles before 30 September 2022. We identified three eligible studies from which we extracted seven ML algorithms. For our data, the χ2 tests demonstrated the homogeneity of the sensitivity's models (χ2 = 7.6987, df = 6, p-value = 0.261) and the specificities of the ML models (χ2 = 3.0151, df = 6, p-value = 0.807). The pooled area under the curve (AUC) for the overall ML models in this study was 0.914 (95%CI: 0.891-0.939) and partial AUC (restricted to observed false positive rates and normalized) was 0.844 (95%CI: 0.80-0.889). Additionally, the pooled sensitivity and pooled specificity values were 0.81 (95% CI: 0.75-0.86) and 0.82 (95% CI: 0.76-0.86), respectively. From all included ML models, support vector machine demonstrated the best test performance. ML models represent a promising, reliable modality for chemo-brain prediction in breast cancer survivors previously treated with chemotherapy, demonstrating high accuracy.
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Affiliation(s)
- Adina Turcu-Stiolica
- Department of Pharmacoeconomics, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Maria Bogdan
- Department of Pharmacology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Elena Adriana Dumitrescu
- Department of Oncology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Daniela Luminita Zob
- Institute of Oncology, Prof Dr. Alexandru Trestioreanu, Soseaua Fundeni, 022328 Bucharest, Romania
| | - Victor Gheorman
- Department of Psychiatry, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Madalina Aldea
- Department of Psychiatry, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Venera Cristina Dinescu
- Department of Health Promotion and Occupational Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Mihaela-Simona Subtirelu
- Department of Pharmacoeconomics, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Dana-Lucia Stanculeanu
- Department of Oncology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Daniel Sur
- 11th Department of Medical Oncology, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400125 Cluj-Napoca, Romania
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Alberti P, Salvalaggio A, Argyriou AA, Bruna J, Visentin A, Cavaletti G, Briani C. Neurological Complications of Conventional and Novel Anticancer Treatments. Cancers (Basel) 2022; 14:cancers14246088. [PMID: 36551575 PMCID: PMC9776739 DOI: 10.3390/cancers14246088] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/05/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
Various neurological complications, affecting both the central and peripheral nervous system, can frequently be experienced by cancer survivors after exposure to conventional chemotherapy, but also to modern immunotherapy. In this review, we provide an overview of the most well-known adverse events related to chemotherapy, with a focus on chemotherapy induced peripheral neurotoxicity, but we also address some emerging novel clinical entities related to cancer treatment, including chemotherapy-related cognitive impairment and immune-mediated adverse events. Unfortunately, efficacious curative or preventive treatment for all these neurological complications is still lacking. We provide a description of the possible mechanisms involved to drive future drug discovery in this field, both for symptomatic treatment and neuroprotection.
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Affiliation(s)
- Paola Alberti
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- NeuroMI (Milan Center for Neuroscience), 20126 Milan, Italy
| | | | - Andreas A. Argyriou
- Neurology Department, Agios Andreas State General Hospital of Patras, 26335 Patras, Greece
| | - Jordi Bruna
- Neuro-Oncology Unit, Hospital Universitari de Bellvitge-ICO Hospitalet, Bellvitge Institute for Biomedical Research (IDIBELL), 08908 Barcelona, Spain
| | - Andrea Visentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, 35131 Padova, Italy
| | - Guido Cavaletti
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Chiara Briani
- Neurology Unit, Department of Neurosciences, University of Padova, 35131 Padova, Italy
- Correspondence:
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West T, Cavallero C, Ceccherini R, Foladore S, Generali D, Versace F, Scaggiante B. Impact of psychosocial, behavioral and lifestyle factors on subjective cognitive complaints and perceived quality of life in a large cohort of Italian breast cancer patients. Front Psychol 2022; 13:1015573. [DOI: 10.3389/fpsyg.2022.1015573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022] Open
Abstract
The impact of psychosocial and behavioral factors on Cancer Related Cognitive Impairment manifestations is still under debate. Study’s purpose is to determine the prevalence rate of cancer related cognitive impairment in a cohort of Italian breast cancer patients and to evaluate the implication of specific behavioral factors. For these purposes, a total of 233 women (106 breast cancer patients and 127 age-matched controls without oncological diagnosis) completed a questionnaire investigating cognitive functionality (FACT-Cog v3.0), sociodemographic characteristics, clinical information, psychosocial and behavioral factors (cognitive reserve, sleep quality, dietary habits, physical activity). The results indicated a higher prevalence rate of subjective cognitive complaints in breast cancer patients (37%) compared to a representative sample of women in the same age group without an oncological diagnosis (p < 0.001). Moreover, breast cancer patients showed significantly lower levels of cognitive reserve (p < 0.05) and worse sleep quality (p < 0.01) compared to age-matched controls. Further analysis revealed that breast cancer patients reporting subjective cognitive complaints differed significantly from breast cancer patients without subjective cognitive complaints on measures of perceived cognitive abilities (p < 0.001) and on the impact of cognitive difficulties on perceived quality of life (p < 0.01). Future studies are needed to examine behavioral directed interventions to prevent subjective cognitive deficits in breast cancer patients.
