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Serini S, Calviello G. Potential of Natural Phenolic Compounds against Doxorubicin-Induced Chemobrain: Biological and Molecular Mechanisms Involved. Antioxidants (Basel) 2024; 13:486. [PMID: 38671933 PMCID: PMC11047710 DOI: 10.3390/antiox13040486] [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: 03/29/2024] [Revised: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
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.
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Affiliation(s)
- Simona Serini
- Department of Translational Medicine and Surgery, Section of General Pathology, School of Medicine and Surgery, Università Cattolica del Sacro Cuore, Largo F. Vito, 00168 Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito, 00168 Rome, Italy
| | - Gabriella Calviello
- Department of Translational Medicine and Surgery, Section of General Pathology, School of Medicine and Surgery, Università Cattolica del Sacro Cuore, Largo F. Vito, 00168 Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito, 00168 Rome, Italy
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2
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Ioffe D, Bhatia-Patel SC, Gandhi S, Hamad EA, Dotan E. Cardiovascular Concerns, Cancer Treatment, and Biological and Chronological Aging in Cancer: JACC Family Series. JACC CardioOncol 2024; 6:143-158. [PMID: 38774000 PMCID: PMC11103051 DOI: 10.1016/j.jaccao.2024.02.001] [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: 10/10/2023] [Revised: 02/08/2024] [Accepted: 02/12/2024] [Indexed: 05/24/2024] Open
Abstract
Cardiovascular disease (CVD) and cancer are leading causes of death globally, particularly among the rapidly growing population of older adults (OAs). CVD is a leading cause of mortality among cancer survivors, often accelerated by cancer treatments associated with short- or long-term cardiotoxicity. Moreover, there is a dynamic relationship among CVD, cancer, and aging, characterized by shared risk factors and biological hallmarks, that plays an important role in caring for OAs, optimizing treatment approaches, and developing preventive strategies. Assessment of geriatric domains (eg, functional status, comorbidities, cognition, polypharmacy, nutritional status, social support, psychological well-being) is critical to individualizing treatment of OAs with cancer. The authors discuss considerations in caring for an aging population with cancer, including methods for the assessment of OAs with CVD and/or cardiovascular risk factors planned for cancer therapy. Multidisciplinary care is critical in optimizing patient outcomes and maintaining quality of life in this growing vulnerable population.
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Affiliation(s)
- Dina Ioffe
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | | | - Sakshi Gandhi
- Department of Medicine, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Eman A. Hamad
- Department of Medicine, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Efrat Dotan
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
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3
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Ahles TA, Orlow I, Schofield E, Li Y, Ryan E, Root JC, Patel SK, McNeal K, Gaynor A, Tan H, Katheria V, Vazquez J, Corrales-Guerrero S, Sadeghi K, Traina T, Hurria A. The impact of APOE and smoking history on cognitive function in older, long-term breast cancer survivors. J Cancer Surviv 2024; 18:575-585. [PMID: 36279076 PMCID: PMC10123173 DOI: 10.1007/s11764-022-01267-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 09/28/2022] [Indexed: 10/31/2022]
Abstract
PURPOSE This study aims to determine whether older breast cancer survivors score lower on neuropsychological tests compared to matched non-cancer controls and to test the hypotheses that survivors who were APOE ε4 carriers would have the lowest cognitive performance but that smoking history would decrease the negative effect of ε4 on cognition. METHODS Female breast cancer survivors who had been diagnosed and treated at age 60 or older and were 5-15-year survivors (N = 328) and age and education matched non-cancer controls (N = 162) were assessed at enrollment and at 8-, 16-, and 24-month follow-ups with standard neuropsychological and psychological assessments. Blood for APOE genotyping was collected, and smoking history was assessed at enrollment. Participants were purposely recruited so that approximately 50% had a history of treatment with chemotherapy or no chemotherapy and approximately 50% had a smoking history. RESULTS After adjusting for age, cognitive reserve, depression, and fatigue, breast cancer survivors scored significantly lower on all domains of cognitive function. A significant two-way interaction demonstrated that the negative effect of ε4 on cognitive performance was stronger among survivors. A significant three-way interaction supported the hypothesis that smoking history had a protective effect on cognitive function in ε4 carriers that was more pronounced in the controls than the survivors. CONCLUSIONS The results support the long-term cognitive impact of breast cancer diagnosis and treatments on older, disease-free survivors, particularly for ε4 carriers. The results also emphasize the importance of assessing smoking history when examining APOE and cognition and are an example of the complex interactions of age, genetics, health behaviors, and disease history in determining cognitive function. IMPLICATIONS FOR CANCER SURVIVORS These results help explain why only a subset of breast cancer survivors appear to be vulnerable to cognitive problems.
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Affiliation(s)
- Tim A Ahles
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Irene Orlow
- Molecular Epidemiology Laboratory, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Elizabeth Schofield
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yuelin Li
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Elizabeth Ryan
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - James C Root
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sunita K Patel
- Departments of Population Science and Supportive Care Medicine, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Katrazyna McNeal
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alexandra Gaynor
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Heidi Tan
- Departments of Population Science and Supportive Care Medicine, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Vani Katheria
- Departments of Population Science and Supportive Care Medicine, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Jessica Vazquez
- Departments of Population Science and Supportive Care Medicine, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Sergio Corrales-Guerrero
- Molecular Epidemiology Laboratory, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Keimya Sadeghi
- Molecular Epidemiology Laboratory, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tiffany Traina
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Arti Hurria
- Center for Cancer and Ageing, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
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4
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Rick O, Gerhardt A, Schilling G. Cancer-Related Cognitive Dysfunction: A Narrative Review for Clinical Practice. Oncol Res Treat 2024; 47:218-223. [PMID: 38471462 DOI: 10.1159/000538277] [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: 07/19/2023] [Accepted: 03/06/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Cancer-related cognitive dysfunction (CRCD) is a major functional disorder in patients with cancer. This central nervous dysfunction is found in up to 60% of patients after tumour therapy, often significantly limits the quality of life, and significantly impedes participation in working life. For this reason, diagnosis and treatment of CRCD are of central importance. This narrative review is intended to provide an overview and support for practical clinical care with regard to diagnostics and therapeutic options. SUMMARY In Germany, CRCD has received insufficient attention in clinical practice due to the lack of guidelines for diagnosis and therapy. The pathophysiology is complex and cannot be explained by chemotherapeutic treatment alone. In addition to the tumour disease as such and the tumour therapy, psychological factors such as anxiety and depression as well as sleep disorders also play a significant role. Today, it is known that in addition to age, molecular genetic changes also have an effect on cognitive function. Morphologically, CRCD can be located in the frontal cortex and hippocampus. In addition to easy-to-use screening instruments such as the visual analogue scale, validated questionnaires such as the Questionnaire of Subjectively Experienced Deficits in Attention (FEDA) developed in Germany are also available. These allow the suspected diagnosis to be substantiated and the patient to be referred to further neurological, neuropsychological, or psycho-oncological diagnostics. Within the framework of further neuropsychological diagnostics, the International Cognition and Cancer Task Force (ICCTF) recommends testing learning, memory, processing speed, and executive functions. From the authors' point of view, a step-by-step diagnosis is recommended in order to avoid overdiagnosis. In clinical practice, graduation according to the "Common Terminology Criteria for Adversity Events" (CTCAE Version 5.0) is suitable for assessing the degree of severity. Cognitive training should be behaviourally oriented and include regular practice of cognitive skills to restore attention, psychomotor speed, memory, and executive functions. The best evidence is currently found for web-based training programmes that can be used by the patient at home. There is also evidence for mindfulness training and physical exercises. In particular, the combination of these three therapeutic elements currently seems to be the optimal treatment strategy for CRCD. KEY MESSAGES Cognitive dysfunction should be given much more attention in the clinical care of cancer patients. Diagnostic tools for this purpose and evidence-based therapeutic interventions are available. In the future, networks should be created that allow for better care of patients with CRCD.
