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

Cancer Survivorship and Subjective Cognitive Decline in the United States

PURPOSE

Studies examining the link between cancer survivorship and subjective cognitive decline (SCD) are lacking. Therefore, the current study aimed to determine the association between cancer survivorship and SCD among a nationally representative sample of middle-aged and older adults.

METHOD

Data were obtained from the 2021 Behavioral Risk Factor Surveillance System Survey. Crude and adjusted logistic regression models, controlling for age, gender, race/ethnicity, educational level, income, and work status, were used to determine the association between cancer survivorship characteristics and SCD.

RESULTS

Respondents who were currently undergoing treatment had 86% higher odds of SCD (adjusted odds ratio [aOR] = 1.86; 95% confidence interval [CI] [1.06, 3.27]) compared to respondents who completed treatment. However, those who refused treatment were less likely to report SCD (aOR = 0.006; 95% CI [<0.001, 0.059]) compared to respondents who completed treatment.

CONCLUSION

Cognition interventions may be helpful for individuals diagnosed with cancer who are undergoing treatment, middle-aged, and have not started treatment. [Journal of Gerontological Nursing, 51(4), 12-18.].

Acute and long-term effects of chemotherapy on cognitive function among Indian breast cancer patients

Introduction

Breast cancer (BC) is the leading cause of morbidity and mortality worldwide. Owing to early diagnosis and better therapeutic care, survivorship in these patients have improved tremendously. Chemotherapy, cornerstone in BC management have been associated with debilitating side effects including the effect on cognitive function, which significantly impairs the quality of life in these patients. Thus, it is imperative to understand the timeline and magnitude of the effects of chemotherapy on cognition to develop better management strategies. This is even more relevant in developing country like India, where there is inconspicuous absence of data in this regard.

Aim

To study the acute and long-term effects of chemotherapy on the cognitive function in BC patients compared to chemotherapy naïve (Cx naïve) BC patients (disease controls) and matched healthy controls (HC) using subjective, objective questionnaires and neuropsychological tests (NPTs).

Methods

The current cross-sectional study involved 120 participants, 30 each of Cx naïve BC patients, during chemotherapy BC patients (during Cx), post-chemotherapy BC patients (post Cx) and HC; all matched for age and education levels. Both subjective and objective assessments of cognitive functions were done in all the groups. Hindi Mental State Examination (HMSE) and FACT Cog questionnaire V3 were used for subjective assessment while Addenbrooke Cognitive Examination-III (ACE-III) questionnaire and domain specific computer based NPT (Wisconsin card sorting task (WCST) (learning), Flanker's (attention and interference) and n back task (working memory) were done for objective assessment. The data were analysed for descriptive and inferential statistics, as appropriate using GraphPad Prism V9.

Results

The subjective assessment using HMSE questionnaire revealed a significantly lower score in post Cx group as compared to HC (p < 0.001); however, it was comparable in other groups. FACT Cog V3 questionnaire revealed significantly higher cognitive impairment among those during Cx compared to Cx naïve patients (p < 0.001), post Cx BC patients (p < 0.001) and HC (p < 0.0001). Meanwhile, the objective assessment using ACE-III examination revealed significantly lesser scores among during Cx patients (p < 0.001), and post Cx BC patients (p < 0.0001) compared to HC group. In NPTs, WCST and N back working memory task revealed significantly lower accuracy in Cx naïve versus post Cx (p = 0.0054, p = 0.0068, respectively) and HC versus post Cx (p = 0.0054, p = 0.0045, respectively), while no significant difference was found in Flanker's task. Furthermore, in WCST there were significantly higher scores present in total reaction time in post Cx compared to Cx naïve: p = 0.00444 and HC: p = 0.0003). In Flanker's task reaction time was higher in all the groups (Cx naïve: p = 0.002, during Cx: p = 0.0007 and Post Cx: p < 0.0001) compared to HC. In addition negative correlation was found between the duration of chemotherapy with Perceived Cognitive Abilities (r = -0.482; p = 0.006), between the total number of cycles with Fact Cog Total (r = -0.373, p = 0.04) and Perceived Cognitive abilities (r = 0.39, p = 0.03), and between total dose and perceived cognitive abilities (r = -0.42, p = 0.014) also a positive correlation was seen between dose of epirubicin with reaction time of n back (r = 0.373, p = 0.04).

Conclusion

Chemotherapy can have a negative impact on the cognitive function in BC patients, manifested as both acute and long-term effects, based on patient reported/subjective and laboratory based/objective cognitive function tests. The deficits were seen mostly seen in domains of attention and working memory across groups compared to matched HC.

Physiological and cognitive changes after treatments of cyclophosphamide, methotrexate, and fluorouracil: implications of the gut microbiome and depressive-like behavior

Introduction

Chemotherapy-induced cognitive impairment colloquially referred to as chemobrain is a poorly understood phenomenon affecting a highly variable proportion of patients with breast cancer. Here we investigate the association between anxiety and despair-like behaviors in mice treated with cyclophosphamide, methotrexate, and fluorouracil (CMF) along with host histological, proteomic, gene expression, and gut microbial responses.

Methods

Forced swim and sociability tests were used to evaluate depression and despair-like behaviors. The tandem mass tag (TMT) proteomics approach was used to assess changes in the neural protein network of the amygdala and hippocampus. The composition of gut microbiota was assessed through 16S rRNA gene sequencing. Finally, quantitative reverse transcription polymerase chain reaction (qRT-PCR) was used to evaluate changes in intestinal gap junction markers.

