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Binarelli G, Joly F, Tron L, Lefevre Arbogast S, Lange M. Management of Cancer-Related Cognitive Impairment: A Systematic Review of Computerized Cognitive Stimulation and Computerized Physical Activity. Cancers (Basel) 2021; 13:5161. [PMID: 34680310 PMCID: PMC8534081 DOI: 10.3390/cancers13205161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/05/2021] [Accepted: 10/11/2021] [Indexed: 01/27/2023] Open
Abstract
Cancer-related cognitive impairment (CRCI) occurs frequently in patients living with cancer, with consequences on quality of life. Recently, research on the management of these difficulties has focused on computerized cognitive stimulation and computerized physical activity programs. This systematic review presents the state of knowledge about interventions based on computerized-cognitive stimulation and/or physical activity to reduce CRCI. The review followed the PRISMA guidelines. A search was conducted in PUBMED and Web of Science databases. Risk of bias analysis was conducted using the Rob2 tool and the quality of evidence was conducted following the GRADE approach. A total of 3776 articles were initially identified and 20 of them met the inclusion criteria. Among them, sixteen investigated computerized-cognitive stimulation and four computerized-physical activity. Most of the studies were randomized controlled trials and assessed the efficacy of a home-based intervention on objective cognition in adults with cancer. Overall, cognitive improvement was found in 11/16 computerized-cognitive stimulation studies and 2/4 computerized-physical activity studies. Cognitive stimulation or physical activity improved especially cognitive complaints, memory, and attention. These results suggest the efficacy of both computerized-cognitive stimulation and physical activity. However, we report a high risk of bias for the majority of studies and a low level of quality of evidence. Therefore, further investigations are needed to confirm the efficacy of these interventions and to investigate the possible added benefit on cognition of a combined computerized-cognitive/physical intervention.
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Affiliation(s)
- Giulia Binarelli
- Clinical Research Department, Centre François Baclesse, 14000 Caen, France; (G.B.); (F.J.)
- ANTICIPE, INSERM, UNICAEN, Normandie University, 14000 Caen, France; (L.T.); (S.L.A.)
| | - Florence Joly
- Clinical Research Department, Centre François Baclesse, 14000 Caen, France; (G.B.); (F.J.)
- ANTICIPE, INSERM, UNICAEN, Normandie University, 14000 Caen, France; (L.T.); (S.L.A.)
- Cancer and Cognition Platform, Ligue Nationale Contre le Cancer, 14000 Caen, France
| | - Laure Tron
- ANTICIPE, INSERM, UNICAEN, Normandie University, 14000 Caen, France; (L.T.); (S.L.A.)
- Cancer and Cognition Platform, Ligue Nationale Contre le Cancer, 14000 Caen, France
| | - Sophie Lefevre Arbogast
- ANTICIPE, INSERM, UNICAEN, Normandie University, 14000 Caen, France; (L.T.); (S.L.A.)
- Cancer and Cognition Platform, Ligue Nationale Contre le Cancer, 14000 Caen, France
| | - Marie Lange
- Clinical Research Department, Centre François Baclesse, 14000 Caen, France; (G.B.); (F.J.)
- ANTICIPE, INSERM, UNICAEN, Normandie University, 14000 Caen, France; (L.T.); (S.L.A.)
- Cancer and Cognition Platform, Ligue Nationale Contre le Cancer, 14000 Caen, France
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102
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Grusdat NP, Stäuber A, Tolkmitt M, Schnabel J, Schubotz B, Schulz H. Routine Cancer Treatment Regimens and Its Impact on Fine Motor Dexterity in Breast Cancer. Oncol Res Treat 2021; 45:37-44. [PMID: 34644712 DOI: 10.1159/000519829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/22/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Breast cancer can be a major challenge for those affected. Knowledge of changes in fine motor dexterity in affected women due to routine cancer therapies can help guide effective support. METHODS For this prospective observational study, we collected data of 79 women with a mean age 54.6 ± 9.5 years prior to, after breast cancer therapy (T1), and at 3-month follow-up. The fine motor dexterity was assessed for 4 treatment subgroups: SC = Surgery + Chemotherapy, SCR = Surgery + Chemotherapy + Radiotherapy Therapy, SR = Surgery + Radiotherapy, and S = Surgery. RESULTS Over time, women with breast cancer showed significant decreases in fine motor dexterity across all treatment groups (p < 0.001). The strongest negative effect was seen in the treatment groups receiving additional chemotherapy. SCR group showed pronounced limitations for dominant hand (DH) -12%; non-dominant hand (NDH) -15%; both hands (BH) -17%; assembly (ASSY) -11% at T1. Significant interaction was noticeable in DH (F = 5.59, p < 0.001), NDH (F = 6.61, p < 0.001), BH (F = 13.11 p < 0.001), and ASSY (F = 5.84 p < 0.001). DISCUSSION/CONCLUSION Our study showed that the extent of change in fine motor dexterity depends on the treatment regimen. The detection of unmet care needs could help to personalize and optimize clinical and survivorship care. Based on our findings, multidisciplinary support initiated early in breast cancer therapy is required.
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Affiliation(s)
- Niklas Paul Grusdat
- Professorship of Sports Medicine/Sports Biology, Chemnitz University of Technology, Chemnitz, Germany
| | - Alexander Stäuber
- Professorship of Sports Medicine/Sports Biology, Chemnitz University of Technology, Chemnitz, Germany
| | - Marion Tolkmitt
- Deutsches Rotes Kreuz Krankenhaus Chemnitz-Rabenstein, German Red Cross Hospital, Chemnitz, Germany
| | - Jens Schnabel
- Deutsches Rotes Kreuz Krankenhaus Chemnitz-Rabenstein, German Red Cross Hospital, Chemnitz, Germany
| | - Birgit Schubotz
- Tumorzentrum Chemnitz e.V., Clinical Cancer Registry Chemnitz, Chemnitz, Germany
| | - Henry Schulz
- Professorship of Sports Medicine/Sports Biology, Chemnitz University of Technology, Chemnitz, Germany
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Zhang H, Li P, Liu T, Wang X, Feng W, Chen R, Wei H, Li G, Ning L, Zhang M, Zhang Y. Focal white matter microstructural alteration after anthracycline-based systemic treatment in long-term breast cancer survivors: a structural magnetic resonance imaging study. Brain Imaging Behav 2021; 16:843-854. [PMID: 34608574 DOI: 10.1007/s11682-021-00551-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2021] [Indexed: 11/29/2022]
Abstract
Understanding the neural correlates of cognitive problems in patients with breast cancer (BC) after systemic treatment have been a topic of increasing investigation. The heterogeneity of the systemic treatment regimens may undermine our ability to identify brain microstructural alterations resulting from any given regimen. We investigated the detrimental effects of the anthracycline-based systemic treatment (AST) regimen (epirubicin and cyclophosphamide + docetaxel + tamoxifen) on brain gray matter (GM) and white matter (WM) microstructural alteration in long-term BC survivors. We performed a battery of neuropsychological tests and structural magnetic resonance imaging (MRI) to 31 long-term BC survivors who had received the AST regimen (AST group) and 43 healthy controls (HC group). Voxel-based morphometry evaluated the whole-brain voxel-wise GM volume, while diffusion tensor imaging technique with tract-based spatial statistics analysis evaluated whole-brain WM microstructural alteration. Partial least squares regression (PLSR) was used to evaluate the relationship between cognitive impairment and brain microstructural alteration in BC survivors. Compared with the HC group, the AST group exhibited a significantly poorer performance in attention, as well as a marginal significantly poorer performance in verbal working memory and executive function. Significantly lower fractional anisotropy (FA), higher radial diffusivity (RD), and lower axial diffusivity (AD) in multiple brain WM regions were showed in AST group compared with the HC group. Overlap of lower FA and higher RD was found in the body of corpus callosum (CC) and bilateral superior corona radiata (SCR), whereas overlap of lower FA and AD was found in the body of CC and right SCR. The PLSR results showed that the WM regions with overlap of lower FA and AD were significantly associated with executive and verbal working memory decline. No significant difference was observed in the GM volume between groups. Our results suggest that microstructural abnormalities of certain vulnerable WM regions in the AST regimen-exposed brain may provide neuroimaging evidence for the identification of brain injury and cognitive impairment induced by specific chemotherapy regimens.
