Towards an index of cognitive efficacy EEG-based estimation of cognitive load among individuals experiencing cancer-related cognitive decline

This paper describes an effort to estimate variations in cognitive effort among cancer survivors experiencing treatment related cognitive decline. EEG-based cognitive state sensing algorithms were validated in the context of an experiment with 5 brain cancer and 5 breast cancer survivors. Workload was manipulated by varying text complexity and time pressure. Analysis indicates that EEG-based cognitive state sensing algorithms were able to distinguish between high and low cognitive workload with an average classification accuracy of 0.84. Results suggest that 5 to 10 channels of EEG can provide enough information to achieve classification accuracies exceeding 0.80. The highest density of informative sites were over the left temporal and mid to inferior frontal regions in the left hemisphere - regions that play a major role in language.

Prevention and management of work disability in Asia Pacific: challenges and opportunities

INTRODUCTION

The economic growth in Asia Pacific brings with it challenges and opportunities in many areas of work and health. As economies grow and work demands increase so do accidents, injures and work disability.

METHODS

Burns, chemical exposures, and construction related injuries are often catastrophic in severity and lead to work disability, major acute medical and subsequent rehabilitation efforts. In addition to these acute injuries, musculoskeletal and chronic illnesses are also sources of work disability.

RESULTS

Industrial injuries and health problems are often explained and managed based on the classic unidimensional hazard prevention model. In contrast, work disability is a multi-factorial problem and requires more complex conceptualizations than an exposure outcome model. The economic impact of disability, limitations of the widely used impairment based disability determination method, lack of adherence to wide scale implementation of evidence based clinical approaches, the need for meaningful stakeholder involvement and the potential of a multivariable view of work disability, in all aspects of work disability prevention, management and policy are discussed in the context of Asia Pacific economic growth.

CONCLUSIONS

With ideal alignment of diverse goals and incentives along with consideration of past efforts in disability prevention and management, new models, processes and policies can be created as commerce in these countries continues to grow.

Return-to-work activities in a Chinese cultural context

INTRODUCTION

Several studies have been conducted in the West showing that return to work (RTW) coordination is a key element to facilitate RTW of injured workers and to prevent work disabilities. However, no study has been carried out to investigate the scope of RTW activities in China. The purpose of this study was to explore the views of key RTW stakeholders on necessary activities for RTW coordination.

METHODS

A cross-sectional survey was conducted in Guangdong province of China. A three-tiered approach including focus group discussions and panel reviews was used to collect RTW activities, analyze the content validity, and classify domains. Descriptive statistics and intra-class correlation (ICC) were used to describe the importance of RTW activities and the degree of agreement on the classification of different domains. A Kruskal-Wallis test with subsequent post-hoc analysis using multiple Mann-Whitney U tests was carried out to check for any differences in the domains of different RTW activities among RTW stakeholders.

RESULTS

The domains of RTW activities in China were similar to those in the West and included workplace assessment and mediation, social problem solving, role and liability clarification, and medical advice. Good agreement (ICC: 0.729-0.844) on the classification of RTW activities into different domains was found. The domains of the RTW activities of healthcare providers differed from those of employers (P = 0.002) and injured workers (P = 0.001). However, there was no significant difference between employers and injured workers.

CONCLUSIONS

This study indicated that differences among stakeholders were observed in terms of areas of relative priority. There is a clear need for research and training in China to establish a nation-wide terminology for RTW coordination, facilitate cross-provincial studies and work toward a more integrated system addressing the diverse perspectives of stakeholders involved in the RTW process.

Interventions to enhance return-to-work for cancer patients

BACKGROUND

Cancer survivors are 1.4 times more likely to be unemployed than healthy people. It is therefore important to provide cancer patients with programmes to support the return-to-work process.

OBJECTIVES

To evaluate the effectiveness of interventions aimed at enhancing return-to-work in cancer patients.