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Affiliation(s)
- Oliver Rick
- Klinik Reinhardshöhe, Bad Wildungen, Germany
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5
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McDeed AP, Van Dyk K, Zhou X, Zhai W, Ahles TA, Bethea TN, Carroll JE, Cohen HJ, Nakamura ZM, Rentscher KE, Saykin AJ, Small BJ, Root JC, Jim H, Patel SK, Mcdonald BC, Mandelblatt JS, Ahn J. Prediction of cognitive decline in older breast cancer survivors: the Thinking and Living with Cancer study. JNCI Cancer Spectr 2024; 8:pkae019. [PMID: 38556480 PMCID: PMC11031271 DOI: 10.1093/jncics/pkae019] [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: 01/11/2024] [Revised: 02/27/2024] [Accepted: 03/05/2024] [Indexed: 04/02/2024] Open
Abstract
PURPOSE Cancer survivors commonly report cognitive declines after cancer therapy. Due to the complex etiology of cancer-related cognitive decline (CRCD), predicting who will be at risk of CRCD remains a clinical challenge. We developed a model to predict breast cancer survivors who would experience CRCD after systematic treatment. METHODS We used the Thinking and Living with Cancer study, a large ongoing multisite prospective study of older breast cancer survivors with complete assessments pre-systemic therapy, 12 months and 24 months after initiation of systemic therapy. Cognition was measured using neuropsychological testing of attention, processing speed, and executive function (APE). CRCD was defined as a 0.25 SD (of observed changes from baseline to 12 months in matched controls) decline or greater in APE score from baseline to 12 months (transient) or persistent as a decline 0.25 SD or greater sustained to 24 months. We used machine learning approaches to predict CRCD using baseline demographics, tumor characteristics and treatment, genotypes, comorbidity, and self-reported physical, psychosocial, and cognitive function. RESULTS Thirty-two percent of survivors had transient cognitive decline, and 41% of these women experienced persistent decline. Prediction of CRCD was good: yielding an area under the curve of 0.75 and 0.79 for transient and persistent decline, respectively. Variables most informative in predicting CRCD included apolipoprotein E4 positivity, tumor HER2 positivity, obesity, cardiovascular comorbidities, more prescription medications, and higher baseline APE score. CONCLUSIONS Our proof-of-concept tool demonstrates our prediction models are potentially useful to predict risk of CRCD. Future research is needed to validate this approach for predicting CRCD in routine practice settings.
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Affiliation(s)
- Arthur Patrick McDeed
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, DC, USA
| | - Kathleen Van Dyk
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA
| | - Xingtao Zhou
- Georgetown University Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, Department of Oncology and Georgetown Lombardi Institute for Cancer and Aging Research, Georgetown University, Washington, DC, USA
| | - Wanting Zhai
- Georgetown University Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, Department of Oncology and Georgetown Lombardi Institute for Cancer and Aging Research, Georgetown University, Washington, DC, USA
| | - Tim A Ahles
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Traci N Bethea
- Georgetown University Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, Department of Oncology and Georgetown Lombardi Institute for Cancer and Aging Research, Georgetown University, Washington, DC, USA
| | - Judith E Carroll
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Harvey Jay Cohen
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA
| | - Zev M Nakamura
- Department of Psychiatry, University of North Carolina–Chapel Hill, Chapel Hill, NC, USA
| | - Kelly E Rentscher
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Andrew J Saykin
- Center for Neuroimaging and Indiana Alzheimer’s Disease Research Center, Department of Radiology and Imaging Sciences and the Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Brent J Small
- School of Aging Studies, University of South Florida, and Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, FL, USA
| | - James C Root
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Heather Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, FL, USA
| | - Sunita K Patel
- Outcomes Division, Population Sciences, City of Hope National Medical Center, Los Angeles, CA, USA
| | - Brenna C Mcdonald
- Center for Neuroimaging and Indiana Alzheimer’s Disease Research Center, Department of Radiology and Imaging Sciences and the Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jeanne S Mandelblatt
- Georgetown University Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, Department of Oncology and Georgetown Lombardi Institute for Cancer and Aging Research, Georgetown University, Washington, DC, USA
| | - Jaeil Ahn
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, DC, USA
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6
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Zhou X, Zhang X, Zhong T, Zhou M, Gao L, Chen L. Prevalence and associated factors of chemotherapy-related cognitive impairment in older breast cancer survivors. J Adv Nurs 2024; 80:484-499. [PMID: 37675947 DOI: 10.1111/jan.15842] [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: 05/13/2023] [Revised: 08/11/2023] [Accepted: 08/23/2023] [Indexed: 09/08/2023]
Abstract
AIMS To examine the prevalence and associated factors of chemotherapy-related cognitive impairment (CRCI) in older breast cancer survivors (BCS). DESIGN Systematic review. DATA SOURCES We searched EMBASE, PubMed, PsychInfo, CINAHL, Cochrance Library, Web of Science, CNKI and SinoMed, without language restrictions, for studies published from the establishment of the database to September 2022. REVIEW METHODS Two researchers independently examined the full texts, data extraction and quality assessment, and any discrepancies were resolved through discussion with a third reviewer. Quality of evidence was assessed using the Newcastle-Ottawa Scale and the Agency for Healthcare Research and Quality Scale. RESULTS The seven included studies showed that the estimated prevalence of CRCI in older BCS ranged from 18.6% to 27% on objective neuropsychological tests and from 7.6% to 49% on subjective cognitive assessments. The areas most affected were attention, memory, executive functioning and processing speed. CRCI was associated with 10 factors in six categories, including sociodemographic (e.g. age, education level), physiological (e.g. sleep disorders, fatigue and comorbidities), psychological (e.g. anxiety, depression), treatment modalities (e.g. chemotherapy cycles, chemotherapy regimens), genetic (e.g. APOE2, APOE4) and lifestyle factor (e.g. physical inactivity). CONCLUSION CRCI is multifactorial and has a relatively high prevalence. However, the results of subjective and objective cognitive examinations were inconsistent, possibly due to variations in tools used to evaluate different definitions of CRCI. Nevertheless, as there are few published studies of older BCS, this conclusion still require verification by well-designed studies in the future. IMPACT We found that the prevalence of CRCI in older adults is relatively high and multifactorial, providing evidence for further health care for this population. NO PATIENT OR PUBLIC CONTRIBUTION There was no patient or public involvement.
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Affiliation(s)
- Xuan Zhou
- Jilin University School of Nursing, Changchun, China
| | - Xueyan Zhang
- Jilin University School of Nursing, Changchun, China
| | | | - Meng Zhou
- Jilin University School of Nursing, Changchun, China
| | - Lan Gao
- The First Hospital of Jilin University, Changchun, China
| | - Li Chen
- Jilin University School of Nursing, Changchun, China
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7
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Rao AR, Noronha V, Ramaswamy A, Kumar A, Pillai A, Gattani S, Sehgal A, Kumar S, Castelino R, Dhekale R, Krishnamurthy J, Mahajan S, Daptardar A, Sonkusare L, Deodhar J, Ansari N, Vagal M, Mahajan P, Timmanpyati S, Nookala M, Chitre A, Kapoor A, Gota V, Banavali S, Badwe RA, Prabhash K. Correlation of the Geriatric Assessment with Overall Survival in Older Patients with Cancer. Clin Oncol (R Coll Radiol) 2024; 36:e61-e71. [PMID: 37953073 DOI: 10.1016/j.clon.2023.11.003] [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: 07/18/2023] [Revised: 10/09/2023] [Accepted: 11/02/2023] [Indexed: 11/14/2023]
Abstract
AIMS Global guidelines recommend that all older patients with cancer receiving chemotherapy should undergo a geriatric assessment. However, utilisation of the geriatric assessment is often constrained by its time-intensive nature, which limits its adoption in settings with limited resources and high demand. There is a lack of evidence correlating the results of the geriatric assessment with survival from the Indian subcontinent. Therefore, the aims of the present study were to assess the impact of the geriatric assessment on survival in older Indian patients with cancer and to identify the factors associated with survival in these older patients. MATERIALS AND METHODS This was an observational study, conducted in the geriatric oncology clinic of the Tata Memorial Hospital (Mumbai, India). Patients aged 60 years and older with cancer who underwent a geriatric assessment were enrolled. We assessed the non-oncological geriatric domains of function and falls, nutrition, comorbidities, cognition, psychology, social support and medications. Patients exhibiting impairment in two or more domains were classified as frail. RESULTS Between June 2018 and January 2022, we enrolled 897 patients. The median age was 69 (interquartile range 65-73) years. The common malignancies were lung (40.5%), oesophagus (31.9%) and genitourinary (12.1%); 54.6% had metastatic disease. Based on the results of the geriatric assessment, 767 (85.4%) patients were frail. The estimated median overall survival in fit patients was 24.3 (95% confidence interval 18.2-not reached) months, compared with 11.2 (10.1-12.8) months in frail patients (hazard ratio 0.54; 95% confidence interval 0.41-0.72, P < 0.001). This difference in overall survival remained significant after adjusting for age, sex, primary tumour and metastatic status (hazard ratio 0.56; 95% confidence interval 0.41-0.74, P < 0.001). In the patients with a performance status of 0 or 1 (n = 454), 365 (80.4%) were frail; the median overall survival in the performance status 0-1 group was 33.0 months (95% confidence interval 24.31-not reached) in the fit group versus 14.4 months (95% confidence interval 12.25-18.73) in the frail patients (hazard ratio 0.50; 95% confidence interval 0.34-0.74, P = 0.001). In the multivariate analysis, the geriatric assessment domains that were predictive of survival were function (hazard ratio 0.68; 95% confidence interval 0.52-0.88; P = 0.003), nutrition (hazard ratio 0.64; 95% confidence interval 0.48-0.85, P = 0.002) and cognition (hazard ratio 0.67; 95% confidence interval 0.49-0.91, P = 0.011). DISCUSSION The geriatric assessment is a powerful prognostic tool for survival among older Indian patients with cancer. The geriatric assessment is prognostic even in the cohort of patients thought to be the fittest, i.e. performance status 0 and 1. Our study re-emphasises the critical importance of the geriatric assessment in all older patients planned for cancer-directed therapy.