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Affiliation(s)
- Huawen Zhang
- Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Republic of China.,Department of Medical Imaging, No.215 Hospital of Shaanxi Nuclear Geology, Xianyang, China
| | - Peng Li
- Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Republic of China.,Department of Medical Imaging, No.215 Hospital of Shaanxi Nuclear Geology, Xianyang, China
| | - Tonghui Liu
- Department of Medical Imaging, No.215 Hospital of Shaanxi Nuclear Geology, Xianyang, China
| | - Xueyuan Wang
- Department of Medical Imaging, No.215 Hospital of Shaanxi Nuclear Geology, Xianyang, China
| | - Wei Feng
- Department of Medical Imaging, No.215 Hospital of Shaanxi Nuclear Geology, Xianyang, China
| | - Rui Chen
- Department of Medical Imaging, No.215 Hospital of Shaanxi Nuclear Geology, Xianyang, China
| | - Hengyang Wei
- Department of Medical Imaging, No.215 Hospital of Shaanxi Nuclear Geology, Xianyang, China
| | - Guoqiang Li
- Department of Medical Imaging, No.215 Hospital of Shaanxi Nuclear Geology, Xianyang, China
| | - Long Ning
- Department of Medical Imaging, No.215 Hospital of Shaanxi Nuclear Geology, Xianyang, China
| | - Ming Zhang
- Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Republic of China.
| | - Yuchen Zhang
- Department of Oncology, The First Affiliated Hospital, Xi'an Jiaotong University, No. 277, West Yanta Road, Xi'an, Shaanxi, 710061, Republic of China.
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Binarelli G, Lange M, Dos Santos M, Grellard JM, Lelaidier A, Tron L, Lefevre Arbogast S, Clarisse B, Joly F. Multimodal Web-Based Intervention for Cancer-Related Cognitive Impairment in Breast Cancer Patients: Cog-Stim Feasibility Study Protocol. Cancers (Basel) 2021; 13:cancers13194868. [PMID: 34638354 PMCID: PMC8508392 DOI: 10.3390/cancers13194868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/02/2021] [Accepted: 09/23/2021] [Indexed: 12/02/2022] Open
Abstract
Simple Summary Cognitive difficulties and their impact on patients’ quality of life are frequently reported by patients treated for breast cancer, who ask for support to improve these difficulties. Cognitive stimulation and physical activity resulted as beneficial for cognitive difficulties, but they are challenging to generalize in hospitals. To overcome this limitation, home-based computerized interventions have been proposed. In this study, the feasibility of a combined intervention of web-based cognitive stimulation and physical activity among breast cancer patients undergoing radiotherapy will be investigated. The overall goal is to develop interventions for cognitive difficulties adapted to supportive care units. Abstract Cancer-related cognitive impairment (CRCI) is a frequent side-effect of cancer treatment, with important consequences on patients’ quality of life. Cognitive stimulation and physical activity are the most efficient in improving cognitive impairment, but they are challenging to generalize in hospitals’ routine and to patients’ needs and schedules. Moreover, the added value of a combination of these interventions needs to be more investigated. The Cog-Stim study is an interventional study investigating the feasibility of a web-based multimodal intervention (combining cognitive stimulation and physical activity for the improvement of cognitive complaints among breast-cancer patients currently treated with radiotherapy (n = 20). Patients will take part in a 12-week program, proposing two sessions per week of web-based cognitive stimulation (20 min/session with HappyNeuron®) and two sessions per week of web-based physical activity (30 min/session with Mooven® platform). Cognitive complaints (FACT-Cog) and objective cognitive functioning (CNS Vital Signs®), anxiety, depression (HADS), sleep disorders (ISI) and fatigue (FACIT-Fatigue) will be assessed before and after the intervention. The primary endpoint is the adherence rate to the intervention program. Patients’ satisfaction, reasons for non-attrition and non-adherence to the program will also be assessed. The overall goal of this study is to collect information to develop web-based interventions for cognitive difficulties in supportive care units.
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Affiliation(s)
- Giulia Binarelli
- Clinical Research Department, Centre François Baclesse, 14000 Caen, France; (M.L.); (M.D.S.); (J.-M.G.); (S.L.A.); (B.C.); (F.J.)
- Interdisciplinary Research Unit for the Prevention and Treatment of Cancers (ANTICIPE), National Institute of Health and Medical Research (INSERM), University of Caen Normandie (UNICAEN), Normandie University, 14000 Caen, France;
- Correspondence: ; Tel.: +33-2-31-45-86-09; Fax: +33-2-31-45-50-97
| | - Marie Lange
- Clinical Research Department, Centre François Baclesse, 14000 Caen, France; (M.L.); (M.D.S.); (J.-M.G.); (S.L.A.); (B.C.); (F.J.)
- Interdisciplinary Research Unit for the Prevention and Treatment of Cancers (ANTICIPE), National Institute of Health and Medical Research (INSERM), University of Caen Normandie (UNICAEN), Normandie University, 14000 Caen, France;
- Cancer and Cognition Platform, Ligue Nationale Contre le Cancer, 14000 Caen, France
| | - Mélanie Dos Santos
- Clinical Research Department, Centre François Baclesse, 14000 Caen, France; (M.L.); (M.D.S.); (J.-M.G.); (S.L.A.); (B.C.); (F.J.)
- Interdisciplinary Research Unit for the Prevention and Treatment of Cancers (ANTICIPE), National Institute of Health and Medical Research (INSERM), University of Caen Normandie (UNICAEN), Normandie University, 14000 Caen, France;
| | - Jean-Michel Grellard
- Clinical Research Department, Centre François Baclesse, 14000 Caen, France; (M.L.); (M.D.S.); (J.-M.G.); (S.L.A.); (B.C.); (F.J.)
| | - Anaïs Lelaidier
- Northwest Data Center (CTD-CNO), Ligue Nationale Contre le Cancer and French National Cancer Institute (INCa), 14000 Caen, France;
| | - Laure Tron
- Interdisciplinary Research Unit for the Prevention and Treatment of Cancers (ANTICIPE), National Institute of Health and Medical Research (INSERM), University of Caen Normandie (UNICAEN), Normandie University, 14000 Caen, France;
- Cancer and Cognition Platform, Ligue Nationale Contre le Cancer, 14000 Caen, France
| | - Sophie Lefevre Arbogast
- Clinical Research Department, Centre François Baclesse, 14000 Caen, France; (M.L.); (M.D.S.); (J.-M.G.); (S.L.A.); (B.C.); (F.J.)
- Interdisciplinary Research Unit for the Prevention and Treatment of Cancers (ANTICIPE), National Institute of Health and Medical Research (INSERM), University of Caen Normandie (UNICAEN), Normandie University, 14000 Caen, France;
- Cancer and Cognition Platform, Ligue Nationale Contre le Cancer, 14000 Caen, France
| | - Benedicte Clarisse
- Clinical Research Department, Centre François Baclesse, 14000 Caen, France; (M.L.); (M.D.S.); (J.-M.G.); (S.L.A.); (B.C.); (F.J.)
| | - Florence Joly
- Clinical Research Department, Centre François Baclesse, 14000 Caen, France; (M.L.); (M.D.S.); (J.-M.G.); (S.L.A.); (B.C.); (F.J.)