SEARCH STRATEGY

We searched the Cochrane Central Register of Controlled Trials (CENTRAL, in The Cochrane Library Issue 2, 2010), MEDLINE, EMBASE, CINAHL, OSH-ROM, PsycINFO, DARE, ClinicalTrials.gov, Trialregister.nl and Controlled-trials.com to February 2010, reference lists of included articles and selected reviews, and contacted authors of relevant articles.

SELECTION CRITERIA

Randomised controlled trials (RCTs) and controlled before-after studies (CBAs) of the effectiveness of psychological, vocational, physical, medical or multidisciplinary interventions enhancing return-to-work in cancer patients. The primary outcome was return-to-work measured as either return-to-work rate or sick leave duration. Secondary outcome was quality of life.

DATA COLLECTION AND ANALYSIS

Two authors independently selected trials, assessed the risk of bias and extracted data. We pooled studies with sufficient data, judged to be clinically homogeneous in different comparisons. We assessed the overall quality of the evidence for each comparison using the GRADE approach.

MAIN RESULTS

Fourteen articles reporting 14 RCTs and 4 CBAs were included. These studies involved a total of 1652 participants. Results indicated low quality evidence of similar return-to-work rates for psychological interventions compared to care as usual (odds ratio (OR) = 2.32, 95% confidence interval (CI) 0.94 to 5.71). No vocational interventions were retrieved. Very low evidence suggested that physical training was not more effective than care as usual on improving return-to-work (OR = 1.20, 95% CI 0.32 to 4.54). Eight RCTs on medical interventions showed low quality evidence that functioning conserving approaches had similar return-to-work rates as more radical treatments (OR = 1.53, 95% CI 0.95 to 2.45). Moderate quality evidence showed multidisciplinary interventions involving physical, psychological and vocational components led to higher return-to-work rates than care as usual (OR = 1.87, 95% CI 1.07 to 3.27). No differences in the effect of psychological, physical, medical or multidisciplinary interventions compared to care as usual were found on quality of life outcomes.

AUTHORS' CONCLUSIONS

Moderate quality evidence showed that employed patients with cancer experience return-to-work benefits from multidisciplinary interventions compared to care as usual. More high quality RCTs aimed at enhancing return-to-work in cancer patients are needed.

Management of unexplained symptoms in survivors of cancer

Quality health care for survivors of cancer must evaluate and manage symptoms that are reported at the surveillance visit but are not linked to a cancer recurrence or a new cancer. At present, this does not always occur. This article analyzes quality of health care for survivors of cancer, taking empirical evidence and clinical expertise into consideration. Although emotional distress on the part of the survivor of cancer may exacerbate or even explain the presence of experienced symptoms, there are other potential explanations as well. When survivors present with persistent symptoms (even if unexplained) after cancer diagnosis and treatment, the symptoms can impact the survivor's function and well-being. Oncologists and other providers need to assess and directly target these symptoms for appropriate triage to those who can best help these survivors reduce the symptoms and their impact.

Cognitive limitations associated with tamoxifen and aromatase inhibitors in employed breast cancer survivors

OBJECTIVES

Previous research has suggested that endocrine therapy is associated with cognitive limitations in breast cancer survivors (BCS); this study examined the relationship in employed BCS, an average of three years post-primary treatment.

METHODS

77 BCS with past or current exposure to tamoxifen or aromatase inhibitors and 56 BCS with no history of endocrine therapy completed self-report measures of cognitive function, anxiety, depression, and fatigue as well as an online neurocognitive battery.

RESULTS

Exposure to endocrine therapy was not related to scores on the objective measures, but moderately related to perceived attentional problems at work (β = -0.20; CI(0.95) = -2.75, -0.25) and perceived cognitive functioning in overall life (β = 0.17; CI(0.95) = 0.33, 11.47) in excess of what could be explained by symptom burden measures. No differences were reported between groups on symptom burden measures. Symptoms of physical fatigue, depression, and anxiety were positively associated with self-report of general cognitive limitations (R(2) change range: 0.28-0.37), and symptoms of depression and anxiety were positively associated with perceived cognitive limitations at work (R(2) change range: 0.21-0.28).

