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Oliveira AF, Torres A, Teixeira RJ, Monteiro S, Pereira A, Santos IM. Perceived cognitive functioning in breast cancer patients treated with chemotherapy compared to matched healthy women: Evidence from a Portuguese study. Int J Nurs Pract 2022:e13119. [DOI: 10.1111/ijn.13119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 11/14/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Ana F. Oliveira
- Center for Health Technology and Services Research of the Health Research Network (CINTESIS@RISE), Department of Education and Psychology University of Aveiro Aveiro Portugal
| | - Ana Torres
- Center for Health Technology and Services Research of the Health Research Network (CINTESIS@RISE), Department of Education and Psychology University of Aveiro Aveiro Portugal
- Portuguese Red Cross School of Healthcare of the North Oliveira de Azeméis Portugal
| | - Ricardo J. Teixeira
- REACH—Clínica de Saúde Mental Porto Portugal
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC) Faculty of Psychology and Educational Sciences – University of Coimbra Coimbra Portugal
| | - Sara Monteiro
- Center for Health Technology and Services Research of the Health Research Network (CINTESIS@RISE), Department of Education and Psychology University of Aveiro Aveiro Portugal
| | - Anabela Pereira
- Research Centre in Didactics and Technology in the Education of Trainers (CIDTFF), Department of Education and Psychology University of Aveiro Aveiro Portugal
| | - Isabel M. Santos
- William James Center for Research (WJCR), Department of Education and Psychology University of Aveiro Aveiro Portugal
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Weiner JK, Smith T, Hoy CK, Sarosh C, Madison JA, Ambati A, Tambralli A, Peters N, Packel C, Gockman K, Zuo Y, Briceño EM, Nagaraja V, Knight JS. Predictors and Interrelationship of Patient-Reported Outcomes in Antiphospholipid Syndrome: A Cross-Sectional Study. ACR Open Rheumatol 2022; 5:28-37. [PMID: 36461647 PMCID: PMC9837395 DOI: 10.1002/acr2.11512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/20/2022] [Accepted: 10/26/2022] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE This study assessed patient-reported outcomes (PROs) in individuals with persistently positive antiphospholipid antibodies (aPL) to better understand how living with aPL may affect their quality of life. METHODS Patients completed Patient-Reported Outcomes Measurement Information System Physical Function (PF) and Cognitive Function (CF) Short Forms as well as the pain intensity (PI) rating (scale of 1-10). Patients were characterized for demographics, clinical manifestations of antiphospholipid syndrome (APS), cardiovascular risk factors, laboratory test results, and medication usage. Multivariate modeling was done via linear regression. RESULTS Of 139 patients, 89 had primary APS, 21 had secondary APS, and 29 had persistent aPL without meeting clinical criteria for APS. The average T scores (±SD) for PF and CF were 45.4 ± 9.2 and 48.6 ± 11.6, respectively; the average for PI was 3.0 ± 2.6. Approximately half of the patients (47%) endorsed at least mild impairment in PF (T score < 45). Mean PF, CF, and PI did not differ between diagnostic groups. Individuals who endorsed more impairment on one measure also tended to endorse more impairment on another (Pearson r = 0.43-0.59). In the multivariate models, age, smoking, pain medications, and serotonergic medications were associated with impairment in at least one PRO domain. The Damage Index for APS was significantly correlated with both PF and CF. CONCLUSION Individuals living with APS endorsed more impairment in PF (and potentially CF) than expected for the general population. The relationship between certain medications and PROs warrants further study, as does the longitudinal trajectory of these and other PROs.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Yu Zuo
- University of MichiganAnn ArborMichigan
| | | | - Vivek Nagaraja
- University of Michigan, Ann Arbor, and Mayo ClinicScottsdaleArizona
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Stapleton S, Darlington ASE, de Bono JS, Wiseman T. What is the impact of targeted therapies given within phase I trials on the cognitive function of patients with advanced cancer: a mixed-methods exploratory study conducted in an early clinical trials unit. BMJ Open 2022; 12:e050590. [PMID: 36442900 PMCID: PMC9710342 DOI: 10.1136/bmjopen-2021-050590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Novel therapies such as small protein molecule inhibitors and immunotherapies are tested in early phase trials before moving to later phase trials and ultimately standard practice. A key aim of these clinical trials is to define a toxicity profile, however, the emphasis is often on safety with measurements of organ toxicity. Other subjective side effects can be under-reported because they are not measured formally within the trial protocols. The concern from clinical practice is that cognitive toxicity is poorly studied and may be under-reported in this context. This could lead to toxicity profiles of new treatments not being fully described and patients with unmet need in terms of acknowledgement and support of symptoms. This protocol outlines a framework of an exploratory study with feasibility aspects to investigate the impact and experience of cognitive changes for patients on phase I trials. METHODS AND ANALYSIS This is a mixed-methods study, combining quantitative and qualitative approaches. The sample is 30 patients with advanced cancer who are participating in phase I trials of novel therapies in the early clinical trials unit of a specialist cancer centre. A test battery of validated cognitive assessments will be taken alongside patient reported outcome measures at three time points from baseline, day eight and day 28 post start of treatment. At day 28, a semi-structured interview will be conducted and the narrative thematically analysed. Results will be integrated to offer a comprehensive description of cognitive function in this patient group. ETHICS AND DISSEMINATION The study has received full HRA and ethical approval. It is the first study to introduce formal cognitive assessments in a cancer phase I trial context. The study has the potential to highlight previously unreported side effects and more importantly unmet need in terms of care for patients who are participating in the trials.
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Affiliation(s)
- Sarah Stapleton
- Drug Development Unit, Royal Marsden Hospital Sutton, Sutton, UK
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | | | - J S de Bono
- Drug Development Unit, Royal Marsden Hospital Sutton, Sutton, UK
- Institute of Cancer Research Division of Cancer Therapeutics, London, UK
| | - Theresa Wiseman
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- The Royal Marsden NHS Foundation Trust, London, UK
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Park JY, Lengacher CA, Reich RR, Park HY, Whiting J, Nguyen AT, Rodríguez C, Meng H, Tinsley S, Chauca K, Gordillo-Casero L, Wittenberg T, Joshi A, Lin K, Ismail-Khan R, Kiluk JV, Kip KE. Translational Genomic Research: The Association between Genetic Profiles and Cognitive Functioning or Cardiac Function Among Breast Cancer Survivors Completing Chemotherapy. Biol Res Nurs 2022; 24:433-447. [PMID: 35499926 PMCID: PMC9630728 DOI: 10.1177/10998004221094386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: Emerging evidence suggests that Chemotherapy (CT) treated breast cancer survivors (BCS) who have "risk variants" in genes may be more susceptible to cognitive impairment (CI) and/or poor cardiac phenotypes. The objective of this preliminary study was to examine whether there is a relationship between genetic variants and objective/subjective cognitive or cardiac phenotypes. Methods and Analysis: BCS were recruited from Moffitt Cancer Center, Morsani College of Medicine, AdventHealth Tampa and Sarasota Memorial Hospital. Genomic DNA were collected at baseline for genotyping analysis. A total of 16 single nucleotide polymorphisms (SNPs) from 14 genes involved in cognitive or cardiac function were evaluated. Three genetic models (additive, dominant, and recessive) were used to test correlation coefficients between genetic variants and objective/subjective measures of cognitive functioning and cardiac outcomes (heart rate, diastolic blood pressure, systolic blood pressure, respiration rate, and oxygen saturation). Results: BCS (207 participants) with a mean age of 56 enrolled in this study. The majority were non-Hispanic white (73.7%), married (63.1%), and received both CT and radiation treatment (77.3%). Three SNPs in genes related to cognitive functioning (rs429358 in APOE, rs1800497 in ANKK1, rs10119 in TOMM40) emerged with the most consistent significant relationship with cognitive outcomes. Among five candidate SNPs related to cardiac functioning, rs8055236 in CDH13 and rs1801133 in MTHER emerged with potential significant relationships with cardiac phenotype. Conclusions: These preliminary results provide initial targets to further examine whether BCS with specific genetic profiles may preferentially benefit from interventions designed to improve cognitive and cardiac functioning following CT.
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Affiliation(s)
- Jong Y. Park
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA
| | | | - Richard R. Reich
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA
| | - Hyun Y. Park
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA
| | - Junmin Whiting
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA
| | - Anh Thy Nguyen
- Department of Epidemiology and
Biostatistics, USF College of Public Health, University of South
Florida, Tampa, FL, USA
| | | | - Hongdao Meng
- School of Aging Studies, College of
Behavioral and Community Sciences, University of South
Floridaa, Tampa, FL, USA
| | - Sara Tinsley
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA
| | | | | | | | - Anisha Joshi
- University of South Florida College
of Nursing, Tampa, FL, USA
| | - Katherine Lin
- University of South Florida College
of Nursing, Tampa, FL, USA
| | - Roohi Ismail-Khan
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA
| | - John V. Kiluk
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA
| | - Kevin E. Kip
- UPMC Health Services
Division, Pittsburgh, PA, USA
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Duval A, Davis CG, Khoo EL, Romanow H, Shergill Y, Rice D, Smith AM, Poulin PA, Collins B. Mindfulness-based stress reduction and cognitive function among breast cancer survivors: A randomized controlled trial. Cancer 2022; 128:2520-2528. [PMID: 35385137 DOI: 10.1002/cncr.34209] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/25/2022] [Accepted: 03/03/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Breast cancer (BC) survivors frequently report changes in cognition after chemotherapy. Mindfulness may benefit survivors by mitigating cancer-related cognitive impairment. As part of a larger study investigating the effects of mindfulness-based stress reduction (MBSR) for BC survivors living with neuropathic pain, the authors assessed whether MBSR would have an effect on cognitive outcomes. METHODS Participants were randomized to an MBSR intervention group (n = 30) or a waitlist control group (n = 30). Cognitive assessments were administered at 3 time points: at baseline, 2 weeks, and 3 months post-MBSR in the intervention group and at equivalent time intervals for the control group. Multilevel models were used to assess whether MBSR significantly improved task performance at each time point. RESULTS MBSR participants showed a significantly greater reduction in prospective and retrospective memory failures at 2 weeks postintervention. No effects of MBSR were noted for objective assessments. CONCLUSIONS These results suggest that MBSR training reduces subjective (but not objective) memory-related impairments in BC survivors who receive treatment with chemotherapy. This study provides insight into a noninvasive intervention to ameliorate memory difficulties in BC survivors.
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Affiliation(s)
- Alicia Duval
- Department of Psychology, Carleton University, Ottawa, Ontario, Canada
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | | | - Eve-Ling Khoo
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Heather Romanow
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Danielle Rice
- Department of Psychology, McGill University, Montreal, Quebec, Canada
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Andra M Smith
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Patricia A Poulin
- Department of Anesthesiology and Pain Medicine, The University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
- Department of Psychology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Barbara Collins
- Department of Psychology, Carleton University, Ottawa, Ontario, Canada
- Department of Psychology, The Ottawa Hospital, Ottawa, Ontario, Canada
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Whittaker AL, George RP, O'Malley L. Prevalence of cognitive impairment following chemotherapy treatment for breast cancer: a systematic review and meta-analysis. Sci Rep 2022; 12:2135. [PMID: 35136066 DOI: 10.1038/s41598-022-05682-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 01/17/2022] [Indexed: 12/22/2022] Open
Abstract
Breast cancer survival rates have markedly improved. Consequently, survivorship issues have received increased attention. One common sequel of treatment is chemotherapy-induced cognitive impairment (CICI). CICI causes a range of impairments that can have a significant negative impact on quality of life. Knowledge of the prevalence of this condition is required to inform survivorship plans, and ensure adequate resource allocation and support is available for sufferers, hence a systematic review of prevalence data was performed. Medline, Scopus, CINAHL and PSYCHInfo were searched for eligible studies which included prevalence data on CICI, as ascertained though the use of self-report, or neuropsychological tests. Methodological quality of included studies was assessed. Findings were synthesised narratively, with meta-analyses being used to calculate pooled prevalence when impairment was assessed by neuropsychological tests. The review included 52 studies. Time-points considered ranged from the chemotherapy treatment period to greater than 10 years after treatment cessation. Summary prevalence figures (across time-points) using self-report, short cognitive screening tools and neuropsychological test batteries were 44%, 16% and 21–34% respectively (very low GRADE evidence). Synthesised findings demonstrate that 1 in 3 breast cancer survivors may have clinically significant cognitive impairment. Prevalence is higher when self-report based on patient experience is considered. This review highlights a number of study design issues that may have contributed to the low certainty rating of the evidence. Future studies should take a more consistent approach to the criteria used to assess impairment. Larger studies are urgently needed.
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Dias-Carvalho A, Ferreira M, Ferreira R, Bastos MDL, Sá SI, Capela JP, Carvalho F, Costa VM. Four decades of chemotherapy-induced cognitive dysfunction: comprehensive review of clinical, animal and in vitro studies, and insights of key initiating events. Arch Toxicol 2021; 96:11-78. [PMID: 34725718 DOI: 10.1007/s00204-021-03171-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 09/23/2021] [Indexed: 01/22/2023]
Abstract
Cognitive dysfunction has been one of the most reported and studied adverse effects of cancer treatment, but, for many years, it was overlooked by the medical community. Nevertheless, the medical and scientific communities have now recognized that the cognitive deficits caused by chemotherapy have a strong impact on the morbidity of cancer treated patients. In fact, chemotherapy-induced cognitive dysfunction or 'chemobrain' (also named also chemofog) is at present a well-recognized effect of chemotherapy that could affect up to 78% of treated patients. Nonetheless, its underlying neurotoxic mechanism is still not fully elucidated. Therefore, this work aimed to provide a comprehensive review using PubMed as a database to assess the studies published on the field and, therefore, highlight the clinical manifestations of chemobrain and the putative neurotoxicity mechanisms.In the last two decades, a great number of papers was published on the topic, mainly with clinical observations. Chemotherapy-treated patients showed that the cognitive domains most often impaired were verbal memory, psychomotor function, visual memory, visuospatial and verbal learning, memory function and attention. Chemotherapy alters the brain's metabolism, white and grey matter and functional connectivity of brain areas. Several mechanisms have been proposed to cause chemobrain but increase of proinflammatory cytokines with oxidative stress seem more relevant, not excluding the action on neurotransmission and cellular death or impaired hippocampal neurogenesis. The interplay between these mechanisms and susceptible factors makes the clinical management of chemobrain even more difficult. New studies, mainly referring to the underlying mechanisms of chemobrain and protective measures, are important in the future, as it is expected that chemobrain will have more clinical impact in the coming years, since the number of cancer survivors is steadily increasing.
