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Sekely A, Zakzanis KK, Mabbott D, Tsang DS, Kongkham P, Zadeh G, Edelstein K. Long-term neurocognitive and psychological outcomes in meningioma survivors: Individual changes over time and radiation dosimetry. Neurooncol Pract 2024; 11:157-170. [PMID: 38496914 PMCID: PMC10940838 DOI: 10.1093/nop/npad072] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024] Open
Abstract
Background This study investigates long-term changes in neurocognitive performance and psychological symptoms in meningioma survivors and associations with radiation dose to circumscribed brain regions. Methods We undertook a retrospective study of meningioma survivors who underwent longitudinal clinical neurocognitive assessments. Change in neurocognitive performance or psychological symptoms was assessed using reliable change indices. Radiation dosimetry, if prescribed, was evaluated based on treatment-planning computerized tomography co-registered with contrast-enhanced 3D T1-weighted magnetic resonance imaging. Mixed effects analyses were used to explore whether incidental radiation to brain regions outside the tumor influences neurocognitive and psychological outcomes. Results Most (range = 41%-93%) survivors demonstrated stable-albeit often below average-neurocognitive and psychological trajectories, although some also exhibited improvements (range = 0%-31%) or declines (range = 0%-36%) over time. Higher radiation dose to the parietal-occipital region (partial R2 = 0.462) and cerebellum (partial R2 = 0.276) was independently associated with slower visuomotor processing speed. Higher dose to the hippocampi was associated with increases in depression (partial R2 = 0.367) and trait anxiety (partial R2 = 0.236). Conclusions Meningioma survivors experience neurocognitive deficits and psychological symptoms many years after diagnosis, and a proportion of them decline over time. This study offers proof of concept that incidental radiation to brain regions beyond the tumor site may contribute to these sequelae. Future investigations should include radiation dosimetry when examining risk factors that contribute to the quality of survivorship in this growing population.
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Affiliation(s)
- Angela Sekely
- Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, Ontario, Canada
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Konstantine K Zakzanis
- Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, Ontario, Canada
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Donald Mabbott
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
- Department of Psychology, Neurosciences, and Mental Health Program, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Derek S Tsang
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Paul Kongkham
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Gelareh Zadeh
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Kim Edelstein
- Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, Ontario, Canada
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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van der Plas E, Darji H, Srivastava DK, Schapiro M, Jeffe D, Perkins S, Howell R, Leisenring W, Armstrong GT, Oeffinger K, Krull K, Edelstein K, Hayashi RJ. Risk factors for neurocognitive impairment, emotional distress, and poor quality of life in survivors of pediatric rhabdomyosarcoma: A report from the Childhood Cancer Survivor Study. Cancer 2024. [PMID: 38373075 DOI: 10.1002/cncr.35236] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Prevalence and risk of poor psychological outcomes following rhabdomyosarcoma (RMS) are not well-established. METHODS Participants in this cross-sectional, case-control study (n = 713 survivors, 42.5% female; mean [SD] age, 30.5 [6.6] years; n = 706 siblings, 57.2% female; mean age, 32.8,[7.9] years) completed measures of neurocognition, emotional distress, and health-related quality of life (HRQOL). Multivariable logistic regression models identified treatments, health behaviors, and chronic conditions associated with impairment. RESULTS Relative to siblings, more survivors reported neurocognitive impairment (task efficiency: 21.1% vs. 13.7%, emotional regulation: 16.7% vs. 11.0%, memory: 19.3% vs. 15.1%), elevated emotional distress (somatic distress: 12.9% vs. 4.7%, anxiety: 11.7% vs. 5.9%, depression: 22.8% vs. 16.9%) and poorer HRQOL (physical functioning: 11.1% vs. 2.8%, role functioning due to physical problems: 16.8% vs. 8.2%, pain: 17.5% vs. 10.0%, vitality: 22.3% vs. 13.8%, social functioning: 14.4% vs. 6.8%, emotional functioning: 17.1% vs. 10.6%). Cranial radiation increased risk for impaired task efficiency (odds ratio [OR], 2.30; 95% confidence interval [CI], 1.14-4.63), whereas chest and pelvic radiation predicted increased risk of physical functioning (OR, 2.68; 95% CI, 1.16-6.21 and OR, 3.44; 95% CI, 1.70-6.95, respectively). Smoking was associated with impaired task efficiency (OR, 2.06; 95% CI, 1.14-3.70), memory (OR, 2.23; 95% CI, 1.26-3.95), anxiety (OR, 2.71; 95% CI, 1.36-5.41) and depression (OR, 1.77; 95% CI, 1.01-3.11). Neurologic conditions increased risk of anxiety (OR, 2.30; 95% CI, 1.04-5.10), and hearing conditions increased risk of depression (OR, 1.79; 95% CI, 1.05-3.03). Neurologic and hearing conditions, respectively, were associated with impaired memory (OR, 2.44; 95% CI, 1.20-4.95 and OR, 1.87; 95% CI, 1.05-3.35) and poor health perception (OR, 2.62; 95% CI, 1.62-1.28 and OR, 2.33; 95% CI, 1.34-4.06). CONCLUSIONS RMS survivors are at significant risk for poor psychological outcomes. Advancing therapies for local control, smoking cessation, and managing chronic medical conditions may mitigate poor outcomes following RMS.
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Affiliation(s)
- Ellen van der Plas
- Department of Hematology/Oncology, Arkansas Children's Hospital, Little Rock, Arkansas, USA
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Himani Darji
- Quantitative Sciences Unit, Department of Medicine, Stanford University, Stanford, California, USA
- Biostatistics Department, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Deo K Srivastava
- Biostatistics Department, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Melissa Schapiro
- Department of Pediatrics, SSM Health Cardinal Glennon Children's Hospital-St. Louis University, St. Louis, Missouri, USA
| | - Donna Jeffe
- John T. Milliken Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Stephanie Perkins
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Rebecca Howell
- Department of Radiation Physics, The MD Anderson Cancer Center, Houston, Texas, USA
| | - Wendy Leisenring
- Clinical Research Division, Fred Hutch Cancer Center, Seattle, Washington, USA
| | - Gregory T Armstrong
- Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Kevin Oeffinger
- Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Kevin Krull
- Psychology and Biobehavioral Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Kim Edelstein
- Department of Supportive Care, Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - Robert J Hayashi
- Washington University School of Medicine in St. Louis, Department of Pediatrics, St. Louis Childrens Hospital, Siteman Cancer Center, St. Louis, Missouri, USA
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Phillips NS, Stratton KL, Williams AM, Ahles T, Ness KK, Cohen HJ, Edelstein K, Yasui Y, Oeffinger K, Chow EJ, Howell RM, Robison LL, Armstrong GT, Leisenring WM, Krull KR. Late-onset Cognitive Impairment and Modifiable Risk Factors in Adult Childhood Cancer Survivors. JAMA Netw Open 2023; 6:e2316077. [PMID: 37256617 PMCID: PMC10233416 DOI: 10.1001/jamanetworkopen.2023.16077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/18/2023] [Indexed: 06/01/2023] Open
Abstract
Importance Long-term survivors of childhood cancer may be at elevated risk for new neurocognitive impairment and decline as they age into adulthood. Objective To determine whether aging adult childhood cancer survivors report more new-onset neurocognitive impairments compared with their siblings and to identify risk factors associated with such impairments. Design, Setting, and Participants Participants of this cohort study included adult survivors of childhood cancer from the Childhood Cancer Survivor Study and their siblings as a control group. The original cohort included survivors who received a diagnosis between January 1, 1970, and December 31, 1986, for whom longitudinal neurocognitive assessment was available. This study examined the prevalence of new-onset neurocognitive impairment between baseline (23.4 years after diagnosis) and follow-up (35.0 years after diagnosis). The analysis was performed from January 2021 to May 2022. Exposures Cancer treatment exposures were abstracted from medical records. Chronic health conditions were graded using Common Terminology Criteria for Adverse Events version 4.03. Main Outcomes and Measures The primary outcome was new-onset (present at follow-up, but not present at baseline) neurocognitive impairment (defined as a score in the worst 10% of the sibling cohort). Impairment was assessed using the Childhood Cancer Survivor Study Neurocognitive questionnaire. Relative risks (RRs) and 95% CIs were used to estimate associations of neurocognitive impairment with treatment and health behaviors and conditions using generalized linear models. Results The cohort comprised 2375 survivors (mean [SD] age at evaluation, 31.8 [7.5] years; 1298 women [54.6%]) of childhood cancer, including acute lymphoblastic leukemia (ALL; 1316 participants), central nervous system (CNS) tumors (488 participants), and Hodgkin lymphoma (HL; 571 participants). A total of 232 siblings (mean [SD] age at evaluation, 34.2 [8.4] years; 134 women [57.8%]) were included. Compared with siblings, a higher proportion of survivors with no impairment in memory at baseline had new-onset memory impairment at follow-up: siblings proportion, 7.8% (95% CI, 4.3%-11.4%); ALL survivors treated with chemotherapy only, 14.0% (95% CI, 10.7%-17.4%); ALL survivors treated with cranial radiation (CRT), 25.8% (95% CI, 22.6%-29.0%); CNS tumor survivors, 34.7% (95% CI, 30.0%-39.5%); and HL survivors, 16.6% (95% CI, 13.4%-19.8%). New-onset memory impairment was associated with CRT in CNS tumor survivors (RR, 1.97; 95% CI, 1.33-2.90) and alkylator chemotherapy greater than or equal to 8000 mg/m2 in ALL survivors treated without CRT (RR, 2.80; 95% CI, 1.28-6.12). Neurologic conditions mediated the impact of CRT on new-onset memory impairment in CNS survivors. Smoking, low educational attainment, and low physical activity were associated with elevated risk for new-onset memory impairment. Conclusions and Relevance These findings suggest that adult survivors of childhood cancer are at elevated risk for late-onset memory impairment related to modifiable risk factors identified early in survivorship.
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Affiliation(s)
- Nicholas S. Phillips
- Epidemiology and Cancer Control Department, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Kayla L. Stratton
- Department of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington
| | - AnnaLynn M. Williams
- Epidemiology and Cancer Control Department, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Tim Ahles
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York City, New York
| | - Kirsten K. Ness
- Epidemiology and Cancer Control Department, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Harvey Jay Cohen
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Kim Edelstein
- Department of Psychology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Yutaka Yasui
- Epidemiology and Cancer Control Department, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Kevin Oeffinger
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Eric J. Chow
- Department of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Rebecca M. Howell
- Department of Radiation Physics, MD Anderson Cancer Center, Houston, Texas
| | - Leslie L. Robison
- Epidemiology and Cancer Control Department, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Gregory T. Armstrong
- Epidemiology and Cancer Control Department, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Wendy M. Leisenring
- Department of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Kevin R. Krull
- Epidemiology and Cancer Control Department, St Jude Children’s Research Hospital, Memphis, Tennessee
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4
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Pole JD, Williams B, Di Giuseppe G, Guger S, Stasiulis E, Greenberg ML, Spiegler BJ, Edelstein K. Measuring what gets done: Using goal attainment scaling in a vocational counseling program for survivors of childhood cancer. Cancer Med 2023; 12:8676-8689. [PMID: 36775957 PMCID: PMC10134366 DOI: 10.1002/cam4.5576] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/22/2022] [Accepted: 12/17/2022] [Indexed: 02/14/2023] Open
Abstract
BACKGROUND Childhood cancer survivors face education and employment challenges due to physical, cognitive, and psychosocial effects of the disease and treatments, with few established programs to assist them. The objectives of this study were to describe the implementation of Goal Attainment Scaling (GAS) to evaluate an educational and vocational counseling program established for survivors of childhood cancer, and analyze patterns of program engagement and client outcomes, stratified by demographic and diagnostic characteristics. METHODS A population-based retrospective cohort study of childhood cancer survivors who were engaged with the Pediatric Oncology Group of Ontario's School and Work Transitions Program (SWTP) between January 2015 and December 2018 was utilized. Survivors were followed from SWTP engagement until May 30, 2019 to capture goal attainment. Individual goals were summarized across various demographic, disease, and treatment strata. RESULTS In total, 470 childhood cancer survivors (median age = 17.9, 58% male) set 4,208 goals in the SWTP during the study period. The mean length of observation was 130.8 weeks (SD = 56.9). Overall, 68% of the goals were achieved. Eighty-three percent of the goals related to further education. Clients diagnosed with a solid tumor set the most goals on average, followed by those with central nervous system tumors and leukemia/lymphoma. CONCLUSIONS The SWTP assists childhood cancer survivors in realizing their academic and vocational goals. Application of GAS in this setting is a feasible way to evaluate program outcomes. From the volume and breadth of the GAS goals set and achieved, the overall success of the SWTP appears strong.
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Affiliation(s)
- Jason D Pole
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Barb Williams
- Pediatric Oncology Group of Ontario, Toronto, Ontario, Canada
| | - Giancarlo Di Giuseppe
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Pediatric Oncology Group of Ontario, Toronto, Ontario, Canada
| | - Sharon Guger
- Department of Psychology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elaine Stasiulis
- Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Kim Edelstein
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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5
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Sekely A, Bernstein LJ, Campbell KL, Mason WP, Laperriere N, Kalidindi N, Or R, Ramos R, Climans SA, Pond GR, Ann Millar B, Shultz D, Tsang DS, Zadeh G, Edelstein K. Neurocognitive impairment, neurobehavioral symptoms, fatigue, sleep disturbance, and depressive symptoms in patients with newly diagnosed glioblastoma. Neurooncol Pract 2023; 10:89-96. [PMID: 36659968 PMCID: PMC9837779 DOI: 10.1093/nop/npac068] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background In addition to poor survival rates, individuals with glioblastoma (GBM) are at risk of neurocognitive impairment due to multiple factors. This study aimed to characterize neurocognitive impairment, neurobehavioral symptoms, fatigue, sleep disturbance, and depressive symptoms in newly diagnosed GBM patients; and to examine whether neurobehavioral symptoms, fatigue, sleep, and depressive symptoms influence neurocognitive performance. Methods This study was part of a prospective, inception cohort, single-arm exercise intervention in which GBM patients underwent a neuropsychological assessment shortly after diagnosis (median 4 weeks; ie, baseline) and 3, 6, 12, and 18 months later, or until tumor progression. Here, we present baseline data. Forty-five GBM patients (mean age = 55 years) completed objective neurocognitive tests, and self-report measures of neurobehavioral symptoms, fatigue, sleep disturbance, and depressive symptoms. Results Compared to normative samples, GBM patients scored significantly lower on all neurocognitive tests, with 34 (76%) patients exhibiting neurocognitive impairment. Specifically, 53% exhibited impairment in memory retention, 51% in executive function, 42% in immediate recall, 41% in verbal fluency, and 24% in attention. There were high rates of clinically elevated sleep disturbance (70%), fatigue (57%), depressive symptoms (16%), and neurobehavioral symptoms (27%). A multivariate regression analysis revealed that depressive symptoms are significantly associated with neurocognitive impairment. Conclusions GBM patients are vulnerable to adverse outcomes including neurocognitive impairment, neurobehavioral symptoms, fatigue, sleep disturbance, and depressive symptoms shortly after diagnosis, prior to completing chemoradiation. Those with increased depressive symptoms are more likely to demonstrate neurocognitive impairment, highlighting the need for early identification and treatment of depression in this population.