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Liu S, Ni J, Yan F, Yin N, Li X, Ma R, Wu J, Zhou G, Feng J. Functional changes of the prefrontal cortex, insula, caudate and associated cognitive impairment (chemobrain) in NSCLC patients receiving different chemotherapy regimen. Front Oncol 2022; 12:1027515. [PMID: 36408140 PMCID: PMC9667024 DOI: 10.3389/fonc.2022.1027515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/21/2022] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION Chemotherapy-induced cognitive impairment (CICI), termed "chemobrain", is highly prevalent in cancer patients following the administration of chemotherapeutic agents. However, the potential pathophysiological mechanisms underlying CICI remain unknown. This study aimed to explore the functional changes of the brain and associated cognitive impairment in non-small cell lung cancer (NSCLC) patients receiving different chemotherapy regimen. METHODS A total of 49 NSCLC patients (25 patients receiving pemetrexed plus carboplatin chemotherapy (PeCC) and 24 patients receiving paclitaxel plus carboplatin chemotherapy (PaCC)) and 61 healthy controls (HCs) were recruited and underwent resting-state functional magnetic resonance imaging (rs-fMRI) scanning, as well as cognitive function tests including Mini Mental State Exam (MMSE), Montreal Cognitive Assessment (MoCA), Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog). Brain functional activities were measured by regional homogeneity (ReHo) values, which were calculated and compared between groups. In addition, the associations between ReHo values of changed brain regions and scores of cognitive scales were evaluated. RESULTS NSCLC patients showed decreased scores of MMSE, MoCA and FACT-Cog and decreased ReHo values in the bilateral superior frontal gyrus (medial), middle frontal gyrus, left inferior frontal gyrus (orbital part) and increased ReHo values in the bilateral insula and caudate. Compared with HCs, patients receiving PeCC demonstrated decreased ReHo values in the right superior frontal gyrus (dorsolateral), left superior frontal gyrus (medial orbital), middle frontal gyrus, insula and rectus gyrus while patients receiving PaCC presented increased ReHo values in the right rolandic operculum, left insula and right caudate. Compared with patients receiving PaCC, patients receiving PeCC had decreased ReHo values in the left superior frontal gyrus (orbital part), middle frontal gyrus and increased ReHo values in the left inferior temporal gyrus, lingual gyrus. Moreover, positive relationships were found between ReHo values of the left and right superior frontal gyrus (medial) and the total scores of FACT-Cog in the patient group. CONCLUSION The findings provided evidences that carboplatin-based chemotherapy could cause CICI accompanied by functional changes in the prefrontal cortex, insula, caudate. These might be the pathophysiological basis for CICI of NSCLC patients and were affected by the differences of chemotherapeutic agent administration through different biological mechanisms.