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Affiliation(s)
- A R Rao
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - V Noronha
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - A Ramaswamy
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - A Kumar
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - A Pillai
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - S Gattani
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - A Sehgal
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, Mumbai, India
| | - S Kumar
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, Mumbai, India
| | - R Castelino
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, Mumbai, India
| | - R Dhekale
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - J Krishnamurthy
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - S Mahajan
- Department of Physiotherapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - A Daptardar
- Department of Physiotherapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - L Sonkusare
- Department of Psycho-oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - J Deodhar
- Department of Psycho-oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - N Ansari
- Department of Occupational Therapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - M Vagal
- Department of Occupational Therapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - P Mahajan
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S Timmanpyati
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - M Nookala
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, Mumbai, India
| | - A Chitre
- Department of Physiotherapy, Mahamana Pandit Madan Mohan Malviya Cancer Center & Homi Bhabha Cancer Hospital, Varanasi, India
| | - A Kapoor
- Department of Medical Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Center & Homi Bhabha Cancer Hospital, Varanasi, India
| | - V Gota
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, Mumbai, India
| | - S Banavali
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - R A Badwe
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - K Prabhash
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India.
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8
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Netherby-Winslow C, Thompson B, Lotta L, Gallagher M, Van Haute P, Yang R, Hott D, Hasan H, Bachmann K, Bautista J, Gerber S, Cory-Slechta DA, Janelsins M. Effects of mammary cancer and chemotherapy on neuroimmunological markers and memory function in a preclinical mouse model. Brain Behav Immun Health 2023; 34:100699. [PMID: 38058985 PMCID: PMC10695847 DOI: 10.1016/j.bbih.2023.100699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 10/26/2023] [Accepted: 10/28/2023] [Indexed: 12/08/2023] Open
Abstract
Treatment modalities for breast cancer, including cyclophosphamide chemotherapy, have been associated with the development of cognitive decline (CRCD), which is characterized by impairments in memory, concentration, attention, and executive functions. We and others have identified a link between inflammation and decreased cognitive performance in patients with breast cancer receiving chemotherapy. In order to better understand the inflammation-associated molecular changes within the brain related to tumor alone or in combination with chemotherapy, we orthotopically implanted mouse mammary tumors (E0771) into female C57BL/6 mice and administered clinically relevant doses of cyclophosphamide and doxorubicin intravenously at weekly intervals for four weeks. We measured serum cytokines and markers of neuroinflammation at 48 h and up to one month post-treatment and tested memory using a reward-based delayed spatial alternation paradigm. We found that breast tumors and chemotherapy altered systemic inflammation and neuroinflammation. We further found that the presence of tumor and chemotherapy led to a decline in memory over time at the longest delay, when memory was the most taxed, compared to shorter delay times. These findings in a clinically relevant mouse model shed light on possible biomarkers for CRCD and add to the growing evidence that anti-inflammatory strategies have the potential to mitigate cancer- or treatment-related side effects.
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Affiliation(s)
- Colleen Netherby-Winslow
- Department of Surgery, Division of Supportive Care in Cancer, University of Rochester, Rochester, NY, United States
| | - Bryan Thompson
- Department of Surgery, Division of Supportive Care in Cancer, University of Rochester, Rochester, NY, United States
| | - Louis Lotta
- Department of Surgery, Division of Supportive Care in Cancer, University of Rochester, Rochester, NY, United States
| | - Mark Gallagher
- Department of Surgery, Division of Supportive Care in Cancer, University of Rochester, Rochester, NY, United States
| | - Paige Van Haute
- Department of Surgery, Division of Supportive Care in Cancer, University of Rochester, Rochester, NY, United States
| | - Rachel Yang
- Department of Surgery, Division of Supportive Care in Cancer, University of Rochester, Rochester, NY, United States
| | - Devin Hott
- Department of Surgery, Division of Supportive Care in Cancer, University of Rochester, Rochester, NY, United States
| | - Hamza Hasan
- Department of Surgery, Division of Supportive Care in Cancer, University of Rochester, Rochester, NY, United States
| | - Katherine Bachmann
- Department of Environmental Medicine, University of Rochester, Rochester, NY, United States
| | - Javier Bautista
- Department of Surgery, Division of Supportive Care in Cancer, University of Rochester, Rochester, NY, United States
| | - Scott Gerber
- Department of Surgery, Division of Surgical Oncology, Rochester, NY, United States
| | | | - Michelle Janelsins
- Department of Surgery, Division of Supportive Care in Cancer, University of Rochester, Rochester, NY, United States
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Sorrera D, Block A, Mackin L, Paul SM, Cooper BA, Hammer MJ, Conley YP, Levine JD, Miaskowski C. Decrements in Both Physical and Cognitive Function Are Associated With a Higher Symptom Burden in Oncology Patients. Semin Oncol Nurs 2023; 39:151516. [PMID: 37968207 DOI: 10.1016/j.soncn.2023.151516] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 08/28/2023] [Accepted: 09/20/2023] [Indexed: 11/17/2023]
Abstract
OBJECTIVES Physical and cognitive function are two of the most important patient-reported outcomes. In oncology patients receiving chemotherapy (N = 1331), purposes were to identify subgroups of patients with distinct joint physical and cognitive function profiles and evaluate for differences in demographic and clinical characteristics, severity of common symptoms, and quality of life outcomes. DATA SOURCES Measures of physical and cognitive functions were obtained six times over two cycles of chemotherapy. All of the other measures were done prior to the second or third cycle of chemotherapy. Latent profile analysis was done to identify the distinct joint physical and cognitive function profiles. Differences among the profiles were evaluated using parametric and nonparametric tests. CONCLUSION Five distinct profiles were identified (ie, Very Low Physical and Low Cognitive Function [18.4%; Both Low], Low Physical and High Cognitive Function [19.8%], Moderate Physical and Low Cognitive Function [26.7%], Changing Physical and Cognitive Function [5.4%], and Normal Physical and Cognitive Function [29.7%]). Patients in the Both Low class had the highest symptom burden and the poorest quality of life. Over 70% of the sample had moderate to severe decrements in one or both of these extremely important patient outcomes. IMPLICATIONS FOR NURSING PRACTICE Clinicians need to assess for both physical and cognitive function using simple subjective and objective measures.
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Affiliation(s)
- Dianne Sorrera
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA
| | - Astrid Block
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA
| | - Lynda Mackin
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA
| | - Steven M Paul
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA
| | - Bruce A Cooper
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA
| | - Marilyn J Hammer
- Cantor Center for Research in Nursing and Patient Care Services, Dan Farber Cancer Institute, Boston, MA
| | - Yvette P Conley
- Department of Health Promotion and Development, School of Nursing, University of Pittsburgh, Pittsburgh, PA
| | - Jon D Levine
- Department of Medicine, School of Medicine, University of California, San Francisco, CA
| | - Christine Miaskowski
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA.
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Karnakis T, Kanaji AL, Gattás-Vernaglia IF, Adriazola IO, Ramos PT, Lima MEPLS, Almeida OLS, Jacob-Filho W, Ferriolli E. Ten years of a geriatric oncology service at a public university cancer centre in Brazil. Ecancermedicalscience 2023; 17:1596. [PMID: 37799943 PMCID: PMC10550289 DOI: 10.3332/ecancer.2023.1596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Indexed: 10/07/2023] Open
Abstract
The implementation of a geriatric oncology service is challenging in both high-income and low-and-middle-income countries. The Octavio Frias de Oliveira Institute of Cancer of Sao Paulo (ICESP) is a tertiary healthcare complex of the Clinics Hospital of the University of Sao Paulo Medical School and is considered a model of excellence in oncology in Latin America. The objective of this manuscript is to describe 10 years of the geriatric oncology service at ICESP and the challenges for its implementation. We performed a narrative description of the ICESP's geriatric oncology service and a general retrospective descriptive analysis of data collected from routine structured medical records of patients referred to the service from 2011 to 2021. This article highlights the different settings in which the service operates (outpatient, pre-operative and hospital follow-up). In this period, 1,700 patients were assessed for preoperative evaluation (median age 83.9, SD 4.95), 468 patients were evaluated for therapeutic decision (median age 79.4, SD 7.38), 968 in general geriatric oncology care outpatient clinics from 2012 to 2021 (median age 78.7, SD 7.91) and 1,391 inpatient evaluations. In the past 10 years, our geriatric oncology team has grown exponentially and changed its characteristics in order to adjust them to the hospital demands, raising awareness among the oncology teams about the benefit of using geriatric assessment and promoting multidisciplinary discussions.