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Affiliation(s)
- Angela Sekely
- Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, Ontario, Canada
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Lori J Bernstein
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Kristin L Campbell
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Warren P Mason
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Normand Laperriere
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Navya Kalidindi
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Rosemarylin Or
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Ronald Ramos
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Seth A Climans
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Gregory R Pond
- Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, Ontario, Canada
| | - Barbara Ann Millar
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - David Shultz
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Derek S Tsang
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Gelareh Zadeh
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Kim Edelstein
- Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, Ontario, Canada
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Higazy R, Ramotar M, Liu ZA, Santiago AT, Kosyak N, Liu G, Simpson R, Shultz DB, Edelstein K. SPCR-04 EFFECTS OF BRAIN METASTASES ON NEUROCOGNITIVE FUNCTION: BASELINE RESULTS OF A LONGITUDINAL TRIAL. Neurooncol Adv 2022. [PMCID: PMC9354190 DOI: 10.1093/noajnl/vdac078.079] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Neurocognitive dysfunction is common in patients with advanced metastatic cancer. The contribution of brain metastases (BrMets) to neurocognitive outcomes is uncertain. We examined the impact of BrMets on cognitive outcomes before CNS-directed treatment and compared findings to patients with advanced metastatic cancer without BrMets. Here we present results from an ongoing prospective, longitudinal study. METHODS English-speaking adults followed at the brain metastases and lung cancer clinics underwent neurocognitive testing using a standardized battery (prior to cranial radiotherapy, if applicable), with follow-up assessments 3, 6, 9, 12, 18, and 24 months later. We calculated z-scores and impairment rates for composite neurocognitive function and memory, attention/working memory, processing speed and executive function domains. Impairment was defined according to International Cancer and Cognition Task Force criteria. RESULTS 78 patients with BrMets (50% female; mean age (SD):61(11) years) and 28 patients with metastatic non-small cell lung cancer (mNSCLC) with no known BrMets (71% female; age 67(9) years) were included. Baseline neurocognitive composite scores were impaired in both groups (BrMets: 61.5%; nonBrMets: 60.7%). Impairment rates varied between groups and across domains (BrMets vs nonBrMets: memory: 35.9%vs25.0%; attention/working memory: 35.8%vs21.4%; processing speed: 10.3%vs7.1%; executive function: 44.0%vs35.7%). Subgroup comparisons between BrMets patients with mNSCLC (N=29) and mNSCLC patients without BrMets, none of whom had targetable mutations, revealed no differences in impairment rates, but BrMets patients had slower processing speed than nonBrMets patients (mean(SD): -0.6(1.4) vs -0.1(1.9); Wilcoxon signed-rank test, p = 0.043). CONCLUSION Neurocognitive impairment in patients with advanced cancers is common. Our preliminary findings demonstrate no clear difference in cognitive outcomes between patients with BrMets and those with advanced metastatic disease not involving the brain. Our work examining how neurocognitive outcomes evolve over time in patients with and without BrMets, and demographic, disease, and treatment variables associated with those outcomes, is ongoing.
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Affiliation(s)
- Randa Higazy
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network , Toronto, ON , Canada
- University of Toronto , Toronto, ON , Canada
| | - Matthew Ramotar
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network , Toronto, ON , Canada
| | - Zhihui Amy Liu
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network , Toronto, ON , Canada
- University of Toronto , Toronto, ON , Canada
| | - Anna T Santiago
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network , Toronto, ON , Canada
| | - Natalya Kosyak
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network , Toronto, ON , Canada
| | - Geoffrey Liu
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network , Toronto, ON , Canada
- University of Toronto , Toronto, ON , Canada
| | - Rebecca Simpson
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network , Toronto, ON , Canada
| | - David B Shultz
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network , Toronto, ON , Canada
- University of Toronto , Toronto, ON , Canada
| | - Kim Edelstein
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network , Toronto, ON , Canada
- University of Toronto , Toronto, ON , Canada
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7
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Tsang DS, Khandwala MM, Liu ZA, Richard N, Shen G, Sekely A, Bernstein LJ, Simpson R, Mason W, Chung C, de Moraes FY, Murray L, Shultz D, Laperriere N, Millar BA, Edelstein K. Neurocognitive performance in adults treated with radiation for a primary brain tumour. Adv Radiat Oncol 2022; 7:101028. [DOI: 10.1016/j.adro.2022.101028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 07/05/2022] [Indexed: 10/31/2022] Open
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8
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Variath C, Climans SA, Edelstein K, Bell JAH. Neuro-oncology clinicians' perspectives on factors affecting brain cancer patients' access to medical assistance in dying: A qualitative study. Death Stud 2022; 47:296-306. [PMID: 35442866 DOI: 10.1080/07481187.2022.2063456] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
In most jurisdictions where medical assistance in dying (MAiD) is legal, patients must have decision-making capacity. Brain cancer often damages the cognitive networks required to maintain decision-making capacity. Using qualitative methodology guided by a relational ethics conceptual framework, this study explored neuro-oncology clinicians' perspectives on access to and eligibility for MAiD for patients diagnosed with brain cancer. We interviewed 24 neuro-oncology clinicians from 6 countries. Participants described the unique challenges facing brain cancer patients, potentially resulting in their inequitable access to MAiD. The findings highlight the importance of early end-of-life conversations, advance care planning, and access to end-of-life treatment options.
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Affiliation(s)
- Caroline Variath
- Lawrence S Bloomberg School of Nursing, Joint Centre for Bioethics, University of Toronto, Toronto, Canada
| | - Seth A Climans
- Departments of Neurology and Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada
| | - Kim Edelstein
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Canada
| | - Jennifer A H Bell
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Canada
- Dalla Lana School of Public Health, Joint Centre for Bioethics, University of Toronto, Toronto, Canada
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9
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Sekely A, Tsang DS, Mabbott D, Kongkham P, Zadeh G, Zakzanis KK, Edelstein K. Radiation dose to circumscribed brain regions and neurocognitive function in patients with meningioma. Neurooncol Pract 2022; 9:208-218. [PMID: 35601975 PMCID: PMC9113401 DOI: 10.1093/nop/npac011] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Although radiation (RT) is standard treatment for many brain tumors, it may contribute to neurocognitive decline. The objective of this study was to investigate associations between RT dose to circumscribed brain regions and specific neurocognitive domains in patients with meningioma. Methods We undertook a retrospective study of 40 patients with meningioma who received RT and underwent an in-depth clinical neurocognitive assessment. Radiation dosimetry characteristics were delineated based on treatment planning computerized tomography co-registered with contrast-enhanced 3D T1-weighted magnetic resonance imaging. Principal components analysis was applied to organize neurocognitive test scores into factors, and multivariate multiple linear regression models were undertaken to examine if RT dose to circumscribed brain regions is associated with specific neurocognitive outcomes. Results Radiation dose to brain regions was associated with neurocognitive functions across a number of domains. High dose to the parietal-occipital region was associated with slower visuomotor processing speed (mean dose, β = -1.100, P = .017; dose to 50% of the region [D50], β = -0.697, P = .049). In contrast, high dose to the dorsal frontal region was associated with faster visuomotor processing speed (mean dose, β = 0.001, P = .036). Conclusions These findings suggest that RT delivered to brain regions (ie, parietal-occipital areas) may contribute to poor neurocognitive outcomes. Given that modern radiotherapy techniques allow for precise targeting of dose delivered to brain regions, prospective trials examining relations between dose and neurocognitive functions are warranted to confirm these preliminary results.
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Affiliation(s)
- Angela Sekely
- Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, Ontario, Canada,Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada,Corresponding Author: Angela Sekely, MA, Graduate Department of Psychological Clinical Science, University of Toronto, 1265 Military Trail SY171, Scarborough, ON M1C 1A4, Canada; Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON, Canada ()
| | - Derek S Tsang
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada,Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Donald Mabbott
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada,Department of Psychology, Neurosciences, and Mental Health Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Paul Kongkham
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada,Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Gelareh Zadeh
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Konstantine K Zakzanis
- Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, Ontario, Canada,Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Kim Edelstein
- Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, Ontario, Canada,Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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10
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Sekely A, Zakzanis KK, Mabbott D, Tsang DS, Kongkham P, Zadeh G, Edelstein K. Long-term neurocognitive, psychological, and return to work outcomes in meningioma patients. Support Care Cancer 2022; 30:3893-3902. [PMID: 35041087 DOI: 10.1007/s00520-022-06838-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 01/13/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION This study aimed to investigate long-term neurocognitive, psychological, and return to work (RTW) outcomes in meningioma patients, and to explore whether neurocognitive and psychological factors influence RTW outcomes in this population. METHODS In this retrospective study, 61 meningioma patients completed in-depth clinical neuropsychological assessments. Of these participants, 42 were of working-age and had RTW information available following neuropsychological assessment. Seventy-one percent and 80% of patients received radiation and surgery, respectively, with 49% receiving both radiation and surgery. Associations between demographic, medical, neurocognitive, psychological, and RTW data were analyzed using multivariable logistic regression analyses. RESULTS In our sample, 68% of patients exhibited global neurocognitive impairment, with the largest effect sizes found on tests of visual memory (d = 0.73), executive function (d = 0.61), and attention (d = 0.54). Twenty-seven percent exhibited moderate to severe levels of depressive symptoms. In addition, 23% and 30% exhibited clinically significant state and trait anxiety, respectively. Forty-eight percent of patients were unable to RTW. Younger age, faster visuomotor processing speed, and, unexpectedly, higher trait anxiety scores were associated with an increased likelihood of returning to work. CONCLUSIONS Meningioma patients are at risk of experiencing neurocognitive deficits, psychological symptoms, and difficulties returning to work. Our results suggest that neurocognitive and psychological factors contribute to RTW status in meningioma patients. Prospective research studies are necessary to increase our understanding of the complexity of functional disability in this growing population.
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Affiliation(s)
- Angela Sekely
- Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, ON, Canada. .,Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON, Canada.
| | - Konstantine K Zakzanis
- Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, ON, Canada.,Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Donald Mabbott
- Department of Psychology, University of Toronto, Toronto, ON, Canada.,Department of Psychology, Neurosciences, and Mental Health Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - Derek S Tsang
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada.,Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Paul Kongkham
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, Toronto, ON, Canada
| | - Gelareh Zadeh
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, Toronto, ON, Canada
| | - Kim Edelstein
- Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, ON, Canada.,Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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11
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Petruccelli M, Parent A, Holwell M, Laperriere N, Millar BA, Shultz D, Liu ZA, Malkov V, Edelstein K, Tsang D. 90: Understanding the Potential Improvements in Neurocognition After Radiation Treatment of Brain Tumours with Proton Therapy. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)08968-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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12
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Eggen AC, Richard NM, Bosma I, Jalving M, Leighl NB, Liu G, Mah K, Higazy R, Shultz DB, Reyners AKL, Rodin G, Edelstein K. Factors associated with cognitive impairment and cognitive concerns in patients with metastatic non-small cell lung cancer. Neurooncol Pract 2021; 9:50-58. [PMID: 35087675 PMCID: PMC8789294 DOI: 10.1093/nop/npab056] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Knowledge regarding cognitive problems in metastatic non-small cell lung cancer (mNSCLC) is limited. Such problems may include both patient-reported cognitive concerns and demonstrable cognitive impairment. Greater understanding of these outcomes is needed to inform rehabilitation strategies for these difficulties. We aimed to identify the frequency of cognitive problems and associated factors in patients with mNSCLC. Methods In this cross-sectional study, adults with mNSCLC completed validated neuropsychological tests and self-report questionnaires measuring cognitive concerns, neurobehavioral concerns, depression, demoralization, illness intrusiveness, self-esteem, and physical symptoms. Cognitive impairment (performance based) was defined according to International Cancer and Cognition Task Force criteria. Clinically significant cognitive concerns were defined by a score ≥1.5 SD below the normative mean on the Functional Assessment of Cancer Therapy-Cognitive Function Perceived Cognitive Impairment (FACT-Cog PCI). Univariate and multivariate logistic regression analyses were performed to identify associated factors. Results Of 238 patients approached, 77 participated (median age: 62 years; range: 37-82). Brain metastases were present in 41 patients (53%), and 23 (29%) received cranial irradiation. Cognitive impairment and cognitive concerns were present in 31 (40%) and 20 patients (26%), respectively. Cognitive impairment and cognitive concerns co-occurred in 10 patients (13%), but their severity was unrelated. Cognitive impairment was associated with cranial irradiation (odds ratio [OR] = 2.89; P = .04), whereas cognitive concerns were associated with greater illness intrusiveness (OR = 1.04; P = .03) and lower self-esteem (OR = 0.86; P = .03). Conclusions Cognitive impairment and cognitive concerns are both common in patients with mNSCLC but are not necessarily related, and their risk factors differ. The association of illness intrusiveness and self-esteem with cognitive concerns can inform therapeutic interventions in this population.
