Prevalence and associated factors of chemotherapy-related cognitive impairment in older breast cancer survivors

A nomogram for predicting cancer-related cognitive impairment in lung cancer patients from a nursing science precision health model perspective

PURPOSE

The nursing science precision health (NSPH) model considers identifying the biological basis of symptoms in order to develop precise intervention strategies that ultimately improve the overall health of the symptomatic individual. This study sought to construct a nomogram for predicting cancer-related cognitive impairment (CRCI) in patients with lung cancer within the context of the NSPH model.

METHODS

A cohort of 252 patients with lung cancer was prospectively collected and randomly divided into training and validation cohorts in a 7:3 ratio. The least absolute shrinkage and selection operator (LASSO) regression method optimized variable selection, followed by multivariate logistic regression to develop a model, which subsequently formed the basis for the nomogram. The nomogram's discrimination and calibration were evaluated using a calibration plot, the Hosmer-Lemeshow test, and the receiver operating characteristic curve (ROC). Decision curve analysis (DCA) quantified the net benefits of the nomogram across various threshold probabilities.

RESULTS

Five pivotal variables were incorporated into the nomogram: age (≥ 65 years), treatment, education level, albumin, and platelet-to-lymphocyte ratio (PLR). The area under the ROC curve (0.970 for the training cohort and 0.973 for the validation cohort) demonstrated the nomogram's excellent discriminative ability. Calibration curves closely aligning with ideal curves indicated accurate predictive capability. Moreover, the nomogram exhibited a positive net benefit for predicted probability thresholds ranging from 1 to 98% in DCA.

CONCLUSION

Key risk factors, including advanced age (≥ 65 years), low education level, combined chemotherapy, low albumin, and high PLR, were significantly associated with higher CRCI incidence. This nomogram model has good performance and can help identify CRCI with high accuracy in lung cancer patients.

The chemotherapy agent doxorubicin induces CNS expression of Ascl1, a regulator of adult neurogenesis and differentiation

Cancer-related cognitive impairment (CRCI) is a common side effect of cancer and its treatments. Cancer chemotherapy has been associated with hippocampal dysfunction and memory impairment. We investigated the effects of one chemotherapy agent, doxorubicin, on the transcription factor Ascl1 and proliferation of stem cells in the brain. We used an inducible mouse model designed to express TdTomato in Ascl1-lineage cells. Five to six-month-old Ascl1-CreERT2:ROSA mice were treated peripherally with a single dose of either doxorubicin (10 mg/kg) or DMSO control (n = 9 per group, n = 4-5 per sex). We analyzed brains of mice that had been exposed to doxorubicin for 2 weeks and had induced Ascl1 expression after the first week. We used immunostaining of neurogenesis stage specific markers to evaluate the doxorubicin effects on neuronal differentiation in the dentate gyrus of the hippocampus. Overall, doxorubicin significantly increased Ascl1 expression by 81% at this time point. As measured by Ascl1 double stains with Sox2, GFAP, and NeuroD1, doxorubicin-treated mice experienced an increase in Ascl1-mediated neural proliferation compared to control. A similar significant increase in the number of Ascl1-expressing cells (by 146%) after doxorubicin treatment was observed in the gray matter of the cerebral cortex. Thus, rather than leading to the loss of developing neurons, we found that a single dose of doxorubicin increased their appearance and progression, suggesting that hippocampal losses from chemotherapies may require greater and more sustained damage.

A pilot study of a targeted cognitive intervention for cancer survivors

PURPOSE

The primary aims of this four week pilot randomized clinical trial (RCT) involving a targeted cognitive intervention (TCI, n = 25) compared to an expectancy matched active control intervention (EMACI, n = 24), in a sample of cancer survivors were to: determine recruitment and retention rates; evaluate preliminary efficacy to improve three objective measures of cognitive function (i.e., attention, working memory, multi-tasking); evaluate adherence rates for and satisfaction with the interventions, and evaluate for treatment-related adverse events (e.g., nausea, motion sickness).

METHODS

Cancer survivors were recruited from previous studies through email. Following a screening call, survivors who consented to participate were oriented to the study measures and procedures via Zoom. Survivors were randomized to the TCI or EMACI and mailed an iPad with the software for their specific intervention and the Adaptive Cognitive Evaluation Explorer (ACE-X, the objective measure of cognitive function). Survivors used the intervention for 25 min per day at least 5 days per week. Differences in objective measures of attention, working memory, and multi-tasking were evaluated using multilevel regression analyses.

RESULTS

For the sustained attention measure, a significant cross-level interaction was found in favor of the TCI group. While improvements in multi-tasking occurred in both groups, while not statistically significant, the trend was larger for the TCI group. Equally important, in both groups, adherence with the intervention was high and adverse effects were minimal.