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Affiliation(s)
- Theodora Karnakis
- Department of Internal Medicine, Division of Geriatrics, University of São Paulo Medical School, São Paulo, Brazil
- Department of Internal Medicine, Division of Geriatrics, Sao Paulo Cancer Institute, University of Sao Paulo Medical School, São Paulo, Brazil
- Laboratory of Medical Investigation in Aging (LIM 66) of São Paulo Medical School, Sao Paulo, Brazil
| | - Ana L Kanaji
- Department of Internal Medicine, Division of Geriatrics, University of São Paulo Medical School, São Paulo, Brazil
- Department of Internal Medicine, Division of Geriatrics, Sao Paulo Cancer Institute, University of Sao Paulo Medical School, São Paulo, Brazil
- Laboratory of Medical Investigation in Aging (LIM 66) of São Paulo Medical School, Sao Paulo, Brazil
| | - Isabella F Gattás-Vernaglia
- Department of Internal Medicine, Division of Geriatrics, University of São Paulo Medical School, São Paulo, Brazil
- Department of Internal Medicine, Division of Geriatrics, Sao Paulo Cancer Institute, University of Sao Paulo Medical School, São Paulo, Brazil
- Laboratory of Medical Investigation in Aging (LIM 66) of São Paulo Medical School, Sao Paulo, Brazil
| | - Izabela O Adriazola
- Department of Internal Medicine, Division of Geriatrics, University of São Paulo Medical School, São Paulo, Brazil
- Department of Internal Medicine, Division of Geriatrics, Sao Paulo Cancer Institute, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Paola T Ramos
- Department of Internal Medicine, Division of Geriatrics, University of São Paulo Medical School, São Paulo, Brazil
- Department of Internal Medicine, Division of Geriatrics, Sao Paulo Cancer Institute, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Maria Eduarda P L S Lima
- Department of Internal Medicine, Division of Geriatrics, University of São Paulo Medical School, São Paulo, Brazil
- Department of Internal Medicine, Division of Geriatrics, Sao Paulo Cancer Institute, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Olga L S Almeida
- Clinical Board of the Clinics Hospital of the University of São Paulo Medical School, Sao Paulo, Brazil
| | - Wilson Jacob-Filho
- Department of Internal Medicine, Division of Geriatrics, University of São Paulo Medical School, São Paulo, Brazil
- Department of Internal Medicine, Division of Geriatrics, Sao Paulo Cancer Institute, University of Sao Paulo Medical School, São Paulo, Brazil
- Laboratory of Medical Investigation in Aging (LIM 66) of São Paulo Medical School, Sao Paulo, Brazil
| | - Eduardo Ferriolli
- Department of Internal Medicine, Division of Geriatrics, University of São Paulo Medical School, São Paulo, Brazil
- Department of Internal Medicine, Division of Geriatrics, Sao Paulo Cancer Institute, University of Sao Paulo Medical School, São Paulo, Brazil
- Laboratory of Medical Investigation in Aging (LIM 66) of São Paulo Medical School, Sao Paulo, Brazil
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11
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Iranzo P, Callejo A, Arbej J, Menao S, Isla D, Andrés R. [Risk factors for cancer-related cognitive impairment in breast and colorectal cancer patients who undergo chemotherapy]. An Sist Sanit Navar 2023; 46:e1040. [PMID: 37594060 PMCID: PMC10498134 DOI: 10.23938/assn.1040] [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: 11/05/2022] [Revised: 03/28/2023] [Accepted: 06/08/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Our study aims to evaluate the impact of different factors on cancer-related cognitive impairment in patients who undergo chemotherapy. METHODOLOGY Prospective longitudinal single-centre study that included patients with breast and colon carcinoma who underwent chemotherapy as part of their treatment. Clinical and genetic characteristics of the patients (single nucleotide polymorphisms, SNPs) were collected. Patients' neurocognitive status was assessed using eleven validated tests at three time points: before chemotherapy (M0 - baseline), between one and four weeks after completing chemotherapy (M1), and between 24-30 weeks after completing chemotherapy (M2). RESULTS Sixty-two patients were included in this study; 82% were female, median age was 56 years (range 30-74), and 64.5% had been diagnosed with breast cancer. Overall, better cognitive results at M0 were associated with age < 55 years, higher educational level, absence of comorbidities, and the CC variant rs471692 (TOP2A). Significant decline was found between M0 to M1 in the Rey Auditory Verbal Learning Test and the Letter and Number test, with evidence of recovery in M2 compared to M0 regarding the following test: Visual Memory, Functioning Assessment Short Test (FAST), Digit Symbol Substitution and Cube. In the multivariate analysis, being =55 years of age, adjuvant chemotherapy, presence of comorbidities, tobacco and alcohol use, and GT variant rs1800795 were associated with cognitive decline between M0 and M1. CONCLUSION Being =55 years of age, female, presence of comorbidities and basic education level are related to a higher risk of cognitive impairment after chemotherapy.
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Affiliation(s)
| | | | - Julio Arbej
- Servicio de Psiquiatría. Hospital Clínico Universitario Lozano Blesa. Zaragoza. España..
| | - Sebastian Menao
- Servicio de Bioquímica. Hospital Clínico Universitario Lozano Blesa. Zaragoza. España..
| | - Dolores Isla
- Servicio de Bioquímica. Hospital Clínico Universitario Lozano Blesa. Zaragoza. España..
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12
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Mandelblatt JS, Small BJ, Zhou X, Nakamura ZM, Cohen HJ, Ahles TA, Ahn J, Bethea TN, Extermann M, Graham D, Isaacs C, Jacobsen PB, Jim HSL, McDonald BC, Patel SK, Rentscher KE, Root JC, Saykin AJ, Tometich DB, Van Dyk K, Zhai W, Breen EC, Carroll JE. Plasma levels of interleukin-6 mediate neurocognitive performance in older breast cancer survivors: The Thinking and Living With Cancer study. Cancer 2023; 129:2409-2421. [PMID: 37096888 PMCID: PMC10750797 DOI: 10.1002/cncr.34784] [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: 10/15/2022] [Revised: 02/08/2023] [Accepted: 03/03/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND Immune activation/inflammation markers (immune markers) were tested to explain differences in neurocognition among older breast cancer survivors versus noncancer controls. METHODS Women >60 years old with primary breast cancer (stages 0-III) (n = 400) were assessed before systemic therapy with frequency-matched controls (n = 329) and followed annually to 60 months; blood was collected during annual assessments from 2016 to 2020. Neurocognition was measured by tests of attention, processing speed, and executive function (APE). Plasma levels of interleukin-6 (IL-6), IL-8, IL-10, tumor necrosis factor α (TNF-α), and interferon γ were determined using multiplex testing. Mixed linear models were used to compare results of immune marker levels by survivor/control group by time and by controlling for age, racial/ethnic group, cognitive reserve, and study site. Covariate-adjusted multilevel mediation analyses tested whether survivor/control group effects on cognition were explained by immune markers; secondary analyses examined the impact of additional covariates (e.g., comorbidity and obesity) on mediation effects. RESULTS Participants were aged 60-90 years (mean, 67.7 years). Most survivors had stage I (60.9%) estrogen receptor-positive tumors (87.6%). Survivors had significantly higher IL-6 levels than controls before systemic therapy and at 12, 24, and 60 months (p ≤ .001-.014) but there were no differences for other markers. Survivors had lower adjusted APE scores than controls (p < .05). Levels of IL-6, IL-10, and TNF-α were related to APE, with IL-6 explaining part of the relationship between survivor/control group and APE (p = .01). The magnitude of this mediation effect decreased but remained significant (p = .047) after the consideration of additional covariates. CONCLUSIONS Older breast cancer survivors had worse long-term neurocognitive performance than controls, and this relationship was explained in part by elevated IL-6.