- Interdisciplinary Research Unit for the Prevention and Treatment of Cancers (ANTICIPE), National Institute of Health and Medical Research (INSERM), University of Caen Normandie (UNICAEN), Normandie University, 14000 Caen, France;
- Cancer and Cognition Platform, Ligue Nationale Contre le Cancer, 14000 Caen, France
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105
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Corley C, Allen AR. A Bibliometric Analysis of Cyclophosphamide, Methotrexate, and Fluorouracil Breast Cancer Treatments: Implication for the Role of Inflammation in Cognitive Dysfunction. Front Mol Biosci 2021; 8:683389. [PMID: 34490346 PMCID: PMC8417522 DOI: 10.3389/fmolb.2021.683389] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 08/10/2021] [Indexed: 11/13/2022] Open
Abstract
Inflammation is considered one of the possible mechanisms behind long-term cognitive dysfunction persistent after chemotherapy treatment. The chemotherapy combination of cyclophosphamide, methotrexate, and fluorouracil (CMF) was one of the older methods of treating breast cancer patients. Decades later, these patients still report experiencing cognitive side effects. In this present bibliometric review, we applied the VOSviewer tool to describe the existing landscape on literature concerning inflammation as it relates to CMF and cognitive dysfunctions. As time progressed, we saw an increase in interest in the topic. By the mid-2010s there were approximately 1,000 publications per year. Terms related to the brain and CNS did not appear until the later years, and terms related to inflammation and breast cancer were very prevalent throughout the three decades. Also, in more recent years, inflammatory markers and plant-derived compounds used to alleviate side effects of the inflammatory response appeared in the search results. The USA remained the most prolific producer of CMF-, inflammation-, and cognitive dysfunction-related papers throughout the three decades followed by Asia and Europe. As research of cognitive dysfunction caused by inflammation due to chemotherapy treatment progresses, more opportunities emerge for therapeutic methods to improve the quality of life for long-term survivors.
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Affiliation(s)
- Christa Corley
- Division of Radiation Health, University of Arkansas for Medical Sciences, Little Rock, AR, United States.,Department of Pharmaceutical Sciences, The University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Antiño R Allen
- Division of Radiation Health, University of Arkansas for Medical Sciences, Little Rock, AR, United States.,Department of Pharmaceutical Sciences, The University of Arkansas for Medical Sciences, Little Rock, AR, United States.,Neurobiology & Developmental Sciences, The University of Arkansas for Medical Sciences, Little Rock, AR, United States
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106
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Peipins LA, Dasari S, Rodriguez JL, White MC, Hodgson ME, Sandler DP. Employment After Breast Cancer Diagnosis and Treatment Among Women in the Sister and the Two Sister Studies. JOURNAL OF OCCUPATIONAL REHABILITATION 2021; 31:543-551. [PMID: 33387171 PMCID: PMC8485879 DOI: 10.1007/s10926-020-09951-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/25/2020] [Indexed: 06/12/2023]
Abstract
Purpose Women undergoing diagnosis and treatment for breast cancer may face challenges in employment. We investigated the impact of demographic, clinical, workplace, and psychosocial characteristics on loss of employment after a breast cancer diagnosis and treatment. We further describe changes in work status and work environment for cancer survivors who sustain employment. Methods We analyzed responses from a survey of breast cancer survivors from the Sister Study and the Two Sister Study cohorts who reported being employed at the time of their breast cancer diagnosis and who reported employment status (lost vs. sustained employment) at the time of survey administration. Multivariate logistic regression was used to identify the effects of lymphedema, neuropathy, problems with memory or attention, social support, health insurance, and sick leave on lost employment, adjusting for demographic characteristics, cancer stage, treatment, and general health. Results Of the 1675 respondents who reported being employed at the time of diagnosis, 83.5% reported being 'currently' employed at the time of the survey. Older age, peripheral neuropathy, lack of sick leave, late stage at diagnosis, a recurrence or a new cancer, problems with memory or attention, and poor general health were significantly associated with lost employment. Conclusions The long-term effects of breast cancer treatment and workplace provisions for leave and accommodation may have a substantial effect on women's ability to sustain employment. The findings from this study highlight challenges reported by cancer survivors that may inform clinical and occupational interventions to support survivors' return to work.
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Affiliation(s)
- Lucy A Peipins
- Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA.
- NCCDPHP/DCPC, Mailstop S-107-4, 4770 Buford Hwy, NE, Chamblee, GA, 30341-3717, USA.
| | | | - Juan L Rodriguez
- Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mary C White
- Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
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107
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Torre M, Dey A, Woods JK, Feany MB. Elevated Oxidative Stress and DNA Damage in Cortical Neurons of Chemotherapy Patients. J Neuropathol Exp Neurol 2021; 80:705-712. [PMID: 34363676 DOI: 10.1093/jnen/nlab074] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The unintended neurologic sequelae of chemotherapy contribute to significant patient morbidity. Chemotherapy-related cognitive impairment (CRCI) is observed in up to 80% of cancer patients treated with chemotherapy and involves multiple cognitive domains including executive functioning. The pathophysiology underlying CRCI and the neurotoxicity of chemotherapy is incompletely understood, but oxidative stress and DNA damage are highly plausible mechanisms based on preclinical data. Unfortunately, validating pathways relevant to CRCI in humans is limited by an absence of relevant neuropathologic studies of patient brain tissue. In the present study, we stained sections of frontal lobe autopsy tissue from cancer patients treated with chemotherapy (n = 15), cancer patients not treated with chemotherapy (n = 10), and patients without history of cancer (n = 10) for markers of oxidative stress (nitrotyrosine, 4-hydroxynonenal) and DNA damage (pH2AX, pATM). Cancer patients treated with chemotherapy had increased staining for markers of oxidative stress and DNA damage in frontal lobe cortical neurons compared to controls. We detected no statistically significant difference in oxidative stress and DNA damage by the duration between last administration of chemotherapy and death. The study highlights the potential relevance of oxidative stress and DNA damage in the pathophysiology of CRCI and the neurotoxicity of chemotherapy.
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Affiliation(s)
- Matthew Torre
- From the Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Adwitia Dey
- From the Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jared K Woods
- From the Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Mel B Feany
- From the Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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108
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Ahles TA, Schofield E, Li Y, Ryan E, Root JC, Patel SK, McNeal K, Gaynor A, Tan H, Katheria V, Vazquez J, Traina T, Hurria A. Relationship between cognitive functioning and frailty in older breast cancer survivors. J Geriatr Oncol 2021; 13:27-32. [PMID: 34366276 DOI: 10.1016/j.jgo.2021.07.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/25/2021] [Accepted: 07/29/2021] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The relationship between cognitive function and frailty in older, long-term breast cancer survivors was examined. MATERIALS AND METHODS Breast cancer survivors who were diagnosed and treated at 60 years of age or above and were 5-15 year disease-free survivors and non-cancer controls matched on age and education were evaluated with neuropsychological tests and the Comprehensive Geriatric Assessment which was used to assess frailty based on a deficit accumulation frailty index (DAFI). RESULTS Unadjusted regression analyses revealed that cancer survivors scored significantly lower on the Language (P = 0.015), Attention, Processing Speed, Executive Function (APE) (P = 0.015), and Learning and Memory (LM) (P = 0.023) domains compared to controls. However, only the LM domain remained significantly different (P = 0.002) in the adjusted analysis. Survivors had significantly higher DAFI scores compared to controls (p = 0.006) and significantly more survivors were categorized as pre-frail or frail (35%) compared to controls (23%, P = 0.009). Increasing frailty scores were associated with worse cognitive performance across all domains (all Ps ≤ 0.004). For the LM domain, there was a significant interaction (P = 0.019) between DAFI score and survivorship vs control status. Survivors demonstrated a significant linear decline in LM scores as DAFI scores increased, whereas controls demonstrated comparable scores between the robust and pre-frail DAFI groups, demonstrating decline in the frailty group only. CONCLUSION Older, long-term breast cancer survivors had lower cognitive performance and higher levels of frailty compared to controls. For the Learning and Memory domain, the decline in performance began in the pre-frail range for survivors, but not controls.