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Affiliation(s)
- Annemarie C Eggen
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Nadine M Richard
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Ingeborg Bosma
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Mathilde Jalving
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Natasha B Leighl
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Geoffrey Liu
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Kenneth Mah
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Randa Higazy
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - David B Shultz
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Anna K L Reyners
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Center of Expertise in Palliative Care, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Kim Edelstein
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
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13
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Bernstein LJ, Edelstein K, Sharma A, Alain C. Chemo-brain: An activation likelihood estimation meta-analysis of functional magnetic resonance imaging studies. Neurosci Biobehav Rev 2021; 130:314-325. [PMID: 34454915 DOI: 10.1016/j.neubiorev.2021.08.024] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 07/24/2021] [Accepted: 08/23/2021] [Indexed: 11/17/2022]
Abstract
Adults with non-central nervous system (CNS) cancers frequently report problems in attention, memory and executive function during or after chemotherapy, referred to as cancer-related cognitive dysfunction (CRCD). Despite numerous studies investigating CRCD, there is no consensus regarding the brain areas implicated. We sought to determine if there are brain areas that consistently show either hyper- or hypo-activation in people treated with chemotherapy for non-CNS cancer (Chemo+). Using activation likelihood estimation on brain coordinates from 14 fMRI studies yielding 25 contrasts from 375 Chemo+ and 429 chemotherapy-naive controls while they performed cognitive tasks, the meta-analysis yielded two significant clusters which are part of the frontoparietal attention network, both showing lower activation in Chemo+. One cluster peaked in the left superior parietal cortex, extending into precuneus, inferior parietal lobule, and angular gyrus. The other peaked in the right superior prefrontal areas, extending into inferior prefrontal cortex. We propose that these observed lower activations reflect a dysfunction in mobilizing and/or sustaining attention due to depletion of cognitive resources. This could explain higher level of mental fatigue reported by Chemo+ and why cancer survivors report problems in a wide variety of cognitive domains.
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Affiliation(s)
- Lori J Bernstein
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Canada.
| | - Kim Edelstein
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Canada
| | - Alisha Sharma
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Claude Alain
- Rotman Research Institute, Baycrest Health Centre, Canada; Department of Psychology, University of Toronto, Canada
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14
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Baba A, Saha A, McCradden MD, Boparai K, Zhang S, Pirouzmand F, Edelstein K, Zadeh G, Cusimano MD. Development and validation of a patient-centered, meningioma-specific quality-of-life questionnaire. J Neurosurg 2021:1-10. [PMID: 33990085 DOI: 10.3171/2020.11.jns201761] [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: 05/30/2020] [Accepted: 11/09/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Meningiomas can have significant impact on health-related quality of life (HRQOL). Patient-centered, disease-specific instruments for assessing HRQOL in these patients are lacking. To this end, the authors sought to develop and validate a meningioma-specific HRQOL questionnaire through a standardized, patient-centered questionnaire development methodology. METHODS The development of the questionnaire involved three main phases: item generation, item reduction, and validation. Item generation consisted of semistructured interviews with patients (n = 30), informal caregivers (n = 12), and healthcare providers (n = 8) to create a preliminary list of items. Item reduction with 60 patients was guided by the clinical impact method, multiple correspondence analysis, and hierarchical cluster analysis. The validation phase involved 162 patients and collected evidence on extreme-groups validity; concurrent validity with the SF-36, FACT-Br, and EQ-5D; and test-retest reliability. The questionnaire takes on average 11 minutes to complete. RESULTS The meningioma-specific quality-of-life questionnaire (MQOL) consists of 70 items representing 9 domains. Cronbach's alpha for each domain ranged from 0.61 to 0.91. Concurrent validity testing demonstrated construct validity, while extreme-groups testing (p = 1.45E-11) confirmed the MQOL's ability to distinguish between different groups of patients. CONCLUSIONS The MQOL is a validated, reliable, and feasible questionnaire designed specifically for evaluating QOL in meningioma patients. This disease-specific questionnaire will be fundamentally helpful in better understanding and capturing HRQOL in the meningioma patient population and can be used in both clinical and research settings.
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Affiliation(s)
- Ami Baba
- 1Division of Neurosurgery, Department of Surgery and
| | | | | | | | - Shudong Zhang
- 1Division of Neurosurgery, Department of Surgery and
| | - Farhad Pirouzmand
- 3Division of Neurosurgery, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto
| | - Kim Edelstein
- 4Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto.,5Department of Psychiatry, Faculty of Medicine, University of Toronto
| | - Gelareh Zadeh
- 6Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto; and
| | - Michael D Cusimano
- 1Division of Neurosurgery, Department of Surgery and.,2Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, University of Toronto.,7Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
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15
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Schuitema I, Alexander T, Hudson MM, Krull KR, Edelstein K. Aging in Adult Survivors of Childhood Cancer: Implications for Future Care. J Clin Oncol 2021; 39:1741-1751. [PMID: 33886351 DOI: 10.1200/jco.20.02534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- Ilse Schuitema
- Department of Health, Medical and Neuropsychology, Leiden University, Leiden, the Netherlands
| | - Tyler Alexander
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN.,Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
| | - Kevin R Krull
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN.,Department of Psychology, St Jude Children's Research Hospital, Memphis, TN
| | - Kim Edelstein
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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16
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Foran SJ, Laperriere N, Edelstein K, Janzen L, Tadic T, Ramaswamy V, Shultz D, Gentili F, Bouffet E, Tsang DS. Reirradiation for recurrent craniopharyngioma. Adv Radiat Oncol 2020; 5:1305-1310. [PMID: 33305092 PMCID: PMC7718531 DOI: 10.1016/j.adro.2020.07.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 04/27/2020] [Revised: 07/08/2020] [Accepted: 07/28/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose Reirradiation is rarely administered to patients with recurrent craniopharyngioma owing to concerns regarding visual and endocrine side effects. The purpose of this case series was to evaluate our institutional experience of patients with craniopharyngioma treated with 2 courses of fractionated radiation therapy. Methods and Materials A retrospective study was performed of all patients with craniopharyngioma treated with 2 courses of fractionated radiation therapy at a single institution. Electronic medical records and radiation therapy records were reviewed. Results We identified 4 eligible patients with recurrent craniopharyngioma. With a median follow-up of 33 months after reirradiation, 3 patients attained disease control; 1 patient developed progressive disease, 27 months after reirradiation. In 3 evaluable patients, vision remained stable or improved after reirradiation; one patient had no light perception before reirradiation. None of the patients experienced additional endocrine toxicities after reirradiation, apart from one patient who had low serum thyroid stimulating hormone before reirradiation and later developed hypothyroidism after treatment. Conclusions Reirradiation may represent a safe and effective therapeutic option for selected patients with recurrent, refractory craniopharyngioma and without other salvage treatment options. Larger studies with longer-term follow up are warranted to better understand outcomes in these patients.
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Affiliation(s)
- Sarah J Foran
- University of Toronto, Faculty of Medicine, Toronto, Canada
| | - Normand Laperriere
- Radiation Medicine Program, Princess Margaret Cancer Center, University Health Network, Toronto, Canada
| | - Kim Edelstein
- Radiation Medicine Program, Princess Margaret Cancer Center, University Health Network, Toronto, Canada
| | - Laura Janzen
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Canada
| | - Tony Tadic
- Radiation Medicine Program, Princess Margaret Cancer Center, University Health Network, Toronto, Canada
| | - Vijay Ramaswamy
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Canada
| | - David Shultz
- Radiation Medicine Program, Princess Margaret Cancer Center, University Health Network, Toronto, Canada
| | - Fred Gentili
- Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Eric Bouffet
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Canada
| | - Derek S Tsang
- Radiation Medicine Program, Princess Margaret Cancer Center, University Health Network, Toronto, Canada.,Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Canada
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17
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Foran S, Laperriere N, Edelstein K, Janzen L, Ramaswamy V, Shultz D, Gentili F, Bouffet E, Tsang D. RARE-02.RE-IRRADIATION FOR RECURRENT CRANIOPHARYNGIOMA. Neuro Oncol 2020. [PMCID: PMC7715751 DOI: 10.1093/neuonc/noaa222.714] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
PURPOSE
Patients with recurrent craniopharyngioma after radiotherapy (RT) have few treatment options. At our institution, re-irradiation has been offered to selected individuals with recurrent craniopharyngioma not suitable for further surgery, intracystic therapy or targeted agents.
METHODS
A retrospective study was performed of patients with craniopharyngioma treated with two courses of fractionated RT. First RT (RT1) prescriptions ranged from 50–54 Gy in 25–30 fractions; re-irradiation (RT2) prescriptions were 54 Gy in 30 fractions with full, in-field overlap of dose. The maximum dose to organs-at-risk (brainstem, optic structures) were maintained at or below the prescription dose. There was no cumulative dose limit to any structure.
RESULTS
We identified four patients. Median RT1-to-RT2 interval was 5.8 years (range, 4.7–20.4). Cumulative maximum doses to optic chiasma and nerves were >100 Gy in all four patients. With a median follow-up of 33 months after RT2, three patients had disease control and are alive at 9, 23 and 42 months from RT2; one patient developed progressive disease and died 33 months after RT2. In three evaluable patients, vision remained stable or improved after RT2; the remaining one patient had no light perception prior to re-irradiation. Two patients had neuropsychological testing before and after RT2; neurocognitive domains were generally stable in one patient but working memory declined in the second patient.
CONCLUSIONS
Despite exceeding usual tolerances for optic chiasm and nerves, visual outcomes were stable in all living patients. Re-irradiation should be discussed as a treatment option for patients with recurrent craniopharyngioma but without other therapeutic options.
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Affiliation(s)
- Sarah Foran
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | - Kim Edelstein
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | | | - David Shultz
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | | | - Derek Tsang
- Princess Margaret Cancer Centre, Toronto, ON, Canada
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18
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Adams SC, Herman J, Lega IC, Mitchell L, Hodgson D, Edelstein K, Travis LB, Sabiston CM, Thavendiranathan P, Gupta AA. Young Adult Cancer Survivorship: Recommendations for Patient Follow-up, Exercise Therapy, and Research. JNCI Cancer Spectr 2020; 5:pkaa099. [PMID: 33681702 PMCID: PMC7919337 DOI: 10.1093/jncics/pkaa099] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 08/31/2020] [Indexed: 12/23/2022] Open
Abstract
Survivors of adolescent and young adult cancers (AYAs) often live 50 to 60 years beyond their diagnosis. This rapidly growing cohort is at increased risk for cancer- and treatment-related 'late effects' that persist for decades into survivorship. Recognition of similar issues in pediatric cancer survivors has prompted the development of evidence-based guidelines for late effects screening and care. However, corresponding evidence-based guidelines for AYAs have not been developed. We hosted an AYA survivorship symposium for a large group of multidisciplinary AYA stakeholders (approximately 200 were in attendance) at Princess Margaret Cancer Centre (Toronto, Ontario, Canada) to begin addressing this disparity. The following overview briefly summarizes and discusses the symposium's stakeholder-identified high-priority targets for late effects screening and care and highlights knowledge gaps to direct future research in the field of AYA survivorship. This overview, although not exhaustive, is intended to stimulate clinicians to consider these high-priority screening and care targets when seeing survivors in clinical settings and, ultimately, to support the development of evidence-based late effects screening and care guidelines for AYAs.
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Affiliation(s)
- Scott C Adams
- Department of Cardiology, Toronto General Hospital Research Institute, Toronto, ON, Canada
- Ted Rogers Cardiotoxicity Prevention Program, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, ON, Canada
- Mental Health & Physical Activity Research Centre, Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, ON, Canada
- Adolescent and Young Adult Oncology Program, Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Jennifer Herman
- Adolescent and Young Adult Oncology Program, Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Iliana C Lega
- Women’s College Hospital, University of Toronto, Toronto, ON, Canada
| | - Laura Mitchell
- Adolescent and Young Adult Oncology Program, Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - David Hodgson
- Division of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Kim Edelstein
- Adolescent and Young Adult Oncology Program, Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON, Canada
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Lois B Travis
- Division of Medical Oncology, Melvin and Bren Simon Cancer Centre, Indiana University, Indianapolis, IN, USA
- Department of Epidemiology, Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA
| | - Catherine M Sabiston
- Mental Health & Physical Activity Research Centre, Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, ON, Canada
| | - Paaladinesh Thavendiranathan
- Ted Rogers Cardiotoxicity Prevention Program, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Abha A Gupta
- Adolescent and Young Adult Oncology Program, Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON, Canada
- Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
- Correspondence to: Abha A. Gupta, MD, MSC, FRCPC, Princess Margaret Cancer Centre, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada (e-mail: )
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19
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Foran S, Laperriere N, Edelstein K, Janzen L, Ramaswamy V, Shultz D, Gentili F, Bouffet E, Tsang D. 54: Re-Irradiation for Recurrent Craniopharyngioma. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(20)30946-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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20
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Eggen AC, Reyners AKL, Shen G, Bosma I, Jalving M, Leighl NB, Liu G, Richard NM, Mah K, Shultz DB, Edelstein K, Rodin G. Death Anxiety in Patients With Metastatic Non-Small Cell Lung Cancer With and Without Brain Metastases. J Pain Symptom Manage 2020; 60:422-429.e1. [PMID: 32145337 DOI: 10.1016/j.jpainsymman.2020.02.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/20/2020] [Accepted: 02/23/2020] [Indexed: 12/16/2022]
Abstract
CONTEXT Death anxiety is common in patients with metastatic cancer, but its relationship to brain metastases and cognitive decline is unknown. Early identification of death anxiety and its determinants allows proactive interventions to be offered to those in need. OBJECTIVES To identify psychological, physical, and disease-related (including brain metastases and cognitive impairment) factors associated with death anxiety in metastatic non-small cell lung cancer (mNSCLC) patients. METHODS A cross-sectional pilot study with mNSCLC outpatients completing standardized neuropsychological tests and validated questionnaires measuring death anxiety, cognitive concerns, illness intrusiveness, depression, demoralization, self-esteem, and common cancer symptoms. We constructed a composite for objective cognitive function (mean neuropsychological tests z-scores). RESULTS Study measures were completed by 78 patients (50% females; median age 62 years [range 37-82]). Median time since mNSCLC diagnosis was 11 months (range 0-89); 53% had brain metastases. At least moderate death anxiety was reported by 43% (n = 33). Objective cognitive impairment was present in 41% (n = 32) and perceived cognitive impairment in 27% (n = 21). Death anxiety, objective, and perceived cognitive impairment did not significantly differ between patients with and without brain metastases. In univariate analysis, death anxiety was associated with demoralization, depression, self-esteem, illness intrusiveness, common physical cancer symptoms, and perceived cognitive impairment. In multivariate analysis, demoralization (P < 0.001) and illness intrusiveness (P = 0.001) were associated with death anxiety. CONCLUSION Death anxiety and brain metastases are common in patients with mNSCLC but not necessarily linked. The association of death anxiety with both demoralization and illness intrusiveness highlights the importance of integrated psychological and symptom management. Further research is needed on the psychological impact of brain metastases.
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Affiliation(s)
- Annemarie C Eggen
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Anna K L Reyners
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Gerald Shen
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Ingeborg Bosma
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Mathilde Jalving
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Natasha B Leighl
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Geoffrey Liu
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Nadine M Richard
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Kenneth Mah
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - David B Shultz
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Kim Edelstein
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.