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Affiliation(s)
- Jeanne S Mandelblatt
- Department of Oncology, Georgetown University Medical Center, Georgetown University, Washington, DC, USA
- Georgetown Lombardi Institute for Cancer and Aging Research, Georgetown University's Lombardi Comprehensive Cancer Center, Washington, DC, USA
- Cancer Prevention and Control Program, Georgetown University's Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Brent J Small
- School of Aging Studies, University of South Florida, Tampa, Florida, USA
| | - Xingtao Zhou
- Department of Biostatistics, Bioinformatics, and Biomathematics, Department of Oncology and Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Zev M Nakamura
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Harvey J Cohen
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina, USA
| | - Tim A Ahles
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jaeil Ahn
- Department of Biostatistics, Bioinformatics, and Biomathematics, Department of Oncology and Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Traci N Bethea
- Department of Oncology, Georgetown University Medical Center, Georgetown University, Washington, DC, USA
- Georgetown Lombardi Institute for Cancer and Aging Research, Georgetown University's Lombardi Comprehensive Cancer Center, Washington, DC, USA
- Cancer Prevention and Control Program, Georgetown University's Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Martine Extermann
- Department of Oncology, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, Florida, USA
| | - Deena Graham
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Claudine Isaacs
- Georgetown Lombardi Comprehensive Cancer Center, Department of Oncology, Department of Medicine, Georgetown University, Washington, DC, USA
| | - Paul B Jacobsen
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Heather S L Jim
- Cancer Prevention and Control Program, H. Lee Moffitt Comprehensive Cancer Center, Tampa, Florida, USA
| | - Brenna C McDonald
- Department of Radiology and Imaging Sciences, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, Indiana, USA
- Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Sunita K Patel
- City of Hope National Medical Center, Los Angeles, California, USA
| | - Kelly E Rentscher
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, California, USA
| | - James C Root
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Andrew J Saykin
- Department of Radiology and Imaging Sciences, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, Indiana, USA
- Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Danielle B Tometich
- Cancer Prevention and Control Program, H. Lee Moffitt Comprehensive Cancer Center, Tampa, Florida, USA
| | - Kathleen Van Dyk
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, California, USA
| | - Wanting Zhai
- Department of Biostatistics, Bioinformatics, and Biomathematics, Department of Oncology and Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Elizabeth C Breen
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, California, USA
| | - Judith E Carroll
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, California, USA
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13
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Esmaili M, Farhud DD, Poushaneh K, Baghdassarians A, Ashayeri H. Executive Functions and Public Health: A Narrative Review. IRANIAN JOURNAL OF PUBLIC HEALTH 2023; 52:1589-1599. [PMID: 37744538 PMCID: PMC10512143 DOI: 10.18502/ijph.v52i8.13398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/10/2023] [Indexed: 09/26/2023]
Abstract
Executive functions (EFs) skills are necessary for regulating the thoughts, emotions, and actions which are associated with many aspects of daily functioning. Executive dysfunction (EDFs) is present in a wide range of mental disorders. New study indicates that EFs may predict health behavior and make it easier to engage in a variety of healthy activities. In this narrative review, EFs and public health are briefly discussed. In general, 133 articles met the inclusion criteria (published 2018-2023) which were reviewed. EFs affect the mental and physical health. Besides individual problems, people with mental problems have heavy costs to society. Mental health cannot be considered separately from general health. Consequently, preventive and therapeutic approaches to mental health should be considered not only at the level of the whole society, but also at the global level.
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Affiliation(s)
- Mina Esmaili
- Department of Psychology, Faculty of Psychology and Educational Sciences, Central Tehran Branch, Islamic Azad University Tehran, Iran
| | - Dariush D. Farhud
- School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Department of Basic Sciences, Iranian Academy of Medical Sciences, Tehran, Iran
| | - Kambiz Poushaneh
- Department of Psychology, Faculty of Psychology and Educational Sciences, Central Tehran Branch, Islamic Azad University Tehran, Iran
| | - Anita Baghdassarians
- Department of Psychology, Faculty of Psychology and Educational Sciences, Central Tehran Branch, Islamic Azad University Tehran, Iran
| | - Hassan Ashayeri
- Department of Basic Sciences, Faculty of Rehabilitation Sciences, Tehran University of Medical Sciences, Tehran, Iran
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Lustberg MB, Kuderer NM, Desai A, Bergerot C, Lyman GH. Mitigating long-term and delayed adverse events associated with cancer treatment: implications for survivorship. Nat Rev Clin Oncol 2023; 20:527-542. [PMID: 37231127 PMCID: PMC10211308 DOI: 10.1038/s41571-023-00776-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2023] [Indexed: 05/27/2023]
Abstract
Despite the importance of chemotherapy-associated adverse events in oncology practice and the broad range of interventions available to mitigate them, limited systematic efforts have been made to identify, critically appraise and summarize the totality of evidence on the effectiveness of these interventions. Herein, we review the most common long-term (continued beyond treatment) and late or delayed (following treatment) adverse events associated with chemotherapy and other anticancer treatments that pose major threats in terms of survival, quality of life and continuation of optimal therapy. These adverse effects often emerge during and continue beyond the course of therapy or arise among survivors in the months and years following treatment. For each of these adverse effects, we discuss and critically evaluate their underlying biological mechanisms, the most commonly used pharmacological and non-pharmacological treatment strategies, and evidence-based clinical practice guidelines for their appropriate management. Furthermore, we discuss risk factors and validated risk-assessment tools for identifying patients most likely to be harmed by chemotherapy and potentially benefit from effective interventions. Finally, we highlight promising emerging supportive-care opportunities for the ever-increasing number of cancer survivors at continuing risk of adverse treatment effects.
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Affiliation(s)
- Maryam B Lustberg
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | | | - Aakash Desai
- Department of Medicine, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Cristiane Bergerot
- Centro de Câncer de Brasília, Instituto Unity de Ensino e Pesquisa, Brasilia, Brazil
| | - Gary H Lyman
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA.
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Vargo MM. Outcome Measures and Patient-Reported Metrics in Cancer Rehabilitation. Curr Oncol Rep 2023; 25:869-882. [PMID: 37148415 DOI: 10.1007/s11912-023-01412-6] [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] [Accepted: 03/20/2023] [Indexed: 05/08/2023]
Abstract
PURPOSE OF REVIEW The current panorama of measurement tools for use in cancer rehabilitation is reviewed. For rehabilitation purposes, evaluating function is of the highest priority. RECENT FINDINGS From a patient-reported outcome (PRO) standpoint, SF-36 and EORTC-QLQ-C30 are in most common use in cancer rehabilitation research; these are quality of life measures that contain functional subdomains. Newer tools which are based on item response theory and have options for both computer assisted or short form (SF) administration, including the Patient-Reported Outcomes Measurement Information System (PROMIS) and Activity Measure for Post-acute Care (AMPAC) instruments, show increasing use, especially PROMIS Physical Function SF, and, recently, PROMIS Cancer Function Brief 3D, which has been validated in the cancer population, with domains of physical function, fatigue, and social participation, to track clinical rehabilitation outcomes. Evaluating objective measures of function in cancer patients is also crucial. Utilization of clinically feasible tools for cancer rehabilitation, to employ for both screening purposes and for monitoring of rehabilitation treatment efficacy, is an evolving area, much needed to promote further research and improved, consistent clinical care for cancer patients and survivors.
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Affiliation(s)
- Mary M Vargo
- Physical Medicine and Rehabilitation, MetroHealth Medical Center, Case Western Reserve University, 4229 Pearl Road, Cleveland, OH, 44109, USA.
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16
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Xinran Z, Shumei Z, Xueying Z, Linan W, Ying G, Peng W, Yahong H, Longting M, Jing W. Construction of a predictive model for cognitive impairment risk in patients with advanced cancer. Int J Nurs Pract 2023:e13140. [PMID: 36759715 DOI: 10.1111/ijn.13140] [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: 07/14/2022] [Revised: 01/12/2023] [Accepted: 01/27/2023] [Indexed: 02/11/2023]
Abstract
AIMS The purpose of this study was to identify risk factors for cognitive impairment in advanced cancer patients and to develop predictive models based on these risk factors. BACKGROUND Cancer-related cognitive impairment seriously affects the quality of life of advanced cancer patients. However, neural network models of cognitive impairment in patients with advanced cancer have not yet been identified. DESIGN A cross-sectional design was used. METHODS This study collected 494 questionnaires between January and June 2022. Statistically significant clinical indicators were selected by univariate analysis, and the artificial neural network model and logistic regression model were used for multivariate analysis. The predicted value of the model was estimated using the area under the subject's working characteristic curve. RESULT The artificial neural network and the logistic regression models suggested that cancer course, anxiety and age were the major risk factors for cognitive impairment in advanced cancer patients. All the indexes of artificial neural network model constructed in this study are better than those of the logistic model. CONCLUSION The artificial neural network model can better predict the risk factors of cognitive impairment in patients with advanced cancer. Better prediction will enable nurses and other healthcare professionals to provide better targeted and timely support.