CONCLUSIONS

These preliminary findings provide promising evidence of feasibility, acceptability, and efficacy that warrant evaluation in a RCT with a larger sample of cancer survivors.

Esketamine reduces postoperative depression in breast cancer through TREK-1 channel inhibition and neurotransmitter modulation

Postoperative depression significantly affects the quality of life of breast cancer patients. This study explores the potential therapeutic effects of esketamine on postoperative depression through modulation of the TREK-1 two-pore domain potassium channel. We analyzed data from 54 female breast cancer patients who underwent surgery at our hospital between 2019 and 2023, dividing them into experimental and control groups based on esketamine treatment. Transcriptomic sequencing of hippocampal neurons from rats identified potassium ion-related pathways and key regulatory genes, including TREK-1, influenced by esketamine. In vitro studies showed that esketamine primarily alleviates depressive symptoms by inhibiting TREK-1 protein expression, enhancing GABA neurotransmitter release, and improving neuronal activity, while overexpression of TREK-1 reversed these effects. Esketamine's inhibition of TREK-1 channels and promotion of hippocampal neuron activity effectively alleviate postoperative depression in breast cancer patients, suggesting a novel therapeutic strategy.

MCC950 Reduces the Anxiodepressive-like Behaviors and Memory Deficits Related to Paclitaxel-Induced Peripheral Neuropathy in Mice

Chemotherapy-induced peripheral neuropathy and the accompanying affective disorders are serious side effects, and their resolution is not guaranteed. Oxidative stress and elevated levels of Nod-like receptor protein 3 (NLRP3) have been detected in the peripheral and central nervous systems of animals with neuropathic pain provoked by several antineoplastic drugs, such as paclitaxel (PTX). Several studies have further indicated that NLRP3 inflammasome inhibition could be an approach for treating chronic pain, but its impact on the anxiodepressive-like behaviors and memory deficits related to PTX-provoked neuropathy has not yet been investigated. MCC950 is a potent and specific inhibitor of the NLRP3 pathway that acts through inhibiting NLRP3 activation and inflammasome formation. We hypothesized that the administration of MCC950 could alleviate the affective and cognitive disorders accompanying PTX-provoked neuropathy. Using male C57BL/6 mice, we assessed the effects of MCC950 on the mechanical and thermal allodynia, anxiodepressive-like behavior, and memory deficits incited by this taxane. The results indicated that the intraperitoneal administration of 10 mg/kg of MCC950 twice daily for three consecutive days fully reversed the PTX-induced mechanical and thermal allodynia. This treatment also completely attenuated the anxiolytic (p < 0.004) and depressive-like behaviors (p < 0.022) and memory deficits (novel object recognition test; p < 0.0018) incited by PTX. These actions were mainly achieved through blocking NLRP3 inflammasome activation in the sciatic nerve, amygdala, and hippocampus, and oxidative stress in the amygdala and hippocampus. MCC950 also normalized the p-ERK 1/2 overexpression in the sciatic nerve and apoptotic responses in the sciatic nerve and the amygdala. This study suggests that MCC950 might be a promising treatment for PTX-induced mental illnesses and neuropathy.

Risk factors for cancer-related cognitive impairment among individuals with lung cancer: a systematic review and meta-analysis

OBJECTIVES

Cancer-related cognitive impairment (CRCI) exerts a negative impact on the quality of life in lung cancer survivors. Risk factors for CRCI in lung cancer patients remain unclear.This study aimed to identify risk factors for CRCI in lung cancer patients.

METHODS

A comprehensive literature search was conducted across PubMed, CINAHL, Web of Science, Wanfang, VIP Database, Embase, and China National Knowledge Infrastructure (CNKI) from their inception until March 10, 2024. Studies were screened, data extracted, and quality assessed using the Agency for Healthcare Research and Quality and Newcastle-Ottawa Scale. Meta-analysis was performed using RevMan 5.4, assessing risk factors through odds ratios (OR) with 95% confidence intervals (CIs).

RESULTS

The analysis was comprised of nine studies, including 1,305 patients. Seven studies were high quality, and two were moderate quality. Identified risk factors for CRCI in lung cancer patients included advanced age (OR = 3.51, 95%CI: 2.14-5.74, I2 = 0.0%), cranial irradiation (OR = 2.12, 95% CI: 1.39-3.22, I2 = 0.0%), anxiety (OR = 2.92, 95% CI: 1.65-5.25, I2 = 37%), and symptom cluster burden (OR = 4.85, 95% CI: 2.99-7.87, I2 = 0.0%). Physical activity (OR = 0.37, 95% CI; 0.23-0.58, I2 = 9.0%) was identified as a protective factor.