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Barlow-Krelina E, Chen Y, Yasui Y, Till C, Gibson TM, Ness KK, Leisenring WM, Howell RM, Nathan PC, Oeffinger KC, Robison LL, Armstrong GT, Krull KR, Edelstein K. Consistent Physical Activity and Future Neurocognitive Problems in Adult Survivors of Childhood Cancers: A Report From the Childhood Cancer Survivor Study. J Clin Oncol 2020; 38:2041-2052. [PMID: 32330104 DOI: 10.1200/jco.19.02677] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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
PURPOSE To investigate longitudinal associations between physical activity (PA) and neurocognitive problems in adult survivors of childhood cancer. METHODS A total of 12,123 5-year survivors diagnosed between 1970 and 1999 (median [range] age at diagnosis, 7 [0-21] years, time since diagnosis at baseline, 16 [6-30] years) and 720 siblings self-reported PA and neurocognitive problems. PA was collected at baseline, and PA and neurocognitive data were obtained 7 (1-12) years and 12 (9-14) years later. PA consistency was defined as any combination of ≥ 75 minutes of vigorous or 150 minutes of moderate activity per week on all surveys. Multiple linear regressions, conducted separately for CNS and non-CNS survivors, identified associations between PA consistency and neurocognitive outcomes (expected mean, 50; standard deviation [SD], 10). Mediating effects of body mass index (BMI) and chronic health conditions (CHCs) were evaluated. RESULTS Survivors were less likely than siblings to report consistent PA (28.1% v 33.6%) and more likely to report problems in Task Efficiency (T-scores mean ± SD: siblings, 50.0 ± 0.4; CNS, 61.4 ± 0.4; non-CNS, 53.3 ± 0.3), Emotion Regulation (siblings, 51.4 ± 0.4; CNS, 54.5 ± 0.3; non-CNS 53.4 ± 0.2), and Memory (siblings, 50.8 ± 0.4; CNS, 58.9 ± 0.4; non-CNS, 53.5 ± 0.2; all P < .001). Survivors of CNS cancers (52.8 ± 0.3) also reported poorer Organization than siblings (49.9 ± 0.4; P < .001). After adjusting for age at diagnosis, age at questionnaire, emotional distress, and cancer treatment exposures, consistent PA was associated with fewer neurocognitive problems compared with consistent inactivity for both CNS and non-CNS groups (T-score differences ranging from -7.9 to -2.2) and larger neurocognitive improvements over time (-6.0 to -2.5), all P ≤ .01. BMI and severe CHCs partially mediated the PA-neurocognitive associations, but the mediation effects were small (change in β ≤ 0.4). CONCLUSION Adult survivors of childhood cancer who report more consistent PA have fewer neurocognitive problems and larger improvements in these concerns many years after treatment.
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Affiliation(s)
| | - Yan Chen
- University of Alberta, Edmonton, Alberta, Canada
| | - Yutaka Yasui
- University of Alberta, Edmonton, Alberta, Canada.,St Jude Children's Research Hospital, Memphis, TN
| | - Christine Till
- York University, Toronto, Ontario, Canada.,Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | | | | | - Paul C Nathan
- Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | | | | | - Kim Edelstein
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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22
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Affiliation(s)
- Derek S Tsang
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Kim Edelstein
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
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23
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Hayek S, Gibson TM, Leisenring WM, Guida JL, Gramatges MM, Lupo PJ, Howell RM, Oeffinger KC, Bhatia S, Edelstein K, Hudson MM, Robison LL, Nathan PC, Yasui Y, Krull KR, Armstrong GT, Ness KK. Prevalence and Predictors of Frailty in Childhood Cancer Survivors and Siblings: A Report From the Childhood Cancer Survivor Study. J Clin Oncol 2019; 38:232-247. [PMID: 31800343 DOI: 10.1200/jco.19.01226] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To estimate the prevalence of frailty among childhood cancer survivors and to determine the direct and indirect effects of treatment exposures, lifestyle factors, and severe, disabling, and life-threatening chronic condition on frailty. METHODS Childhood cancer survivors (≥ 5 years since diagnosis), treated between 1970 and 1999 when < 21 years old (n = 10,899; mean age, 37.6 ± 9.4 years; 48% male, 86% white) and siblings were included (n = 2,097; mean age, 42.9 ± 9.4 years). Frailty was defined as ≥ 3 of the following: low lean mass, exhaustion, low energy expenditure, walking limitations, and weakness. Generalized linear models were used to evaluate direct and indirect associations between frailty and treatment exposures, sociodemographic characteristics, lifestyle factors, and chronic condition. RESULTS The overall prevalence of frailty among survivors was 3 times higher compared with siblings (6.4%; 95% CI, 4.1% to 8.7%; v 2.2%; 95% CI, 1.2% to 3.2%). Survivors of CNS tumors (9.5%; 95% CI, 5.2% to 13.8%) and bone tumors (8.1%; 95% CI, 5.1% to 11.1%) had the highest prevalence of frailty. Survivors exposed to cranial radiation, pelvic radiation ≥ 34 Gy, abdominal radiation > 40 Gy, cisplatin ≥ 600 mg/m2, amputation, or lung surgery had increased risk for frailty. These associations were partially but not completely attenuated when sociodemographic characteristics, lifestyle factors, and chronic conditions were added to multivariable models. Cranial radiation (prevalence ratio [PR], 1.47; 95% CI, 1.20 to 1.76), pelvic radiation ≥ 34 Gy (PR, 1.46; 95% CI, 1.01 to 2.11), and lung surgery (PR, 1.75; 95% CI, 1.28 to 2.38) remained significant after sociodemographic, lifestyle, and chronic conditions were accounted for. CONCLUSION Childhood cancer survivors reported a higher prevalence of frailty compared with siblings. Radiation and lung surgery exposures were associated with increased risk for frailty. Interventions to prevent, delay onset, or remediate chronic disease and/or promote healthy lifestyle are needed to decrease the prevalence of frailty and preserve function in this at-risk population.
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Affiliation(s)
- Samah Hayek
- St Jude Children's Research Hospital, Memphis, TN
| | | | | | | | | | | | | | | | - Smita Bhatia
- University of Alabama at Birmingham, Birmingham, AL
| | | | | | | | | | - Yutaka Yasui
- St Jude Children's Research Hospital, Memphis, TN
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24
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Eggen A, Richard N, Shen G, Shultz D, Leighl N, Liu G, Sun A, Bosma I, Reyners A, Jalving M, Rodin G, Edelstein K. NCOG-03. COGNITIVE CONCERNS AND PERFORMANCE IN PATIENTS WITH METASTATIC NON-SMALL CELL LUNG CANCER (mNSCLC). Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.664] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
INTRODUCTION
Cognitive concerns and objective cognitive impairment are both common in cancer patients, although the relationship between these variables is uncertain. Brain metastases have the potential to affect both outcomes. We examined the relationships between cognitive concerns, cognitive performance, and psychological disturbance in mNSCLC patients with and without brain metastases.
METHODS
mNSCLC patients completed standardized neuropsychological tests (HVLT-R, TMTA/B, COWA) and questionnaires measuring cognitive and neurobehavioral concerns, depression, demoralization, self-esteem, illness intrusiveness, and physical symptoms. Perceived cognitive impairment was defined as FACT-Cog scores ≤1.5 SD below the normative mean. Impaired cognitive performance was defined as ≥2 test scores ≤1.5 SD or one test score ≤2.0 SD below normative means. Multivariate analyses used the mean composite of neuropsychological test z-scores (COG-comp). Progressive disease (extra- and/or intracranial) was defined as radiological progression or clinical deterioration within one month before the study.
RESULTS
74 patients participated (53% female; median age 62 (37–82); 30% EGFR mutated). Time since mNSCLC diagnosis was 11 months (median; 0–89). 50% had brain metastases, 21 of whom received cranial radiation (11 SRS, 10 WBRT±SRS). 27% reported cognitive concerns and 42% were impaired on objective testing (HVLT-R:34%, TMT:27%, COWA:16%). Neither was more common in patients with brain metastases. COG-comp (mean±SD: –0.39±0.91) was unrelated to cognitive concerns. In multivariate analyses, less depression (p< 0.01) and illness intrusiveness (p=0.03), and absence of disease progression (p=0.03) were related to better perceived cognitive function. No significant associations were found between cognitive performance and demographic, disease, or psychological variables.
CONCLUSION
Cognitive impairment is common in mNSCLC patients with or without brain metastases, but is independent of cognitive concerns. Cognitive concerns which are linked to depression, illness intrusiveness and disease progression, may be more likely to reflect the impact of cognitive changes in daily life. Both merit further clinical and research attention.
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Affiliation(s)
| | | | - Gerald Shen
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - David Shultz
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | - Geoffrey Liu
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Alexander Sun
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Ingeborg Bosma
- University Medical Center Groningen, Groningen, Netherlands
| | - Anna Reyners
- University Medical Center Groningen, Groningen, Netherlands
| | | | - Gary Rodin
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Kim Edelstein
- Princess Margaret Cancer Centre, Toronto, ON, Canada
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Fernandes HA, Richard NM, Edelstein K. Cognitive rehabilitation for cancer-related cognitive dysfunction: a systematic review. Support Care Cancer 2019; 27:3253-3279. [PMID: 31147780 DOI: 10.1007/s00520-019-04866-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [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: 10/23/2018] [Revised: 04/23/2019] [Accepted: 05/09/2019] [Indexed: 01/03/2023]
Abstract
PURPOSE Individuals with non-central nervous system (CNS) cancers can experience cancer-related cognitive dysfunction (CRCD), negatively impacting daily functioning and quality of life. This systematic review examined cognitive rehabilitation programs aimed at improving cognitive function. METHODS PsychInfo and PubMed were searched in February 2019. Eligible studies evaluated a cognitive rehabilitation program for adults with non-CNS cancers and included at least one objective cognitive measure. Across studies, we assessed methodological quality using relevant criteria based on published intervention-related review guidelines and examined findings from performance-based and self-reported outcome measures. RESULTS 19 studies met inclusion criteria, totalling 1124 participants altogether. These studies included randomized controlled trials (n = 12), partial, quasi or non-randomized controlled trials (n = 3) and single-arm pilot studies (n = 4). All studies found improvements on at least one cognitive measure (performance-based or self-reported). By cognitive domain, objective improvements in memory were most commonly reported, followed by executive functions and processing speed. In terms of methodological quality, studies generally provided clear descriptions of participants and interventions. However, limitations included lack of standardized terminology for interventions, discrepancies in outcome measures, and incomplete statistical reporting. CONCLUSIONS The available evidence supports clinical implementation of cognitive rehabilitation to improve CRCD, with further work in program development, dissemination, and feasibility recommended. We provide specific recommendations to facilitate future research and integration in this field.
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Affiliation(s)
- Holly A Fernandes
- Department of Psychology, Faculty of Health, York University, 4700 Keele St., Toronto, ON, M3J 1P3, Canada.
| | - Nadine M Richard
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Kim Edelstein
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Hayek S, Gibson TM, Leisenring W, Guida JL, Gramatges MM, Lupo P, Howell RM, Oeffinger KC, Bhatia S, Edelstein K, Hudson MM, Robison LL, Nathan PC, Yasui Y, Krull KR, Armstrong GT, Ness KK. Frailty among childhood cancer survivors: A report from the Childhood Cancer Survivor Study (CCSS). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.10026] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10026 Background: Childhood cancer survivors are at increased risk for frailty, which is a loss of physiological capacity that is typically observed among older adults. Aims: Estimate the prevalence of frailty among survivors, and examine direct and indirect effects of treatment, lifestyle, and chronic disease factors on frailty. Methods: CCSS participants who were > 5-year survivors of childhood cancer, diagnosed between 1970-1999 at <21 years of age (n=10,899, 48% male), and siblings (n=2,097, 42% male) were included. Frailty was defined from self-reported data at mean ages of 37.6±9.4 and 42.9±9.8 years for survivors and siblings, respectively, as ≥3 of the following: low lean mass, exhaustion, low energy expenditure, slow walking, and weakness. Results: The prevalence of frailty among survivors was higher compared to siblings (5.8%, 95% CI: 5.4-6.3% vs. 1.9%, 95% CI 1.4-2.5%). Prevalence was highest in survivors of CNS tumors (9.5%, 5.2-13.8%), bone sarcomas (8.1%, 5.1-11.1%) and Hodgkin lymphoma (7.5%, 4.9-10.1%). In models adjusted for sex, age at assessment, and race/ethnicity, treatment exposures were associated with frailty (Table). After adjusting for the presence of chronic diseases and lifestyle factors, these associations were attenuated. Conclusions: The prevalence of frailty among survivors (6.0% at 38 years of age) was similar to the general population aged ≥65 years (9.0%). Radiation, platinum, amputation and thoracotomy increased risk for frailty. Findings suggest interventions to prevent, delay onset, or remediate chronic disease and/or promote healthy lifestyle are needed to preserve function in this population. [Table: see text]
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Affiliation(s)
- Samah Hayek
- St. Jude Children's Research Hospital, Memphis, TN
| | | | | | | | | | | | - Rebecca M. Howell
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Smita Bhatia
- University of Alabama at Birmingham, Birmingham, AL
| | - Kim Edelstein
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | | | | | - Yutaka Yasui
- St. Jude Children's Research Hospital, Memphis, TN
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27
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O'Kane GM, Su J, Tse BC, Tam V, Tse T, Lu L, Borean M, Tam E, Labbé C, Naik H, Mittmann N, Doherty MK, Bradbury PA, Leighl NB, Shepherd FA, Richard NM, Edelstein K, Shultz D, Brown MC, Xu W, Howell D, Liu G. The Impact of Brain Metastases and Associated Neurocognitive Aspects on Health Utility Scores in EGFR Mutated and ALK Rearranged NSCLC: A Real World Evidence Analysis. Oncologist 2019; 24:e501-e509. [PMID: 30952820 DOI: 10.1634/theoncologist.2018-0544] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 08/26/2018] [Accepted: 03/07/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND In lung cancer, brain metastases (BM) and their treatment are associated with high economic burden and inferior health-related quality of life. In the era of targeted therapy, real world evidence through health utility scores (HUS) is critical for economic analyses. MATERIALS AND METHODS In a prospective observational cohort study (2014-2016), outpatients with stage IV lung cancer completed demographic and EQ-5D-3L surveys (to derive HUS). Health states and clinicopathologic variables were obtained from chart abstraction. Patients were categorized by the presence or absence of BM; regression analyses identified factors that were associated with HUS. A subset of patients prospectively completed neurocognitive function (NCF) tests and/or the FACT-brain (FACT-Br) questionnaire, which were then correlated with HUS (Spearman coefficients; regression analyses). RESULTS Of 519 patients with 1,686 EQ-5D-3L-derived HUS, 94 (18%) completed NCF tests and 107 (21%) completed FACT-Br; 301 (58%) never developed BM, 24 (5%) developed first BM during study period, and 194 (37%) had BM at study entry. The sample was enriched (46%) for EGFR mutations (EGFRm) and ALK-rearrangements (ALKr). There were no HUS differences by BM status overall and in subsets by demographics. In multivariable analyses, superior HUS was associated with having EGFRm/ALKr (p < .0001), no prior radiation for extracranial disease (p < .001), and both intracranial (p = .002) and extracranial disease control (p < .01). HUS correlated with multiple elements of the FACT-Br and tests of NCF. CONCLUSION Having BM in lung cancer is not associated with inferior HUS in a population enriched for EGFRm and ALKr. Patients exhibiting disease control and those with oncogene-addicted tumors have superior HUS. IMPLICATIONS FOR PRACTICE In the setting of EGFR mutations or ALK rearrangement non-small cell lung cancer (NSCLC), a diagnosis of brain metastases no longer consigns the patient to an inferior health state suggesting that new economic analyses in NSCLC are needed in the era of targeted therapies. Additionally, the EQ-5D questionnaire is associated with measures of health-related quality of life and neurocognitive scores suggesting this tool should be further explored in prospective clinical studies.