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Affiliation(s)
- Zhu Xinran
- Department of Nursing, Tianjin Medical University, Tianjin, China
| | - Zhuang Shumei
- Department of Nursing, Tianjin Medical University, Tianjin, China
| | - Zhou Xueying
- Department of Nursing, Tianjin Medical University, Tianjin, China
| | - Wang Linan
- Department of Nursing, Tianjin Medical University, Tianjin, China
| | - Guo Ying
- Tianjin First Central Hospital, Tianjin, China
| | - Wang Peng
- Tianjin Medical College, Tianjin, China
| | - Hou Yahong
- Chinese people'Armed Police Force, Tianjin, China
| | - Ma Longting
- Hematology Hospital, Chinese Academy of Medical Sciences, Tianjin, China
| | - Wang Jing
- Tianjin Central Obstetrics and Gynecology Hospital, Tianjin, China
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A self-administered immersive virtual reality tool for assessing cognitive impairment in patients with cancer. Asia Pac J Oncol Nurs 2023; 10:100205. [PMID: 37012969 PMCID: PMC10066517 DOI: 10.1016/j.apjon.2023.100205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 02/07/2023] [Indexed: 03/04/2023] Open
Abstract
Objective This study was aimed at exploring the feasibility and validity of a self-administered immersive virtual reality (VR) tool designed to assess cognitive impairment in patients with cancer. Methods In a cross-sectional survey study, an immersive tool was used to rate the previously recommended core assessment domains of cancer-related cognitive impairment-comprising attention, verbal learning memory, processing speed, executive function and verbal fluency-via an interactive VR scenario. Results A total of 165 patients with cancer participated in this study. The participants' mean age was 47.74 years (SD = 10.59). Common cancer types included lung, liver, breast and colorectal cancer, and most patients were in early disease stages (n = 146, 88.5%). Participants' performance in the VR cognition assessment showed a moderate to strong positive correlation with their paper-and-pencil neurocognitive test results (r = 0.34-0.76, P < 0.001), thus indicating high concurrent validity of the immersive VR cognition assessment tool. For all participants, the mean score for the VR-based cognition assessment was 5.41 (SD = 0.70) out of a potential maximum of 7.0. The mean simulation sickness score for the VR-based tool, as rated by the patients, was 0.35 (SD = 0.19), thereby indicating that minimal simulation sickness occurred during the VR-assisted cognition assessment. Conclusions Given its demonstrated validity, and the patients' high presence scores and minimal sickness scores, this VR-based cognition assessment tool is a feasible and acceptable instrument for measuring cognitive impairment in patients with cancer. However, further psychometric assessments should be implemented in clinical settings.
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18
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Carroll JE, Nakamura ZM, Small BJ, Zhou X, Cohen HJ, Ahles TA, Ahn J, Bethea TN, Extermann M, Graham D, Isaacs C, Jim HS, Jacobsen PB, McDonald BC, Patel SK, Rentscher K, Root J, Saykin AJ, Tometich DB, Van Dyk K, Zhai W, Breen EC, Mandelblatt JS. Elevated C-Reactive Protein and Subsequent Patient-Reported Cognitive Problems in Older Breast Cancer Survivors: The Thinking and Living With Cancer Study. J Clin Oncol 2023; 41:295-306. [PMID: 36179271 PMCID: PMC9839283 DOI: 10.1200/jco.22.00406] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/24/2022] [Accepted: 07/26/2022] [Indexed: 01/25/2023] Open
Abstract
PURPOSE To examine longitudinal relationships between levels of C-reactive protein (CRP) and cognition in older breast cancer survivors and noncancer controls. METHODS English-speaking women age ≥ 60 years, newly diagnosed with primary breast cancer (stage 0-III), and frequency-matched controls were enrolled from September 2010 to March 2020; women with dementia, neurologic disorders, and other cancers were excluded. Assessments occurred presystemic therapy/enrollment and at annual visits up to 60 months. Cognition was measured using the Functional Assessment of Cancer Therapy-Cognitive Function and neuropsychological testing. Mixed linear effect models tested for survivor-control differences in natural log (ln)-transformed CRP at each visit. Random effect-lagged fluctuation models tested directional effects of ln-CRP on subsequent cognition. All models controlled for age, race, study site, cognitive reserve, obesity, and comorbidities; secondary analyses evaluated if depression or anxiety affected results. RESULTS There were 400 survivors and 329 controls with CRP specimens and follow-up data (average age of 67.7 years; range, 60-90 years). The majority of survivors had stage I (60.9%), estrogen receptor-positive (87.6%) tumors. Survivors had significantly higher adjusted mean ln-CRP than controls at baseline and 12-, 24-, and 60-month visits (all P < .05). Higher adjusted ln-CRP predicted lower participant-reported cognition on subsequent visits among survivors, but not controls (P interaction = .008); effects were unchanged by depression or anxiety. Overall, survivors had adjusted Functional Assessment of Cancer Therapy-Cognitive Function scores that were 9.5 and 14.2 points lower than controls at CRP levels of 3.0 and 10.0 mg/L. Survivors had poorer neuropsychological test performance (v controls), with significant interactions with CRP only for the Trails B test. CONCLUSION Longitudinal relationships between CRP and cognition in older breast cancer survivors suggest that chronic inflammation may play a role in development of cognitive problems. CRP testing could be clinically useful in survivorship care.
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Affiliation(s)
- Judith E. Carroll
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, CA
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA
| | - Zev M. Nakamura
- Department of Psychiatry, University of North Carolina–Chapel Hill, Chapel Hill, NC
| | - Brent J. Small
- School of Aging Studies, University of South Florida, Tampa, FL
| | - Xingtao Zhou
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, DC
- Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University, Washington, DC
| | - Harvey J. Cohen
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC
| | - Tim A. Ahles
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jaeil Ahn
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, DC
- Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University, Washington, DC
| | - Traci N. Bethea
- Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University, Washington, DC
| | - Martine Extermann
- Department of Oncology, Moffitt Cancer Center, University of South Florida, Tampa, FL
| | - Deena Graham
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ
| | - Claudine Isaacs
- Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University, Washington, DC
| | | | - Paul B. Jacobsen
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Brenna C. McDonald
- Department of Radiology and Imaging Sciences, Melvin and Bren Simon Comprehensive Cancer Center, and Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, Indianapolis, IN
| | | | - Kelly Rentscher
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, CA
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA
| | - James Root
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrew J. Saykin
- Department of Radiology and Imaging Sciences, Melvin and Bren Simon Comprehensive Cancer Center, and Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, Indianapolis, IN
| | | | - Kathleen Van Dyk
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA
| | - Wanting Zhai
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, DC
- Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University, Washington, DC
| | - Elizabeth C. Breen
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, CA
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA
| | - Jeanne S. Mandelblatt
- Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University, Washington, DC
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Liu H, Li Y, Li Y, Wang J, Su N, Cui N, Xu K, Sun Y, Cao F. Psychometric properties of the Chinese version of the Cognitive Reserve Assessment Scale in Health in patients with cancer. BMC Psychiatry 2023; 23:5. [PMID: 36597052 PMCID: PMC9811687 DOI: 10.1186/s12888-022-04506-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 12/28/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Cognitive reserve is a modifiable factor that could prevent cognitive decline in patients with cancer. The Cognitive Reserve Assessment Scale in Health (CRASH) is an instrument used to assess cognitive reserve. This study aims to develop and examine the psychometric properties of the Chinese version of the CRASH for patients with cancer. METHODS A cross-sectional survey was conducted with 167 cancer patients from four wards of two hospitals in China. Thirty-one patients were re-assessed to examine the test-retest reliability. Four translators and three reviewers developed the Chinese version of the scale. We assessed its structural validity, concurrent validity, internal consistency, test-retest reliability, measurement error, and floor/ceiling effects. RESULTS Confirmatory factor analysis showed a good model fit with the four-factor structure of the original CRASH. The CRASH scores were statistically significantly associated with neuropsychological test scores, indicating sufficient concurrent validity. The internal consistency was acceptable, except for leisure activities, with standardized Cronbach's alphas (0.64-0.94) and standardized Omega (0.66-0.95). There was excellent test-retest reliability, with a high intraclass correlation coefficient (0.914-0.993) of total scores and scores for each domain. The measurement error was acceptable, and no floor or ceiling effects were observed. CONCLUSIONS The Chinese version of the CRASH is a valid and reliable instrument to assess cognitive reserve in patients with cancer. Moreover, cognitive reserve measured by the CRASH was associated with low cognitive performance in cancer patients.