DISCUSSION

Symptoms of depression, anxiety, and fatigue should be screened for and treated in BCS, as an approach to mitigating perceived cognitive limitations. However, healthcare providers should be aware that cognitive limitations exist in excess of what can be associated with symptom burden, and may be related to endocrine therapy and other cancer treatments.

It's not over when it's over: long-term symptoms in cancer survivors--a systematic review

BACKGROUND

The number of cancer survivors is steadily increasing. Following completion of primary cancer treatment and many years thereafter, specific symptoms continue to negatively affect cancer survivors. The purpose of this article is to review the evidence of symptom burden following primary treatment for cancer in survivors of the most common types of cancer (breast, gynecological, prostate, and colorectal).

METHODS

A systematic review of literature published between the years 2000-2008 that reported late-effects and/or long-term psychosocial symptoms associated with cancer survivorship post-completion of primary cancer treatment was conducted. The symptoms include physical limitations, cognitive limitations, depression/anxiety, sleep problems, fatigue, pain, and sexual dysfunctions.

RESULTS

Symptom burden associated with cancer survivorship was consistent among the four most common types of cancer (breast, gynecological, prostate, and rectal/colon), despite various types of treatment exposure. Generally, across the cancer groups, depressive symptoms, pain, and fatigue were commonly found in cancer survivors.

CONCLUSIONS

Based on longitudinal and cross-sectional evidence, cancer survivors can experience symptoms for more than 10 years following treatment. These symptoms were present in survivors of all four cancer types who underwent a wide variety of treatment. The results indicate that these symptoms should be evaluated and managed to optimize long-term outcomes.

Workstyle as a predictor of pain and restricted work associated with upper extremity disorders: a prospective study

PURPOSE

A patient's reaction to a perceived increase in work demand may be related to his or her upper limb symptoms. The purpose of this study was to determine whether a brief measure of a patient's perception of how they respond to perceived increases in demands at work predicts pain levels and work status 6 months after an initial consultation with a hand surgeon.

METHODS

Working patients with diverse upper extremity diagnoses completed a measure of response to job stress at their first clinic visit and were followed for 6 months during their prescribed treatment course. Controlling for age, gender, job type, diagnosis, patient perceptions of work-relatedness, baseline pain, grip strength, and treatment (surgery vs no surgery) analyses were conducted to determine whether self-reported response to perceived job stress was associated with pain and work status 6 months after the initial consultation.

RESULTS

Higher scores on the patient-reported job stress measure predicted higher levels of pain at 6 months. The measure was also a modest but significant predictor of work status at 6 months.

CONCLUSIONS

Evaluation of a working patient's self-reported cognitive and behavioral response to perceived increases in work demands, or what has been referred to as workstyle, predicts subsequent levels of upper extremity pain and work status. Generalization to other practice settings requires further study. This measure provides a brief evaluation of reaction to job stress that can be an important factor in certain patients with upper extremity symptoms. Future controlled studies addressing this aspect of the clinical picture are indicated.

TYPE OF STUDY/LEVEL OF EVIDENCE

Prognostic IV.

Pattern of workplace disputes in cancer survivors: a population study of ADA claims

BACKGROUND

The Americans with Disability Act (ADA) claim patterns can provide information on sources of potential work discrimination faced by employees with various health problems. This study investigated the pattern of ADA disputes among cancer survivors and non-cancer related impairments.

MATERIALS AND METHODS

Using multivariable logistic regression adjusting for demographics, employees with cancer related claims were compared to employees with other impairment related claims for alleged violations from 2000 to 2005. The impairments were grouped into orthopedic, behavioral, medical, neurological, sensory, cancer, cancer comorbid (cancer and non-cancer impairments), and comorbid "other" (non-cancer comorbid disorders). The dispute categories included: termination, reasonable accommodation, relations, terms, hiring, and a nonspecific "other" category.