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Affiliation(s)
- Grainne M O'Kane
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Jie Su
- Ontario Cancer Institute Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Brandon C Tse
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Vivian Tam
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Tiffany Tse
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Lin Lu
- Ontario Cancer Institute Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Michael Borean
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Emily Tam
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Catherine Labbé
- Centre de recherce de l'Institute universitarie de cardiologie et de pneumonologie de Quebec, University of Laval, Sherbrooke, Quebec, Canada
| | - Hiten Naik
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nicole Mittmann
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Mark K Doherty
- Medical Oncology and Hematology Division, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Penelope A Bradbury
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Natasha B Leighl
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Frances A Shepherd
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Nadine M Richard
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Kim Edelstein
- Gerry and Nancy Pencer Brain Tumor Centre, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - David Shultz
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - M Catherine Brown
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Wei Xu
- Ontario Cancer Institute Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Doris Howell
- Princess Margaret Cancer Centre Research Institute, Toronto, Ontario, Canada
| | - Geoffrey Liu
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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28
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Daniel LC, Wang M, Mulrooney DA, Srivastava DK, Schwartz LA, Edelstein K, Brinkman TM, Zhou ES, Howell RM, Gibson TM, Leisenring W, Oeffinger KC, Neglia J, Robison LL, Armstrong GT, Krull KR. Sleep, emotional distress, and physical health in survivors of childhood cancer: A report from the Childhood Cancer Survivor Study. Psychooncology 2019; 28:903-912. [PMID: 30817058 DOI: 10.1002/pon.5040] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [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: 01/10/2019] [Revised: 02/22/2019] [Accepted: 02/25/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Sleep disorders are associated with psychological and physical health, although reports in long-term survivors of childhood cancer are limited. We characterized the prevalence and risk factors for behaviors consistent with sleep disorders in survivors and examined longitudinal associations with emotional distress and physical health outcomes. METHODS Survivors (n = 1933; median [IQR] age = 35 [30, 41]) and siblings (n = 380; age = 33 [27, 40]) from the Childhood Cancer Survivor Study completed measures of sleep quality, fatigue, and sleepiness. Emotional distress and physical health outcomes were assessed approximately 5 years before and after the sleep survey. Multivariable logistic or modified Poisson regression models examined associations with cancer diagnosis, treatment exposures, and emotional and physical health outcomes. RESULTS Survivors were more likely to report poor sleep efficiency (30.8% vs 24.7%; prevalence ratio [PR] = 1.26; 95% confidence interval, 1.04-1.53), daytime sleepiness (18.7% vs 14.2%; PR = 1.31 [1.01-1.71]), and sleep supplement use (13.5% vs 8.3%; PR = 1.56 [1.09-2.22]) than siblings. Survivors who developed emotional distress were more likely to report poor sleep efficiency (PR = 1.70 [1.40-2.07]), restricted sleep time (PR = 1.35 [1.12-1.62]), fatigue (PR = 2.11 [1.92-2.32]), daytime sleepiness (PR = 2.19 [1.71-2.82]), snoring (PR = 1.85 [1.08-3.16]), and more sleep medication (PR = 2.86 [2.00-4.09]) and supplement use (PR = 1.89[1.33-2.69]). Survivors reporting symptoms of insomnia (PR = 1.46 [1.02-2.08]), fatigue (PR = 1.31 [1.01-1.72]), and using sleep medications (PR = 2.16 [1.13-4.12]) were more likely to develop migraines/headaches. CONCLUSIONS Survivors report more sleep difficulties and efforts to manage sleep than siblings. These sleep behaviors are related to worsening or persistently elevated emotional distress and may result in increased risk for migraines. Behavioral interventions targeting sleep may be important for improving health outcomes.
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Affiliation(s)
- Lauren C Daniel
- Department of Psychology, Rutgers University-Camden, Camden, New Jersey
| | - Mingjuan Wang
- Department of Psychology and Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Daniel A Mulrooney
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Deo Kumar Srivastava
- Department of Psychology and Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Lisa A Schwartz
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kim Edelstein
- Pencer Brain Tumor Centre, Princess Margaret Hospital, Toronto, Ontario, Canada
| | - Tara M Brinkman
- Department of Psychology and Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Eric S Zhou
- Perini Family Survivors' Center, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Rebecca M Howell
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Todd M Gibson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Wendy Leisenring
- Cancer Prevention, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Kevin C Oeffinger
- Division of Medical Oncology, Departments of Medicine and Community and Family Medicine, Duke University Medical Center, Durham, North Carolina
| | - Joseph Neglia
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Kevin R Krull
- Department of Psychology and Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
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29
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Bernstein LJ, D'Amico DN, Richard NM, McCready DR, Howell D, Jones JM, Edelstein K. Abstract PD6-01: Prevalence and predictors of self-reported memory ability in a large sample of breast cancer survivors. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-pd6-01] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: A substantial subset of women previously treated for breast cancer report deficits in cognitive abilities such as memory. Cancer-related cognitive dysfunction (CRCD) has been linked to a variety of factors including chemotherapy. However, the reported prevalence of symptoms is variable and investigations of CRCD correlates in large samples are limited. This study aimed to 1) investigate whether the prevalence of patient-reported memory problems differs as a function of having received chemotherapy and time-since-treatment; and 2) identify additional factors associated with patient-reported memory in a large sample of breast cancer survivors.
Method: In this cross-sectional cohort study, self-administered questionnaires including those assessing memory (Multifactorial Memory Questionnaire) and lifestyle behaviors were mailed to 1500 disease-free breast cancer survivors from three time-since-treatment cohorts (early: 6-18 months, middle: 2-4 years, or late: 5-12 years post-treatment). Demographic and clinical information was collected and confirmed from chart review. The prevalence of clinically significant memory dysfunction was estimated using published normative cut-off scores. We tested whether chemotherapy and time-since-treatment affected memory (analysis of variance), or increased the risk of significant memory dysfunction (odds ratio chi-squared test). Using a forward stepwise regression model, we explored whether patient characteristics (age, education, comorbidities, concussion history, adverse life events), type of treatment (chemotherapy, radiotherapy, hormonal therapy), or lifestyle behaviors (adherence to a Mediterranean diet, physical activity, sleep efficiency, stress management practices) were associated with patient-reported memory.
Results: 773 questionnaire packages were returned (mean age=60.4±11.7). 436 (56%) survivors had received chemotherapy (Ch+), and 337 (44%) had not (Ch-). 314 (41%) were early survivors, 244 (32%) were middle, and 215 (28%) were late. Ch+ reported poorer memory than Ch- (F(1, 764)=12.752, p<0.001), with no effect of time-since-treatment or interaction. Prevalence of significant memory dysfunction was higher in Ch+ (28%) than in Ch- (15%) (OR=2.130, 95% CI 1.479-3.066). Younger age and history of concussion were significantly associated with worse patient-reported memory (p=0.002, p<0.001). Unlike chemotherapy (p=0.018), neither radiation nor hormonal treatment was a significant predictor of memory symptoms. Increased physical activity (p=0.002) and higher sleep efficiency (p<0.001) were associated with better memory. Survivors reporting greater memory symptoms also reported greater use of stress management techniques (p=0.026).
Conclusion: This large study indicates that chemotherapy doubles the risk of memory symptoms up to at least 10 years post-treatment. Results also point to sleep hygiene and physical activity as potentially meaningful targets for self-management training to reduce CRCD in breast cancer survivors.
Citation Format: Bernstein LJ, D'Amico DN, Richard NM, McCready DR, Howell D, Jones JM, Edelstein K. Prevalence and predictors of self-reported memory ability in a large sample of breast cancer survivors [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr PD6-01.
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Affiliation(s)
- LJ Bernstein
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; University of Toronto, Toronto, Canada; Ryerson University, Toronto, Canada
| | - DN D'Amico
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; University of Toronto, Toronto, Canada; Ryerson University, Toronto, Canada
| | - NM Richard
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; University of Toronto, Toronto, Canada; Ryerson University, Toronto, Canada
| | - DR McCready
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; University of Toronto, Toronto, Canada; Ryerson University, Toronto, Canada
| | - D Howell
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; University of Toronto, Toronto, Canada; Ryerson University, Toronto, Canada
| | - JM Jones
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; University of Toronto, Toronto, Canada; Ryerson University, Toronto, Canada
| | - K Edelstein
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; University of Toronto, Toronto, Canada; Ryerson University, Toronto, Canada
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Edelstein K, Campbell K, Bernstein L, Lax I, Backhouse F, Pond G, Kalidindi N, Or R, Laperriere N, Millar BA, Shultz D, Berlin A, Zadeh G, Maurice C, Mason W. RBTT-04. DOES EXERCISE IMPROVE PROGRESSION FREE SURVIVAL AND QUALITY OF LIFE IN PATIENTS WITH GLIOBLASTOMA? A TRIAL IN PROGRESS. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.974] [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] [Indexed: 11/14/2022] Open
Affiliation(s)
- Kim Edelstein
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | - Lori Bernstein
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Ilyse Lax
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Felicity Backhouse
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | - Navya Kalidindi
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Rosemarylin Or
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Normand Laperriere
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Barbara-Ann Millar
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - David Shultz
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Alejandro Berlin
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Gelareh Zadeh
- Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Catherine Maurice
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Warren Mason
- University of Toronto University Health Network, Toronto, ON, Canada
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Daniel LC, Wang M, Srivastava D, Schwartz L, Brinkman T, Edelstein K, Mulrooney D, Zhou E, Howell R, Gibson T, Leisenring W, Armstrong GT, Krull K. 0863 Sleep Behaviors And Patterns In Adult Survivors Of Childhood Cancers: A Report From The Childhood Cancer Survivor Study (CCSS). Sleep 2018. [DOI: 10.1093/sleep/zsy061.862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - M Wang
- St. Jude Children’s Research Hospital, Memphis, TN
| | - D Srivastava
- St. Jude Children’s Research Hospital, Memphis, TN
| | - L Schwartz
- The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - T Brinkman
- St. Jude Children’s Research Hospital, Memphis, TN
| | - K Edelstein
- Princess Margaret Cancer Center, Toronto, ON, CANADA
| | - D Mulrooney
- St. Jude Children’s Research Hospital, Memphis, TN
| | - E Zhou
- Havard Medical School, Boston, MA
| | - R Howell
- MD Anderston Cancer Center, Houston, TX
| | - T Gibson
- St. Jude Children’s Research Hospital, Memphis, TN
| | - W Leisenring
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - K Krull
- St. Jude Children’s Research Hospital, Memphis, TN
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Richard N, Shultz D, Laperriere N, Berlin A, Conrad T, Millar BA, Bernstein M, Kongkham P, Zadeh G, Edelstein K. NCOG-01. PATIENT-REPORTED COGNITIVE CONCERNS AND QUALITY OF LIFE IN BRAIN METASTASES. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Edelstein K, D'Agostino NM, Pond GR, Kavan P, Gupta AA, Aubin S, Matthew A, Wahl K, Crump M, Hodgson DC, Bedard PL, Muanza T, Batist G, Bernstein LJ. Neurocognitive functions and psychological distress in young adults with cancer (YAC): A prospective, longitudinal study. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.10064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10064 Background: Non-CNS cancer and treatments are associated with neurocognitive sequelae in older adults; whether YAC (age 18-39 yrs) are protected from these effects is unknown. In YAC, cancer interferes with education and occupational attainment and is associated with psychological distress. This prospective, inception-cohort study characterizes neurocognitive functions and psychological distress in YAC. Methods: YAC completed a 2-hr battery of standardized neurocognitive tests and questionnaires 1.7 ± 1 months after diagnosis prior to chemotherapy (mean ± SD, T1) and 8.2 ± 1.2 (T2) and 14.2 ± 1.6 (T3) months later. Healthy YA with no cancer history (HYA) were tested at similar time points. Tests were scored using published norms, transformed to T-scores, and grouped into neurocognitive domains. Results: YAC (n = 108; lymphoma, breast, gyne, GI, GU, sarcoma) were grouped according to whether they required chemotherapy (n = 70) or not (n = 38), and compared to 63 HYA. At baseline, there were no group differences in neurocognitive performance, number of impaired tests, or neurocognitive complaints (Kruskal Wallis, all p-values > .4). About 70% of each group completed assessments at T2 and T3. Mean performance improved over time (random effects models, all p-values < .01), but there were no group differences or interactions between group and time. There were also no differences in proportions of participants in each group whose test scores improved ( > 10 points) or declined ( < 10 points) from T1 to T2 or T3. Adjusting for psychological distress, fatigue, or neurocognitive complaints did not change these results, despite higher symptoms of somatic distress, anxiety and fatigue in YAC compared to healthy YA over time (all p-values < .03). Conclusions: Before chemotherapy and up to about 14 months later, YAC have elevated distress and fatigue, but do not demonstrate the cognitive decline reported in older cancer patients. Our findings are consistent with research suggesting that aging brains are more vulnerable to neurotoxic insult. Whether the effects of cancer treatment emerge later in YAC, placing them at risk for accelerated aging as reported in older patients, remains to be examined.