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Affiliation(s)
- Tim A Ahles
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Elizabeth Schofield
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yuelin Li
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Elizabeth Ryan
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - James C Root
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sunita K Patel
- Departments of Population Science and Supportive Care Medicine, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Katrazyna McNeal
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alexandra Gaynor
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Heidi Tan
- Departments of Population Science and Supportive Care Medicine, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Vani Katheria
- Departments of Population Science and Supportive Care Medicine, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Jessica Vazquez
- Departments of Population Science and Supportive Care Medicine, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Tiffany Traina
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Arti Hurria
- Center for Cancer and Ageing, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
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Wurz A, Ayson G, Smith AM, Brunet J. A proof-of-concept sub-study exploring feasibility and preliminary evidence for the role of physical activity on neural activity during executive functioning tasks among young adults after cancer treatment. BMC Neurol 2021; 21:300. [PMID: 34344355 PMCID: PMC8336393 DOI: 10.1186/s12883-021-02280-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 06/10/2021] [Indexed: 11/28/2022] Open
Abstract
Background Executive functioning (EF) deficits are troubling for adolescents and young adults (AYAs) after cancer treatment. Physical activity (PA) may enhance neural activity underlying EF among older adults affected by cancer. Establishing whether PA enhances neural activity among AYAs is warranted. As part of a two-arm, mixed-methods pilot randomized controlled trial (RCT), this proof-of-concept sub-study sought to answer the following questions: (1) is it feasible to use neuroimaging with EF tasks to assess neural activity changes following a 12-week PA intervention? And (2) is there preliminary evidence that a 12-week PA intervention enhances neural activity among AYAs after cancer treatment? Methods AYAs in the pilot RCT were approached for enrollment into this sub-study. Those who were eligible and enrolled, completed functional magnetic resonance imaging (fMRI) with EF tasks (letter n-back, Go/No Go) pre- and post-PA intervention. Sub-study enrollment, adherence to scheduled fMRI scans, outliers, missing data, and EF task performance data were collected. Data were analyzed with descriptive statistics, blood oxygen level dependent (BOLD) analyses, and paired sample t-tests. Results Nine eligible participants enrolled into this sub-study; six attended scheduled fMRI scans. One outlier was identified and was subsequently removed from the analytical sample. Participants showed no differences in EF task performance from pre- to post-PA intervention. Increases in neural activity in brain regions responsible for motor control, information encoding and processing, and decision-making were observed post-PA intervention (p < 0.05; n = 5). Conclusions Findings show that fMRI scans during EF tasks detected neural activity changes (as assessed by the BOLD signal) from pre- to post-PA intervention. Results thus suggest future trials confirming that PA enhances neural activity underlying EF are needed, though feasibility issues require careful consideration to ensure trial success. Trial registration clinicaltrials.gov, NCT03016728. Registered January 11, 2017, clinicaltrials.gov/ct2/show/NCT03016728. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02280-y.
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Affiliation(s)
- Amanda Wurz
- School of Human Kinetics, University of Ottawa, 125 University Private, Montpetit Hall, Room 339, K1N 6N5, Ottawa, Ontario, Canada.,Present affiliation: Faculty of Kinesiology, University of Calgary, Alberta, Calgary, Canada
| | - Gladys Ayson
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Andra M Smith
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Jennifer Brunet
- School of Human Kinetics, University of Ottawa, 125 University Private, Montpetit Hall, Room 339, K1N 6N5, Ottawa, Ontario, Canada. .,Cancer Therapeutic Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada. .,Institut du savoir Montfort, Hôpital Montfort, Ottawa, Ontario, Canada.
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110
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Swainston J, Louis C, Moser J, Derakshan N. Neurocognitive efficiency in breast cancer survivorship: A performance monitoring ERP study. Int J Psychophysiol 2021; 168:9-20. [PMID: 34242661 DOI: 10.1016/j.ijpsycho.2021.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/26/2021] [Accepted: 06/28/2021] [Indexed: 12/24/2022]
Abstract
Breast cancer diagnosis and treatment can lead to longer term cognitive and emotional vulnerability, making the ability to efficiently adapt to setbacks critical. Whilst cancer-related cognitive impairments (CRCI) are often reported amongst breast cancer survivors, investigation into the capacity to efficiently process errors is limited. The present study investigated the neurocognitive correlates of cognitive-control related performance monitoring, an important function influencing behavioural adjustment to mistakes. 62 participants (30 Breast Cancer Survivors, 32 Non-Cancer) completed a modified flanker task designed to challenge response inhibition as we measured neurocognitive indices of performance monitoring (ERN, the error-related negativity; CRN, the correct-response negativity; Pe, the error positivity). Findings indicated a blunted CRN and larger ∆ERN in the breast cancer survivors compared to the non-cancer group, in the absence of performance effects. This was followed by a larger Pe in the breast cancer survivors' group, indicating an exaggerated performance monitoring response. For women affected by breast cancer, findings suggest an early disrupted neural response to monitoring cognitive performance, followed by the requirement for more effortful processing in the conscious response to errors, indicating deficits in neurocognitive efficiency. These findings have important implications for developing cognitive rehabilitation programmes for breast cancer survivors affected by cognitive dysfunction to assist in the monitoring and adjustment of performance required to meet established goals in the face of adversity.
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Affiliation(s)
- Jessica Swainston
- Department of Psychological Sciences, Birkbeck, University of London, UK.
| | - Courtney Louis
- Department of Psychology, Michigan State University, USA
| | - Jason Moser
- Department of Psychology, Michigan State University, USA
| | - Nazanin Derakshan
- Department of Psychological Sciences, Birkbeck, University of London, UK
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111
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Magnuson A, Ahles T, Chen BT, Mandelblatt J, Janelsins MC. Cognitive Function in Older Adults With Cancer: Assessment, Management, and Research Opportunities. J Clin Oncol 2021; 39:2138-2149. [PMID: 34043437 PMCID: PMC8260910 DOI: 10.1200/jco.21.00239] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/11/2021] [Accepted: 03/25/2021] [Indexed: 12/12/2022] Open
Affiliation(s)
- Allison Magnuson
- Department of Medicine, University of Rochester Medical Center, Wilmot Cancer Institute, Rochester, NY
| | - Tim Ahles
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Bihong T. Chen
- Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, CA
| | - Jeanne Mandelblatt
- Georgetown-Lombardi Comprehensive Cancer Center, Cancer Control Program, Georgetown University Medical Center, Washington, DC
| | - Michelle C. Janelsins
- Department of Surgery, Cancer Control, University of Rochester Medical Center, Wilmot Cancer Institute, Rochester, NY
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112
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Von Ah D, Crouch AD, Monahan PO, Stump TE, Unverzagt FW, Storey S, Cohee AA, Cella D, Champion VL. Association of cognitive impairment and breast cancer survivorship on quality of life in younger breast cancer survivors. J Cancer Surviv 2021; 16:812-822. [PMID: 34173970 PMCID: PMC9300496 DOI: 10.1007/s11764-021-01075-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 06/12/2021] [Indexed: 01/22/2023]
Abstract
Purpose Younger breast cancer survivors (BCS) often report cognitive impairment and poor quality of life (QoL), which could be interrelated. The purpose of this study was to examine the association of cognitive impairment and breast cancer status (BCS versus healthy control (HC)), with QoL, which included psychological (depressive symptoms, well-being, perceived stress, and personal growth) and physical well-being (physical functioning and fatigue). Methods Four hundred ninety-eight BCS (≤45 years at diagnosis) who were 3 to 8 years post-chemotherapy treatment and 394 HC completed subjective questionnaires and a one-time neuropsychological assessment, including tests of attention, memory, processing speed, and verbal fluency. For each test, cognitive impairment was defined as scoring 1.5 and 2.0 standard deviations below the mean of the HC group. Separate linear regression models for each outcome were ran controlling for known covariates. Results BCS reported significantly more memory problems than HC (p < 0.0001), with up to 23% having significant impairment. Cognitive performance did not differ significantly between BCS and HCs. BCS vs. HCs had greater depression and fatigue, yet more personal growth. Objective and subjective cognitive impairment were significantly related to greater depressive symptoms and perceived stress and lower well-being and physical functioning; whereas, objective impairment was related to less personal growth and subjective impairment was related to greater fatigue. Conclusions Younger BCS report significant cognitive impairment years after treatment which may relate to greater decrements in QoL. Implications to Cancer Survivors Assessment and interventions to address cognitive concerns may also influence QoL outcomes in younger BCS. Supplementary Information The online version contains supplementary material available at 10.1007/s11764-021-01075-x.