CONCLUSION

Advanced age, cranial irradiation, anxiety, and symptom cluster burden are significant risk factors for CRCI, while physical activity serves as a protective factor. These insights provide healthcare professionals with an evidence-based framework for managing CRCI in lung cancer patients.

Factors associated with perceived cognitive function in breast cancer patients treated with chemotherapy: A multicenter cross-sectional study

PURPOSE

This study aimed to investigate the factors associated with perceived cognitive function among breast cancer patients treated with chemotherapy in China.

METHODS

The study was a multicenter cross-sectional design. Data were collected from 10 public hospitals in China between April 2022 and February 2023. A total of 741 participants completed questionnaires assessing sociodemographic and medical characteristics, perceived cognitive function, sleep quality, fatigue, anxiety, and depression. Hierarchical multiple regression analysis was used to assess the determinants of cognitive function.

RESULTS

The hierarchical multiple regression model accounted for 31.5% of variation in perceived cognitive function (sociodemographic 4.5%; medical 6.6%; exercise frequency 6.6%; sleep quality 2.1%; fatigue 2.8%; anxiety combined with depression 9.0%). Education level, chemotherapy type, number of chemotherapy cycles, and cyclophosphamide drug use were significant predisposing factors of perceived cognitive function (p < 0.001). Exercising ≥3 times/week (p < 0.001) was a significant factor positively influencing perceived cognitive function, meanwhile, anxiety (p < 0.001) and depression (p < 0 0.001) were negative factors.

CONCLUSION

Our findings suggest that patients with low education levels, postoperative chemotherapy, cyclophosphamide treatment, and a greater number of chemotherapy cycles need more assessment. Sedentary patients, those who have never exercised, and those with anxiety or depression all showed greater cognitive decline. By identifying susceptible populations, encouraging regular exercise, and addressing anxiety and depression, healthcare professionals can contribute significantly to prevent patients' cognitive decline throughout chemotherapy.

Potential of Natural Phenolic Compounds against Doxorubicin-Induced Chemobrain: Biological and Molecular Mechanisms Involved

Chemotherapy-induced cognitive impairment or "chemobrain" is a prevalent long-term complication of chemotherapy and one of the more devastating. Most of the studies performed so far to identify the cognitive dysfunctions induced by antineoplastic chemotherapies have been focused on treatment with anthracyclines, frequently administered to breast cancer patients, a population that, after treatment, shows a high possibility of long survival and, consequently, of chemobrain development. In the last few years, different possible strategies have been explored to prevent or reduce chemobrain induced by the anthracycline doxorubicin (DOX), known to promote oxidative stress and inflammation, which have been strongly implicated in the development of this brain dysfunction. Here, we have critically analyzed the results of the preclinical studies from the last few years that have evaluated the potential of phenolic compounds (PheCs), a large class of natural products able to exert powerful antioxidant and anti-inflammatory activities, in inhibiting DOX-induced chemobrain. Several PheCs belonging to different classes have been shown to be able to revert DOX-induced brain morphological damages and deficits associated with learning, memory, and exploratory behavior. We have analyzed the biological and molecular mechanisms implicated and suggested possible future perspectives in this research area.

A study of the mediating effect of social support on self-disclosure and demoralization in Chinese older adult homebound breast cancer patients

Purpose

Demoralization is common in older adult homebound breast cancer patients, seriously affecting their quality of life. This study aimed to investigate the demoralization of older adult homebound breast cancer patients and to analyse the mediating effects of social support between self-disclosure and demoralization.

Methods

The study enrolled 368 older adult homebound breast cancer patients reviewed in outpatient clinics of three hospitals from January 2022 to August 2023. A questionnaire survey was conducted using the general information questionnaire, the distress disclosure index (DDI), the social support revalued scale (SSRS), and the demoralization scale (DS). Path analysis was conducted to test the hypothesised serial mediation model.

Results

The total scores of self-disclosure, social support, and demoralization were 37 (25-42), 34 (19-48.75), and 46.5 (35-68), respectively. The results indicated a positive correlation between self-disclosure and social support (p < 0.01). In contrast, a statistically significant negative correlation was observed between self-disclosure, social support, and various demoralization dimensions (p < 0.01). Social support played a partial mediation effects between self-disclosure and demoralization, indirect effect =0.6362, SE = -0.591, 95% CI (-0.785 ~ -0.415); Self-disclosure direct effect demoralization, direct effect =0.3638, SE = -0.337, 95% CI (-0.525 ~ -0.144); total effect, SE = -0.929, 95% CI (-0.945 ~ -0.904).

Discussion

Social support a partial mediated between self-disclosure and demoralization in Chinese older adult homebound breast cancer patients. Clinical staff should focus on developing a social support system for Chinese older adult homebound breast cancer patients, encouraging patients to reveal their minds, and providing psychological counselling to enhance self-confidence and rebirth from adversity.