Results and discussion

We observed that CMF induced social and despair-like behavior in mice 96 hours following treatment. Proteomic analysis identified changes in various proteins related to progressive neurological disease, working memory deficit, primary anxiety disorder, and gene expression revealing increases in NMDA and AMPA receptors in both the hippocampus and the amygdala because of CMF treatment. These changes finally, we observed immediate changes in the microbial population after chemotherapy treatment, with a notable abundance of Muribaculaceae and Romboutsia which may contribute to changes seen in the gut.

A scoping review of cognitive assessment tools and domains for chemotherapy-induced cognitive impairments in cancer survivors

Backgrounds

Cancer survivors suffer from specific symptoms known as chemotherapy-induced cognitive impairments (CICIs). CICIs are difficult to capture with existing assessments such as the brief screening test for dementia. Although recommended neuropsychological tests (NPTs) exist, international consensus and shared cognitive domains of assessment tools are unknown. The aim of this scoping review was as follows: (1) to identify studies that assess CICIs in cancer survivors; (2) to identify shared cognitive assessment tools and domains by mapping the domains reported in studies using the International Classification of Functioning, Disability and Health (ICF) framework.

Methods

The study followed the recommendations made by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. We searched the following three databases through October 2021: PubMed, CINAHL, and Web of Science. Prospective longitudinal or cross-sectional studies were selected to determine CICI-specific assessment tools for adult cancer survivors.

Results

Sixty-four prospective studies (36 longitudinal studies and 28 cross-sectional studies) were included after checking for eligibility. The NPTs were divided into seven main cognitive domains. The specific mental functions were often used in the order of memory, attention, higher-level cognitive functions, and psychomotor functions. Perceptual functions were used less frequently. In some ICF domains, shared NPTs were not clearly identified. In some different domains, the same NPTs were used, such as the trail making test and the verbal fluency test. When the association between the publishing year and the amount of NPT use was examined, it was found that the amount of tool use tended to decline over the publication years. The Functional Assessment of Cancer Therapy-Cognitive function (FACT-Cog) was a shared consensus tool among the patient-reported outcomes (PROs).

Conclusion

Chemotherapy-induced cognitive impairments are currently gaining interest. Shared ICF domains such as memory and attention were identified for NPTs. There was a gap between the publicly recommended tools and the tools actually used in the studies. For PROs, a clearly shared tool, FACT-Cog, was identified. Mapping the domains reported in studies using the ICF can help in the process of reviewing consensus on which NPTs may be used to target cognitive domains.

Systematic review registration

https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000053710, identifier UMIN000047104.

Chemobrain in Breast Cancer: Mechanisms, Clinical Manifestations, and Potential Interventions

Among the potential adverse effects of breast cancer treatment, chemotherapy-related cognitive impairment (CRCI) has gained increased attention in the past years. In this review, we provide an overview of the literature regarding CRCI in breast cancer, focusing on three main aspects. The first aspect relates to the molecular mechanisms linking individual drugs commonly used to treat breast cancer and CRCI, which include oxidative stress and inflammation, reduced neurogenesis, reduced levels of specific neurotransmitters, alterations in neuronal dendrites and spines, and impairment in myelin production. The second aspect is related to the clinical characteristics of CRCI in patients with breast cancer treated with different drug combinations. Data suggest the incidence rates of CRCI in breast cancer vary considerably, and may affect more than 50% of treated patients. Both chemotherapy regimens with or without anthracyclines have been associated with CRCI manifestations. While cross-sectional studies suggest the presence of symptoms up to 20 years after treatment, longitudinal studies confirm cognitive impairments lasting for at most 4 years after the end of chemotherapy. The third and final aspect is related to possible therapeutic interventions. Although there is still no standard of care to treat CRCI, several pharmacological and non-pharmacological approaches have shown interesting results. In summary, even if cognitive impairments derived from chemotherapy resolve with time, awareness of CRCI is crucial to provide patients with a better understanding of the syndrome and to offer them the best care directed at improving quality of life.

The COMT Genetic Factor Regulates Chemotherapy-Related Prospective Memory Impairment in Survivors With HER2-/+ Breast Cancer

Background

Previous findings indicated that polymorphism in gene catechol-O-methyltransferase (COMT) had been linked to chemotherapy-related cognitive impairment (CRCI). Nevertheless, the motivation of COMT polymorphisms in regulating cognitive impairment in breast cancer survivors with disparate status of human epidermal growth factor receptor 2 (HER2) was still vague.

Objective

The current research aimed to evaluate the regulation of the risk by COMT genotype on CRCI in breast cancer survivors with disparate status of HER2.

Methods

Breast cancer survivors (103 with HER2− and 118 with HER2+) underwent neuropsychological tests before and after chemotherapy, containing event- and time-based prospective memory (EBPM and TBPM). Three single-nucleotide polymorphisms (SNPs) were estimated by providing peripheral blood, containing COMT (rs165599, rs737865, and rs4680).

Results

The EBPM and TBPM performances was lower as compared with these before chemotherapy (z = −7.712, z = −2.403, respectively, p < 0.01). Furthermore, the EBPM and TBPM performances of HER2− group survivors were lower than those of HER2+ group survivors after chemotherapy (z = −7.181, p < 0.01; z = −2.205 p < 0.05, respectively). The survivors with COMT (rs165599) A/A genotype carriers had a meaningfully poorer chance of memory descend [dominant model: adjusted, OR = 2.21, CI (95%) = 1.156–4.225, p = 0.016] and showed better on TBPM test, relative to G/G genotype. Patients with the COMT (rs737865) A/G and G/G genotype showed protective function than the patients with the A/A and performed better on MMSE and TBPM tests.

Conclusion

The types of HER2 may be correlated to chemotherapy-related prospective memory impairments in breast cancer survivors. Furthermore, the COMT (rs165599, rs737865) polymorphisms were correlated to the risk of TBPM decline scores and possibly be a potential genetic identifying for increasing risk of CRCI in breast cancer patients with disparate status of HER2.