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Affiliation(s)
- Ana Dias-Carvalho
- Associate Laboratory i4HB-Institute for Health and Bioeconomy, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313, Porto, Portugal. .,UCIBIO-Applied Molecular Biosciences Unit, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313, Porto, Portugal.
| | - Mariana Ferreira
- Associate Laboratory i4HB-Institute for Health and Bioeconomy, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313, Porto, Portugal.,UCIBIO-Applied Molecular Biosciences Unit, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313, Porto, Portugal.,LAQV/REQUIMTE, Department of Chemistry, University of Aveiro, Aveiro, Portugal
| | - Rita Ferreira
- LAQV/REQUIMTE, Department of Chemistry, University of Aveiro, Aveiro, Portugal
| | - Maria de Lourdes Bastos
- Associate Laboratory i4HB-Institute for Health and Bioeconomy, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313, Porto, Portugal.,UCIBIO-Applied Molecular Biosciences Unit, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313, Porto, Portugal
| | - Susana Isabel Sá
- Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal.,Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - João Paulo Capela
- Associate Laboratory i4HB-Institute for Health and Bioeconomy, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313, Porto, Portugal.,UCIBIO-Applied Molecular Biosciences Unit, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313, Porto, Portugal.,Faculdade de Ciências da Saúde, Universidade Fernando Pessoa, Porto, Portugal
| | - Félix Carvalho
- Associate Laboratory i4HB-Institute for Health and Bioeconomy, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313, Porto, Portugal.,UCIBIO-Applied Molecular Biosciences Unit, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313, Porto, Portugal
| | - Vera Marisa Costa
- Associate Laboratory i4HB-Institute for Health and Bioeconomy, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313, Porto, Portugal. .,UCIBIO-Applied Molecular Biosciences Unit, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313, Porto, Portugal.
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Syed Alwi SM, Narayanan V, Che Din N, Mohd Taib NA. Cognitive Rehabilitation Programs for Survivors of Breast Cancer Treated With Chemotherapy: A Systematic Review. Rehabilitation Oncology 2021; 39:155-67. [DOI: 10.1097/01.reo.0000000000000268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Janelsins MC, Mohamed M, Peppone LJ, Magnuson A, Belcher EK, Melnik M, Dakhil S, Geer J, Kamen C, Minasian L, Reagan PM, Mohile SG, Morrow GR, Ahles TA, Heckler CE. Longitudinal Changes in Cognitive Function in a Nationwide Cohort Study of Patients With Lymphoma Treated With Chemotherapy. J Natl Cancer Inst 2021; 114:47-59. [PMID: 34255086 PMCID: PMC8755506 DOI: 10.1093/jnci/djab133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 04/29/2021] [Accepted: 07/12/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Cancer-related cognitive decline (CRCD) is an important clinical problem, but limited research exists on assessment of cognitive function in patients with lymphoma. METHODS The overall objective of this nationwide, prospective, observational study conducted in the National Cancer Institute Community Clinical Oncology Research Program (NCORP) was to assess changes in memory, attention, and executive function in patients with lymphoma from pre- (A1) to postchemotherapy (A2) and to 6 months postchemotherapy (A3). Individuals without cancer served as noncancer controls, paired to patients by age and sex, and assessed at the same time-equivalent points. Longitudinal linear mixed models (LMM) including A1, A2, and A3 and adjusting for age, education, race, sex, cognitive reserve score, baseline anxiety, and depressive symptoms were fit. We assessed changes in patients compared with control participants without cancer and assessed differences in cognitive function in those patients with Hodgkin vs non-Hodgkin disease and by disease subtype. All statistical tests were 2-sided. RESULTS Patients with lymphoma (n = 248) and participants without cancer serving as controls (n = 212) were recruited from 19 NCORP sites. From pre- to postchemotherapy and from prechemotherapy to 6 months follow-up, patients reported more cognitive problems over time compared with controls (Functional Assessment of Cancer-Therapy-Cognitive Function [FACT-Cog] perceived cognitive impairment effect size (ES) = 0.83 and 0.84 for A1 to A2 and A1 to A3, respectively; P < .001; single-item cognitive symptoms ES range = 0.55 to 0.70 inclusive of A1 to A2 and A1 to A3; P < .001); the complaints were more pronounced in women with lymphoma compared with men with lymphoma (FACT-Cog Perceived Cognitive Impairment (PCI) score group-by-time-by-sex interaction, P = .007). Patients with lymphoma also performed statistically significantly less well on tests of verbal memory and delayed recall, attention and executive function, and telephone-based category fluency. CONCLUSION Patients with lymphoma experience worse patient-reported and objectively assessed cognitive function from prechemotherapy to 6-month follow-up compared with age- and sex-paired controls without cancer assessed at similar time intervals.
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Affiliation(s)
- Michelle C Janelsins
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY, USA,Correspondence to: Michelle C. Janelsins, PhD, MPH, University of Rochester Medical Center, James P. Wilmot Cancer Institute, Associate Professor, Department of Surgery, Division of Supportive Care in Cancer, Associate Professor of Neuroscience, Oncology and Radiation Oncology, 265 Crittenden Blvd, CU 420658, Rochester, NY 14642, USA (e-mail: )
| | - Mostafa Mohamed
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY, USA
| | - Luke J Peppone
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY, USA
| | - Allison Magnuson
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY, USA
| | - Elizabeth K Belcher
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY, USA
| | - Marianne Melnik
- Cancer Research Consortium of West Michigan NCI Community Oncology Research Program, Grand Rapids, MI, USA
| | - Shaker Dakhil
- Wichita NCI Community Oncology Research Program, Wichita, KS, USA
| | - Jodi Geer
- Metro Minnesota Community Oncology Research Program, Saint Louis Park, MN, USA
| | - Charles Kamen
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY, USA
| | | | - Patrick M Reagan
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY, USA
| | - Supriya G Mohile
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY, USA
| | - Gary R Morrow
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY, USA
| | - Tim A Ahles
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Charles E Heckler
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY, USA
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Park HY, Lee H, Sohn J, An SK, Namkoong K, Lee E. Increased resting-state cerebellar-cortical connectivity in breast cancer survivors with cognitive complaints after chemotherapy. Sci Rep 2021; 11:12105. [PMID: 34103606 DOI: 10.1038/s41598-021-91447-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/25/2021] [Indexed: 11/08/2022] Open
Abstract
Cognitive complaints after chemotherapy are common in breast cancer patients, but the neural bases for these complaints remain unclear. This pilot study explored resting-state functional connectivity (FC) as a marker of subtle cognitive changes in breast cancer patients who experience cognitive complaints. Chemotherapy-treated (n = 20, at least 6 months off therapy) and untreated (n = 17, disease-control) female breast cancer patients with cognitive complaints and healthy controls (n = 20) were recruited. The FC of the right dorsolateral prefrontal cortex was calculated, and any correlations between this FC and neuropsychological assessments were determined. Chemotherapy-treated patients with cognitive complaints displayed increased FC between the right dorsolateral prefrontal cortex and both the contralateral cerebellar lobule VII and the cerebellar vermis XI, compared to the disease-control and healthy-control groups, despite unimpaired neuropsychological performance. The increased FC was negatively correlated with executive function and attention in breast cancer survivors with cognitive complaints. Our pilot study findings provide evidence that cerebellar-cortical FC changes may be a pathophysiological basis for chemotherapy-related cognitive complaints. In addition, the FC changes have the potential to reflect minor or compensated cognitive function impairment in breast cancer patients.
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Smith TM, Wang W. Comparison of a standard computer-assisted cognitive training program to a music enhanced program: A mixed methods study. Cancer Rep (Hoboken) 2021; 4:e1325. [PMID: 33301652 PMCID: PMC8451368 DOI: 10.1002/cnr2.1325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/27/2020] [Accepted: 11/05/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Between 17 and 75% of breast cancer survivors (BCS) experience long-term cognitive deficits such as deficits in memory, attention, processing speed, and executive function. AIMS This study aimed to (a) compare effects of a standard computer-assisted cognitive training (CACT) program to a CACT program enhanced with music (CACT+A) to improve focus and concentration on BCS' memory, cognition, quality of life (QOL), and participation in everyday activities; and (b) garner participants' perspectives of effects of the programs to determine best practice. METHODS An embedded design was employed in this mixed methods study. Participants who reported cognitive problems were recruited through breast cancer support groups. Four pre and post-tests were used followed by a qualitative interview. RESULTS Twenty-five BCS, ages 31 to 72 years participated. The CACT group demonstrated significantly improved pre to post-test scores for working memory, QOL, and three subscales of the Model of Human Occupation Screening Tool (MOHOST) measuring participation in everyday activities. The CACT+A group had significant improvement for four FACT-Cog cognitive function subscales and the total score. Five themes emerged from the interview: Cognitive skill, Strategy learned, No change, QOL factors, and Participation in everyday activities. The CACT+A group expressed experiencing a larger ratio of improvements, most notably for memory and QOL factors. CONCLUSION CACT+A is an auspicious intervention option for BCS who self-report cognitive issues. It is convenient to participate in at home and allows BCS to safely self-isolate if need be. This study is a registered clinical trial protocol: TexasWU record 19 959.
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12
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Harrison RA, Rao V, Kesler SR. The association of genetic polymorphisms with neuroconnectivity in breast cancer patients. Sci Rep 2021; 11:6169. [PMID: 33731765 DOI: 10.1038/s41598-021-85768-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 03/02/2021] [Indexed: 11/21/2022] Open
Abstract
Genetic polymorphisms in select genes, including APOE (apolipoprotein E), COMT (Catechol-O-Methyltransferase), MDR1 (multi-drug resistance 1), BDNF (brain derived neurotrophic factor), and GST (glutathione-S-transferase), have been associated with vulnerability to cognitive impairment. In this study, we evaluated the relationship of these genetic variants to measures of brain health in patients with breast cancer, including neurocognitive testing and functional connectome analysis. Women with breast cancer (n = 83) and female healthy controls (n = 53) were evaluated. They underwent resting-state functional MRI scans and neurocognitive testing. Polymerase chain reaction (PCR) was performed on saliva samples to identify single nucleotide polymorphisms (SNPs) in candidate genes: APOE, COMT, MDR1, BDNF, and GST. Breast cancer patients treated with chemotherapy had slower processing speed (p = 0.04) and poorer reported executive function (p < 0.0001) than healthy controls. Those chemotherapy-treated patients that were APOE e4 carriers had significantly slower processing speed. A greater number of risk-related alleles was associated with poorer connectivity in the regions of the left cuneus and left calcarine. While breast cancer patients that are APOE e4 carriers may have a select vulnerability to processing speed impairments, other risk-related alleles were not found to influence cognitive test performance in this population. Conversely, regions of impaired functional connectivity appeared to be related to risk-related genetic polymorphisms in breast cancer patients. This suggests that a cancer patient’s SNPs in candidate genes may influence the risk of neurotoxicity. Further study evaluating the impact of genotype on biomarkers of brain health in cancer survivors is warranted.
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Dijkshoorn ABC, van Stralen HE, Sloots M, Schagen SB, Visser-Meily JMA, Schepers VPM. Prevalence of cognitive impairment and change in patients with breast cancer: A systematic review of longitudinal studies. Psychooncology 2021; 30:635-648. [PMID: 33533166 PMCID: PMC8248098 DOI: 10.1002/pon.5623] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 12/23/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Patients with breast cancer face cognitive impairment that affects their quality of life; partially attributable to treatment. Our aim was to detail the prevalence and change of cognitive impairment during the course of treatment. We also investigated the effect of therapy (chemotherapy [CT]) vs. radiotherapy and/or endocrine therapy vs. healthy controls). METHODS This article reviews longitudinal cohort studies published to date in Medline and Embase that (i) assess cognition before and after therapy, (ii) report prevalence cognitive impairment or change, and (iii) use standardized and valid neuropsychological tests. We used the original authors' criteria for cognitive impairment. RESULTS The title and abstract of 891 articles were screened, resulting in the identification of 90 potentially relevant articles while applying the eligibility criteria. After full-text examination, 17 studies were included. Prevalence of cognitive impairment range from 25% before therapy, through 24% after therapy to 21% at maximal 1-year follow-up (FU). Compared to their pretreatment cognitive functioning, 24% of patients decline after treatment and 24% at 1-year FU. Some studies also reported cognitive improvement showing that 15% and 31% of patients improve, respectively. In general, patients undergoing CT have a higher chance of cognitive impairment and decline than no-CT patients and healthy controls. CONCLUSIONS This study shows that one out of four breast cancer patients shows cognitive impairment prior to treatment administration CT and a significant number of patients decline during the course of disease, suggesting that cognitive impairment is not exclusively related to CT and/or no-CT therapies. This study shows that assessment of cognitive functioning, ideally over time, is crucial and may help the implementation of personalized rehabilitation pathways.