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Affiliation(s)
- Siwen Liu
- Research Center for Clinical Oncology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Jie Ni
- Department of Oncology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Fei Yan
- Department of Oncology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Na Yin
- Department of Radiology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaoyou Li
- Department of Oncology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Rong Ma
- Research Center for Clinical Oncology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Jianzhong Wu
- Research Center for Clinical Oncology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Guoren Zhou
- Department of Oncology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China,*Correspondence: Jifeng Feng, ; Guoren Zhou,
| | - Jifeng Feng
- Research Center for Clinical Oncology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China,Department of Oncology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China,*Correspondence: Jifeng Feng, ; Guoren Zhou,
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Schroyen G, Schramm G, Van Weehaeghe D, Leenaerts N, Vande Casteele T, Blommaert J, Koole M, Smeets A, Van Laere K, Sunaert S, Deprez S. Cerebral glucose changes after chemotherapy and their relation to long-term cognitive complaints and fatigue. Front Oncol 2022; 12:1021615. [PMID: 36313711 PMCID: PMC9612406 DOI: 10.3389/fonc.2022.1021615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 09/21/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose To investigate the short-term cerebral metabolic effects of intravenous chemotherapy and their association with long-term fatigue/cognitive complaints. Experimental design Using [18F]-FDG-PET/CT whole-body scans, we retrospectively quantified relative cerebral glucose metabolism before and after neoadjuvant chemotherapy in a cohort of patients treated for non-metastatic breast cancer (2009-2019). Self-report of cognitive complaints and fatigue were prospectively assessed 7 ± 3 years after therapy. Metabolic changes were estimated with i) robust mixed-effects modelling in regions-of-interest (frontal, parietal, temporal, occipital, and insular cortex) and ii) general-linear modelling of whole-brain voxel-wise outcomes. iii) The association between metabolic changes and self-reported outcomes was evaluated using linear regression-analysis. Results Of the 667 screened patients, 263 underwent PET/CT before and after chemotherapy and 183 (48 ± 9 years) met the inclusion criteria. After chemotherapy, decreased frontal and increased parietal and insular metabolism were observed (|ß|>0.273, pFDR<0.008). Separately, additional increased occipital metabolism after epiribucin+ cyclophosphamide (EC) and temporal metabolism after EC+ fluorouracil chemotherapy were observed (ß>0.244, pFDR≤0.048). Voxel-based analysis (pcluster-FWE<0.001) showed decreased metabolism in the paracingulate gyrus (-3.2 ± 3.9%) and putamen (3.1 ± 4.1%) and increased metabolism in the lateral cortex (L=2.9 ± 3.1%) and pericentral gyri (3.0 ± 4.4%). Except for the central sulcus, the same regions showed changes in EC, but not in FEC patients. Of the 97 self-reported responders, 23% and 27% experienced extreme fatigue and long-term cognitive complaints, respectively, which were not associated with metabolic changes. Conclusion Both hyper- and hypometabolism were observed after chemotherapy for breast cancer. Combined with earlier findings, this study could support inflammatory mechanisms resulting in relative hypermetabolism, mainly in the parietal/occipital cortices. As early metabolic changes did not precede long-term complaints, further research is necessary to identify vulnerable patients.
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Affiliation(s)
- Gwen Schroyen
- Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Leuven Cancer Institute, KU Leuven, Leuven, Belgium
- Department of Imaging and Pathology, Translational MRI, KU Leuven, Leuven, Belgium
- *Correspondence: Gwen Schroyen,
| | - Georg Schramm
- Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Department of Imaging and Pathology, Nuclear Medicine and Molecular Imaging, KU Leuven, Leuven, Belgium