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Affiliation(s)
- Diane Von Ah
- Indiana University School of Nursing, 600 Barnhill Drive, NU 120, Indianapolis, IN 46202 USA
| | - Adele D. Crouch
- Indiana University School of Nursing, 600 Barnhill Drive, NU 120, Indianapolis, IN 46202 USA
| | - Patrick O. Monahan
- Department of Biostatistics, Indiana University School of Medicine, HS3000, Indianapolis, IN 46202 USA
| | - Timothy E. Stump
- Department of Biostatistics, Indiana University School of Medicine, HS3000, Indianapolis, IN 46202 USA
| | - Frederick W. Unverzagt
- Department of Psychiatry, Indiana University School of Medicine, 355 W. 16th Street, Suite 2800, Indianapolis, IN 46202 USA
| | - Susan Storey
- Department of Psychiatry, Indiana University School of Medicine, 355 W. 16th Street, Suite 2800, Indianapolis, IN 46202 USA
| | - Andrea A. Cohee
- Indiana University School of Nursing, 600 Barnhill Drive, NU 120, Indianapolis, IN 46202 USA
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave – 21st Floor, Chicago, IL 60611 USA
- Institute for Public Health and Medicine-Center for Patent Centered Outcomes, Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave – 21st Floor, Chicago, IL 60611 USA
| | - Victoria L. Champion
- IU Simon Cancer Center, Indiana University School of Nursing, 600 Barnhill Drive, NU 318, Indianapolis, IN 46202 USA
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113
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Wei XL, Yuan RZ, Jin YM, Li S, Wang MY, Jiang JT, Wu CQ, Li KP. Effect of Baduanjin exercise intervention on cognitive function and quality of life in women with breast cancer receiving chemotherapy: study protocol of a randomized controlled trial. Trials 2021; 22:405. [PMID: 34147107 PMCID: PMC8214282 DOI: 10.1186/s13063-021-05355-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 06/04/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND More than 50% cognitive impairment was reported by cancer patients before and after medical treatment. However, there are no effective interventions to manage the cognitive problem in women with breast cancer. This pilot study was designed to evaluate the protective effect of Baduanjin exercise on cognitive function and cancer-related symptoms in women with early-stage breast cancer undergoing chemotherapy. METHOD A single-blinded, randomized control trial was designed. The trial will recruit 70 patients with early-stage breast cancer scheduled to receive chemotherapy from Shanghai in China. All participants will be randomly assigned to (1:1) the supervised Baduanjin group (5 times/week, 30 min each time) or the wait-list control group for 3 months. The effect of Baduanjin exercise intervention will be evaluated by outcome measures including subjective and objective cognitive function, symptoms (fatigue, depression, and anxiety), and health-related quality of life at pre-intervention (T0), 8 weeks (T1), and 12 weeks (T2). The PCI score in the FACT-Cog as the primary cognitive outcome will be reported descriptively, while effect sizes and 95% confidence intervals (CIs) will be calculated. The collected data will be analyzed by using an intention-to-treat principle and linear mixed-effects modeling. DISCUSSION This is the first randomized clinical trial to investigate whether Baduanjin exercise will have a positive role in improving cognitive function in women with breast cancer receiving chemotherapy. If possible, Baduanjin exercise will be a potential non-pharmacological intervention to manage cognitive dysfunction and promote survivorship care among breast cancer survivors. TRIAL REGISTRATION Chinese Clinical Trial Registry (ChiCTR) ChiCTR2000033152 . Registered on 22 May 2020.
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Affiliation(s)
- Xiao-Lin Wei
- School of Nursing, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Shanghai, 201203, China
| | - Ru-Zhen Yuan
- School of Nursing, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Shanghai, 201203, China
| | - Yong-Mei Jin
- Nursing Department, The Seventh People's Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, 358 Datong Road, Shanghai, 200137, China
| | - Shu Li
- Department of Respiratory Medicine, The Seventh People's Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, 358 Datong Road, Shanghai, 200137, China
| | - Ming-Yue Wang
- School of Nursing, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Shanghai, 201203, China
| | - Jie-Ting Jiang
- School of Nursing, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Shanghai, 201203, China
| | - Cai-Qin Wu
- School of Nursing, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Shanghai, 201203, China.
| | - Kun-Peng Li
- Department of Neurorehabilitation, The Second Rehabilitation Hospital of Shanghai, 860 Changjiang Road, Shanghai, 200441, China.
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114
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Triebel K, Anderson J, Nakkina SR, Vance DE. Can Breast Cancer Survivors Benefit from Speed of Processing Training? A Perspective Article on Treatment and Research. NURSING: RESEARCH AND REVIEWS 2021. [DOI: 10.2147/nrr.s312214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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115
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Anderson JE, Trujillo M, McElroy T, Groves T, Alexander T, Kiffer F, Allen AR. Early Effects of Cyclophosphamide, Methotrexate, and 5-Fluorouracil on Neuronal Morphology and Hippocampal-Dependent Behavior in a Murine Model. Toxicol Sci 2021; 173:156-170. [PMID: 31651976 DOI: 10.1093/toxsci/kfz213] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Breast cancer (BC) is the most common cancer among women. Fortunately, BC survival rates have increased because the implementation of adjuvant chemotherapy leading to a growing population of survivors. However, chemotherapy-induced cognitive impairments (CICIs) affect up to 75% of BC survivors and may be driven by inflammation and oxidative stress. Chemotherapy-induced cognitive impairments can persist 20 years and hinder survivors' quality of life. To identify early effects of CMF administration in mice, we chose to evaluate adult female mice at 2-week postchemotherapy. Mice received weekly IP administration of CMF (or saline) for 4 weeks, completed behavioral testing, and were sacrificed 2 weeks following their final CMF injection. Behavioral results indicated long-term memory (LTM) impairments postchemotherapy, but did not reveal short-term memory deficits. Dendritic morphology and spine data found increases in overall spine density within CA1 basal and CA3 basal dendrites, but no changes in DG, CA1 apical, or CA3 apical dendrites. Further analysis revealed decreases in arborization across the hippocampus (DG, CA1 apical and basal, CA3 apical and basal). These physiological changes within the hippocampus correlate with our behavioral data indicating LTM impairments following CMF administration in female mice 2-week postchemotherapy. Hippocampal cytokine analysis identified decreases in IL-1α, IL-1β, IL-3, IL-10, and TNF-α levels.
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Affiliation(s)
- Julie E Anderson
- Division of Radiation Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205.,Department of Pharmaceutical Sciences, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205
| | - Madison Trujillo
- Division of Radiation Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205.,Department of Pharmaceutical Sciences, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205
| | - Taylor McElroy
- Division of Radiation Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205.,Department of Pharmaceutical Sciences, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205
| | - Thomas Groves
- Division of Radiation Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205.,Department of Pharmaceutical Sciences, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205.,Neurobiology & Developmental Sciences, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205
| | - Tyler Alexander
- Division of Radiation Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205.,Department of Pharmaceutical Sciences, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205
| | - Frederico Kiffer
- Division of Radiation Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205.,Department of Pharmaceutical Sciences, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205
| | - Antiño R Allen
- Division of Radiation Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205.,Department of Pharmaceutical Sciences, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205.,Neurobiology & Developmental Sciences, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205
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116
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Dobretsova A, Derakshan N. Cognitive function and emotional vulnerability in metastatic breast cancer: Moderating effects of age and social support. Psychooncology 2021; 30:1563-1571. [PMID: 33991121 DOI: 10.1002/pon.5732] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/01/2021] [Accepted: 04/24/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Previous literature has established a relationship between cognitive function and symptoms of anxiety, depression, and post-traumatic stress in primary breast cancer, but not in metastatic breast cancer (MBC). The current study examined the relationship between cognitive function and symptoms of anxiety, depression, and post-traumatic stress as well as the moderating effects of age, time since MBC diagnosis, and social support. METHODS Subjective and objective measures of cognitive function as well as self-reports of emotional vulnerability were completed by 59 women diagnosed with MBC who were recruited through social media and support groups. RESULTS Emotional vulnerability scores were associated with perceived measures of cognitive function. Additionally, low levels of perceived cognitive function were met with increased levels of depression with social support moderating this relationship buffering against depression. Age was found to moderate the relationship between cognitive function and post-traumatic stress with younger women at a greater risk of vulnerability. Out of all the emotional vulnerability measures, only anxiety negatively correlated with objective task performance. CONCLUSIONS This study established a relationship between cognitive function and emotional vulnerability in MBC patients. It emphasised how vulnerable younger MBC women are to post-traumatic stress, and the importance of the combined effects of cognitive function and social support in buffering against depression. Our results have important implications for developing new interventions and treatment plans that consider the roles of these factors in ensuring a better quality of life in MBC.