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Affiliation(s)
- Aicha B C Dijkshoorn
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Haike E van Stralen
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maurits Sloots
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sanne B Schagen
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Johanna M A Visser-Meily
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands.,Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Vera P M Schepers
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands.,Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
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Rodríguez Martín B, Fernández Rodríguez EJ, Rihuete Galve MI, Cruz Hernández JJ. Study of Chemotherapy-Induced Cognitive Impairment in Women with Breast Cancer. Int J Environ Res Public Health 2020; 17:ijerph17238896. [PMID: 33265966 PMCID: PMC7730121 DOI: 10.3390/ijerph17238896] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/02/2020] [Accepted: 11/26/2020] [Indexed: 11/29/2022]
Abstract
Background: Oncology patients experience a large number of symptoms and, those referring to cognitive performance has an ever-increasing importance in clinical practice, due to the increase in survival rates and interest in the patient’s quality of life. The studies reviewed showed that chemotherapy-related cognitive impairment might occur in 15 and 50% of oncology patients. The main objective of this research was to study the impact of chemotherapy on the cognitive function of patients with locoregional breast cancer. Method: Analytical, prospective, longitudinal study using three measures, unifactorial intrasubject design, non-probability, and random selection sampling. The sample comprised women newly diagnosed with locoregional breast cancer in stages I, II, IIIA who received chemotherapy at the University Hospital of Salamanca (Complejo Asistencial Universitario de Salamanca), randomly selected for three years. Semi-structured interviews were conducted, and anxiety and depression (Hospital Anxiety and Depression scale, HAD); quality of life (QLQ-BR23 scale) and the following cognitive variables were assessed—processing speed, attention, memory, and executive functions (subtests of the Wechsler Intelligence Scale and the Trail Making Test). Results: The final sample size included 151 participants; 23 were excluded. A decline in cognitive performance was observed in patients, which did not completely recover two months after chemotherapy was completed. Additionally, worse cognitive performance was observed in patients with anxious or depressive symptoms. There was a negative impact on the quality of life. Conclusion: Chemotherapy had an impact on the cognitive performance of oncology patients in most cognitive domains studied.
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Affiliation(s)
- Blanca Rodríguez Martín
- Medical Oncology Service, Salamanca University Hospital, 37007 Salamanca, Spain; (E.J.F.R.); (M.I.R.G.); (J.J.C.H.)
- Correspondence:
| | - Eduardo José Fernández Rodríguez
- Medical Oncology Service, Salamanca University Hospital, 37007 Salamanca, Spain; (E.J.F.R.); (M.I.R.G.); (J.J.C.H.)
- Nursing and Physiotherapy Department, University of Salamanca, 37007 Salamanca, Spain
| | - María Isabel Rihuete Galve
- Medical Oncology Service, Salamanca University Hospital, 37007 Salamanca, Spain; (E.J.F.R.); (M.I.R.G.); (J.J.C.H.)
- Nursing and Physiotherapy Department, University of Salamanca, 37007 Salamanca, Spain
| | - Juan Jesús Cruz Hernández
- Medical Oncology Service, Salamanca University Hospital, 37007 Salamanca, Spain; (E.J.F.R.); (M.I.R.G.); (J.J.C.H.)
- Medicine Department, University of Salamanca, 37007 Salamanca, Spain
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15
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Floyd R, Dyer AH, Kennelly SP. Non-pharmacological interventions for cognitive impairment in women with breast cancer post-chemotherapy: A systematic review. J Geriatr Oncol 2020; 12:173-181. [PMID: 32536427 DOI: 10.1016/j.jgo.2020.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/29/2020] [Accepted: 05/27/2020] [Indexed: 12/29/2022]
Abstract
PURPOSE Cognitive impairment is a well-reported side-effect of chemotherapy in persons with breast cancer. Whilst non-pharmacological interventions have proven efficacious in the management of cognitive impairment in high-risk groups, their efficacy in cognitive impairment post-chemotherapy in patients with breast cancer remains unclear. METHODS Medline, CINAHL, PsycINFO, Web of Science and Cochrane were searched for randomized controlled trials of non-pharmacological interventions for cognitive impairment post-chemotherapy in women with breast cancer. RESULTS Of 429 results, 83 full-texts were reviewed with ten meeting inclusion criteria. Interventions included cognitive training, exercise and complementary therapies. The non-pharmacological interventions assessed displayed variable benefits in subjective and/or objective cognitive assessments, with no strong evidence for beneficial effects across included studies. No studies assessed the efficacy of multi-domain interventions. CONCLUSIONS There is mixed evidence supporting non-pharmacological interventions for cognitive impairment post-chemotherapy in women with breast cancer. Moving forward, multidomain trials combining non-pharmacological interventions are imperative in this high risk cohort.
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Affiliation(s)
- Ruairí Floyd
- Graduate Entry Medical School, University of Limerick, Ireland.
| | - Adam H Dyer
- Department of Age-related Healthcare, Tallaght University Hospital, Ireland; Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Ireland
| | - Seán P Kennelly
- Department of Age-related Healthcare, Tallaght University Hospital, Ireland; Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Ireland
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16
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Cerulla Torrente N, Navarro Pastor JB, de la Osa Chaparro N. Systematic review of cognitive sequelae of non-central nervous system cancer and cancer therapy. J Cancer Surviv 2020; 14:464-82. [PMID: 32146576 DOI: 10.1007/s11764-020-00870-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 02/22/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The aim of this review is to provide an updated overview of chemotherapy-related cognitive impairment (CRCI) in patients with cancer outside central nervous system (CNS), its incidence and prevalence, the cognitive pattern in neuropsychological studies, neuroimaging findings, and the relationship between chemobrain and aging. Methodological limitations of studies are also discussed. METHODS This review was guided by the PRISMA statement. The MEDLINE and Scopus databases were employed to search articles about CRCI in non-CNS cancer patients published from January 2004 to September 2019. Two types of research were reviewed: prospective studies addressing the effects of chemotherapy on cognition and systematic reviews about factors related with CRCI, also as neuroimaging findings and current available treatments. RESULTS Fifty-nine studies meeting the criteria were analyzed: 47 were longitudinal studies on cancer and cognition and 12 were reviews on risk factors, neuroimaging, and treatment. The majority of studies find cognitive impairment in patients with cancer treated with chemotherapy. The body of the literature on breast cancer is the most abundant, but there are also studies on colorectal, testicular, and lung cancer. Neuroimaging studies show changes in structure and activation in patients undergoing chemotherapy. Non-pharmacological treatment is effective for improving cognition and quality of life. CONCLUSIONS The occurrence of CRCI during the course of treatment in people with different types of cancer is frequent. Some risk factors have been identified, but CRCI is a complex phenomenon, with mediating factors related to cancer and treatment and moderating factors related with lifestyle and health. IMPLICATIONS FOR CANCER SURVIVORS This review highlights the importance of recognizing that this cognitive dysfunction is frequent, mild to moderate in nature but with great impact on quality of life.
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Abstract
Background Neurotoxicity is a frequent side effect of cytotoxic chemotherapy and affects a large number of patients. Despite the high medical need, few research efforts have addressed the impact of cytotoxic agents on cognition (ie, postchemotherapy cognitive impairment; PCCI). One unsolved question is whether individual cytotoxic drugs have differential effects on cognition. We thus examine the current state of research regarding PCCI. Neurological symptoms after targeted therapies and immunotherapies are not part of this review. Methods A literature search was conducted in the PubMed database, and 1215 articles were reviewed for predefined inclusion and exclusion criteria. Thirty articles were included in the systematic review. Results Twenty-five of the included studies report significant cognitive impairment. Of these, 21 studies investigated patients with breast cancer. Patients mainly received combinations of 5-fluorouracil, epirubicin, cyclophosphamide, doxorubicin, and taxanes (FEC/FEC-T). Five studies found no significant cognitive impairment in chemotherapy patients. Of these, 2 studies investigated patients with colon cancer receiving 5-fluorouracil and oxaliplatin (FOLFOX). Independent risk factors for PCCI were patient age, mood alterations, cognitive reserve, and the presence of apolipoprotein E e4 alleles. Conclusions There is evidence that certain chemotherapy regimens cause PCCI more frequently than others as evidenced by 21 out of 23 studies in breast cancer patients (mainly FEC-T), whereas 2 out of 3 studies with colon cancer patients (FOLFOX) did not observe significant changes. Further studies are needed defining patient cohorts by treatment protocol in addition to cancer type to elucidate the effects of individual cytotoxic drugs on cognitive functions.
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Affiliation(s)
- Petra Huehnchen
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik und Hochschulambulanz für Neurologie, Germany.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Cluster of Excellence NeuroCure, Germany.,Berlin Institute of Health, Germany
| | - Antonia van Kampen
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik und Hochschulambulanz für Neurologie, Germany
| | - Wolfgang Boehmerle
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik und Hochschulambulanz für Neurologie, Germany.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Cluster of Excellence NeuroCure, Germany
| | - Matthias Endres
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik und Hochschulambulanz für Neurologie, Germany.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Cluster of Excellence NeuroCure, Germany.,Berlin Institute of Health, Germany.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Stroke Research Berlin, Germany.,German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany.,DZHK (German Center for Cardiovascular Research), partner site Berlin, Germany
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18
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Di Iulio F, Cravello L, Shofany J, Paolucci S, Caltagirone C, Morone G. Neuropsychological disorders in non-central nervous system cancer: a review of objective cognitive impairment, depression, and related rehabilitation options. Neurol Sci 2019; 40:1759-1774. [PMID: 31049790 DOI: 10.1007/s10072-019-03898-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 04/12/2019] [Indexed: 01/17/2023]
Abstract
AIM The objective of the present review was to systematically characterize the types of cognitive impairment that are found in different non-brain types of cancer as measured by objective and validated tests, and also to further examine depression and cognitive function in cancer patients and explore their available rehabilitation treatments. RESULTS A total of 29 articles were reviewed. Most of these studies suggest that chemotherapy as well as the combination of chemotherapy and hormonal therapy can influence cognition in different types of cancer patients. Breast cancer patients appear to be the most affected in neuropsychological function, specifically in terms of cognitive impairment and reduced quality of life, as compared to other non-brain solid tumours. Overall, the most impaired functions were verbal ability, memory, executive function, and motor speed. CONCLUSION Chemotherapy-related cognitive dysfunction remains under-recognized and undertreated. The various studies reported differing and non-homogenous findings with mixed results, obtained by self-reporting and web-assisted assessment, with other confounding factors such as age and depression during both cancer diagnosis and treatment. An objective neuropsychological assessment is fundamental to avoid underestimation of the extent of chemobrain. Self-reported and web-assisted assessment may ultimately result in confusion between the neuropsychological signs of chemobrain versus those of depression.
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Affiliation(s)
| | - Luca Cravello
- Centro Regionale Alzheimer ASST Rhodense, Passirana di Rho Hospital, Milan, Italy
| | | | | | - Carlo Caltagirone
- IRCCS Fondazione Santa Lucia, Rome, Italy
- Università degli Studi di Roma Tor Vergata, Rome, Italy
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Sales MVC, Suemoto CK, Apolinario D, Serrao V, Andrade CS, Conceição DM, Amaro E, de Melo BAR, Riechelmann RP. Effects of Adjuvant Chemotherapy on Cognitive Function of Patients With Early-stage Colorectal Cancer. Clin Colorectal Cancer 2019; 18:19-27. [DOI: 10.1016/j.clcc.2018.09.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 09/04/2018] [Accepted: 09/10/2018] [Indexed: 01/03/2023]
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Li TY, Chen VCH, Yeh DC, Huang SL, Chen CN, Chai JW, Chen CCC, Weng JC. Investigation of chemotherapy-induced brain structural alterations in breast cancer patients with generalized q-sampling MRI and graph theoretical analysis. BMC Cancer 2018; 18:1211. [PMID: 30514266 PMCID: PMC6280365 DOI: 10.1186/s12885-018-5113-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 11/20/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Breast neoplasms are the most common cancer among women in Taiwan. Cognitive deficits are common complications of breast cancer survivors treated with chemotherapy. The most frequently observed disorders involve executive function and memory impairment. With improvements in tumor intervention and the consequent increase in the number of cancer survivors, the quality of life of patients has become an important issue. We are interested in the early effects of chemotherapy on the brain structures of patients. In addition, generalized q-sampling imaging (GQI), a wide range of q-space datasets for a more accurate and sophisticated diffusion MR approach, was first used in this topic. METHODS As diffusion tensor imaging (DTI) is associated with restrictions in the resolution of crossing fibers, we attempted to use GQI, which can overcome these difficulties and is advantageous over DTI for tractography of the crossing fibers. This cross-sectional study included two groups: breast cancer survivors who had completed their chemotherapy (n = 19) and healthy controls (n = 20). All participants underwent diffusion MRI exams and neuropsychological assessments. We included four parts in our image analysis, i.e., voxel-based statistical analysis, multiple regression analysis, graph theoretical analysis and network-based statistical analysis. RESULTS The results from the voxel-based statistical analysis showed significantly lower GFA and NQA values in the breast cancer group than those in the control group. We found significant positive correlations between the FACT-Cog and GQI indices. In the graph theoretical analysis, the breast cancer group demonstrated significantly longer characteristic path length. Adjuvant chemotherapy affected the integrity of white matter and resulted in poor cognitive performance, as indicated by the correlations between the neuropsychological assessment scales and the GQI indices. In addition, it was found that the characteristic path lengths in the breast cancer group increased, indicating that the brain network integration became worse. CONCLUSIONS Our study demonstrated alterations in structural brain networks and associated neuropsychological deficits among breast cancer survivors.
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Affiliation(s)
- Tsung-Yuan Li
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Vincent Chin-Hung Chen
- School of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Dah-Cherng Yeh
- Breast Medical Center, Cheng Ching Hospital Chung Kang Branch, Taichung, Taiwan
| | - Shu-Ling Huang
- Department of Psychology, Chung Shan Medical University, Taichung, Taiwan
| | - Cheng-Nan Chen
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jyh-Wen Chai
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - Clayton Chi-Chang Chen
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Medical Education, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jun-Cheng Weng
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi, Taiwan. .,Department of Medical Imaging and Radiological Sciences, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, 33302, Taiwan.