| | - Donatienne Van Weehaeghe
- Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Department of Imaging and Pathology, Nuclear Medicine and Molecular Imaging, KU Leuven, Leuven, Belgium
- Division of Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Nicolas Leenaerts
- Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Department of Neurosciences, Mind-Body Research, KU Leuven, Leuven, Belgium
- University Psychiatric Centre, KU Leuven, Leuven, Belgium
- Department of Psychiatry, University Hospitals Leuven, Leuven, Belgium
| | - Thomas Vande Casteele
- Leuven Brain Institute, KU Leuven, Leuven, Belgium
- University Psychiatric Centre, KU Leuven, Leuven, Belgium
- Department of Psychiatry, University Hospitals Leuven, Leuven, Belgium
- Department of Neurosciences, Neuropsychiatry, KU Leuven, Leuven, Belgium
| | - Jeroen Blommaert
- Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Leuven Cancer Institute, KU Leuven, Leuven, Belgium
- Department of Oncology, Gynaecological Oncology, KU Leuven, Leuven, Belgium
| | - Michel Koole
- Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Leuven Cancer Institute, KU Leuven, Leuven, Belgium
- Department of Imaging and Pathology, Nuclear Medicine and Molecular Imaging, KU Leuven, Leuven, Belgium
| | - Ann Smeets
- Leuven Cancer Institute, KU Leuven, Leuven, Belgium
- Department of Oncology, Surgical Oncology, KU Leuven, Leuven, Belgium
- Surgical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Koen Van Laere
- Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Leuven Cancer Institute, KU Leuven, Leuven, Belgium
- Department of Imaging and Pathology, Nuclear Medicine and Molecular Imaging, KU Leuven, Leuven, Belgium
- Division of Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Stefan Sunaert
- Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Department of Imaging and Pathology, Translational MRI, KU Leuven, Leuven, Belgium
- Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Sabine Deprez
- Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Leuven Cancer Institute, KU Leuven, Leuven, Belgium
- Department of Imaging and Pathology, Translational MRI, KU Leuven, Leuven, Belgium
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Taha M, Elazab ST, Badawy AM, Saati AA, Qusty NF, Al-Kushi AG, Sarhan A, Osman A, Farage AE. Activation of SIRT-1 Pathway by Nanoceria Sheds Light on Its Ameliorative Effect on Doxorubicin-Induced Cognitive Impairment (Chemobrain): Restraining Its Neuroinflammation, Synaptic Dysplasticity and Apoptosis. Pharmaceuticals (Basel) 2022; 15:ph15080918. [PMID: 35893742 PMCID: PMC9394293 DOI: 10.3390/ph15080918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 02/04/2023] Open
Abstract
Chemo fog is one of the most serious health concerns encountered by cancer survivors receiving doxorubicin (DOX)-based chemotherapy. Oxidative stress, neuroinflammation, apoptosis and impairment of synaptic plasticity are regarded as the key factors implicated in DOX-induced cognitive impairment. This research aimed to assess the possible neuroprotective effect of cerium oxide nanoparticles (CeNPs) against DOX-induced neurotoxicity. Forty-eight rats were divided into four groups (12 rats/group): control group, CeNPs group (received oral CeNPs solution (35 mg/kg) daily for 4 weeks), and DOX group (were administered DOX intraperitoneally (2 mg/kg, once/week for 4 weeks)) and DOX+ CeNPs group. The findings revealed that CeNPs mitigated behavioral alterations in DOX-induced cognitive deficit. Additionally, CeNPs alleviated the histopathological abnormalities in hippocampus and ameliorated DOX-induced neuroinflammation by downregulating the expression of NF-κB, TNF-α, IL-1β and IL6. In addition, CeNPs antagonized the apoptosis through reducing the protein expression of cytochrome c and caspase 3. In addition, it stimulated the antioxidant defense, as indicated by upregulating the expression of the Nrf2, HO-1 and PGC-1α genes. CeNPs improved synaptic plasticity via acting on the BDNF. These actions were related through the modification of SIRT-1 expression. Based on the aforementioned results, CeNPs antagonized the doxorubicin-induced neurodegeneration by its antioxidant, anti-inflammatory and antiapoptotic effects, alongside its SIRT-1 mediated mechanisms.