RESULTS

This study analyzed 59,981 cases over a 6 year period. All comparisons were made in relation to the cancer group. There was a protective effect for any impairment other than cancer (OR = 0.29-0.63, 95% CI = 0.25-0.72) related to discharge from work. Also, orthopedic (OR = 0.81, 95% CI = 0.71-0.93), general medical (OR = 0.82, 95% CI = 0.72-0.94), and neurological (OR = 0.83, 95% CI = 0.71-0.96) impairments were found to be protective for claims related to terms of employment relative to cancer. Cancer survivors who reported a second impairment in addition to cancer were more likely to file disputes that involved relations with others at work (OR = 1.47, 95% CI = 1.16-1.87) in comparison to those with cancer only. Orthopedic (OR = 2.42, 95% CI = 2.13-2.76), neurological (OR = 1.50, 95% CI = 1.30-1.72), and sensory (OR = 1.50, 95% CI = 1.29-1.73) groups were more likely to file accommodation related disputes than the cancer group. Sensory (OR = 4.41, 95% CI = 3.45-5.63), other-comorbid (OR = 2.33, 95% CI = 1.85-2.94), medical (OR = 1.92, 95% CI = 1.51-2.44), and neurological (OR = 1.59, 95% CI = 1.23-2.05) impairment groups filed more disputes related to hiring than the cancer or the cancer-comorbid group.

CONCLUSION

Cancer survivors are more likely to file job loss claims and differential treatment related to workplace policies. Those with cancer and another impairment file more claims related to relationship problems at work than cancer only. The factors accounting for these claims need to be explored in future research in order to develop more specific evidence based policy and practice.

IMPLICATIONS FOR CANCER SURVIVORS

While the percentage of cancer survivors who file claims are relatively small, job termination and terms of employment are more likely to be concerns for cancer survivors than employees with other types of impairments. If a cancer survivor has another health problem as well relationship disputes are likely to emerge.

Work Productivity in Brain Tumor Survivors

OBJECTIVE

To determine the association of symptom burden to work limitation among working survivors of malignant brain tumors.

METHODS

Working adults with malignant brain tumors (n = 95) and a non-cancer comparison (n = 131) group completed a web-based questionnaire. Measures of demographics, tumor type and treatment, fatigue, emotional distress, cognitive limitations, and factors that can positively impact work, including health behaviors and problem solving, were obtained.

RESULTS

Survivors of malignant brain tumors reported higher levels of work limitations and time off from work than the non-cancer group. Higher levels of symptom burden, lower levels of health behaviors, and more negative problem solving orientation were characteristic of the brain tumor survivor group. These variables were not differentially associated with work limitations among brain cancer survivors or the comparison group. Depressive symptoms, fatigue, cognitive limitations, sleep, and negative problem solving orientation were independently associated with work limitations, accounting for 65% of the variance in work limitations.

CONCLUSIONS

Despite higher levels of burden, poorer health behaviors, and negative problem solving coping style, modifiable factors account for most of the variance in work limitations for both groups. Efforts to modify these variables should be evaluated.

Models of return to work for musculoskeletal disorders

BACKGROUND

Musculoskeletal pain disorders are the most prevalent, costly, disabling, and commonly researched conditions in the workplace, yet the development of overarching conceptual models of return to work (RTW) in these conditions has been lagging.

METHOD

A critical review of the literature was performed using multiple medical and health search engines in order to provide an evaluation of the evolution and the state of the art of health and disability models with a focus on specific models of RTW.

RESULTS

The main tenets, implications for diagnosis, treatment, and disability compensation, are the key perspectives analyzed for the following specific models of RTW: biomedical, psychosocial, forensic, ecological/case management, biopsychosocial, and two more recent models developed by the Institute of Medicine and the World Health Organization, respectively.

CONCLUSIONS

Future development of models that are truly transdisciplinary, and address temporal and multidimensional aspects of occupational disability, remains a goal.

Optimal port placement and enhanced guidance in robotically assisted cardiac surgery

BACKGROUND

Optimal port placement and enhanced guidance in robotically assisted cardiac surgery is required to improve preoperative planning and intraoperative navigation.