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Anderson DE, Bhatt VR, Schmid K, Lunning M, Holstein SA, Rizzo M. Electrophysiological Measure of Impaired Information Processing in Drivers with Hematological Malignancy. Transp Res Rec 2018; 2672:64-73. [PMID: 31031516 PMCID: PMC6482833 DOI: 10.1177/0361198118791666] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
The broad goal of this study is to measure remote effects of cancer on brain physiology and behaviors that underpin instrumental activities of daily living such as automobile driving. Studies of hematological malignancies (HM) have demonstrated impairments in multiple brain functions shown to be critical for safe automobile driving. In the current pilot study, brain physiology during driving simulation was examined in 14 HM patients and 13 healthy comparison drivers. Electroencephalography was used to measure the eye fixation-related potential (EFRP)-a positive amplitude deflection evoked approximately 100 milliseconds after eye movement termination. Previous studies have demonstrated sensitivity of EFRP activity to information-processing capacity. All drivers completed visual search tasks to evaluate the relationship between driving-related changes in performance and EFRP activity. Results showed smaller EFRP amplitudes in drivers who had: (1) greater driving-related changes in visual search performance (p = 0.03, Cohen's d = 0.91); and (2) HM diagnosis (p = 0.18, Cohen's d = 0.54). Extending previous studies, these results provide neural evidence of reduced information-processing capacity associated with cancer diagnosis. Future large-scale studies are needed to confirm these results, given the high level of uncertainty and small sample size. This study provides a novel platform for linking changes in brain physiology and safety-critical driving behaviors.
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Affiliation(s)
- David E. Anderson
- Department of Neurological Sciences, University of Nebraska Medical Center, Nebraska Medical Center, Omaha, NE
| | - Vijaya R. Bhatt
- Department of Internal Medicine, Division of Oncology & Hematology, Nebraska Medical Center, Omaha, NE
| | - Kendra Schmid
- Department of Biostatistics, University of Nebraska Medical Center, Nebraska Medical Center, Omaha, NE
| | - Matthew Lunning
- Department of Internal Medicine, Division of Oncology & Hematology, Nebraska Medical Center, Omaha, NE
| | - Sarah A. Holstein
- Department of Internal Medicine, Division of Oncology & Hematology, Nebraska Medical Center, Omaha, NE
| | - Matthew Rizzo
- Department of Neurological Sciences, University of Nebraska Medical Center, Nebraska Medical Center, Omaha, NE
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Janelsins MC, Heckler CE, Peppone LJ, Ahles TA, Mohile SG, Mustian KM, Palesh O, O’Mara AM, Minasian LM, Williams AM, Magnuson A, Geer J, Dakhil SR, Hopkins JO, Morrow GR. Longitudinal Trajectory and Characterization of Cancer-Related Cognitive Impairment in a Nationwide Cohort Study. J Clin Oncol 2018; 36:JCO2018786624. [PMID: 30240328 PMCID: PMC6225503 DOI: 10.1200/jco.2018.78.6624] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Cancer-related cognitive impairment (CRCI) is an important clinical problem in patients with breast cancer receiving chemotherapy. Nationwide longitudinal studies are needed to understand the trajectory and severity of CRCI in specific cognitive domains. PATIENTS AND METHODS The overall objective of this nationwide, prospective, observational study conducted within the National Cancer Institute Community Clinical Oncology Research Program was to assess trajectories in specific cognitive domains in patients with breast cancer (stage I-IIIC) receiving chemotherapy, from pre- (A1) to postchemotherapy (A2) and from prechemotherapy to 6 months postchemotherapy (A3); controls were assessed at the same time-equivalent points. The primary aim assessed visual memory using the Cambridge Neuropsychological Test Automated Battery Delayed Match to Sample test by longitudinal mixed models including A1, A2, and A3 and adjusting for age, education, race, cognitive reserve score, and baseline anxiety and depressive symptoms. We also assessed trajectories of CRCI in other aspects of memory as well as in attention and executive function with computerized, paper-based, and telephone-based cognitive tests. RESULTS In total, 580 patients with breast cancer (mean age, 53.4 years) and 363 controls (mean age, 52.6 years) were assessed. On the Delayed Match to Sample test, the longitudinal mixed model results revealed a significant group-by-time effect ( P < .005); patients declined over time from prechemotherapy (A1) to 6 months postchemotherapy (A3; P = .005), but controls did not change ( P = .426). The group difference between patients and controls was also significant, revealing declines in patients but not controls ( P = .017). Several other models of computerized, standard, and telephone tests indicated significantly worse performance by patients compared with controls from pre- to postchemotherapy and from prechemotherapy to 6 months postchemotherapy. CONCLUSION This nationwide study showed CRCI in patients with breast cancer affects multiple cognitive domains for at least 6 months postchemotherapy.
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Affiliation(s)
- Michelle C. Janelsins
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Supriya G. Mohile, Karen M. Mustian, Annalynn M. Williams, Allison Magnuson, and Gary R. Morrow, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Oxana Palesh, Stanford Cancer Center, Stanford, CA; Ann M. O’Mara and Lori M. Minasian, National Cancer Institute (NCI), National Institutes of Health, Rockville, MD; Jodi Geer, Metro Minnesota NCI Community Oncology Research Program (NCORP), Saint Louis Park, MN; Shaker R. Dakhil, Wichita NCORP, Wichita, KS; and Judith O. Hopkins, Southeast Clinical Oncology Research Consortium NCORP, Winston-Salem, NC
| | - Charles E. Heckler
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Supriya G. Mohile, Karen M. Mustian, Annalynn M. Williams, Allison Magnuson, and Gary R. Morrow, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Oxana Palesh, Stanford Cancer Center, Stanford, CA; Ann M. O’Mara and Lori M. Minasian, National Cancer Institute (NCI), National Institutes of Health, Rockville, MD; Jodi Geer, Metro Minnesota NCI Community Oncology Research Program (NCORP), Saint Louis Park, MN; Shaker R. Dakhil, Wichita NCORP, Wichita, KS; and Judith O. Hopkins, Southeast Clinical Oncology Research Consortium NCORP, Winston-Salem, NC
| | - Luke J. Peppone
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Supriya G. Mohile, Karen M. Mustian, Annalynn M. Williams, Allison Magnuson, and Gary R. Morrow, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Oxana Palesh, Stanford Cancer Center, Stanford, CA; Ann M. O’Mara and Lori M. Minasian, National Cancer Institute (NCI), National Institutes of Health, Rockville, MD; Jodi Geer, Metro Minnesota NCI Community Oncology Research Program (NCORP), Saint Louis Park, MN; Shaker R. Dakhil, Wichita NCORP, Wichita, KS; and Judith O. Hopkins, Southeast Clinical Oncology Research Consortium NCORP, Winston-Salem, NC
| | - Tim A. Ahles
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Supriya G. Mohile, Karen M. Mustian, Annalynn M. Williams, Allison Magnuson, and Gary R. Morrow, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Oxana Palesh, Stanford Cancer Center, Stanford, CA; Ann M. O’Mara and Lori M. Minasian, National Cancer Institute (NCI), National Institutes of Health, Rockville, MD; Jodi Geer, Metro Minnesota NCI Community Oncology Research Program (NCORP), Saint Louis Park, MN; Shaker R. Dakhil, Wichita NCORP, Wichita, KS; and Judith O. Hopkins, Southeast Clinical Oncology Research Consortium NCORP, Winston-Salem, NC
| | - Supriya G. Mohile
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Supriya G. Mohile, Karen M. Mustian, Annalynn M. Williams, Allison Magnuson, and Gary R. Morrow, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Oxana Palesh, Stanford Cancer Center, Stanford, CA; Ann M. O’Mara and Lori M. Minasian, National Cancer Institute (NCI), National Institutes of Health, Rockville, MD; Jodi Geer, Metro Minnesota NCI Community Oncology Research Program (NCORP), Saint Louis Park, MN; Shaker R. Dakhil, Wichita NCORP, Wichita, KS; and Judith O. Hopkins, Southeast Clinical Oncology Research Consortium NCORP, Winston-Salem, NC
| | - Karen M. Mustian
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Supriya G. Mohile, Karen M. Mustian, Annalynn M. Williams, Allison Magnuson, and Gary R. Morrow, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Oxana Palesh, Stanford Cancer Center, Stanford, CA; Ann M. O’Mara and Lori M. Minasian, National Cancer Institute (NCI), National Institutes of Health, Rockville, MD; Jodi Geer, Metro Minnesota NCI Community Oncology Research Program (NCORP), Saint Louis Park, MN; Shaker R. Dakhil, Wichita NCORP, Wichita, KS; and Judith O. Hopkins, Southeast Clinical Oncology Research Consortium NCORP, Winston-Salem, NC
| | - Oxana Palesh
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Supriya G. Mohile, Karen M. Mustian, Annalynn M. Williams, Allison Magnuson, and Gary R. Morrow, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Oxana Palesh, Stanford Cancer Center, Stanford, CA; Ann M. O’Mara and Lori M. Minasian, National Cancer Institute (NCI), National Institutes of Health, Rockville, MD; Jodi Geer, Metro Minnesota NCI Community Oncology Research Program (NCORP), Saint Louis Park, MN; Shaker R. Dakhil, Wichita NCORP, Wichita, KS; and Judith O. Hopkins, Southeast Clinical Oncology Research Consortium NCORP, Winston-Salem, NC
| | - Ann M. O’Mara
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Supriya G. Mohile, Karen M. Mustian, Annalynn M. Williams, Allison Magnuson, and Gary R. Morrow, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Oxana Palesh, Stanford Cancer Center, Stanford, CA; Ann M. O’Mara and Lori M. Minasian, National Cancer Institute (NCI), National Institutes of Health, Rockville, MD; Jodi Geer, Metro Minnesota NCI Community Oncology Research Program (NCORP), Saint Louis Park, MN; Shaker R. Dakhil, Wichita NCORP, Wichita, KS; and Judith O. Hopkins, Southeast Clinical Oncology Research Consortium NCORP, Winston-Salem, NC
| | - Lori M. Minasian
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Supriya G. Mohile, Karen M. Mustian, Annalynn M. Williams, Allison Magnuson, and Gary R. Morrow, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Oxana Palesh, Stanford Cancer Center, Stanford, CA; Ann M. O’Mara and Lori M. Minasian, National Cancer Institute (NCI), National Institutes of Health, Rockville, MD; Jodi Geer, Metro Minnesota NCI Community Oncology Research Program (NCORP), Saint Louis Park, MN; Shaker R. Dakhil, Wichita NCORP, Wichita, KS; and Judith O. Hopkins, Southeast Clinical Oncology Research Consortium NCORP, Winston-Salem, NC
| | - Annalynn M. Williams
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Supriya G. Mohile, Karen M. Mustian, Annalynn M. Williams, Allison Magnuson, and Gary R. Morrow, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Oxana Palesh, Stanford Cancer Center, Stanford, CA; Ann M. O’Mara and Lori M. Minasian, National Cancer Institute (NCI), National Institutes of Health, Rockville, MD; Jodi Geer, Metro Minnesota NCI Community Oncology Research Program (NCORP), Saint Louis Park, MN; Shaker R. Dakhil, Wichita NCORP, Wichita, KS; and Judith O. Hopkins, Southeast Clinical Oncology Research Consortium NCORP, Winston-Salem, NC
| | - Allison Magnuson
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Supriya G. Mohile, Karen M. Mustian, Annalynn M. Williams, Allison Magnuson, and Gary R. Morrow, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Oxana Palesh, Stanford Cancer Center, Stanford, CA; Ann M. O’Mara and Lori M. Minasian, National Cancer Institute (NCI), National Institutes of Health, Rockville, MD; Jodi Geer, Metro Minnesota NCI Community Oncology Research Program (NCORP), Saint Louis Park, MN; Shaker R. Dakhil, Wichita NCORP, Wichita, KS; and Judith O. Hopkins, Southeast Clinical Oncology Research Consortium NCORP, Winston-Salem, NC
| | - Jodi Geer
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Supriya G. Mohile, Karen M. Mustian, Annalynn M. Williams, Allison Magnuson, and Gary R. Morrow, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Oxana Palesh, Stanford Cancer Center, Stanford, CA; Ann M. O’Mara and Lori M. Minasian, National Cancer Institute (NCI), National Institutes of Health, Rockville, MD; Jodi Geer, Metro Minnesota NCI Community Oncology Research Program (NCORP), Saint Louis Park, MN; Shaker R. Dakhil, Wichita NCORP, Wichita, KS; and Judith O. Hopkins, Southeast Clinical Oncology Research Consortium NCORP, Winston-Salem, NC
| | - Shaker R. Dakhil
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Supriya G. Mohile, Karen M. Mustian, Annalynn M. Williams, Allison Magnuson, and Gary R. Morrow, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Oxana Palesh, Stanford Cancer Center, Stanford, CA; Ann M. O’Mara and Lori M. Minasian, National Cancer Institute (NCI), National Institutes of Health, Rockville, MD; Jodi Geer, Metro Minnesota NCI Community Oncology Research Program (NCORP), Saint Louis Park, MN; Shaker R. Dakhil, Wichita NCORP, Wichita, KS; and Judith O. Hopkins, Southeast Clinical Oncology Research Consortium NCORP, Winston-Salem, NC
| | - Judith O. Hopkins
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Supriya G. Mohile, Karen M. Mustian, Annalynn M. Williams, Allison Magnuson, and Gary R. Morrow, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Oxana Palesh, Stanford Cancer Center, Stanford, CA; Ann M. O’Mara and Lori M. Minasian, National Cancer Institute (NCI), National Institutes of Health, Rockville, MD; Jodi Geer, Metro Minnesota NCI Community Oncology Research Program (NCORP), Saint Louis Park, MN; Shaker R. Dakhil, Wichita NCORP, Wichita, KS; and Judith O. Hopkins, Southeast Clinical Oncology Research Consortium NCORP, Winston-Salem, NC
| | - Gary R. Morrow
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Supriya G. Mohile, Karen M. Mustian, Annalynn M. Williams, Allison Magnuson, and Gary R. Morrow, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Oxana Palesh, Stanford Cancer Center, Stanford, CA; Ann M. O’Mara and Lori M. Minasian, National Cancer Institute (NCI), National Institutes of Health, Rockville, MD; Jodi Geer, Metro Minnesota NCI Community Oncology Research Program (NCORP), Saint Louis Park, MN; Shaker R. Dakhil, Wichita NCORP, Wichita, KS; and Judith O. Hopkins, Southeast Clinical Oncology Research Consortium NCORP, Winston-Salem, NC
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23
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Lambert M, Ouimet LA, Wan C, Stewart A, Collins B, Vitoroulis I, Bielajew C. Cancer-related cognitive impairment in breast cancer survivors: An examination of conceptual and statistical cognitive domains using principal component analysis. Oncol Rev 2018; 12:371. [PMID: 30294410 PMCID: PMC6170883 DOI: 10.4081/oncol.2018.371] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 08/07/2018] [Indexed: 12/25/2022] Open
Abstract
There is a great deal of variability in the composition of neuropsychological test batteries used in the assessment of cancerrelated cognitive impairment (CRCI). Not only the development of a gold standard approach for CRCI assessment would allow for easier identification of women suffering from CRCI but it would also promote optimal care for survivors. As a first step towards the development of a valid and reliable unified test battery, the objective of this study was to verify whether the theoretical domains commonly used in CRCI assessment are statistically supported, before and after breast cancer treatment. Principal component analyses (PCA) were performed on the results from 23 neuropsychological tests grouped into eight conceptual domains. For baseline data, the Kaiser-Meyer-Olkin was .82 and Bartlett's X2(253, N=95) = 949.48, P<0.001. A five-component solution explained 60.94% of the common variance. For the post-treatment data, the Kaiser-Meyer-Olkin was .83 and Bartlett's X2(253, N=95) = 1007.21, P<0.001 and a five component solution explained 62.03% of the common variance. Although a visual comparison of the theoretical model with those determined via PCA indicated important overlap between conceptual domains and statistical components, significant dissimilarities were also observed.