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Affiliation(s)
- Anna Dobretsova
- Department of Psychological Sciences, Birkbeck, University of London, London, UK.,Birkbeck Centre for Building Resilience in Breast Cancer (BRiC), London, UK
| | - Nazanin Derakshan
- Department of Psychological Sciences, Birkbeck, University of London, London, UK.,Birkbeck Centre for Building Resilience in Breast Cancer (BRiC), London, UK
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117
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van der Willik KD, Jóźwiak K, Hauptmann M, van de Velde EED, Compter A, Ruiter R, Stricker BH, Ikram MA, Schagen SB. Change in cognition before and after non-central nervous system cancer diagnosis: A population-based cohort study. Psychooncology 2021; 30:1699-1710. [PMID: 34004035 DOI: 10.1002/pon.5734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Clinical studies showing that non-central nervous system cancer patients can develop cognitive impairment have primarily focused on patients with specific cancer types and intensive treatments. To better understand the course of cognitive function in the general population of cancer patients, we assessed cognitive trajectories of patients before and after cancer diagnosis in a population-based setting. METHODS Between 1989 and 2014, 2211 participants from the population-based Rotterdam study had been diagnosed with cancer of whom 718 (32.5%) had undergone ≥1 cognitive assessment before and after diagnosis. Cognition was measured every 3 to 6 years using a neuropsychological battery. Linear mixed models were used to compare cognitive trajectories of patients before and after diagnosis with those of age-matched cancer-free controls (1:3). RESULTS Median age at cancer diagnosis was 70.3 years and 47.1% were women. Most patients (68.1%) had received local treatment only. Cognitive trajectories of patients before and after cancer diagnosis were largely similar to those of controls. After diagnosis, the largest difference was found on a memory test (patients declined with 0.14 units per year on the Word Learning Test: delayed recall [95% CI = -0.35; 0.07] and controls with 0.09 units [95% CI = -0.18;-0.00], p for difference = .59). CONCLUSIONS In this longitudinal cohort, cancer did not appear to alter the trajectory of change in cognitive test results over time from that seen in similar individuals without cancer, although most cancer patients did not receive systemic therapies. Future studies should focus on identifying subgroups of patients who are at high risk for developing cognitive impairment.
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Affiliation(s)
- Kimberly D van der Willik
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Katarzyna Jóźwiak
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Michael Hauptmann
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Edolie E D van de Velde
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Annette Compter
- Department of Neuro-oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Rikje Ruiter
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Bruno H Stricker
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sanne B Schagen
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Psychology, Brain and Cognition, University of Amsterdam, Amsterdam, The Netherlands
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118
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Neuroimmune reactivity marker expression in rodent models of chemotherapy-induced cognitive impairment: A systematic scoping review. Brain Behav Immun 2021; 94:392-409. [PMID: 33516919 DOI: 10.1016/j.bbi.2021.01.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/15/2020] [Accepted: 01/18/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Chemotherapy-induced cognitive impairment (CICI) is a debilitating side effect arising from chemotherapy treatments. The condition is characterised by a range of cognitive deficits including impairment to memory, attention, and concentration. Whilst the underlying mechanisms that contribute to CICI remain unclear, neuroinflammation has been suggested as one key contributor. METHOD A comprehensive systematic search of EMBASE and Medline via PubMed was conducted to identify studies on neuroimmune reactivity marker expression changes and resulting cognitive changes in preclinical rodent models of CICI. RESULTS A total of twenty studies met the eligibility criteria and were included in the scoping review. There was significant heterogeneity in the methodology employed in the included studies. Our findings demonstrate that widespread changes in cytokines, chemokines, microglia reactivity, and astrocyte reactivity are observed in CICI in the brain regions expected to be affected, given the nature of the cognitive impairment observed in CICI. CONCLUSIONS Although there was considerable heterogeneity in study design that made comparisons between studies difficult, our findings suggest that neuroinflammation commonly occurs in CICI preclinical rodent models and shows an association with cognitive impairment.
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119
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Van Dyk K, Zhou X, Small BJ, Ahn J, Zhai W, Ahles T, Graham D, Jacobsen PB, Jim H, McDonald BC, Nudelman Holohan K, Patel SK, Rebeck GW, Root JC, Saykin AJ, Cohen HJ, Mandelblatt JS, Carroll JE. Protective Effects of APOE ε2 Genotype on Cognition in Older Breast Cancer Survivors: The Thinking and Living With Cancer Study. JNCI Cancer Spectr 2021; 5:pkab013. [PMID: 33748669 PMCID: PMC7962698 DOI: 10.1093/jncics/pkab013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 01/21/2021] [Indexed: 11/14/2022] Open
Abstract
Background Cancer-related cognitive decline (CRCD) has been linked to apolipoprotein E (APOE) gene ε4 polymorphisms. APOE ε4 polymorphisms are also the strongest genetic risk for late-onset Alzheimer disease (AD), whereas ε2 polymorphisms protect against AD. However, the effects of ε2 polymorphisms on CRCD have not been evaluated. Methods We evaluated nonmetastatic breast cancer survivors (n = 427) and matched noncancer controls (n = 407) ages 60-98 years assessed presystemic therapy from August 2010 to December 2017 with annual follow-up to 24 months. Neuropsychological assessment measured attention, processing speed, executive function, and learning and memory. Linear mixed-effects models tested the effects of having an ε2 allele (vs none) on longitudinal cognitive domain z scores by treatment group (chemotherapy with or without hormonal therapy, hormonal therapy, and control) controlling for covariates; participants with ε2/ε4 genotype were excluded. Sensitivity analyses examined effects of other covariates and any ε4 positivity. Results There was an interaction with genotype for attention, processing speed, and executive functioning domain scores (Beta = 0.32, 95% confidence interval = 0.00 to 0.65); the chemotherapy group with an ε2 allele had higher scores at baseline and maintained higher scores over time compared with those without an ε2 allele, and this protective effect was not seen for other groups. There was no effect of ε2 on learning and memory domain scores. Conclusions APOE ε2 polymorphisms may protect against CRCD in older breast cancer survivors receiving chemotherapy. With replication, this information could be useful for survivorship care and informing future studies of possible links to AD and defining mechanisms of protection.
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Affiliation(s)
- Kathleen Van Dyk
- UCLA Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, David Geffen School of Medicine, Jane and Terry Semel Institute for Neuroscience and Human Behavior, Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Xingtao Zhou
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown-Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Brent J Small
- School of Aging Studies, University of South Florida, and Senior Member, Health Outcome and Behavior Program and Biostatistics Resource Core, H. Lee Moffitt Cancer Center and Research Institute at the University of South Florida, Tampa, FL, USA
| | - Jaeil Ahn
- Department of Biostatistics, Bioinformatics, and Biomathematics, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Wanting Zhai
- Department of Biostatistics, Bioinformatics, and Biomathematics, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Tim Ahles
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | | | - Paul B Jacobsen
- Division of Cancer Control and Population Sciences, Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD, USA
| | - Heather Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, FL, USA
| | - Brenna C McDonald
- Department of Radiology and Imaging Sciences, Center for Neuroimaging, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kelly Nudelman Holohan
- Department of Medical and Molecular Genetics, Indiana Alzheimer’s Disease Research Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sunita K Patel
- Departments of Population Sciences and Supportive Care Medicine, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - G William Rebeck
- Department of Neurosciences, Georgetown University School of Medicine, Georgetown University, Washington, DC, USA
| | - James C Root
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
- Departments of Psychiatry and Anesthesiology, Weill Medical College of Cornell University, New York, NY, USA
| | - Andrew J Saykin
- Department of Radiology and Imaging Sciences, Center for Neuroimaging, Indiana Alzheimer’s Disease Research Center, and the Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Harvey Jay Cohen
- Center for the Study of Aging and Human Development, Duke Cancer Institute, Duke University School of Medicine, Durham, NC, USA
| | - Jeanne S Mandelblatt
- Department of Oncology, Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Judith E Carroll
- UCLA Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, David Geffen School of Medicine, Jane and Terry Semel Institute for Neuroscience and Human Behavior, Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, CA, USA
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Lomeli N, Lepe J, Gupta K, Bota DA. Cognitive complications of cancer and cancer-related treatments - Novel paradigms. Neurosci Lett 2021; 749:135720. [PMID: 33582187 PMCID: PMC8423125 DOI: 10.1016/j.neulet.2021.135720] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/28/2021] [Accepted: 02/01/2021] [Indexed: 01/07/2023]
Abstract
As advances in diagnostics and therapeutic strategies in oncology have increased the number of cancer survivors, the investigation of the mechanisms associated with long-term cognitive complications of cancer treatment has become an important topic of interest. The neurotoxic effects of chemotherapeutic agents have been described in pre-clinical and clinical research. In vitro and rodent studies have identified some underlying mechanisms contributing to chemotherapy-induced neurotoxicity and cognitive impairment for various chemotherapy drugs and other cancer treatments. However, investigation of the direct biological effects of cancer and other potential contributing factors in the pathogenesis of cancer-related cognitive impairment (CRCI) has only recently come into focus. This review will highlight evidence from pre-clinical tumor-bearing rodent models suggesting that cancer influences the cognitive and behavioral changes reported in human cancer populations through direct or indirect pathways that alter the normal neuroinflammatory responses, induce structural brain deficits, and decrease neurogenesis. We reflect on human clinical cancer research indicating that cognitive and behavioral changes precede cancer treatment in some malignancies. We also highlight implications for future areas of CRCI research based on novel findings on the interplay between cancer, chemotherapy, inflammation, tau pathology, and dysregulation of the microbiota-gut-brain axis.