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Affiliation(s)
- Kim Edelstein
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | | | | | - Abha A. Gupta
- Department of Medical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | - Andrew Matthew
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Kate Wahl
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Michael Crump
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | | | | | - Gerald Batist
- Department of Oncology, Faculty of Medicine, McGill University and Segal Cancer Centre, Montreal, QC, Canada
| | - Lori J. Bernstein
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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Richard NM, Bernstein LJ, Shultz D, Laperriere N, Kongkham PN, Berlin A, Conrad TD, Millar BA, Bernstein M, Zadeh G, Edelstein K. Cognitive support program for patients with brain metastases. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.tps2086] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS2086 Background: Brain metastases occur in ~30% of cancer patients. While treatment options continue to evolve, prognosis remains poor in both morbidity and survival, and quality of life (QOL) is increasingly emphasized. Most patients will experience cognitive dysfunction. Deficits in executive and self-regulatory functions, memory, and communication interfere with patients’ functional independence, participation in valued activities, relationships and QOL; they also affect families and caregivers. There are currently no established interventions for oncology and supportive care teams to address cognitive dysfunction and its impact on patient and family QOL. This study targets this gap in knowledge and clinical practice through development and piloting of a novel cognitive support program (CSP) for brain metastasis patients and their primary caregivers. Methods: Building on relevant neuroscience and behavioral research in other cognitively-impaired populations, we designed the CSP as a brief, structured, client-centered program. Using a prospective longitudinal design, 24 cognitively-impaired patients are being recruited from an outpatient multidisciplinary brain metastasis clinic. Each patient, together with their primary caregiver, attends 3 weekly individual sessions to learn strategies for memory, communication and executive functions. At-home practice between sessions applies the strategies in daily activities. Feasibility will be assessed through retention and adherence. Preliminary efficacy will be assessed by reliable change on cognitive, functional and QOL measures completed by patients pre-, post-, and 3 months following the CSP intervention. Caregivers will complete ratings of patient functioning and their own QOL at the same intervals. Analyses of variance will examine CSP intervention effects, with regression analyses to explore moderating effects of participant demographics, baseline levels of cognitive impairment, disease and treatment factors (e.g., volume and location of brain lesions, CNS-directed treatments received). Results of this pilot trial will lay the groundwork for a future randomized trial and further development of cognitive supports for brain metastasis patients and their families.
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Affiliation(s)
- Nadine M. Richard
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Lori J. Bernstein
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - David Shultz
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Normand Laperriere
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Paul N. Kongkham
- Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Alejandro Berlin
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | - Barbara-Ann Millar
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Mark Bernstein
- Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Gelareh Zadeh
- MacFeeters-Hamilton Brain Tumour Centre, University Health Network, Toronto, ON, Canada
| | - Kim Edelstein
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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35
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Jacola LM, Edelstein K, Liu W, Pui CH, Hayashi R, Kadan-Lottick NS, Srivastava D, Henderson T, Leisenring W, Robison LL, Armstrong GT, Krull KR. Cognitive, behaviour, and academic functioning in adolescent and young adult survivors of childhood acute lymphoblastic leukaemia: a report from the Childhood Cancer Survivor Study. Lancet Psychiatry 2016; 3:965-972. [PMID: 27639661 PMCID: PMC5056029 DOI: 10.1016/s2215-0366(16)30283-8] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 07/26/2016] [Accepted: 07/27/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND Survivors of childhood acute lymphoblastic leukaemia (ALL) are at risk for neurocognitive deficits that affect development in adolescence and young adulthood, and influence educational attainment and future independence. We examined a large and diverse cohort of survivors to identify risk predictors and modifiers of these outcomes. METHODS In this cohort study, cognitive and behaviour symptoms were assessed via a standardised parent questionnaire for 1560 adolescent survivors of ALL diagnosed between 1970 and 1999. Clinically significant symptoms (≥90th percentile) and learning problems were compared between survivors and a sibling cohort. Multivariable regression models were used to examine associations with demographic and treatment characteristics. Models were adjusted for inverse probability of sampling weights to reflect undersampling of ALL survivors in the expansion cohort. In a subset of survivors with longitudinal data (n=925), we examined associations between adolescent symptoms or problems and adult educational attainment. FINDINGS Compared with siblings, survivors treated with chemotherapy only were more likely to demonstrate headstrong behaviour (155 [19%] of 752 survivors vs 88 [14%] of 610 siblings, p=0·010), inattention-hyperactivity (15 [19%] vs 86 [14%], p<0·0001), social withdrawal (142 [18%] vs 75 [12%], p=0·002), and had higher rates of learning problems (191 [28%] vs 76 [14%], p<0·0001). In multivariable models among survivors, increased cumulative dose of intravenous methotrexate (ie, >4·3 g/m2) conferred increased risk of inattention-hyperactivity (relative risk [RR] 1·53, 95% CI 1·13-2·08). Adolescent survivors with cognitive or behaviour problems and those with learning problems were less likely to graduate from college as young adults than adolescent survivors without cognitive or behaviour problems. INTERPRETATION Although modern therapy for childhood ALL has eliminated the use of cranial radiation therapy, adolescent survivors treated with chemotherapy only remain at increased risk for cognitive, behaviour, and academic problems that adversely affect adult education outcomes. FUNDING National Cancer Institute, American Lebanese-Syrian Associated Charities.
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Affiliation(s)
- Lisa M Jacola
- Department of Psychology, St Jude Children's Research Hospital, Memphis TN, USA.
| | - Kim Edelstein
- Pencer Brain Tumor Centre, Princess Margaret Cancer Center, Toronto, ON, Canada
| | - Wei Liu
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis TN, USA
| | - Ching-Hon Pui
- Department of Oncology, St Jude Children's Research Hospital, Memphis TN, USA
| | - Robert Hayashi
- Department of Oncology, Washington University at St Louis, St Louis, MO, USA
| | - Nina S Kadan-Lottick
- Yale Section of Pediatric Hematology-Oncology and Yale Cancer Center, New Haven, CT, USA
| | - Deokumar Srivastava
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis TN, USA
| | - Tara Henderson
- Department of Oncology, University of Chicago, Chicago, IL, USA
| | - Wendy Leisenring
- Clinical Research and Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis TN, USA
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis TN, USA
| | - Kevin R Krull
- Department of Psychology, St Jude Children's Research Hospital, Memphis TN, USA; Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis TN, USA
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36
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D'Agostino NM, Edelstein K, Zhang N, Recklitis CJ, Brinkman TM, Srivastava D, Leisenring WM, Robison LL, Armstrong GT, Krull KR. Comorbid symptoms of emotional distress in adult survivors of childhood cancer. Cancer 2016; 122:3215-3224. [PMID: 27391586 DOI: 10.1002/cncr.30171] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 05/19/2016] [Accepted: 05/20/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Childhood cancer survivors are at risk for emotional distress symptoms, but symptom comorbidity has not been previously examined. This study examined distress profiles for adult survivors of childhood cancer diagnosed between 1970 and 1999. METHODS Self-reported depression, anxiety, and somatization symptoms from Brief Symptom Inventory 18 were examined in survivors (n = 16,079) and siblings (n = 3085) from the Childhood Cancer Survivor Study. A latent profile analysis identified clusters of survivors with individual and comorbid symptoms. Disease, treatment, and demographic predictors of distress comorbidity patterns were examined with multinomial logistic regressions. RESULTS Four clinically relevant profiles were identified: low distress on all subscales (asymptomatic, 62%), high distress on all subscales (comorbid distress, 11%), elevated somatization (somatic symptoms, 13%), and elevated depression and anxiety (affective distress, 14%). Compared with siblings, fewer survivors were asymptomatic (62% vs 74%, P < .0001), and more had comorbid distress (11% vs 5%, P < .0001). Survivors of leukemia (odds ratio [OR], 1.34; 95% confidence interval [CI], 1.12-1.61), central nervous system tumors (OR, 1.30; 95% CI, 1.05-1.61), and sarcoma (OR, 1.26; 95% CI, 1.01-1.57) had a greater risk of comorbid distress than survivors of solid tumors. Psychoactive medications were associated with comorbid distress (P < .0001), and this suggested that this group was refractory to traditional medical management. Comorbid distress was associated with poor perceived health (OR, 31.7; 95% CI, 23.1-43.3), headaches (OR, 3.2; 95% CI, 2.8-3.7), and bodily pain (OR, 4.0; 95% CI, 3.2-5.0). CONCLUSIONS A significant proportion of survivors are at risk for comorbid distress, which may require extensive treatment approaches beyond those used for individual symptoms. Cancer 2016;122:3215-24. © 2016 American Cancer Society.
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Affiliation(s)
| | - Kim Edelstein
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Nan Zhang
- St. Jude Children's Research Hospital, Memphis, Tennessee
| | | | | | | | | | | | | | - Kevin R Krull
- St. Jude Children's Research Hospital, Memphis, Tennessee
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Cabrera S, Edelstein K, Mason WP, Tartaglia MC. Assessing behavioral syndromes in patients with brain tumors using the frontal systems behavior scale (FrSBe). Neurooncol Pract 2016; 3:113-119. [PMID: 31386079 PMCID: PMC6668266 DOI: 10.1093/nop/npv055] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 06/21/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Personality changes following brain tumors may be due to disruption of frontal-subcortical networks. The relation between personality changes and tumor parameters such as volumes of the surgical cavity, residual tumor, or nonspecific white matter abnormalities is unknown. In this study we examined the relation between these tumor parameters and abnormal behaviors typically associated with frontal lobe dysfunction. METHODS Thirty-one patients with intracranial tumors who completed the Frontal Systems Behavior Scale (FrSBe) during clinical neuropsychological assessment and had a solitary, well-delimited brain lesion on MRI within 3 months of that assessment were included. Tumor parameters were manually segmented using OsiriX. Nonparametric statistics were used to determine the relationship between tumor parameters and frontal behavioral dysfunction as measured by FrSBe scores. RESULTS Patients reported significantly more behavior problems after tumor diagnosis. Tumor cavity volume was correlated with self-reported Executive Dysfunction (rho = 0.450, P = .047), and there was a trend in the relationship with self-reported Apathy (rho = 0.438, P = .053). Nonspecific white matter abnormality volume was also correlated with self-reported Apathy (rho = 0.810, P = .01). There were no correlations between FrSBe scores and residual tumor volume or summed volumes of tumor-related parameters. CONCLUSION Our results suggest that tumor parameters have differential effects on behaviors associated with frontal-subcortical networks and corroborate the high frequency of behavioral dysfunction in brain tumor patients. Examination of these relationships in a prospective trial is warranted to establish incidence, prevalence, risk factors, and consequences of behavioral disturbances in brain tumor patients.
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Affiliation(s)
- Sergio Cabrera
- Memory Clinic, Toronto Western
Hospital, 399 Bathurst St, Toronto M5T 2S8,
Canada (S.C., M.C.T.); Pencer Brain Tumor
Centre, Princess Margaret Cancer
Centre, 610 University Ave, Toronto M5G 2M9,
Canada (S.C., K.E., W.P.M.); Department of Psychosocial
Oncology & Palliative Care, Princess
Margaret Cancer Centre, 610 University Ave, Toronto M5G
2M9, Canada (K.E.); Department of Hematology
Oncology, Princess Margaret Cancer
Centre, 610 University Ave, Toronto M5G 2M9,
Canada (S.C., W.P.M.); Department of Neurology,
University of Toronto,
Toronto, Canada (S.C., W.P.M., M.C.T.);
Department of Psychiatry, University of Toronto, Toronto,
Canada (K.E.); Tanz Centre for Research in Neurodegenerative
Disease, University of Toronto,
Toronto, Canada (M.C.T.)
| | - Kim Edelstein
- Memory Clinic, Toronto Western
Hospital, 399 Bathurst St, Toronto M5T 2S8,
Canada (S.C., M.C.T.); Pencer Brain Tumor
Centre, Princess Margaret Cancer
Centre, 610 University Ave, Toronto M5G 2M9,
Canada (S.C., K.E., W.P.M.); Department of Psychosocial
Oncology & Palliative Care, Princess
Margaret Cancer Centre, 610 University Ave, Toronto M5G
2M9, Canada (K.E.); Department of Hematology
Oncology, Princess Margaret Cancer
Centre, 610 University Ave, Toronto M5G 2M9,
Canada (S.C., W.P.M.); Department of Neurology,
University of Toronto,
Toronto, Canada (S.C., W.P.M., M.C.T.);
Department of Psychiatry, University of Toronto, Toronto,
Canada (K.E.); Tanz Centre for Research in Neurodegenerative
Disease, University of Toronto,
Toronto, Canada (M.C.T.)
| | - Warren P. Mason
- Memory Clinic, Toronto Western
Hospital, 399 Bathurst St, Toronto M5T 2S8,
Canada (S.C., M.C.T.); Pencer Brain Tumor
Centre, Princess Margaret Cancer
Centre, 610 University Ave, Toronto M5G 2M9,
Canada (S.C., K.E., W.P.M.); Department of Psychosocial
Oncology & Palliative Care, Princess
Margaret Cancer Centre, 610 University Ave, Toronto M5G
2M9, Canada (K.E.); Department of Hematology
Oncology, Princess Margaret Cancer
Centre, 610 University Ave, Toronto M5G 2M9,
Canada (S.C., W.P.M.); Department of Neurology,
University of Toronto,
Toronto, Canada (S.C., W.P.M., M.C.T.);
Department of Psychiatry, University of Toronto, Toronto,
Canada (K.E.); Tanz Centre for Research in Neurodegenerative
Disease, University of Toronto,
Toronto, Canada (M.C.T.)
| | - Maria Carmela Tartaglia
- Memory Clinic, Toronto Western
Hospital, 399 Bathurst St, Toronto M5T 2S8,
Canada (S.C., M.C.T.); Pencer Brain Tumor
Centre, Princess Margaret Cancer
Centre, 610 University Ave, Toronto M5G 2M9,
Canada (S.C., K.E., W.P.M.); Department of Psychosocial
Oncology & Palliative Care, Princess
Margaret Cancer Centre, 610 University Ave, Toronto M5G
2M9, Canada (K.E.); Department of Hematology
Oncology, Princess Margaret Cancer
Centre, 610 University Ave, Toronto M5G 2M9,
Canada (S.C., W.P.M.); Department of Neurology,
University of Toronto,
Toronto, Canada (S.C., W.P.M., M.C.T.);
Department of Psychiatry, University of Toronto, Toronto,
Canada (K.E.); Tanz Centre for Research in Neurodegenerative
Disease, University of Toronto,
Toronto, Canada (M.C.T.)