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24
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Abstract
Advances in cancer treatments have led to substantially improved survival for patients with cancer. However, many patients experience changes in cognition as a side effect of both cancer and cancer treatment. This occurs with both central nervous system (CNS) tumors and non-CNS tumors and in both children and adults. Studies of patients with non-CNS cancer have shown that cancer-related cognitive impairment (CRCI), which can include changes in memory, executive function, attention, and processing speed, occurs in up to 30% of patients prior to any treatment and in up to 75% of patients during treatment. A subset of patients with non-CNS and CNS cancer appear to be at higher risk for CRCI, so much research has gone into identifying who is vulnerable. Risk factors for CRCI in adults include cognitive reserve, age, genetic factors, and ethnicity; risk factors for children include genetic factors, female sex, younger age at diagnosis, chemotherapy dose, and both dose and field size for radiation. Although the field has made substantial strides in understanding and treating CRCI, more research is still needed to improve outcomes for both pediatric and adult cancer survivors.
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Affiliation(s)
- Sara J Hardy
- From the University of Rochester Medical Center, Rochester, NY; St. Jude Children's Research Hospital, Memphis, TN; The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kevin R Krull
- From the University of Rochester Medical Center, Rochester, NY; St. Jude Children's Research Hospital, Memphis, TN; The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jeffrey S Wefel
- From the University of Rochester Medical Center, Rochester, NY; St. Jude Children's Research Hospital, Memphis, TN; The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michelle Janelsins
- From the University of Rochester Medical Center, Rochester, NY; St. Jude Children's Research Hospital, Memphis, TN; The University of Texas MD Anderson Cancer Center, Houston, TX
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25
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Kim HJ, Barsevick AM, Chan A, Chae JW. Chemotherapy-associated cognitive impairments in Korean cancer patients: Risk factors and functional outcome. Psychooncology 2018; 27:1995-2001. [DOI: 10.1002/pon.4759] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 04/23/2018] [Accepted: 04/29/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Hee-Ju Kim
- College of Nursing; Catholic University of Korea; Seoul South Korea
| | | | - Alexandre Chan
- Department of Pharmacy; National University of Singapore; Singapore
- Duke-NUS Medical School; Singapore
| | - Jung-woo Chae
- College of Pharmacy; Chungnam National University; Daejeon South Korea
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26
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Antoine V, Courtial M, de Wazieres B, Di Castri A, Duvjnak S, Geronimi L, Labarias C, Le Guillou C, Martin-Allier A, Matelot D, Moitrelle C, Santoni F, Solinas G, Viala M. [Cognitive decline in geriatric oncology: Trends, evaluation and treatment]. Bull Cancer 2018; 105:720-734. [PMID: 29773225 DOI: 10.1016/j.bulcan.2018.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 03/13/2018] [Accepted: 04/05/2018] [Indexed: 12/19/2022]
Abstract
Cancer prevalence increases with aging. Prevalent or incident neurocognitive disorders are frequent in geriatric oncology. Cognitive decline associated with cancer increases the risk of under or over-cancer treatment and makes therapeutic decisions complex. In this context, we present tools to optimize cognitive impairment screening, identification of underlying mechanisms and specific treatments. Geriatric specialists intervention can help global care, social services utilization and patient's orientation when ambulatory cares become difficult.
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Affiliation(s)
- V Antoine
- CHU de Caremeau, pôle de gérontologie, place Robert-Debré, 30000 Nîmes, France.
| | - M Courtial
- CHU de Caremeau, pôle de gérontologie, place Robert-Debré, 30000 Nîmes, France
| | - B de Wazieres
- CHU de Caremeau, pôle de gérontologie, place Robert-Debré, 30000 Nîmes, France
| | - A Di Castri
- CHU de Caremeau, pôle de gérontologie, place Robert-Debré, 30000 Nîmes, France
| | - S Duvjnak
- CHU de Caremeau, pôle de gérontologie, place Robert-Debré, 30000 Nîmes, France
| | - L Geronimi
- CHU de Caremeau, pôle de gérontologie, place Robert-Debré, 30000 Nîmes, France
| | - C Labarias
- CHU de Caremeau, pôle de gérontologie, place Robert-Debré, 30000 Nîmes, France
| | - C Le Guillou
- CHU de Caremeau, pôle de gérontologie, place Robert-Debré, 30000 Nîmes, France
| | - A Martin-Allier
- CHU de Caremeau, pôle de gérontologie, place Robert-Debré, 30000 Nîmes, France
| | - D Matelot
- CHU de Caremeau, pôle de gérontologie, place Robert-Debré, 30000 Nîmes, France
| | - C Moitrelle
- CHU de Caremeau, pôle de gérontologie, place Robert-Debré, 30000 Nîmes, France
| | - F Santoni
- CHU de Caremeau, pôle de gérontologie, place Robert-Debré, 30000 Nîmes, France
| | - G Solinas
- CHU de Caremeau, pôle de gérontologie, place Robert-Debré, 30000 Nîmes, France
| | - M Viala
- CHU de Caremeau, pôle de gérontologie, place Robert-Debré, 30000 Nîmes, France
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27
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Abstract
As the population of cancer survivors has grown into the millions, there has been increasing emphasis on understanding how the late effects of treatment affect survivors' ability to return to work/school, their capacity to function and live independently, and their overall quality of life. This review focuses on cognitive change associated with cancer and cancer treatments. Research in this area has progressed from a pharmacotoxicology perspective to a view of the cognitive change as a complex interaction of aspects of the treatment, vulnerability factors that increase risk for posttreatment cognitive decline, cancer biology, and the biology of aging. Methodological advances include the development of (a) measurement approaches that assess more fine-grained subcomponents of cognition based on cognitive neuroscience and (b) advanced statistical approaches. Conceptual issues that arise from this multidimensional perspective are described in relation to future directions, understanding of mechanisms, and development of innovative interventions.
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Affiliation(s)
- Tim A Ahles
- Neurocognitive Research Lab, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA; ,
| | - James C Root
- Neurocognitive Research Lab, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA; ,
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28
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McDonough PM, Prigozhina NL, Basa RCB, Price JH. Assay of Calcium Transients and Synapses in Rat Hippocampal Neurons by Kinetic Image Cytometry and High-Content Analysis: An In Vitro Model System for Postchemotherapy Cognitive Impairment. Assay Drug Dev Technol 2018; 15:220-236. [PMID: 28723268 DOI: 10.1089/adt.2017.797] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Postchemotherapy cognitive impairment (PCCI) is commonly exhibited by cancer patients treated with a variety of chemotherapeutic agents, including the endocrine disruptor tamoxifen (TAM). The etiology of PCCI is poorly understood. Our goal was to develop high-throughput assay methods to test the effects of chemicals on neuronal function applicable to PCCI. Rat hippocampal neurons (RHNs) were plated in 96- or 384-well dishes and exposed to test compounds (forskolin [FSK], 17β-estradiol [ES]), TAM or fulvestrant [FUL], aka ICI 182,780) for 6-14 days. Kinetic Image Cytometry™ (KIC™) methods were developed to quantify spontaneously occurring intracellular calcium transients representing the activity of the neurons, and high-content analysis (HCA) methods were developed to quantify the expression, colocalization, and puncta formed by synaptic proteins (postsynaptic density protein-95 [PSD-95] and presynaptic protein Synapsin-1 [Syn-1]). As quantified by KIC, FSK increased the occurrence and synchronization of the calcium transients indicating stimulatory effects on RHN activity, whereas TAM had inhibitory effects. As quantified by HCA, FSK also increased PSD-95 puncta and PSD-95:Syn-1 colocalization, whereas ES increased the puncta of both PSD-95 and Syn-1 with little effect on colocalization. The estrogen receptor antagonist FUL also increased PSD-95 puncta. In contrast, TAM reduced Syn-1 and PSD-95:Syn-1 colocalization, consistent with its inhibitory effects on the calcium transients. Thus TAM reduced activity and synapse formation by the RHNs, which may relate to the ability of this agent to cause PCCI. The results illustrate that KIC and HCA can be used to quantify neurotoxic and neuroprotective effects of chemicals in RHNs to investigate mechanisms and potential therapeutics for PCCI.
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Affiliation(s)
| | | | | | - Jeffrey H Price
- 1 Vala Sciences Inc. , San Diego, California.,3 The Scintillon Institute , San Diego, California
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29
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Jung MS, Zhang M, Askren MK, Berman MG, Peltier S, Hayes DF, Therrien B, Reuter-Lorenz PA, Cimprich B. Cognitive dysfunction and symptom burden in women treated for breast cancer: a prospective behavioral and fMRI analysis. Brain Imaging Behav 2018; 11:86-97. [PMID: 26809289 DOI: 10.1007/s11682-016-9507-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Neural dysfunction and cognitive complaints are associated with chemotherapy for breast cancer although trajectory and contributory factors remain unclear. We prospectively examined neurocognition using fMRI and self-reported cognitive, physical and psychological symptoms in women treated with adjuvant chemotherapy over one year. Patients treated with (n = 28) or without (n = 34) chemotherapy for localized breast cancer and healthy controls (n = 30) performed a Verbal Working Memory Task (VWMT) during fMRI and provided self-reports at baseline (pre-adjuvant treatment), five- (M5) and 12-months (M12). Repeated measures ANOVA and multivariable regression determined change over time and possible predictors (e.g., hemoglobin, physical symptoms, worry) of VWMT performance, fMRI activity in the frontoparietal executive network, and cognitive complaints at M12. Trajectories of change in VWMT performance for chemotherapy and healthy control groups differed significantly with the chemotherapy group performing worse at M12. Chemotherapy patients had persistently higher spatial variance (neural inefficiency) in executive network fMRI-activation than both other groups from baseline to M12. Cognitive complaints were similar among groups over time. At M12, VWMT performance and executive network spatial variance were each independently predicted by chemotherapy treatment and their respective baseline values, while cognitive complaints were predicted by baseline level, physical symptoms and worry. Executive network inefficiency and neurocognitive performance deficits pre-adjuvant treatment predict cognitive dysfunction one-year post-baseline, particularly in chemotherapy-treated patients. Persistent cognitive complaints are linked with physical symptom severity and worry regardless of treatment. Pre-chemotherapy interventions should target both neurocognitive deficits and symptom burden to improve cognitive outcomes for breast cancer survivors.
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Affiliation(s)
- Mi Sook Jung
- College of Nursing Chungnam National University, 266 Munhwa-ro Jung-gu, Daejeon, 35015, South Korea.
| | - Min Zhang
- University of Michigan, 500 S State St, Ann Arbor, MI, 48109, USA
| | | | - Marc G Berman
- University of Chicago, 5801 S Ellis Ave, Chicago, IL, 60637, USA
| | - Scott Peltier
- University of Michigan, 500 S State St, Ann Arbor, MI, 48109, USA
| | - Daniel F Hayes
- University of Michigan, 500 S State St, Ann Arbor, MI, 48109, USA
| | - Barbara Therrien
- University of Michigan, 500 S State St, Ann Arbor, MI, 48109, USA
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30
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Lange M, Laviec H, Castel H, Heutte N, Leconte A, Léger I, Giffard B, Capel A, Dubois M, Clarisse B, Coquan E, Di Fiore F, Gouérant S, Bartélémy P, Pierard L, Fizazi K, Joly F. Impact of new generation hormone-therapy on cognitive function in elderly patients treated for a metastatic prostate cancer: Cog-Pro trial protocol. BMC Cancer 2017; 17:549. [PMID: 28814281 PMCID: PMC5559794 DOI: 10.1186/s12885-017-3534-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 08/03/2017] [Indexed: 01/28/2023] Open
Abstract
Background New generation hormone-therapies (NGHT) targeting the androgen signalling pathway are nowadays proposed to elderly patients with metastatic castration-resistant prostate cancer (CRPCa). The impact of these treatments on cognitive function has never been evaluated whereas cognitive impairment may have an impact on the autonomy and the treatment adherence. The aim of this study is to prospectively assess the incidence of cognitive impairment in elderly men after treatment by NGHT for a metastatic CRPCa. Methods/design The Cog-Pro study is a multicentre longitudinal study including CRPCa patients ≥70 years old treated with NGHT (n = 134), control metastatic prostate cancer patients without castration resistance treated with first generation androgen deprivation therapy (n = 55), and healthy participants (n = 33), matched on age and education. Cognitive, geriatric and quality of life assessment and biological tests will be performed at baseline, 3, 6 and 12 months after start of the treatment (inclusion time). The primary endpoint is the proportion of elderly patients receiving a NGHT who will experience a decline in cognitive performances within 3 months after study enrollment. Secondary endpoints concern: autonomy, quality of life, anxiety, depression, cognitive reserve, adherence to hormone-therapy, comparison of the cognitive impact of 2 different NGHT (abiraterone acetate and enzalutamide), impact of co-morbidities and biological assessments. Discussion Evaluating, understanding and analyzing the incidence, severity of cognitive impairments and their impact on quality of life, autonomy and adherence in this group of patients with advanced disease is a challenge. This study should help to improve cancer care of elderly patients and secure the use of oral treatments as the risk of non-observance does exist. Our results will provide up-to date information for patients and caregivers on impact of these treatments on cognitive function in order to help the physicians in the choice of the treatment. Trial registration NCT02907372, registered: July 26, 2016.