METHODS

Offline optimal port placement is planned on a three-dimensional virtual reconstruction of the patient's computed tomography scan. Using this data, an accurate in vivo port placement can be performed, which is achieved by augmented reality techniques superimposing virtual models of the thorax and the teleoperator arms on top of the real worldview.

RESULTS

A new system incorporating both port placement planning and intraoperative navigation in robotically assisted minimally invasive heart surgery was established to aid the operative workflow. A significant reduction of operation time by improved planning and intraoperative support is anticipated.

CONCLUSIONS

The enhanced intraoperative orientation possibilities may lead to further decrease in operation time and have the continuing ability to improve quality.

Psychosocial interventions for depression, anxiety, and quality of life in cancer survivors: meta-analyses

OBJECTIVE

The purpose of this meta-analysis was to investigate the effects of cognitive behavioral therapy (CBT) and patient education (PE) on commonly reported problems (depression, anxiety, pain, physical functioning, and quality of life (QOL)) in adult cancer survivors.

METHODS

Meta analyses of randomized controlled trials of CBT and PE were conducted. MEDLINE, PSYCHINFO and the Cochrane Database were searched from 1993-2004. The effects of individual versus group interventions and short (<8 months) versus long (>8 months) term follow up are also reported.

RESULTS

Fifteen studies met quality criteria. The sample size was 1,492 adult cancer survivors with an age range of 18-84. 790 were randomly assigned to intervention groups and 702 to control groups. CBT varied in duration from 4 weekly one-hour sessions to 55 weekly two-hour sessions. PE ranged from a single 20-minute session to 6 weekly one-hour sessions. Follow up ranged from 1 week to 14 months. CBT was effective for depression (ES = 1.2; 95% CI = 0.22-2.19), anxiety (ES = 1.99; 95% CI = 0.69-3.31), and QOL (ES = 0.91; 95% CI = 0.38-1.44). QOL was improved at both short and (ES = 1.45, 95% CI = .43-2.47) and long term (ES = .26; 95% CI = .06-.46) follow up. PE was not related to improved outcomes.

CONCLUSIONS

CBT is related to short-term effects on depression and anxiety and both short and long term effects on QOL. Individual interventions were more effective than group. Various CBT approaches provided in an individual format can assist cancer survivors in reducing emotional distress and improving quality of life.

Secondary prevention of work-related upper extremity disorders: recommendations from the Annapolis conference

INTRODUCTION

Efforts to improve the secondary prevention of work-related upper extremity (WRUE) symptoms continue to present a challenge. As with many occupational musculoskeletal pain disorders no single, direct cause-effect relationship exists among specific exposures, pathologic processes, and symptoms. The field has yet to create truly effective and efficient interventions for these problems that are based on current epidemiological and clinical knowledge.

METHODS

A working conference was held in Annapolis, Maryland on September 23rd and 24th, 2005 with leaders in research and application related to upper extremity disorders to address this challenge. The intent of the meeting was to review "state of the art" evidence in epidemiology and intervention research in order to develop suggestions regarding next steps in intervention research and application. On day 2 a number of stakeholders were present to discuss what they perceived as the missing pieces in both epidemiological research and applied intervention research in order to generate more effective workplace interventions.

RESULTS

The papers in this series of the Journal of Occupational Rehabilitation indicate that scientifically sound progress has been made over the past decade in identifying ergonomic, workplace psychosocial, and individual factors in both the etiology and exacerbation of these symptoms/disorders. However, there is a gap between this knowledge and the development and practical implementation of comprehensive interventions for these problems. The conference also highlighted the paucity of economic analyses of the impact of these disorders as well as the economic study of the impact of intervention. Approaches for such evaluations were presented and are included in this special section of the journal.

CONCLUSIONS

This series of papers and the summary of the invited group's discussions provided in this paper clearly emphasize the need for innovative ways to think about these problems and specific research topics that can help translate this knowledge into effective secondary prevention efforts.