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D'Agostino NM, Edelstein K, Zhang N, Recklitis CJ, Brinkman TM, Srivastava D, Leisenring WM, Robison LL, Armstrong GT, Krull KR. Predicting patterns of distress in adult survivors of childhood cancer: A latent profile analysis from the Childhood Cancer Survivor Study. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.3_suppl.210] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
210 Background: Although most survivors are emotionally healthy, subgroups report elevated or increasing distress over time. Distress often involves comorbid symptoms, which are difficult to treat. Predictors of comorbidity have not been examined in survivors. This study identifies patterns of distress and examines disease, treatment and demographic predictors in long-term survivors diagnosed between 1970-99. Methods: Latent profile analyses were used to identify clusters of survivors (N = 16079) and siblings (N = 3085) based on symptoms of somatization, anxiety, and depression from the Brief Symptom Inventory – 18. Bayesian information criterion & Lo-Mendell-Rubin adjusted likelihood ratio test were used to select cluster number. Multinomial logistic regression was used to identify predictors of cluster membership stratified by sex. Results: Four clusters were identified: low distress on all subscales (asymptomatic); high distress on all subscales (global distress); primary somatization (somatic distress); primary depression (affective distress). Compared to siblings, fewer survivors were asymptomatic (62% v. 74%) and more had global distress (11% v. 5%), p’s < 0.0001. More male (66%) than female (58%) survivors were asymptomatic, and more females reported somatic (17% vs 10%) and global (12% vs 9%) distress, all p’s < 0.0001. Among females, fair/poor perceived health (OR 30.9, 95% CI 19.4-49.1); pain (OR 3.4, 95% CI 2.4-4.8), divorced/separated (OR 2.3, 95% CI 1.7-3), less than college education (OR 1.9, 95% CI 1.5-2.3), and antimetabolite therapy (OR 1.3, 95% CI 1.1-1.6) were associated with global distress. Fair/poor perceived health (OR 26.2, 95% CI 17.6-38.9), pain (OR 5.1, 95% CI 3.8- 6.8), divorced/separated (OR 3.0, 95% CI 2.2-4), and anthracycline therapy (OR 1.2, 95% CI 1.0-1.4) were associated with global distress in males. Diagnosis, age at or time since diagnosis, and radiation were not significant predictors. Conclusions: Results support the conceptual distinction between somatic versus affective symptoms of distress and highlight sex differences and health-related predictors of distress, all which have implications for treatment approaches.
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Affiliation(s)
| | - Kim Edelstein
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Nan Zhang
- St. Jude Children's Research Hospital, Memphis, TN
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Edelstein K, D'Agostino NM, Pond GR, Aubin S, Matthew A, Gupta AA, Kavan P, Crump M, Bedard PL, Schuh AC, Hodgson DC, Wahl K, Simpson R, Vuong T, Muanza T, Batist G, Bernstein LJ. Neurocognitive function and psychological distress in young adults (YA) with cancer. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.3_suppl.199] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
199 Background: Cancer treatment is associated with neurocognitive sequelae and changes in structural and functional brain imaging in older adults, even if they do not receive central nervous system directed therapy. Because the brain continues to develop into the 3rd decade of life, YA (age 18-39 yrs) may also be vulnerable to neurocognitive dysfunction. In YA, cancer disrupts acquisition of developmental milestones and is associated with psychological distress. This study aims to characterize neurocognitive functions and its relation to psychological distress in YA. Here we present baseline results of our longitudinal study. Methods: In this prospective, inception-cohort study, we recruited 3 groups of YA from ambulatory oncology clinics: YA with cancers (YAC; lymphoma, breast, gynecology, gastrointestinal, genitourinary, sarcoma) who required chemotherapy (YAC+, n = 55), YAC who do not require it (YAC-, n = 31), and healthy YA (HYA, n = 54). Participants completed a 2-hr battery of standardized neurocognitive tests and validated self-report questionnaires. YAC were assessed within 3 months of diagnosis, and YAC+prior to chemotherapy. Test scores were converted to age-corrected scaled scores and transformed to z-scores (mean 0, SD 1). A global neurocognitive function score and 6 domain scores were evaluated. Results: There were no group differences in neurocognitive domains (ANOVA, all p-values > .1), or in the number of impaired test scores (defined as z < -1). YAC+ reported greater symptoms of somatic distress (p = .001) and anxiety (p = .004) than both HYA and YAC-. Symptoms were unrelated to neurocognitive performance (ρ < .16 for all). However, each group had poorer memory compared to population norms (1-sample t-tests: YAC+ p = .007; YAC- p = .047; HYA p = .023). Conclusions: Prior to treatment, neurocognitive functions of YAC were not different from HYA, suggesting that cancer itself is not a neurocognitive risk factor in YA. It is important to use appropriate control groups, rather than relying on normative data for comparison. We continue to follow this cohort to document neurocognitive function and distress over time, and to identify risk factors that contribute to outcomes in YA.
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Affiliation(s)
- Kim Edelstein
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | | | | | - Andrew Matthew
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | - Petr Kavan
- Department of Oncology, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Michael Crump
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Philippe L. Bedard
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Andre C. Schuh
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - David C. Hodgson
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Kate Wahl
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | - Te Vuong
- Jewish General Hospital, Montreal, QC, Canada
| | | | - Gerald Batist
- McGill University and Segal Cancer Centre, Jewish General Hospital, Montreal, QC, Canada
| | - Lori J. Bernstein
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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Richard NM, Bernstein LJ, Mason WP, Laperriere N, Chung C, Millar BA, Maurice C, Edelstein K. Cognitive rehabilitation for brain tumor survivors: A pilot study. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.3_suppl.140] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
140 Background: Brain tumor survivors often face unique challenges from chronic cognitive deficits such as memory problems or executive dysfunction. Cognitive rehabilitation is a relatively new field. With few well-controlled studies in cancer patients, oncology and supportive care teams lack accessible, reliable tools to address cognitive dysfunction. This pilot study evaluated the feasibility and potential efficacy of two behavioral interventions for brain tumor survivors. Methods: We compared two programs, each with 8 individual treatment sessions and daily homework. Goal Management Training (GMT) is a neuroscience-based integration of mindfulness and strategy training. The Brain Health Workshop (BHW) offers supportive psychoeducation about living with a brain tumor. Using a prospective randomized design, 6 brain tumor patients (with chronic cognitive dysfunction, ≥ 3 months post-radiation or surgery) were enrolled in GMT or BHW and completed a battery of measures at baseline and post-training. Composite scores were calculated by domain, with objective tests of attention, processing speed, memory, and executive functioning, and subjective measures of coping, mood, behavioral regulation and cognitive symptoms. Patient feedback was obtained in post-training qualitative interviews. Results: All patients (Table 1) completed all study activities. Analyses of group differences in composite change scores showed greater improvement in executive functions and greater attainment of pre-training functional goals in the GMT group (p's < .05). The BHW group showed a trend toward greater improvement in mood and behavioral regulation that did not reach statistical significance. Patients in both groups reported satisfaction with their program and continued, frequent (daily to every other day) use of their new knowledge following training. Conclusions: This pilot study demonstrated the feasibility of cognitive rehabilitation for brain tumor survivors between 1 and 8 years post-diagnosis. Results suggest unique benefits of each intervention that will be further explored in a larger clinical trial. [Table: see text]
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Affiliation(s)
- Nadine M. Richard
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Lori J. Bernstein
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Warren P. Mason
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Normand Laperriere
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Caroline Chung
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Barbara Ann Millar
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Catherine Maurice
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Kim Edelstein
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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Prasad PK, Hardy KK, Zhang N, Edelstein K, Srivastava D, Zeltzer L, Stovall M, Seibel NL, Leisenring W, Armstrong GT, Robison LL, Krull K. Psychosocial and Neurocognitive Outcomes in Adult Survivors of Adolescent and Early Young Adult Cancer: A Report From the Childhood Cancer Survivor Study. J Clin Oncol 2015; 33:2545-52. [PMID: 26150441 DOI: 10.1200/jco.2014.57.7528] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To characterize psychological and neurocognitive function in long-term cancer survivors diagnosed during adolescence and early young adulthood (AeYA). METHODS Six thousand one hundred ninety-two survivors and 390 siblings in the Childhood Cancer Survivor Study completed the Brief Symptom Inventory-18 and a Neurocognitive Questionnaire. Treatment and demographic predictors were examined, and associations with social attainment (employment, education, and living independently) were evaluated. Logistic regression models were used to compute odds ratios (ORs) and corresponding 95% CIs. RESULTS Among survivors, 2,589 were diagnosed when AeYA (11 to 21 years old). Adjusted for current age and sex, these survivors, compared with siblings, self-reported higher rates of depression (11.7% v 8.0%, respectively; OR, 1.55; 95% CI, 1.04 to 2.30) and anxiety (7.4% v 4.4%, respectively; OR, 2.00; 95% CI, 1.17 to 3.43) and more problems with task efficiency (17.2% v 10.8%, respectively; OR, 1.72; 95% CI, 1.21 to 2.43), emotional regulation (19.1% v 14.1%, respectively; OR, 1.74; 95% CI, 1.26 to 2.40), and memory (25.9% v 19.0%, respectively; OR, 1.44; 95% CI, 1.09 to 1.89). Few differences were noted between survivors diagnosed with leukemia or CNS tumor before 11 years old versus during later adolescence, although those diagnosed with lymphoma or sarcoma during AeYA were at reduced risk for self-reported psychosocial and neurocognitive problems. Unemployment was associated with self-reports of impaired task efficiency (OR, 2.93; 95% CI, 2.28 to 3.77), somatization (OR, 2.29; 95% CI, 1.77 to 2.98), and depression (OR, 1.94; 95% CI, 1.43 to 2.63). CONCLUSION We demonstrated that risk for poor functional outcome is not limited to survivors' diagnoses in early childhood. AeYA is a critical period of development, and cancer during this period can impact neurocognitive and emotional function and disrupt vocational attainment.
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Affiliation(s)
- Pinki K Prasad
- Pinki K. Prasad, Louisiana State University School of Medicine, New Orleans, LA; Kristina K. Hardy, Children's National Medical Center, Washington, DC; Nan Zhang, Deokumar Srivastava, Gregory T. Armstrong, Leslie L. Robison, and Kevin Krull, St Jude Children's Research Hospital, Memphis, TN; Lonnie Zeltzer, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA; Marilyn Stovall, The University of Texas MD Anderson Cancer Center, Houston, TX; Nita L. Seibel, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; and Kim Edelstein, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
| | - Kristina K Hardy
- Pinki K. Prasad, Louisiana State University School of Medicine, New Orleans, LA; Kristina K. Hardy, Children's National Medical Center, Washington, DC; Nan Zhang, Deokumar Srivastava, Gregory T. Armstrong, Leslie L. Robison, and Kevin Krull, St Jude Children's Research Hospital, Memphis, TN; Lonnie Zeltzer, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA; Marilyn Stovall, The University of Texas MD Anderson Cancer Center, Houston, TX; Nita L. Seibel, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; and Kim Edelstein, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Nan Zhang
- Pinki K. Prasad, Louisiana State University School of Medicine, New Orleans, LA; Kristina K. Hardy, Children's National Medical Center, Washington, DC; Nan Zhang, Deokumar Srivastava, Gregory T. Armstrong, Leslie L. Robison, and Kevin Krull, St Jude Children's Research Hospital, Memphis, TN; Lonnie Zeltzer, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA; Marilyn Stovall, The University of Texas MD Anderson Cancer Center, Houston, TX; Nita L. Seibel, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; and Kim Edelstein, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Kim Edelstein
- Pinki K. Prasad, Louisiana State University School of Medicine, New Orleans, LA; Kristina K. Hardy, Children's National Medical Center, Washington, DC; Nan Zhang, Deokumar Srivastava, Gregory T. Armstrong, Leslie L. Robison, and Kevin Krull, St Jude Children's Research Hospital, Memphis, TN; Lonnie Zeltzer, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA; Marilyn Stovall, The University of Texas MD Anderson Cancer Center, Houston, TX; Nita L. Seibel, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; and Kim Edelstein, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Deokumar Srivastava
- Pinki K. Prasad, Louisiana State University School of Medicine, New Orleans, LA; Kristina K. Hardy, Children's National Medical Center, Washington, DC; Nan Zhang, Deokumar Srivastava, Gregory T. Armstrong, Leslie L. Robison, and Kevin Krull, St Jude Children's Research Hospital, Memphis, TN; Lonnie Zeltzer, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA; Marilyn Stovall, The University of Texas MD Anderson Cancer Center, Houston, TX; Nita L. Seibel, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; and Kim Edelstein, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Lonnie Zeltzer
- Pinki K. Prasad, Louisiana State University School of Medicine, New Orleans, LA; Kristina K. Hardy, Children's National Medical Center, Washington, DC; Nan Zhang, Deokumar Srivastava, Gregory T. Armstrong, Leslie L. Robison, and Kevin Krull, St Jude Children's Research Hospital, Memphis, TN; Lonnie Zeltzer, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA; Marilyn Stovall, The University of Texas MD Anderson Cancer Center, Houston, TX; Nita L. Seibel, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; and Kim Edelstein, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Marilyn Stovall
- Pinki K. Prasad, Louisiana State University School of Medicine, New Orleans, LA; Kristina K. Hardy, Children's National Medical Center, Washington, DC; Nan Zhang, Deokumar Srivastava, Gregory T. Armstrong, Leslie L. Robison, and Kevin Krull, St Jude Children's Research Hospital, Memphis, TN; Lonnie Zeltzer, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA; Marilyn Stovall, The University of Texas MD Anderson Cancer Center, Houston, TX; Nita L. Seibel, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; and Kim Edelstein, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Nita L Seibel
- Pinki K. Prasad, Louisiana State University School of Medicine, New Orleans, LA; Kristina K. Hardy, Children's National Medical Center, Washington, DC; Nan Zhang, Deokumar Srivastava, Gregory T. Armstrong, Leslie L. Robison, and Kevin Krull, St Jude Children's Research Hospital, Memphis, TN; Lonnie Zeltzer, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA; Marilyn Stovall, The University of Texas MD Anderson Cancer Center, Houston, TX; Nita L. Seibel, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; and Kim Edelstein, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Wendy Leisenring