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Affiliation(s)
- Naomi Lomeli
- Department of Neurology, University of California Irvine, Irvine, CA, USA.
| | - Javier Lepe
- Department of Pathology & Laboratory Medicine, University of California Irvine, Irvine, CA, USA.
| | - Kalpna Gupta
- Department of Medicine, University of California Irvine, Irvine, CA, USA.
| | - Daniela A Bota
- Department of Neurology, University of California Irvine, Irvine, CA, USA; Department of Pathology & Laboratory Medicine, University of California Irvine, Irvine, CA, USA; Chao Family Comprehensive Cancer Center, University of California Irvine, Irvine, CA, USA.
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Ma J, Sun H, Zhang Y, Chen D, Hu H. Fabrication of epidermal growth factor imprinted and demethylcantharidin loaded dendritic mesoporous silica nanoparticle: An integrated drug vehicle for chemo-/antibody synergistic cancer therapy. J Drug Deliv Sci Technol 2021. [DOI: 10.1016/j.jddst.2021.102387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Lim CYS, Laidsaar-Powell RC, Young JM, Kao SCH, Zhang Y, Butow P. Colorectal cancer survivorship: A systematic review and thematic synthesis of qualitative research. Eur J Cancer Care (Engl) 2021; 30:e13421. [PMID: 33733545 DOI: 10.1111/ecc.13421] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 12/06/2020] [Accepted: 01/15/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION With rapid changes in treatments for colorectal cancer (CRC), qualitative research into CRC survivorship requires greater synthesis. This paper aims to fill this gap through a systematic review (PROSPERO CRD42019131576) and thematic synthesis of the qualitative literature on survivorship experiences across early-stage and advanced CRC survivors. METHODS CINAHL, Embase, MEDLINE, PsycINFO and PubMed were searched for qualitative CRC survivorship papers. Titles, abstracts and full texts were screened. Included articles (n = 81) underwent data extraction, CASP qualitative bias ratings and thematic synthesis. RESULTS Bowel dysfunction caused functional limitations and negative quality of life (QoL), while stomas posed threats to body image and confidence. Physical symptoms hindered return to work, increasing financial burdens. Survivors' unmet needs included information regarding symptom expectations and management, and ongoing support throughout recovery. Advanced and early-stage survivors shared similar experiences. Advanced survivors struggled with fear of cancer recurrence/progression and feelings of powerlessness. Functional limitations, financial impacts and sexuality in advanced survivors were underexplored areas. CONCLUSION CRC and its treatments impact survivors' QoL in all areas. A coordinated supportive care response is required to address survivors' unmet needs. Future qualitative studies should explore advanced CRC subpopulations, treatment-specific impacts on QoL and long-term (>5 years) impacts on CRC survivors.
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Affiliation(s)
- Chloe Yi Shing Lim
- Centre for Medical Psychology and Evidence-Based Decision-Making (CeMPED), School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - Rebekah Clare Laidsaar-Powell
- Centre for Medical Psychology and Evidence-Based Decision-Making (CeMPED), School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - Jane M Young
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,RPA Institute of Academic Surgery (IAS) and Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District, Sydney, NSW, Australia
| | - Steven Chuan-Hao Kao
- Department of Medical Oncology, Chris O'Brien Lifehouse, Sydney, NSW, Australia.,Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Yuehan Zhang
- National Centre for Epidemiology and Population Health, Australian National University Research School of Population Health, Canberra, ACT, Australia
| | - Phyllis Butow
- Centre for Medical Psychology and Evidence-Based Decision-Making (CeMPED), School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
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The association of genetic polymorphisms with neuroconnectivity in breast cancer patients. Sci Rep 2021; 11:6169. [PMID: 33731765 PMCID: PMC7971072 DOI: 10.1038/s41598-021-85768-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 03/02/2021] [Indexed: 11/21/2022] Open
Abstract
Genetic polymorphisms in select genes, including APOE (apolipoprotein E), COMT (Catechol-O-Methyltransferase), MDR1 (multi-drug resistance 1), BDNF (brain derived neurotrophic factor), and GST (glutathione-S-transferase), have been associated with vulnerability to cognitive impairment. In this study, we evaluated the relationship of these genetic variants to measures of brain health in patients with breast cancer, including neurocognitive testing and functional connectome analysis. Women with breast cancer (n = 83) and female healthy controls (n = 53) were evaluated. They underwent resting-state functional MRI scans and neurocognitive testing. Polymerase chain reaction (PCR) was performed on saliva samples to identify single nucleotide polymorphisms (SNPs) in candidate genes: APOE, COMT, MDR1, BDNF, and GST. Breast cancer patients treated with chemotherapy had slower processing speed (p = 0.04) and poorer reported executive function (p < 0.0001) than healthy controls. Those chemotherapy-treated patients that were APOE e4 carriers had significantly slower processing speed. A greater number of risk-related alleles was associated with poorer connectivity in the regions of the left cuneus and left calcarine. While breast cancer patients that are APOE e4 carriers may have a select vulnerability to processing speed impairments, other risk-related alleles were not found to influence cognitive test performance in this population. Conversely, regions of impaired functional connectivity appeared to be related to risk-related genetic polymorphisms in breast cancer patients. This suggests that a cancer patient’s SNPs in candidate genes may influence the risk of neurotoxicity. Further study evaluating the impact of genotype on biomarkers of brain health in cancer survivors is warranted.
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Henneghan AM, Van Dyk K, Kaufmann T, Harrison R, Gibbons C, Heijnen C, Kesler SR. Measuring Self-Reported Cancer-Related Cognitive Impairment: Recommendations From the Cancer Neuroscience Initiative Working Group. J Natl Cancer Inst 2021; 113:1625-1633. [PMID: 33638633 PMCID: PMC8849125 DOI: 10.1093/jnci/djab027] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/07/2021] [Accepted: 02/22/2021] [Indexed: 12/15/2022] Open
Abstract
Cancer and its treatments are associated with increased risk for cancer-related cognitive impairment (CRCI). Methods and measures used to study and assess self-reported CRCI (sr-CRCI), however, remain diverse, resulting in heterogeneity across studies. The Patient-Reported Outcomes Working Group has been formed to promote homogeneity in the methods used to study sr-CRCI. In this report, using a psychometric taxonomy, we inventory and appraise instruments used in research to measure sr-CRCI, and we consider advances in patient-reported outcome methodology. Given its psychometric properties, we recommend the Patient-Reported Outcome Measurement Information System Cognitive Function Short Form 8a for measurement of sr-CRCI in cancer patients and survivors, at a minimum, to increase scientific rigor and progress in addressing CRCI.