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Affiliation(s)
- Medhat Taha
- Department of Anatomy and Embryology, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt;
- Department of Anatomy, Al-Qunfudah Medical College, Umm Al-Qura University, Al-Qunfudhah 28814, Saudi Arabia
- Correspondence:
| | - Sara T. Elazab
- Department of Pharmacology, Faculty of Veterinary Medicine, Mansoura University, Mansoura 35516, Egypt; or
| | - Alaa. M. Badawy
- Department of Anatomy and Embryology, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt;
| | - Abdullah A. Saati
- Department of Community Medicine and Pilgrims Healthcare, Faculty of Medicine, Umm Al-Qura University, Makkah 24382, Saudi Arabia;
| | - Naeem F. Qusty
- Medical Laboratories Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah 24382, Saudi Arabia;
| | - Abdullah G. Al-Kushi
- Department of Human Anatomy, Faculty of Medicine, Umm Al-Qura University, Makkah 24382, Saudi Arabia;
| | - Anas Sarhan
- Department of Internal Medicine, College of Medicine, Umm Al-Qura University, Makkah 24382, Saudi Arabia;
| | - Amira Osman
- Department of Histology, Faculty of Medicine, Kafrelsheikh University, Kafr Elsheikh 33511, Egypt;
| | - Amira E. Farage
- Department of Anatomy and Embryology, Faculty of Medicine, Kafrelsheikh University, Kafr Elsheikh 33511, Egypt;
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Durán-Gómez N, López-Jurado CF, Nadal-Delgado M, Pérez-Civantos D, Guerrero-Martín J, Cáceres MC. Chemotherapy-Related Cognitive Impairment in Patients with Breast Cancer Based on Functional Assessment and NIRS Analysis. J Clin Med 2022; 11:jcm11092363. [PMID: 35566489 PMCID: PMC9100963 DOI: 10.3390/jcm11092363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/03/2022] [Accepted: 04/21/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Chemotherapy-related cognitive impairment (CRCI), or “chemobrain,” isdefined as a phenomenon of cognitive deficits in cancer patients after chemotherapy and is characterized by deficits in areas of cognition, including memory, attention, speed of processing, and executive function, which seriously affect quality of life. The purpose of this study is to investigate the impact of CRCI in breast cancer (BC) patients in chemotherapy treatment (CT+) or not (CT−) and to analyze their relationship with detectable objective changes in cerebral activity during the execution of a phonological and semantic verbal fluency task (PVF and SVF). Methods: An observational, cross-sectional study was carried out at Badajoz University Hospital (Spain). A total of 180 women with BC were included. We used Cognitive Scale (FACT-Cog) for neuropsychological subjective assessment, obtaining scores of perceived cognitive impairment (PCI), and near-infrared spectroscopy system (NIRS) for neuropsychological objective assessment during a verbal fluency task (PVF and SVF), determining alterations in the prefrontal cortex (PFC) assessed as changes in regional saturation index (rSO2). Results: A total of 41.7% percent of the patients in the sample had PCI. CT+ was significantly associated with a worse impact in PCI (X¯ = 50.60 ± 15.64 vs. X¯ = 55.01 ± 12.10; p = 0.005). Average rSO2 decreased significantly in CT+ (X¯ = 63.30 ± 8.02 vs. X¯ = 67.98 ± 7.80; p < 0.001), and BC patients showed a significant decrease in PVF and SVF on average (X¯ = 41.99 ± 9.52 vs. X¯ = 47.03 ± 9.31, and X¯ = 33.43 ± 11.0 vs. X¯ = 36.14 ± 10.68, respectively; p < 0.001). Conclusions: Our findings suggest that cognitive impairments in the domain of executive functioning exist among patients with BC who received CT. The results corroborate the hypothesis that CT is an important factor in cognitive impairment in patients with BC, which has been demonstrated by both subjective (PCI) and objective (PVF, SVF, and rSO2) neuropsychological measures. The combination of doxorubicin, cyclophosphamide, and docetaxel induce cognitive impairment.
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Affiliation(s)
- Noelia Durán-Gómez
- Departamento de Enfermería, Facultad de Medicina y Ciencias de la Salud, Universidad de Extremadura, 06006 Badajoz, Spain; (C.F.L.-J.); (J.G.-M.); (M.C.C.)
- Correspondence: ; Tel.: +34-92-428-9466
| | - Casimiro Fermín López-Jurado
- Departamento de Enfermería, Facultad de Medicina y Ciencias de la Salud, Universidad de Extremadura, 06006 Badajoz, Spain; (C.F.L.-J.); (J.G.-M.); (M.C.C.)
| | | | - Demetrio Pérez-Civantos
- Facultad de Medicina y Ciencias de la Salud, Universidad de Extremadura, Hospital Universitario de Badajoz, 06006 Badajoz, Spain;
| | - Jorge Guerrero-Martín
- Departamento de Enfermería, Facultad de Medicina y Ciencias de la Salud, Universidad de Extremadura, 06006 Badajoz, Spain; (C.F.L.-J.); (J.G.-M.); (M.C.C.)
| | - Macarena C. Cáceres
- Departamento de Enfermería, Facultad de Medicina y Ciencias de la Salud, Universidad de Extremadura, 06006 Badajoz, Spain; (C.F.L.-J.); (J.G.-M.); (M.C.C.)
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