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Affiliation(s)
- Hong Liu
- grid.27255.370000 0004 1761 1174Department of Nursing Psychology, School of Nursing and Rehabilitation, Shandong University, No.44 Wenhuaxi Road, Jinan city, 250012 Shandong Province China
| | - Yanyan Li
- grid.11135.370000 0001 2256 9319School of Nursing, Peking University, Beijing, China
| | - Yang Li
- grid.89336.370000 0004 1936 9924School of Nursing, The University of Texas at Austin, Austin, USA
| | - Jianwen Wang
- grid.27255.370000 0004 1761 1174Department of Nursing Psychology, School of Nursing and Rehabilitation, Shandong University, No.44 Wenhuaxi Road, Jinan city, 250012 Shandong Province China
| | - Na Su
- grid.440144.10000 0004 1803 8437Imaging Department, Shandong Cancer Hospital and Institute, Jinan, China
| | - Naixue Cui
- grid.27255.370000 0004 1761 1174Department of Nursing Psychology, School of Nursing and Rehabilitation, Shandong University, No.44 Wenhuaxi Road, Jinan city, 250012 Shandong Province China
| | - Kun Xu
- grid.440144.10000 0004 1803 8437Department of Gastrointestinal Surgery, Shandong Cancer Hospital and Institute, Jinan, China
| | - Yaoyao Sun
- grid.27255.370000 0004 1761 1174Department of Nursing Psychology, School of Nursing and Rehabilitation, Shandong University, No.44 Wenhuaxi Road, Jinan city, 250012 Shandong Province China
| | - Fenglin Cao
- Department of Nursing Psychology, School of Nursing and Rehabilitation, Shandong University, No.44 Wenhuaxi Road, Jinan city, 250012, Shandong Province, China.
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20
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Van Dyk K, Ahn J, Zhou X, Zhai W, Ahles TA, Bethea TN, Carroll JE, Cohen HJ, Dilawari AA, Graham D, Jacobsen PB, Jim H, McDonald BC, Nakamura ZM, Patel SK, Rentscher KE, Saykin AJ, Small BJ, Mandelblatt JS, Root JC. Associating persistent self-reported cognitive decline with neurocognitive decline in older breast cancer survivors using machine learning: The Thinking and Living with Cancer study. J Geriatr Oncol 2022; 13:1132-1140. [PMID: 36030173 PMCID: PMC10016202 DOI: 10.1016/j.jgo.2022.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 07/16/2022] [Accepted: 08/10/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Many cancer survivors report cognitive problems following diagnosis and treatment. However, the clinical significance of patient-reported cognitive symptoms early in survivorship can be unclear. We used a machine learning approach to determine the association of persistent self-reported cognitive symptoms two years after diagnosis and neurocognitive test performance in a prospective cohort of older breast cancer survivors. MATERIALS AND METHODS We enrolled breast cancer survivors with non-metastatic disease (n = 435) and age- and education-matched non-cancer controls (n = 441) between August 2010 and December 2017 and followed until January 2020; we excluded women with neurological disease and all women passed a cognitive screen at enrollment. Women completed the FACT-Cog Perceived Cognitive Impairment (PCI) scale and neurocognitive tests of attention, processing speed, executive function, learning, memory and visuospatial ability, and timed activities of daily living assessments at enrollment (pre-systemic treatment) and annually to 24 months, for a total of 59 individual neurocognitive measures. We defined persistent self-reported cognitive decline as clinically meaningful decline (3.7+ points) on the PCI scale from enrollment to twelve months with persistence to 24 months. Analysis used four machine learning models based on data for change scores (baseline to twelve months) on the 59 neurocognitive measures and measures of depression, anxiety, and fatigue to determine a set of variables that distinguished the 24-month persistent cognitive decline group from non-cancer controls or from survivors without decline. RESULTS The sample of survivors and controls ranged in age from were ages 60-89. Thirty-three percent of survivors had self-reported cognitive decline at twelve months and two-thirds continued to have persistent decline to 24 months (n = 60). Least Absolute Shrinkage and Selection Operator (LASSO) models distinguished survivors with persistent self-reported declines from controls (AUC = 0.736) and survivors without decline (n = 147; AUC = 0.744). The variables that separated groups were predominantly neurocognitive test performance change scores, including declines in list learning, verbal fluency, and attention measures. DISCUSSION Machine learning may be useful to further our understanding of cancer-related cognitive decline. Our results suggest that persistent self-reported cognitive problems among older women with breast cancer are associated with a constellation of mild neurocognitive changes warranting clinical attention.
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Affiliation(s)
- Kathleen Van Dyk
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, CA, United States of America; Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA, United States of America.
| | - Jaeil Ahn
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, DC, United States of America
| | - Xingtao Zhou
- Georgetown Lombardi Comprehensive Cancer Center Georgetown University, Washington, DC, United States of America
| | - Wanting Zhai
- Georgetown Lombardi Comprehensive Cancer Center Georgetown University, Washington, DC, United States of America
| | - Tim A Ahles
- Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Traci N Bethea
- Georgetown Lombardi Comprehensive Cancer Center Georgetown University, Washington, DC, United States of America
| | - Judith E Carroll
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, CA, United States of America; Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, CA, United States of America
| | - Harvey Jay Cohen
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, United States of America
| | - Asma A Dilawari
- Georgetown Lombardi Comprehensive Cancer Center Georgetown University, Washington, DC, United States of America
| | - Deena Graham
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, United States of America
| | - Paul B Jacobsen
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, United States of America
| | - Heather Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, FL, United States of America
| | - Brenna C McDonald
- Center for Neuroimaging, Department of Radiology and Imaging Sciences and the Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Zev M Nakamura
- Department of Psychiatry, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States of America
| | - Sunita K Patel
- City of Hope National Medical Center, Los Angeles, CA, United States of America
| | - Kelly E Rentscher
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, CA, United States of America; Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, CA, United States of America
| | - Andrew J Saykin
- Center for Neuroimaging, Department of Radiology and Imaging Sciences and the Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Brent J Small
- University of South Florida, Health Outcome and Behavior Program and Biostatistics Resource Core, H. Lee Moffitt Cancer Center, Research Institute at the University of South Florida, Tampa, FL, United States of America
| | - Jeanne S Mandelblatt
- Georgetown Lombardi Comprehensive Cancer Center Georgetown University, Washington, DC, United States of America
| | - James C Root
- Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
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Cognitive Trajectories in Older Patients with Cancer Undergoing Radiotherapy—A Prospective Observational Study. Curr Oncol 2022; 29:5164-5178. [PMID: 35877269 PMCID: PMC9317354 DOI: 10.3390/curroncol29070409] [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: 06/20/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 11/23/2022] Open
Abstract
Cognitive function can be affected by cancer and/or its treatment, and older patients are at a particular risk. In a prospective observational study including patients ≥65 years referred for radiotherapy (RT), we aimed to investigate the association between patient- and cancer-related factors and cognitive function, as evaluated by the Montreal Cognitive Assessment (MoCA), and sought to identify groups with distinct MoCA trajectories. The MoCA was performed at baseline (T0), RT completion (T1), and 8 (T2) and 16 (T3) weeks later, with scores ranging between 0 and 30 and higher scores indicating better function. Linear regression and growth mixture models were estimated to assess associations and to identify groups with distinct MoCA trajectories, respectively. Among 298 patients with a mean age of 73.6 years (SD 6.3), the baseline mean MoCA score was 24.0 (SD 3.7). Compared to Norwegian norm data, 37.9% had cognitive impairment. Compromised cognition was independently associated with older age, lower education, and physical impairments. Four groups with distinct trajectories were identified: the very poor (6.4%), poor (8.1%), fair (37.9%), and good (47.7%) groups. The MoCA trajectories were mainly stable. We conclude that cognitive impairment was frequent but, for most patients, was not affected by RT. For older patients with cancer, and in particular for those with physical impairments, we recommend an assessment of cognitive function.
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Vargas A, Holub K, Biete A. Systemic inflammation in older patients with breast cancer: the missing point in geriatric evaluations to sharpen survival prediction. Clin Transl Oncol 2022; 24:1800-1808. [PMID: 35474170 DOI: 10.1007/s12094-022-02836-5] [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: 02/22/2022] [Accepted: 04/06/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Breast cancer (BC) prevalence steadily increases in older patients but their treatment is based on the geriatric evaluations of comorbidities and potential benefits proved in clinical trials with younger patients. The lack of better decision-making tools urges to promote the search for new prognostic markers. The association between inflammation, aging and cancer may be crucial for better treatment selection. We sought to analyze its impact on the survival of older BC patients, evaluating the interaction with age and comorbidities. METHODS We evaluated the relationship between inflammatory biomarkers at BC diagnosis (circulating blood cell counts and inflammatory indexes) and BC-related and not related mortality rate, evaluating the influence of comorbidities and age through the competitive risks assessment. RESULTS We analyzed 148 consecutive BC patients aged ≥ 70 years old, diagnosed with BC and regional lymph node metastases. After the median follow-up of 51.5 months, 59 patients died (28 due to breast cancer progression and 31 because of other causes). Increased levels of circulating monocytes, neutrophils and neutrophil-to-lymphocytes ratio and decreased level of eosinophils and eosinophil multiple by neutrophils-to-lymphocytes ratio were associated with higher probability of BC-related death but not with death related to other causes. CONCLUSION Our data suggest a role of inflammatory parameters as a possible prognostic tool in therapeutic decision-making process in older patients with BC, as increased level of inflammation was associated with cancer-specific mortality. Prospective studies may give the possibility of refining the geriatric evaluation for BC treatment in elderly.