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Affiliation(s)
- Marie Lange
- INSERM, U1086 ANTICIPE, Normandie University, UNICAEN, 14076, Caen, France.,Clinical Research Department, Centre François Baclesse, 14076, Caen, France.,Cancer and Cognition Platform, Ligue Nationale Contre le Cancer, 14076, Caen, France
| | - Heidi Laviec
- Medical Oncology Department, Centre François Baclesse, 14076, Caen, France
| | - Hélène Castel
- Cancer and Cognition Platform, Ligue Nationale Contre le Cancer, 14076, Caen, France.,Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, Normandie University, UNIROUEN, INSERM, DC2N, 76000, Rouen, France
| | - Natacha Heutte
- INSERM, U1086 ANTICIPE, Normandie University, UNICAEN, 14076, Caen, France.,Clinical Research Department, Centre François Baclesse, 14076, Caen, France
| | - Alexandra Leconte
- Clinical Research Department, Centre François Baclesse, 14076, Caen, France
| | - Isabelle Léger
- INSERM, U1086 ANTICIPE, Normandie University, UNICAEN, 14076, Caen, France.,Cancer and Cognition Platform, Ligue Nationale Contre le Cancer, 14076, Caen, France.,UPO, Gustave Roussy, 94800, Villejuif, France.,NeuroHIV Rehabilitation Unit, Bicêtre University Hospital, 94275, Le Kremlin Bicêtre, France
| | - Bénédicte Giffard
- Cancer and Cognition Platform, Ligue Nationale Contre le Cancer, 14076, Caen, France.,Normandie University, UNICAEN, EPHE Paris, INSERM, U1077, 14000, Caen, France
| | - Aurélie Capel
- Clinical Research Department, Centre François Baclesse, 14076, Caen, France
| | - Martine Dubois
- Cancer and Cognition Platform, Ligue Nationale Contre le Cancer, 14076, Caen, France.,Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, Normandie University, UNIROUEN, INSERM, DC2N, 76000, Rouen, France
| | - Bénédicte Clarisse
- Clinical Research Department, Centre François Baclesse, 14076, Caen, France
| | - Elodie Coquan
- Clinical Research Department, Centre François Baclesse, 14076, Caen, France.,Medical Oncology Department, Centre François Baclesse, 14076, Caen, France
| | - Frédéric Di Fiore
- Medical Oncology Department, Centre Henri-Becquerel, 76000, Rouen, France.,Digestive and Urology Oncology Unit, Rouen University Hospital, 76000, Rouen, France
| | - Sophie Gouérant
- Medical Oncology Department, Centre Henri-Becquerel, 76000, Rouen, France.,Digestive and Urology Oncology Unit, Rouen University Hospital, 76000, Rouen, France
| | - Philippe Bartélémy
- Medical Oncology and Hematology Department, Hôpitaux Universitaires de Strasbourg, 67000, Strasbourg, France
| | - Laure Pierard
- Medical Oncology and Hematology Department, Hôpitaux Universitaires de Strasbourg, 67000, Strasbourg, France
| | - Karim Fizazi
- Medical Oncology Department, Gustave Roussy, 94800, Villejuif, France
| | - Florence Joly
- INSERM, U1086 ANTICIPE, Normandie University, UNICAEN, 14076, Caen, France. .,Clinical Research Department, Centre François Baclesse, 14076, Caen, France. .,Cancer and Cognition Platform, Ligue Nationale Contre le Cancer, 14076, Caen, France. .,Medical Oncology Department, CHU de Caen, 14000, Caen, France.
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Abstract
BACKGROUND Cognitive decline caused by chemotherapy used in the treatment of malignant diseases was reported in several studies. ICCTF recommends the diagnosis of cognitive function in patient treated with chemotherapy. One of the suggested method is Verbal Fluency Test (VFT). METHODS Study was carried out on a group of 30 women with early breast cancer treated with adjuvant chemotherapy and 29 healthy controls. The patients underwent neuropsychological assessment using VFT at three time points: T1: before chemotherapy, T2: mid-chemotherapy and T3: post-chemotherapy. The examination in healthy controls was conducted at the same time intervals. RESULTS In phonetic fluency task patients produced more words at T2 compared to T1 (Z = 2.02; p < 0.05) and at T3 compared to T1, both patients (Z = 2.36; p < 0.05) and controls (Z = 2.57; p < 0.01). The patients scored lower than controls (Z = -2.04; p < 0.05) as well as on average cluster size in the same task (Z = -2.38; p < 0.05) at T3, while they scored higher on the number of phonetic switches at T2 compared to T1 (Z = 2.62; p < 0.01) and at T3 compared to T1 (Z = 2.50; p < 0.01). In semantic task controls produced more words at T3 than at T1 (Z = 2.62; p < 0.01) and at T3 compared to T2 (Z = 2.89; p < 0.01) and semantic clusters at T3 compared to T2 (Z = 2.43; p < 0.05). In patients, number of clusters was smaller at T3 compared to T2 (Z = -2.85; p < 0.05), while number of semantic switches was higher at T3 than at T2 (Z = 3.05; p < 0.01). Patients scored also lower than controls on number of semantic switches at T2 (Z = -2.05; p < 0.05). CONCLUSIONS Chemotherapy does not decrease verbal fluency, but it has a negative impact on semantic memory.
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Affiliation(s)
- Paulina Andryszak
- Institute of Psychology, Kazimierz Wielki University, Staffa 1, 85-867, Bydgoszcz, Poland.
| | - Monika Wiłkość
- Institute of Psychology, Kazimierz Wielki University, Staffa 1, 85-867, Bydgoszcz, Poland
- Department of Psychiatry, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | - Bogdan Żurawski
- The Franciszek Lukaszczyk Oncology Center in Bydgoszcz, Bydgoszcz, Poland
| | - Paweł Izdebski
- Institute of Psychology, Kazimierz Wielki University, Staffa 1, 85-867, Bydgoszcz, Poland
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Meattini I, Desideri I, Francolini G, Vannini A, Perna M, Garlatti P, Grassi R, Livi L. Systemic therapies and cognitive impairment for breast cancer: an overview of the current literature. Med Oncol 2017; 34:74. [PMID: 28364269 DOI: 10.1007/s12032-017-0935-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 03/28/2017] [Indexed: 12/26/2022]
Abstract
Both endocrine and chemotherapy can be utilized for breast cancer patients' management, in multiple setting (i.e., primary systemic therapy, adjuvant, metastatic treatment). Health-related quality of life in breast cancer survivors can be significantly influenced by cognitive impairment, which has been related in several previously reported experiences to systemic therapies administration. However, although the growing body of literature, the impact of both chemo- and endocrine therapy on cognitive function is currently unclear, due to many confounding factors (i.e., multiple therapies, duration of therapy, comorbidity, age). The aim of the present review is to present an overview of the current literature concerning the possible influence of endocrine and systemic therapy on breast cancer patients' cognitive impairment.
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Affiliation(s)
- Icro Meattini
- Azienda Ospedaliero Universitaria Careggi - University of Florence, Largo G.A. Brambilla 3, 50134, Florence, Italy.
| | - Isacco Desideri
- Azienda Ospedaliero Universitaria Careggi - University of Florence, Largo G.A. Brambilla 3, 50134, Florence, Italy
| | - Giulio Francolini
- Azienda Ospedaliero Universitaria Careggi - University of Florence, Largo G.A. Brambilla 3, 50134, Florence, Italy
| | - Agnese Vannini
- Azienda Ospedaliero Universitaria Careggi - University of Florence, Largo G.A. Brambilla 3, 50134, Florence, Italy
| | - Marco Perna
- Azienda Ospedaliero Universitaria Careggi - University of Florence, Largo G.A. Brambilla 3, 50134, Florence, Italy
| | - Pietro Garlatti
- Azienda Ospedaliero Universitaria Careggi - University of Florence, Largo G.A. Brambilla 3, 50134, Florence, Italy
| | - Roberta Grassi
- Azienda Ospedaliero Universitaria Careggi - University of Florence, Largo G.A. Brambilla 3, 50134, Florence, Italy
| | - Lorenzo Livi
- Azienda Ospedaliero Universitaria Careggi - University of Florence, Largo G.A. Brambilla 3, 50134, Florence, Italy
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Ramalho M, Fontes F, Ruano L, Pereira S, Lunet N. Cognitive impairment in the first year after breast cancer diagnosis: A prospective cohort study. Breast 2017; 32:173-178. [PMID: 28208082 DOI: 10.1016/j.breast.2017.01.018] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 01/27/2017] [Accepted: 01/28/2017] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The objective of this study was to assess the relation between cancer treatments and incident cognitive impairment in breast cancer patients, taking into account the levels of anxiety before treatment. MATERIALS AND METHODS We conducted a prospective cohort study with 418 newly diagnosed breast cancer patients with no cognitive impairment, defined as values at least 1.5 standard deviations below age- and education-adjusted cut-offs in the Montreal Cognitive Assessment (MoCA), at baseline. The Hospital Anxiety and Depression Scale and MoCA were used for evaluations before treatment and at 1-year after diagnosis. We used Poisson regressions to compute adjusted relative risks (RR) and corresponding 95% confidence intervals (95%CI) to identify predictors of cognitive impairment. RESULTS The median (Percentile 25, Percentile 75) MoCA score before treatment was 24 (21, 26). A total of 8.1% (95%CI: 5.8, 11.2) of the patients presented incident cognitive impairment during the follow-up. There was a statistically significant interaction between anxiety at baseline and the effect of chemotherapy on the incidence of cognitive impairment (P for interaction = 0.028). There was a significantly increased risk of incident cognitive impairment among patients with no anxiety prior to treatment with schemes including doxorubicin and cyclophosphamide (adjusted RR = 4.22, 95%CI: 1.22, 14.65). CONCLUSION There was a statistically significant association between chemotherapy and cognitive impairment, but only among women with no anxiety at baseline.
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Affiliation(s)
- Mariana Ramalho
- Instituto de Saúde Pública da Universidade do Porto, Rua das Taipas, nº135, 4050-600, Porto, Portugal
| | - Filipa Fontes
- ISPUP - EPIUnit, Universidade do Porto, Rua das Taipas, nº135, 4050-600, Porto, Portugal
| | - Luís Ruano
- ISPUP - EPIUnit, Universidade do Porto, Rua das Taipas, nº135, 4050-600, Porto, Portugal; Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Susana Pereira
- ISPUP - EPIUnit, Universidade do Porto, Rua das Taipas, nº135, 4050-600, Porto, Portugal; Instituto Português de Oncologia do Porto, Rua Dr. António Bernardino de Almeida, 4200-075, Porto, Portugal
| | - Nuno Lunet
- ISPUP - EPIUnit, Universidade do Porto, Rua das Taipas, nº135, 4050-600, Porto, Portugal; Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
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Oh PJ. Predictors of cognitive decline in people with cancer undergoing chemotherapy. Eur J Oncol Nurs 2016; 27:53-59. [PMID: 28027862 DOI: 10.1016/j.ejon.2016.12.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 11/18/2016] [Accepted: 12/10/2016] [Indexed: 12/17/2022]
Abstract
PURPOSE The purpose of this study was to investigate the impact of demographic factors, disease/treatment-related factors, and psychological factors on cognitive function. METHOD A cross-sectional study was conducted. Participants were recruited from the oncology inpatient units of two hospitals. A convenience sample of 175 patients with cancer who underwent chemotherapy were recruited. The Everyday Cognition Scale (ECog), the Korean version of the Mini Mental State Examination (K-MMSE), Functional Assessment of Cancer Therapy-Fatigue (FACT-F) scale, Hospital Anxiety and Depression Scale (HADS), and a questionnaire to collect information about demographic, disease, and treatment information were completed. RESULTS More participants showed a mild decline in cognitive function and self-reported cognitive decline (39.4%) than had objectively confirmed decline (20%). Notably, 53.7-62.9% of the participants showed memory loss and a decline in divided attention. Demographic factors (age, sex), disease/treatment-related factors (chemotherapy cycles, fatigue), and psychological factors (depression) were predictors of cognitive decline in 49.6% of participants. CONCLUSIONS Old age and cumulative chemotherapy cycles were the main influential factors for objectively confirmed cognitive decline, and fatigue was the most common predictor of self-reported cognitive decline. Depression was one of the predictors of perceived cognitive decline, but it was not significant for objectively measured cognitive function. Thus, treatment-related factors such as fatigue had a greater impact on cognitive decline than psychological factors.
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Affiliation(s)
- Pok-Ja Oh
- Department of Nursing, Sahmyook University, 815 Kongnung-dong, Hwarang-ro, Nowon-gu, Seoul 01795, South Korea.