- Pinki K. Prasad, Louisiana State University School of Medicine, New Orleans, LA; Kristina K. Hardy, Children's National Medical Center, Washington, DC; Nan Zhang, Deokumar Srivastava, Gregory T. Armstrong, Leslie L. Robison, and Kevin Krull, St Jude Children's Research Hospital, Memphis, TN; Lonnie Zeltzer, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA; Marilyn Stovall, The University of Texas MD Anderson Cancer Center, Houston, TX; Nita L. Seibel, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; and Kim Edelstein, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Gregory T Armstrong
- Pinki K. Prasad, Louisiana State University School of Medicine, New Orleans, LA; Kristina K. Hardy, Children's National Medical Center, Washington, DC; Nan Zhang, Deokumar Srivastava, Gregory T. Armstrong, Leslie L. Robison, and Kevin Krull, St Jude Children's Research Hospital, Memphis, TN; Lonnie Zeltzer, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA; Marilyn Stovall, The University of Texas MD Anderson Cancer Center, Houston, TX; Nita L. Seibel, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; and Kim Edelstein, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Leslie L Robison
- Pinki K. Prasad, Louisiana State University School of Medicine, New Orleans, LA; Kristina K. Hardy, Children's National Medical Center, Washington, DC; Nan Zhang, Deokumar Srivastava, Gregory T. Armstrong, Leslie L. Robison, and Kevin Krull, St Jude Children's Research Hospital, Memphis, TN; Lonnie Zeltzer, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA; Marilyn Stovall, The University of Texas MD Anderson Cancer Center, Houston, TX; Nita L. Seibel, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; and Kim Edelstein, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Kevin Krull
- Pinki K. Prasad, Louisiana State University School of Medicine, New Orleans, LA; Kristina K. Hardy, Children's National Medical Center, Washington, DC; Nan Zhang, Deokumar Srivastava, Gregory T. Armstrong, Leslie L. Robison, and Kevin Krull, St Jude Children's Research Hospital, Memphis, TN; Lonnie Zeltzer, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA; Marilyn Stovall, The University of Texas MD Anderson Cancer Center, Houston, TX; Nita L. Seibel, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; and Kim Edelstein, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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Richard NM, Bernstein LJ, Mason WP, Laperriere N, Chung C, Millar BA, Maurice C, Edelstein K. Rehabilitation of cognitive dysfunction in brain tumor patients. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.tps9637] [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] [Indexed: 11/20/2022] Open
Affiliation(s)
- Nadine M. Richard
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Lori J. Bernstein
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Warren P. Mason
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Normand Laperriere
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Caroline Chung
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Barbara Ann Millar
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Catherine Maurice
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Kim Edelstein
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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Edelstein K, D'Agostino NM, Pond GR, Aubin S, Matthew A, Wahl K, Gupta AA, Kavan P, Crump M, Bedard PL, Schuh AC, Hodgson DC, Vuong T, Muanza T, Batist G, Bernstein LJ. Cancer-related cognitive dysfunction (CRCD) and psychosocial development in young adult cancer survivors. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.tps9636] [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] [Indexed: 11/20/2022] Open
Affiliation(s)
- Kim Edelstein
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | | | | | - Andrew Matthew
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Kate Wahl
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Abha A. Gupta
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Petr Kavan
- McGill University and Segal Cancer Centre, Jewish General Hospital, Montreal, QC, Canada
| | - Michael Crump
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Philippe L. Bedard
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Andre C. Schuh
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - David C. Hodgson
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Te Vuong
- Jewish General Hospital, Montreal, QC, Canada
| | | | | | - Lori J Bernstein
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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D'Agostino NM, Edelstein K, Zhang N, Recklitis CJ, Brinkman TM, Srivastava D, Leisenring WM, Robison LL, Armstrong GT, Krull KR. Patterns and predictors of psychological distress in adult survivors of childhood cancer: A Childhood Cancer Survivor Study (CCSS). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.10065] [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] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Kim Edelstein
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Nan Zhang
- St. Jude Children's Research Hospital, Memphis, TN
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Edelstein K, Laperriere N, Bernstein LJ, Simpson R, Chung C, Millar BA, Mason WP. Neurocognitive functions in adults treated with radiation for primary brain tumors: A longitudinal study. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.2097] [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] [Indexed: 11/20/2022] Open
Affiliation(s)
- Kim Edelstein
- Princess Margaret Cancer Centre, Toronto, ON, Canada
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D'Agostino NM, Edelstein K. Psychosocial challenges and resource needs of young adult cancer survivors: implications for program development. J Psychosoc Oncol 2014; 31:585-600. [PMID: 24175897 DOI: 10.1080/07347332.2013.835018] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Young adult (YA) cancer survivors have specific needs because of their age and life stage. The authors investigated the challenges and resource needs of YA survivors, exploring the influence of age at diagnosis (i.e., diagnosis during childhood vs. young adulthood) and the diagnosis of a brain tumor. The authors conducted four focus groups with YA survivors (N = 22, age 18-35), treated for brain tumors or other cancers in childhood (mean age at diagnosis ± SD: brain, 10.7 ± 2.86; other cancers, 10.5 ± 3.51) or as YAs (brain, 23.5 ± 4.04; other cancers, 25.6 ± 4.10). Transcripts of audiotaped sessions were coded using thematic analysis. Common challenges across the groups included physical appearance, fertility, late effects, social relationships, and changing priorities. Childhood cancer survivors struggled with identity formation, social isolation, and health care transitions. Concerns specific to survivors diagnosed as YAs included financial independence and protecting parents. Childhood brain tumor survivors struggled with cognitive deficits, limited career options, and poor social skills, whereas brain tumor survivors diagnosed as YAs emphasized cognitive decline, loss of autonomy, and living with an incurable disease. Despite the unique challenges identified, all groups described similar resource needs including peer support, age-specific information, and having health care providers proactively raise salient issues. Young adult cancer survivors have many similar psychosocial and information needs regardless of age at or type of diagnosis that differ from those of pediatric and older adult survivors. With improved survival rates, the small number of YA in any one institution will grow. It will become increasingly important to create comprehensive, age-appropriate YA programs that address overlapping and unique needs of survivors at this life stage.
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Affiliation(s)
- Norma Mammone D'Agostino
- a Psychosocial Oncology and Palliative Care, Ontario Cancer Institute and Campbell Family Institute for Cancer Research, Princess Margaret Hospital, and Department of Psychiatry , University of Toronto , Toronto , Canada
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Kanter C, D'Agostino NM, Daniels M, Stone A, Edelstein K. Together and apart: providing psychosocial support for patients and families living with brain tumors. Support Care Cancer 2013; 22:43-52. [PMID: 23989499 DOI: 10.1007/s00520-013-1933-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 08/05/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE Brain tumors are associated with neurological sequelae and poor survival, contributing to distress in patients and their families. Our institution has conducted separate support groups for brain tumor patients and caregivers since 1999. This retrospective cohort study aimed to identify characteristics of brain tumor group participants in relation to attendance frequency, and compare themes of discussion in patient and caregiver groups. METHODS Demographic and medical characteristics were obtained from patient and caregiver group registration sheets and medical chart review. We quantified discussion topics recorded by group facilitators between 1999 and 2006, extracted themes, and examined similarities and differences in the way these themes were expressed. RESULTS A total of 137 patients and 238 caregivers attended the groups; about half attended more than one session. The chart review of a randomly selected subset of patient participants revealed that 57.5 % were married, 58.8 % had high-grade gliomas, and 55 % attended their first group within 3 months of diagnosis or at tumor progression. Both groups discussed physical and cognitive consequences, emotional reactions, relationships, coping, end of life, and practical issues. Caregivers discussed difficulties achieving self-care and caregiver burden. CONCLUSIONS Brain tumor support group facilitators can expect to encounter a range of medical and psychosocial issues in accommodating patients' and caregivers' diverse concerns. Separate brain tumor patient and caregiver groups may allow participants to explore those concerns without worrying about effects on their friends or family. It remains to be seen whether the groups meet the needs of attendees, and whether those who do not attend the groups have unmet needs.
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Affiliation(s)
- Cheryl Kanter
- Pencer Brain Tumor Centre, Princess Margaret Cancer Centre, 610 University Ave Room 18-714, Toronto, ON, M5G 2M9, Canada,
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Habets EJ, Taphoorn MJ, Nederend S, Klein M, Delgadillo D, Hoang-Xuan K, Bottomley A, Allgeier A, Seute T, Gijtenbeek AM, De Gans J, Enting RH, Tijssen CC, Van den Bent MJ, Reijneveld JC, Xu H, Halbert K, Bliss R, Trusheim J, Hunt MA, Bunevicius A, Tamasauskas S, Tamasauskas A, Deltuva V, Field KM, Guyatt N, Fleet M, Rosenthal MA, Drummond KJ, Field KM, Fleet M, Guyatt N, Drummond KJ, Rosenthal MA, Oliver H, Tobias M, Eva V, Matthias S, Johannes S, Oliver S, Christian TJ, Dietmar K, Gabriele S, Thomas R, Nikkhah G, Uwe S, Markus L, Michael W, Manfred W, Strowd RE, Swett K, Harmon M, Pop-Vicas A, Chan M, Tatter SB, Ellis TL, Blevins M, High K, Lesser GJ, Benouaich-Amiel A, Taillandier L, Vercueil L, Valton L, Szurhaj W, Idbaih A, Delattre JY, Loiseau H, Klein I, Block V, Ramirez C, Laigle-Donadey F, Le Rhun E, Harrison C, Van Horn A, Sapienza C, Schlimper C, Schlag H, Weber F, Acquaye AA, Gilbert MR, Armstrong TS, Acquaye AA, Vera-Bolanos E, Gilbert MR, Armstrong TS, Walbert T, Armstrong TS, Elizabeth VB, Gilbert M, Affronti ML, Woodring S, Allen K, Herndon JE, McSherry F, Peters KB, Friedman HS, Desjardins A, Freeman W, Cheshire S, Cone C, Kalinowski KH, Kim JY, Lay HH, Poillucci V, Southerland C, Tetterton J, Kirkpatrick J, Vredenburgh JJ, Affronti ML, Woodring S, Herndon JE, McSherry F, Peters KB, Friedman HS, Desjardins A, Freeman W, Cheshire S, Cone C, Kalinowski KH, Kim JY, Lay HH, Poillucci V, Southerland C, Tetterton J, Vredenburgh JJ, Edelstein K, Coate L, Mason WP, Jewitt NC, Massey C, Devins GM, Lin L, Chiang HH, Acquaye AA, Vera-Bolanos E, Cahill JE, Gilbert MR, Armstrong TS, Amidei CM, Lovely M, Page MD, Mogensen K, Arzbaecher J, Lupica K, Maher ME, Lin L, Acquaye AA, Vera-Bolanos E, Cahill JE, Gilbert MR, Armstrong TS, Duong HT, Kelly DF, Peters KB, Woodring S, Herndon JE, McSherry F, Vredenburgh JJ, Desjardins A, Friedman HS, Gning I, Armstrong TS, Wefel JS, Acquaye AA, Vera-Bolanos E, Mendoza TR, Gilbert MR, Cleeland CS, Guthikonda B, Thakur JD, Banerjee A, Shorter C, Sonig A, Khan IS, Gardner GL, Nanda A, Reddy K, Gaspar L, Kavanagh B, Waziri A, Chen C, Boele F, Hoeben W, Hilverda K, Lenting J, Calis AL, Sizoo E, Collette E, Heimans J, Postma T, Taphoorn M, Reijneveld J, Klein M. CLIN-SYMPTOM MANAGEMENT/QUALITY OF LIFE. Neuro Oncol 2012; 14:vi153-vi159. [PMCID: PMC3488794 DOI: 10.1093/neuonc/nos240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023] Open
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Edelstein K, Cirino PT, Hasher L, Fletcher JM, Dennis M. Sleep problems, chronotype, and diurnal preferences in children and adults with spina bifida. J Biol Rhythms 2012; 27:172-5. [PMID: 22476778 DOI: 10.1177/0748730411435209] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Spina bifida meningomyelocele (SBM) is a neural tube defect that involves dysraphism of the spinal cord and extensive reorganization of the brain. The authors assessed the relationship between chronotype, diurnal preferences, and sleep problems in individuals with SBM and healthy controls. Although individuals with SBM showed the characteristic decelerating quadratic relationship between age and chronotype, the curve was displaced, peaking at a younger age in controls compared with SBM (23.4 vs. 29.2 years). Groups did not differ in morningness-eveningness preferences. Individuals with SBM endorsed more sleep problems than controls. Further examination of the relationship between entrainment and sleep in SBM is warranted.
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Coate LE, Edelstein K, Massey C, Jewitt NC, Mason WP, Devins GM. Illness intrusiveness and subjective well-being in patients with glioblastoma multiforme. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.2063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2063 Background: Glioblastoma multiforme (GBM) is the most common adult CNS malignancy. The quality-of-life (QOL) impact of its neurological sequelae and poor prognosis is poorly understood. In this study we examined relations between disease severity and mood in GBM patients. Methods: GBM patients (n=73) completed validated questionnaires examining depression (CESD), positive affect (ABS), illness intrusiveness (II), and health-related QOL (EORTC-QLQ30, BN-20). Median age was 53 years (range 26-75), median time since diagnosis was 1.1 years (range 0.1-12.4). 88% were on temozolomide. Questionnaire scores were compared to normative data from GI, GU, Breast, Head and Neck, Lymphoma, and Lung cancer groups using t-tests. Hierarchical multiple regression analyses tested the impact of disease severity indicators (ECOG; Symptoms, derived from QLQ30, BN20) and potential moderators on mood and whether II mediates those effects. Results: GBM patients reported less positive affect, more depression and greater II than other cancer patients (p<.05). Increase in symptoms correlated with greater II (β=.59; 95% CI [.31, .87], p<.0001) and depression (β=.37; 95% CI [.20, .55], p<.0001) and less positive affect (β=-.04; 95% CI [-.08, -.01], p=.02). Surprisingly, higher ECOG (i.e., poorer performance status) was associated with less II (β=-3.58; 95%CI [-7.06, -.10], p=.04) and depression (β=-2.20; 95%CI [-4.21, -.19], p=.03). II partially mediated the relations between disease severity and mood, evidenced by the change in the disease severity coefficient when II was added to the models (mean change measured by bootstrap sampling: CESD=.23, 95% CI [.06, .43]; ABS=.21, 95%CI [.02, .44]). The occurrence of other stressful life events was associated with II (β=2.73; 95% CI [.43, 5.02], p=.02), but there was no evidence of a moderating effect on this or any other relationship (p>.05). Conclusions: GBM patients are more distressed than other cancer patients. GBM-induced lifestyle disruptions partially mediate the association between disease severity and subjective well-being. Efforts to engage patients in valued activities and interests, despite the constraints, can help to preserve QOL.
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Affiliation(s)
| | | | | | | | - Warren P. Mason
- Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada
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