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Affiliation(s)
- Andrés Vargas
- Radiation Oncology Department, Instituto de Radiomedicina (IRAM), Avenida Américo Vespucio 1314, Vitacura, 7630000, Santiago de Chile, Chile.
- Facultad de Medicina, Universidad Diego Portales, Santiago, Chile.
| | - Katarzyna Holub
- Facultat de Medicina, Universitat de Barcelona, C/Casanova 143, 08036, Barcelona, Spain
| | - Albert Biete
- Facultat de Medicina, Universitat de Barcelona, C/Casanova 143, 08036, Barcelona, Spain
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23
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Levit LA, Arora S, Kluetz PG, Magnuson A, Rahman A, Harvey RD. Call to Action for Improving Oral Anticancer Agent Adherence. J Clin Oncol 2022; 40:1036-1040. [PMID: 34990218 DOI: 10.1200/jco.21.02529] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Laura A Levit
- American Society of Clinical Oncology, Alexandria, VA
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24
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de Ruiter MB, Reneman L, Kieffer JM, Oldenburg HSA, Schagen SB. Brain White Matter Microstructure as a Risk Factor for Cognitive Decline After Chemotherapy for Breast Cancer. J Clin Oncol 2021; 39:3908-3917. [PMID: 34591652 DOI: 10.1200/jco.21.00627] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Cognitive decline is frequently observed after chemotherapy. As chemotherapy is associated with changes in brain white matter microstructure, we investigated whether white matter microstructure before chemotherapy is a risk factor for cognitive decline after chemotherapy. METHODS Neuropsychologic tests were administered before and 6 months (n = 49), 2 years (n = 32), and 3 years (n = 32) after chemotherapy in patients with breast cancer receiving anthracycline-based chemotherapy (BC + CT group), at matched intervals to patients with BC who did not receive systemic therapy (BC - CT group: n = 39, 23, and 19, respectively) and to no-cancer controls (NC group: n = 37, 29, and 28, respectively). Using multivariate normative comparison, we evaluated to what extent the cognitive profiles of patients deviated from those of controls. Fractional anisotropy (FA), derived from magnetic resonance diffusion tensor imaging, was used to measure white matter microstructure before treatment. FA was evaluated as a risk factor for cognitive decline, in addition to baseline age, fatigue, cognitive complaints, and premorbid intelligence quotient. We subsequently ran voxel-wise diffusion tensor imaging analyses to investigate white matter microstructure in specific nerve tracts. RESULTS Low FA independently predicted cognitive decline early (6 months, P = .013) and late (3 years, P < .001) after chemotherapy. FA did not predict cognitive decline in the BC - CT and NC groups. Voxel-wise analysis indicated involvement of white matter tracts essential for cognitive functioning. CONCLUSION Low FA may reflect low white matter reserve. This may be a risk factor for cognitive decline after chemotherapy for BC. If validated in future trials, identification of patients with low white matter reserve could improve patient care, for example, by facilitating targeted, early interventions or even by influencing choices of patients and doctors for receiving chemotherapy.
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Affiliation(s)
- Michiel B de Ruiter
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Liesbeth Reneman
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Jacobien M Kieffer
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Hester S A Oldenburg
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Sanne B Schagen
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands.,Brain and Cognition, Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
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DuMontier C, Loh KP, Soto-Perez-de-Celis E, Dale W. Reply to S. Sommerlatte et al. J Clin Oncol 2021; 39:3761-3762. [PMID: 34533981 PMCID: PMC8601260 DOI: 10.1200/jco.21.01865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 07/31/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
- Clark DuMontier
- Clark DuMontier, MD, MPH, New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA, Brigham and Women's Hospital, Boston, MA; Kah Poh Loh, MBBCh, BAO, MS, James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY; Enrique Soto-Perez-de-Celis, MD, Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; and William Dale, MD, PhD, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Kah Poh Loh
- Clark DuMontier, MD, MPH, New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA, Brigham and Women's Hospital, Boston, MA; Kah Poh Loh, MBBCh, BAO, MS, James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY; Enrique Soto-Perez-de-Celis, MD, Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; and William Dale, MD, PhD, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Enrique Soto-Perez-de-Celis
- Clark DuMontier, MD, MPH, New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA, Brigham and Women's Hospital, Boston, MA; Kah Poh Loh, MBBCh, BAO, MS, James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY; Enrique Soto-Perez-de-Celis, MD, Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; and William Dale, MD, PhD, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - William Dale
- Clark DuMontier, MD, MPH, New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA, Brigham and Women's Hospital, Boston, MA; Kah Poh Loh, MBBCh, BAO, MS, James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY; Enrique Soto-Perez-de-Celis, MD, Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; and William Dale, MD, PhD, City of Hope Comprehensive Cancer Center, Duarte, CA
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26
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Romanovsky L, Magnuson A, Puts M. Cognitive assessment for older adults with cancer. J Geriatr Oncol 2021; 13:378-380. [PMID: 34686473 DOI: 10.1016/j.jgo.2021.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/08/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Lindy Romanovsky
- Division of Geriatric Medicine and General Internal Medicine, Department of Medicine, Sinai Health System and University Health Network, Toronto, Ontario, Canada.
| | - Allison Magnuson
- Divisions of Hematology/Oncology and Geriatrics, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
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Tuch G, Soo WK, Luo KY, Frearson K, Oh EL, Phillips JL, Agar M, Lane H. Cognitive Assessment Tools Recommended in Geriatric Oncology Guidelines: A Rapid Review. Curr Oncol 2021; 28:3987-4003. [PMID: 34677257 PMCID: PMC8534877 DOI: 10.3390/curroncol28050339] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 09/24/2021] [Accepted: 10/04/2021] [Indexed: 12/26/2022] Open
Abstract
Cognitive assessment is a cornerstone of geriatric care. Cognitive impairment has the potential to significantly impact multiple phases of a person's cancer care experience. Accurately identifying this vulnerability is a challenge for many cancer care clinicians, thus the use of validated cognitive assessment tools are recommended. As international cancer guidelines for older adults recommend Geriatric Assessment (GA) which includes an evaluation of cognition, clinicians need to be familiar with the overall interpretation of the commonly used cognitive assessment tools. This rapid review investigated the cognitive assessment tools that were most frequently recommended by Geriatric Oncology guidelines: Blessed Orientation-Memory-Concentration test (BOMC), Clock Drawing Test (CDT), Mini-Cog, Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Short Portable Mental Status Questionnaire (SPMSQ). A detailed appraisal of the strengths and limitations of each tool was conducted, with a focus on practical aspects of implementing cognitive assessment tools into real-world clinical settings. Finally, recommendations on choosing an assessment tool and the additional considerations beyond screening are discussed.
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Affiliation(s)
- Gina Tuch
- Department of Geriatric Medicine, Alfred Health, Melbourne, VIC 3004, Australia
| | - Wee Kheng Soo
- Eastern Health Clinical School, Monash University, Box Hill, VIC 3128, Australia;
- Cancer Services, Eastern Health, Box Hill, VIC 3128, Australia
- Aged Medicine Program, Eastern Health, Box Hill, VIC 3128, Australia
| | - Ki-Yung Luo
- Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia; (K.-Y.L.); (K.F.); (E.L.O.); (H.L.)
| | - Kinglsey Frearson
- Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia; (K.-Y.L.); (K.F.); (E.L.O.); (H.L.)
| | - Ek Leone Oh
- Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia; (K.-Y.L.); (K.F.); (E.L.O.); (H.L.)
| | - Jane L. Phillips
- Queensland University of Technology, Brisbane City, QLD 4000, Australia;
| | - Meera Agar
- University of Technology Sydney, Ultimo, NSW 2007, Australia;
| | - Heather Lane
- Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia; (K.-Y.L.); (K.F.); (E.L.O.); (H.L.)
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Dale W, Jacobsen PB, Mohile SG. Geriatric Oncology Comes of Age: Advancing the Science of Caring for Older Adults With Cancer. J Clin Oncol 2021; 39:2055-2057. [PMID: 34043451 DOI: 10.1200/jco.21.00887] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- William Dale
- City of Hope National Medical Center, Duarte, CA
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