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Kim HG, Shin NY, Bak Y, Kim KR, Jung YC, Han K, Lee SK, Lim SM. Altered intrinsic brain activity after chemotherapy in patients with gastric cancer: A preliminary study. Eur Radiol 2016; 27:2679-2688. [DOI: 10.1007/s00330-016-4578-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 08/08/2016] [Accepted: 08/22/2016] [Indexed: 12/25/2022]
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Roe K, Visovatti MK, Brooks T, Baydoun M, Clark P, Barton DL. Use of complementary therapies for side effect management in breast cancer: evidence and rationale. Breast Cancer Management 2016. [DOI: 10.2217/bmt-2016-0013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Women diagnosed with breast cancer can experience chronic side effects after curative treatment concludes, negatively impacting survivorship. The most prevalent side effects addressed in the medical and nursing literature include symptoms such as hot flashes, fatigue, myalgias/arthralgias and cognitive impairment. Complementary therapies, particularly natural products including herbs, dietary supplements, vitamins, minerals, and probiotics, and mind–body techniques that include such modalities as yoga, meditation, massage, acupuncture, relaxation, tai chi and hypnosis show promise for treatment of some of these symptoms associated with cancer care. However, the research in this area is nascent and much more work is needed to understand symptom physiology and mechanisms of action of complementary therapies. The purpose of this paper was to summarize key evidence from Phase II and III randomized clinical trials in order to provide guidance to distinguish promising versus nonpromising interventions for symptom management.
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Affiliation(s)
- Kelly Roe
- School of Nursing, University of Michigan, Ann Arbor, MI 48109, USA
| | | | - Trevor Brooks
- School of Nursing, University of Michigan, Ann Arbor, MI 48109, USA
| | - Mohamad Baydoun
- School of Nursing, University of Michigan, Ann Arbor, MI 48109, USA
| | - Patricia Clark
- School of Nursing, University of Michigan, Ann Arbor, MI 48109, USA
| | - Debra L Barton
- School of Nursing, University of Michigan, Ann Arbor, MI 48109, USA
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Lange M, Heutte N, Rigal O, Noal S, Kurtz JE, Lévy C, Allouache D, Rieux C, Lefel J, Clarisse B, Veyret C, Barthélémy P, Longato N, Castel H, Eustache F, Giffard B, Joly F. Decline in Cognitive Function in Older Adults With Early-Stage Breast Cancer After Adjuvant Treatment. Oncologist 2016; 21:1337-1348. [PMID: 27473044 DOI: 10.1634/theoncologist.2016-0014] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 04/26/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The impact of chemotherapy on cognition among elderly patients has received little attention, although such patients are more prone to presenting with age-related cognitive deficits and/or cognitive decline during chemotherapy. The present study assessed the cognitive function in older adults treated for early-stage breast cancer (EBC). PATIENTS AND METHODS The participants were newly diagnosed EBC patients aged ≥65 years without previous systemic treatment or neurological or psychiatric disease and matched healthy controls. They underwent two assessments: before starting adjuvant therapy and after the end of chemotherapy (including doxorubicin ± docetaxel [CT+ group], n = 58) or radiotherapy for patients who did not receive chemotherapy (CT- group, n = 61), and at the same interval for the healthy controls (n = 62). Neuropsychological and geriatric assessments were performed. Neuropsychological data were analyzed using the Reliable Change Index. RESULTS Forty-nine percent of the patients (mean age, 70 ± 4 years) had objective cognitive decline after adjuvant treatment that mainly concerned working memory. Among these patients, 64% developed a cognitive impairment after adjuvant treatment. Comorbidity was not associated with cognitive decline. No significant difference in objective cognitive decline was found between the two groups of patients; however, the CT+ group had more subjective cognitive complaints after treatment (p = .008). The oldest patients (aged 70-81 years) tended to have more objective decline with docetaxel (p = .05). CONCLUSION This is the largest published study assessing cognitive function in older adults with EBC that included a group of patients treated with modern chemotherapy regimens. Approximately half the patients had objective cognitive decline after adjuvant treatment. The oldest patients were more likely to have cognitive decline with chemotherapy, particularly with docetaxel. IMPLICATIONS FOR PRACTICE This is the largest published study assessing cognitive function in older adults with early-stage breast cancer that included a group of patients treated with modern chemotherapy regimens. Approximately half the patients had objective cognitive decline after adjuvant treatment. The oldest patients were more likely to have cognitive decline with chemotherapy, particularly with docetaxel. Cognitive deficits could affect patients' quality of life and their compliance to treatment. Assessing cognitive dysfunctions in the elderly cancer population is a challenge in clinical practice, but it could influence the choice of the most appropriate therapy, including the use of oral drugs.
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Affiliation(s)
- Marie Lange
- Normandie University, UNICAEN, INSERM, U1086, Caen, France
- Clinical Research Department, Centre François Baclesse, Caen, France
| | - Natacha Heutte
- Normandie University, UNICAEN, INSERM, U1086, Caen, France
- Clinical Research Department, Centre François Baclesse, Caen, France
| | - Olivier Rigal
- Care Support Department, Centre Henri-Becquerel, Rouen, France
- Medical Oncology Department, Centre Henri-Becquerel, Rouen, France
| | - Sabine Noal
- Breast Committee, Centre François Baclesse, Caen, France
| | - Jean-Emmanuel Kurtz
- Oncology-Hematology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | | | | | - Chantal Rieux
- Clinical Research Department, Centre François Baclesse, Caen, France
| | - Johan Lefel
- Care Support Department, Centre Henri-Becquerel, Rouen, France
| | | | - Corinne Veyret
- Medical Oncology Department, Centre Henri-Becquerel, Rouen, France
| | - Philippe Barthélémy
- Oncology-Hematology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Nadine Longato
- Oncology-Hematology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Hélène Castel
- Normandie University, UNIROUEN, INSERM, U982, Rouen, France
| | - Francis Eustache
- Normandie University, UNICAEN, EPHE Paris, INSERM, U1077, Caen, France
| | - Bénédicte Giffard
- Normandie University, UNICAEN, EPHE Paris, INSERM, U1077, Caen, France
| | - Florence Joly
- Normandie University, UNICAEN, INSERM, U1086, Caen, France
- Clinical Research Department, Centre François Baclesse, Caen, France
- Medical Oncology, CHU de Caen, Caen, France
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Abstract
IMPORTANCE Chemotherapy exposure is a known risk factor for cancer-related cognitive impairments. Anthracycline-based regimens are commonly used chemotherapies that have been shown to be associated with cognitive impairment and brain changes in clinical studies. OBJECTIVE To directly compare the effects of anthracycline and nonanthracycline regimens on cognitive status and functional brain connectivity. DESIGN, SETTING, AND PARTICIPANTS In this observational study, we retrospectively examined cognitive and resting state functional magnetic resonance imaging data acquired from 62 primary breast cancer survivors (mean [SD] age, 54.7 [8.5] years) who were more than 2 years off-therapy, on average. Twenty of these women received anthracycline-based chemotherapy as part of their primary treatment, 19 received nonanthracycline regimens, and 23 did not receive any chemotherapy. Participants were enrolled at a single academic institution (Stanford University) from 2008 to 2014, and the study analyses were performed at this time. MAIN OUTCOMES AND MEASURES Cognitive status was measured using standardized neuropsychological tests, and functional brain connectivity was evaluated using resting state functional magnetic resonance imaging with a focus on the brain's default mode network. RESULTS The anthracycline group demonstrated significantly lower verbal memory performance including immediate recall (F = 3.73; P = .03) and delayed recall (F = 11.11; P < .001) as well as lower left precuneus connectivity (F = 7.48; P = .001) compared with the other 2 groups. Patient-reported outcomes related to cognitive dysfunction (F = 7.27; P = .002) and psychological distress (F = 5.64; P = .006) were similarly elevated in both chemotherapy groups compared with the non-chemotherapy-treated controls. CONCLUSIONS AND RELEVANCE These results suggest that anthracyclines may have greater negative effects than nonanthracycline regimens on particular cognitive domains and brain network connections. Both anthracycline and nonanthracycline regimens may have nonspecific effects on other cognitive domains as well as certain patient reported outcomes. Further research is needed to identify potential methods for protecting the brain against the effects of various chemotherapeutic agents.
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Affiliation(s)
- Shelli R Kesler
- Department of Neuro-oncology, University of Texas MD Anderson Cancer Center, Houston
| | - Douglas W Blayney
- Division of Medical Oncology, Stanford University School of Medicine, Stanford, California
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Dwek MR, Rixon L, Simon A, Hurt C, Newman S. Examining the effects of adjuvant chemotherapy on cognition and the impact of any cognitive impairment on quality of life in colorectal cancer patients: study protocol. BMC Psychol 2015; 3:43. [PMID: 26612628 PMCID: PMC4660774 DOI: 10.1186/s40359-015-0100-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 11/16/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Research suggests that chemotherapy can cause deficits in both patients' objectively measured and self-reported cognitive abilities which can in turn affect their quality of life (QoL). The majority of research studies have used post-treatment retrospective designs or have not included a control group in prospective cohorts. This has limited the conclusions that can be drawn from the results. There have also been a disproportionate number of studies focussed on women with breast cancer, which has limited the generalisability of the results to other cancer populations. AIM This study aims to identify the extent and impact of chemotherapy-induced cognitive decline in colorectal cancer patients. Possible associations with poorer QoL will also be explored. DESIGN This will be a longitudinal controlled cohort study. Questionnaires measuring subjective cognitive functioning, QoL, fatigue and mood, and neuropsychological assessments of objective cognitive function will be collected pre-, mid- and post- chemotherapy treatment from a consecutive sample of 78 colorectal cancer patients from five London NHS Trusts. A further 78 colorectal cancer surgery only patients will be assessed at equivalent time points; this will allow the researchers to compare the results of patients undergoing surgery, but not chemotherapy against those receiving both treatments. Pre- and post-chemotherapy difference scores will be calculated to detect subtle changes in cognitive function as measured by the objective neuropsychological assessments and the self-reported questionnaires. A standardised z-score will be computed for every patient on each neuropsychological test, and for each test at each time point. The post-chemotherapy score will then be subtracted from the pre-chemotherapy score to produce a relative difference score for each patient. ANCOVA will be used to compare mean difference z-scores between the chemotherapy and surgery-only groups while controlling for the effects of gender, age, depression, anxiety, fatigue and education. DISCUSSION The result from this study will indicate whether a decline in cognitive functioning can be attributed to chemotherapy or to disease, surgical or some other confounding factor. Identification of risk factors for cognitive deficits may be used to inform targeted interventions, in order to improve QoL and help patients' cope.
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Affiliation(s)
- Marie-Rose Dwek
- School of Health Sciences, City University London, 10 Northampton Square, London, EC1V 0HB, UK.
| | - Lorna Rixon
- School of Health Sciences, City University London, 10 Northampton Square, London, EC1V 0HB, UK.
| | - Alice Simon
- School of Health Sciences, City University London, 10 Northampton Square, London, EC1V 0HB, UK.
| | - Catherine Hurt
- School of Health Sciences, City University London, 10 Northampton Square, London, EC1V 0HB, UK.
| | - Stanton Newman
- School of Health Sciences, City University London, 10 Northampton Square, London, EC1V 0HB, UK.
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Williams AM, Janelsins MC, van Wijngaarden E. Cognitive function in cancer survivors: analysis of the 1999-2002 National Health and Nutrition Examination Survey. Support Care Cancer 2015; 24:2155-2162. [PMID: 26559193 DOI: 10.1007/s00520-015-2992-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 10/26/2015] [Indexed: 01/31/2023]
Abstract
PURPOSE Cancer and its treatment may affect cognitive function through a number of direct and indirect pathways including inflammation, lipid metabolism, vascular damage, and changes in the blood-brain barrier. While short-term treatment-related cognitive changes are well recognized, only limited research is available in older, long-term survivors of cancer. METHODS Using NHANES data from 1999 to 2002, 408 cancer survivors and 2639 non-cancer participants aged 60 years old and above were identified. Cognitive function of these groups were compared using the Digit Symbol Substitution Test (DSST) and self-reported problems with memory or confusion. RESULTS After adjustment for covariates, cancer survivors scored, on average, 1.99 points lower on the DSST compared to non-cancer survivors (-1.99, 95 % CI -3.94, -0.05). Cancer survivors also had 17 % higher odds of self-reporting problems with memory or confusion (OR 1.17, 95 % CI 0.89, 1.53). CONCLUSION In this nationally representative sample of older US adults, cancer survivors had lower DSST scores than non-survivors and had more self-reported problems with memory or confusion.
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Affiliation(s)
- A M Williams
- Department of Public Health Sciences, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA.
| | - M C Janelsins
- Department of Surgery, Cancer Control, University of Rochester Medical Center, Rochester, NY, USA
| | - E van Wijngaarden
- Department of Public Health Sciences, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
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Munoz LA, Campbell C, Bowyer P. The Role of Occupational Therapy in Older Adults With Cognitive Impairments and an Oncology Diagnosis. Topics in Geriatric Rehabilitation 2015; 31:281-6. [DOI: 10.1097/tgr.0000000000000078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
OBJECTIVE To investigate the association between self-reported cognition and demographic/psychosocial variables in individuals with a self-reported diagnosis of multiple sclerosis (MS). DESIGN Secondary longitudinal analysis of mailed self-report surveys over a period of 2 years. SETTING Community. PARTICIPANTS 407 community-dwelling individuals from the Pacific Northwest with a self-reported diagnosis of MS. MAIN OUTCOME MEASURES Subjective general cognitive concerns and subjective executive difficulties as measured by the Neuro-QOL Applied Cognition-Executive Function-Short Form (SF) and the Applied Cognition-General Concerns-SF. RESULTS Univariate and multiple linear regression analyses were used to identify statistically significant longitudinal predictors of perceived cognitive difficulties 2 years later. Fatigue and anxiety were statistically significant predictors of general cognitive concerns. Fatigue and perceived stress were statistically significant predictors of perceived executive difficulties. Fatigue was the strongest predictor in both models. CONCLUSIONS In MS, perceived cognitive impairment is frequently linked to depression without consideration of other possible contributors. This study suggests that in people with MS, fatigue is a stronger predictor of self-reported cognitive function 2 years later than depression.
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Affiliation(s)
- Meghan Beier
- Department of Rehabilitation Medicine, University of Washington School of Medicine
| | - Dagmar Amtmann
- Department of Rehabilitation Medicine, University of Washington School of Medicine
| | - Dawn M Ehde
- Department of Rehabilitation Medicine, University of Washington School of Medicine
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Lengacher CA, Reich RR, Kip KE, Paterson CL, Park HY, Ramesar S, Jim HSL, Alinat CB, Park JY. Moderating Effects of Genetic Polymorphisms on Improvements in Cognitive Impairment in Breast Cancer Survivors Participating in a 6-Week Mindfulness-Based Stress Reduction Program. Biol Res Nurs 2015; 17:393-404. [PMID: 25882604 PMCID: PMC10131135 DOI: 10.1177/1099800415577633] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Breast cancer (BC) survivors often report cognitive impairment, which may be influenced by single-nucleotide polymorphisms (SNPs). The purpose of this study was to test whether particular SNPs were associated with changes in cognitive function in BC survivors and whether these polymorphisms moderated cognitive improvement resulting from the Mindfulness-Based Stress Reduction for Breast Cancer (MBSR[BC]) program. BC survivors recruited from Moffitt Cancer Center and the University of South Florida's Breast Health Program, who had completed adjuvant radiation and/or chemotherapy treatment, were randomized to either the 6-week MBSR(BC) program (n = 37) or usual care (UC; n = 35) group. Measures of cognitive function and demographic and clinical history data were attained at baseline and at 6 and 12 weeks. A total of 10 SNPs from eight genes known to be related to cognitive function were analyzed using blood samples. Results showed that SNPs in four genes (ankyrin repeat and kinase domain containing 1 [ANKK1], apolipoprotein E [APOE], methylenetetrahydrofolate reductase [MTHFR], and solute carrier family 6 member 4 [SLC6A4]) were associated with cognitive impairment. Further, rs1800497 in ANKK1 was significantly associated with improvements in cognitive impairment in response to MBSR(BC). These results may help to identify individuals who would be better served by MBSR(BC) or other interventions.
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Affiliation(s)
- Cecile A Lengacher
- College of Nursing, University of South Florida, Tampa, FL, USA Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Richard R Reich
- College of Arts and Sciences, University of South Florida Sarasota-Manatee, Sarasota, FL, USA Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, USA
| | - Kevin E Kip
- College of Nursing, University of South Florida, Tampa, FL, USA
| | | | - Hyun Y Park
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA
| | - Sophia Ramesar
- College of Nursing, University of South Florida, Tampa, FL, USA
| | - Heather S L Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | | | - Jong Y Park
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA
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Ono M, Ogilvie JM, Wilson JS, Green HJ, Chambers SK, Ownsworth T, Shum DHK. A meta-analysis of cognitive impairment and decline associated with adjuvant chemotherapy in women with breast cancer. Front Oncol 2015; 5:59. [PMID: 25806355 PMCID: PMC4354286 DOI: 10.3389/fonc.2015.00059] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 02/25/2015] [Indexed: 11/13/2022] Open
Abstract
A meta-analysis was performed to quantify the magnitude and nature of the association between adjuvant chemotherapy and performance on a range of cognitive domains among breast cancer patients. A total of 27 studies (14 cross-sectional, 8 both cross-sectional and prospective, and 5 prospective) were included in the analyses, involving 1562 breast cancer patients who had undergone adjuvant chemotherapy and 2799 controls that included breast cancer patients who did not receive adjuvant chemotherapy. A total of 737 effect sizes (Cohen's d) were calculated for cross-sectional and prospective longitudinal studies separately and classified into eight cognitive domains. The mean effect sizes varied across cross-sectional and prospective longitudinal studies (ranging from -1.12 to 0.62 and -0.29 to 1.12, respectively). Each cognitive domain produced small effect sizes for cross-sectional and prospective longitudinal studies (ranging from -0.25 to 0.41). Results from cross-sectional studies indicated a significant association between adjuvant chemotherapy and cognitive impairment that held across studies with varied methodological approaches. For prospective studies, results generally indicated that cognitive functioning improved over time after receiving adjuvant chemotherapy. Greater cognitive impairment was reported in cross-sectional studies comparing chemotherapy groups with healthy control groups. Results suggested that cognitive impairment is present among breast cancer patients irrespective of a history of chemotherapy. Prospective longitudinal research is warranted to examine the degree and persisting nature of cognitive impairment present both before and after chemotherapy, with comparisons made to participants' cognitive function prior to diagnosis. Accurate understanding of the effects of chemotherapy is essential to enable informed decisions regarding treatment and to improve quality of life among breast cancer patients.
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Affiliation(s)
- Miyuki Ono
- Griffith Health Institute Behavioural Basis of Health Program, School of Applied Psychology, Griffith University , Brisbane, QLD , Australia
| | - James M Ogilvie
- Griffith Health Institute Behavioural Basis of Health Program, School of Applied Psychology, Griffith University , Brisbane, QLD , Australia
| | - Jennifer S Wilson
- Griffith Health Institute Behavioural Basis of Health Program, School of Applied Psychology, Griffith University , Brisbane, QLD , Australia
| | - Heather J Green
- Griffith Health Institute Behavioural Basis of Health Program, School of Applied Psychology, Griffith University , Gold Coast, QLD , Australia
| | - Suzanne K Chambers
- Griffith Health Institute Behavioural Basis of Health Program, School of Applied Psychology, Griffith University , Brisbane, QLD , Australia
| | - Tamara Ownsworth
- Griffith Health Institute Behavioural Basis of Health Program, School of Applied Psychology, Griffith University , Brisbane, QLD , Australia
| | - David H K Shum
- Griffith Health Institute Behavioural Basis of Health Program, School of Applied Psychology, Griffith University , Brisbane, QLD , Australia ; Griffith Health Institute Behavioural Basis of Health Program, School of Applied Psychology, Griffith University , Gold Coast, QLD , Australia
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Hoogendam YY, Schagen SB, Ikram MA, Boogerd W, Seynaeve C, Seidler RD, Breteler MMB, Van der Geest JN, Koppelmans V. Late effects of adjuvant chemotherapy for breast cancer on fine motor function. Psychooncology 2015; 24:1799-807. [PMID: 25756497 DOI: 10.1002/pon.3796] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 01/27/2015] [Accepted: 02/12/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Adjuvant chemotherapy for breast cancer has been associated with deterioration of fine motor skill. Which aspects of motor performance are underlying this problem is unclear but important because manual motor deterioration could affect quality of life. The current study aims to investigate late effects of adjuvant chemotherapy for breast cancer on fine motor function, using both speed and accuracy measures. METHOD We compared fine motor function of 174 women who had received adjuvant Cyclophosphamide Methotrexate 5-Fluorouracil chemotherapy for breast cancer on average 20 years ago with that of a population sample of 195 women without a history of cancer. Fine motor function was measured with the Purdue Pegboard Test and the Archimedes spiral test. RESULTS The group of chemotherapy-exposed breast cancer survivors was slower in drawing an Archimedes spiral than the reference group. Furthermore, in the chemotherapy-exposed subjects, we found that older age is related to more crossings of the spiral template, more return movements, and more deviations from the template. Such relationships were not observed within the reference group. No significant between-group differences were found for any of the Purdue Pegboard measures. CONCLUSIONS Compared with a population-based reference group, Cyclophosphamide Methotrexate 5-Fluorouracil chemotherapy-exposed breast cancer survivors demonstrated motor slowing while drawing an Archimedes spiral, on average 20 years after completion of primary treatment. Furthermore, the Archimedes spiral test is a more sensitive measure than the Purdue Pegboard Test to assess fine manual motor performance in long-term breast cancer survivors following chemotherapy.
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Affiliation(s)
- Yoo Young Hoogendam
- Department of Radiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Sanne B Schagen
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - M Arfan Ikram
- Department of Radiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Willem Boogerd
- Department of Neuro-oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Caroline Seynaeve
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Rachael D Seidler
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA.,Department of Psychology, University of Michigan, Ann Arbor, MI, USA.,Neuroscience Program, University of Michigan, Ann Arbor, MI, USA
| | - Monique M B Breteler
- German Center for Neurodegenerative diseases (DZNE), Bonn, Germany.,Institute for Medical Biometry, Informatics, and Epidemiology, University Bonn, Bonn, Germany
| | - Jos N Van der Geest
- Department of Radiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Department of Neuroscience, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Vincent Koppelmans
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,School of Kinesiology, University of Michigan, Ann Arbor, MI, USA
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Wefel JS, Kesler SR, Noll KR, Schagen SB. Clinical characteristics, pathophysiology, and management of noncentral nervous system cancer-related cognitive impairment in adults. CA Cancer J Clin 2015; 65:123-38. [PMID: 25483452 PMCID: PMC4355212 DOI: 10.3322/caac.21258] [Citation(s) in RCA: 315] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Answer questions and earn CME/CNE Over the past few decades, a body of research has emerged confirming what many adult patients with noncentral nervous system cancer have long reported-that cancer and its treatment are frequently associated with cancer-related cognitive impairment (CRCI). The severity of CRCI varies, and symptoms can emerge early or late in the disease course. Nonetheless, CRCI is typically mild to moderate in nature and primarily involves the domains of memory, attention, executive functioning, and processing speed. Animal models and novel neuroimaging techniques have begun to unravel the pathophysiologic mechanisms underlying CRCI, including the role of inflammatory cascades, direct neurotoxic effects, damage to progenitor cells, white matter abnormalities, and reduced functional connectivity, among others. Given the paucity of research on CRCI with other cancer populations, this review synthesizes the current literature with a deliberate focus on CRCI within the context of breast cancer. A hypothetical case-study approach is used to illustrate how CRCI often presents clinically and how current science can inform practice. While the literature regarding intervention for CRCI is nascent, behavioral and pharmacologic approaches are discussed.
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Affiliation(s)
- Jeffrey S. Wefel
- Associate Professor, Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Corresponding author: Jeffrey S. Wefel, PhD, Department of Neuro-Oncology, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 431, Houston, TX 77030;
| | - Shelli R. Kesler
- Associate Professor, Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kyle R. Noll
- Associate Professor, Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sanne B. Schagen
- Associate Professor, Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Philpot RM. Potential Use of Nicotinic Receptor Agonists for the Treatment of Chemotherapy-Induced Cognitive Deficits. Neurochem Res 2015; 40:2018-31. [DOI: 10.1007/s11064-015-1528-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 01/09/2015] [Accepted: 01/28/2015] [Indexed: 10/24/2022]
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Lepage C, Smith AM, Moreau J, Barlow-Krelina E, Wallis N, Collins B, MacKenzie J, Scherling C. A prospective study of grey matter and cognitive function alterations in chemotherapy-treated breast cancer patients. Springerplus 2014; 3:444. [PMID: 25184110 PMCID: PMC4149682 DOI: 10.1186/2193-1801-3-444] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 07/30/2014] [Indexed: 11/10/2022]
Abstract
PURPOSE Subsequent to chemotherapy treatment, breast cancer patients often report a decline in cognitive functioning that can adversely impact many aspects of their lives. Evidence has mounted in recent years indicating that a portion of breast cancer survivors who have undergone chemotherapy display reduced performance on objective measures of cognitive functioning relative to comparison groups. Neurophysiological support for chemotherapy-related cognitive impairment has been accumulating due to an increase in neuroimaging studies in this field; however, longitudinal studies are limited and have not examined the relationship between structural grey matter alterations and neuropsychological performance. The aim of this study was to extend the cancer-cognition literature by investigating the association between grey matter attenuation and objectively measured cognitive functioning in chemotherapy-treated breast cancer patients. METHODS Female breast cancer patients (n = 19) underwent magnetic resonance imaging after surgery but before commencing chemotherapy, one month following treatment, and one year after treatment completion. Individually matched controls (n = 19) underwent imaging at similar intervals. All participants underwent a comprehensive neuropsychological battery comprising four cognitive domains at these same time points. Longitudinal grey matter changes were investigated using voxel-based morphometry. RESULTS One month following chemotherapy, patients had distributed grey matter volume reductions. One year after treatment, a partial recovery was observed with alterations persisting predominantly in frontal and temporal regions. This course was not observed in the healthy comparison group. Processing speed followed a similar trajectory within the patient group, with poorest scores obtained one month following treatment and some improvement evident one year post-treatment. CONCLUSION This study provides further credence to patient claims of altered cognitive functioning subsequent to chemotherapy treatment.
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Affiliation(s)
- Chris Lepage
- School of Psychology, University of Ottawa, Vanier Hall, 136 Jean Jacques Lussier, Ottawa, ON K1N 6 N5 Canada
| | - Andra M Smith
- School of Psychology, University of Ottawa, Vanier Hall, 136 Jean Jacques Lussier, Ottawa, ON K1N 6 N5 Canada
| | - Jeremy Moreau
- School of Psychology, University of Ottawa, Vanier Hall, 136 Jean Jacques Lussier, Ottawa, ON K1N 6 N5 Canada
| | - Emily Barlow-Krelina
- School of Psychology, University of Ottawa, Vanier Hall, 136 Jean Jacques Lussier, Ottawa, ON K1N 6 N5 Canada
| | - Nancy Wallis
- School of Psychology, University of Ottawa, Vanier Hall, 136 Jean Jacques Lussier, Ottawa, ON K1N 6 N5 Canada
| | - Barbara Collins
- School of Psychology, University of Ottawa, Vanier Hall, 136 Jean Jacques Lussier, Ottawa, ON K1N 6 N5 Canada ; Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Ottawa, ON K1Y 4E9 Canada
| | - Joyce MacKenzie
- Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Ottawa, ON K1Y 4E9 Canada
| | - Carole Scherling
- Memory and Aging Center, Neurology, UCSF, Sandler Neuroscience Center, 675 Nelson Rising Lane, San Francisco, CA 94158 USA
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