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Affiliation(s)
- Ashley M Henneghan
- School of Nursing, University of Texas at Austin, Austin, TX, USA,Department of Oncology, Dell Medical School, University of Texas at Austin, Austin, TX, USA,Correspondence to: Ashley M. Henneghan, PhD, RN, FAAN, School of Nursing, University of Texas at Austin, 1710 Red River St, Austin TX, 78712, USA (e-mail: )
| | - Kathleen Van Dyk
- Semel Institute, Department of Psychiatry and Biobehavioral Sciences David Geffen School of Medicine, Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, CA, USA
| | - Tara Kaufmann
- Department of Oncology , Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Rebecca Harrison
- Department of Neuro Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Christopher Gibbons
- Department of Symptom Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Cobi Heijnen
- Department of Symptom Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shelli R Kesler
- School of Nursing, Department of Diagnostic Medicine, Dell Medical School, University of Texas at Austin, Austin, TX, USA
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Brown T, Sykes D, Allen AR. Implications of Breast Cancer Chemotherapy-Induced Inflammation on the Gut, Liver, and Central Nervous System. Biomedicines 2021; 9:biomedicines9020189. [PMID: 33668580 PMCID: PMC7917715 DOI: 10.3390/biomedicines9020189] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/10/2021] [Accepted: 02/10/2021] [Indexed: 12/18/2022] Open
Abstract
Breast Cancer is still one of the most common cancers today; however, with advancements in diagnostic and treatment methods, the mortality and survivorship of patients continues to decrease and increase, respectively. Commonly used treatments today consist of drug combinations, such as doxorubicin and cyclophosphamide; docetaxel, doxorubicin, and cyclophosphamide; or doxorubicin, cyclophosphamide, and paclitaxel. Although these combinations are effective at destroying cancer cells, there is still much to be understood about the effects that chemotherapy can have on normal organ systems such as the nervous system, gastrointestinal tract, and the liver. Patients can experience symptoms of cognitive impairments or “chemobrain”, such as difficulty in concentrating, memory recollection, and processing speed. They may also experience gastrointestinal (GI) distress symptoms such as diarrhea and vomiting, as well as hepatotoxicity and long term liver damage. Chemotherapy treatment has also been shown to induce peripheral neuropathy resulting in numbing, pain, and tingling sensations in the extremities of patients. Interestingly, researchers have discovered that this array of symptoms that cancer patients experience are interconnected and mediated by the inflammatory response.
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Affiliation(s)
- Taurean Brown
- Division of Radiation Health, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA;
- Department of Pharmaceutical Sciences, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
- Department of Neurobiology & Developmental Sciences, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - DeLawrence Sykes
- Department of Biology, Pomona College, Claremont, CA 91711, USA;
| | - Antiño R. Allen
- Division of Radiation Health, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA;
- Department of Pharmaceutical Sciences, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
- Department of Neurobiology & Developmental Sciences, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
- Correspondence: ; Tel.: +1-501-686-7335
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Becker JH, Ezratty C, Jahan N, Goel M, Harris YT, Lin JJ. The impact of cognitive impairment on self-regulatory styles in breast cancer survivors. Psychooncology 2021; 30:970-978. [PMID: 33484026 DOI: 10.1002/pon.5633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 01/18/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Cognitive impairment (CI) is highly prevalent in breast cancer survivors (BCS), and can be a barrier to health-promoting behaviours. However, the ways in which CI may affect self-regulation or motivation to perform such behaviours have not been explored. We assessed if BCS with CI report greater extrinsic self-regulation compared to those without CI and if this relationship persists after controlling for depression. METHODS We recruited BCS with diabetes and assessed cognition and motivation to perform healthy diabetes management behaviours (e.g., diet and exercise). Participants completed a cognitive battery evaluating attention, working memory, executive functioning (EF), processing speed (PS), language and memory. The Treatment Self-Regulation Questionnaire (TSRQ) assessed intrinsic versus extrinsic motivation. Depression was determined by a score ≥16 on the Center for Epidemiological Studies Depression Scale. Wilcoxon rank-sum test compared associations between CI and TSRQ scores. RESULTS Participants were 118 older adults (mean age 65 years). Participants with CI in the following domains had higher extrinsic self-regulation scores compared to those without CI: attention (p < 0.01), PS (p = 0.01), EF (p < 0.01), language (p = 0.02; p = 0.04) and memory (p = 0.04; p = 0.03). After adjusting for depression, the relationship between CI and higher extrinsic self-regulation scores remained significant. CONCLUSIONS BCS with CI appear to rely more on external sources of motivation to perform health behaviours, regardless of depression. Future studies and interventions to improve health behaviours should consider screening for CI and involving caregivers for those with CI to improve outcomes.
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Affiliation(s)
- Jacqueline H Becker
- Division of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Charlotte Ezratty
- Division of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Nusrat Jahan
- Medicine, Howard University College of Medicine, Washington, District of Columbia, USA
| | - Mita Goel
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Yael Tobi Harris
- Division of Endocrinology, Diabetes & Metabolism, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York, USA
| | - Jenny J Lin
- Division of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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127
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Dorland HF, Abma FI, Roelen CAM, Bültmann U, Amick BC. Validation of the Work Role Functioning Questionnaire 2.0 in cancer patients. Eur J Cancer Care (Engl) 2021; 30:e13420. [PMID: 33538368 PMCID: PMC8365733 DOI: 10.1111/ecc.13420] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 11/06/2020] [Accepted: 01/13/2021] [Indexed: 12/17/2022]
Abstract
Objective The Work Role Functioning Questionnaire 2.0 (WRFQ), measuring the percentage of time a worker has difficulties in meeting the work demands for a given health state, has shown strong reliability and validity in various populations with different chronic conditions. The present study aims to validate the WRFQ in working cancer patients. Methods A validation study of the WRFQ 2.0 was conducted, using baseline data from the longitudinal Work Life after Cancer study. Structural validity (Confirmatory Factor Analysis, CFA), internal consistency (Cronbach's alpha) and discriminant validity (hypothesis testing) were evaluated. Results 352 working cancer patients, most of them diagnosed with breast cancer (48%) and 58% in a job with mainly non‐manual tasks, showed a mean WRFQ score of 78.6 (SD = 17.1), which means that they had on average difficulties for 78.6% of the time they spent working. Good internal consistency (α = 0.96) and acceptable to good fit for both the four and five‐factor model (CFA) was found. The WRFQ distinguished between cancer patients reporting good vs. poor health (80.3 vs. 73.0, p = 0.001), low vs. high fatigue (82.0 vs. 72.2, p < 0.001), no vs. clinical depression (80.4 vs. 58.8, p < 0.001) and low vs. high cognitive symptoms (86.1 vs. 64.7, p < 0.001). Conclusions The WRFQ 2.0 is a reliable and valid instrument to measure work functioning in working cancer patients. Further psychometric research on responsiveness is needed to support its use in health practice.
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Affiliation(s)
- Heleen F Dorland
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Femke I Abma
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Corné A M Roelen
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ute Bültmann
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Benjamin C Amick
- Fay W Boozman College of Public Health, University of Arkansas Medical Sciences, Little Rock, Arkansas, USA
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128
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Dijkshoorn ABC, van Stralen HE, Sloots M, Schagen SB, Visser-Meily JMA, Schepers VPM. Prevalence of cognitive impairment and change in patients with breast cancer: A systematic review of longitudinal studies. Psychooncology 2021; 30:635-648. [PMID: 33533166 PMCID: PMC8248098 DOI: 10.1002/pon.5623] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 12/23/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Patients with breast cancer face cognitive impairment that affects their quality of life; partially attributable to treatment. Our aim was to detail the prevalence and change of cognitive impairment during the course of treatment. We also investigated the effect of therapy (chemotherapy [CT]) vs. radiotherapy and/or endocrine therapy vs. healthy controls). METHODS This article reviews longitudinal cohort studies published to date in Medline and Embase that (i) assess cognition before and after therapy, (ii) report prevalence cognitive impairment or change, and (iii) use standardized and valid neuropsychological tests. We used the original authors' criteria for cognitive impairment. RESULTS The title and abstract of 891 articles were screened, resulting in the identification of 90 potentially relevant articles while applying the eligibility criteria. After full-text examination, 17 studies were included. Prevalence of cognitive impairment range from 25% before therapy, through 24% after therapy to 21% at maximal 1-year follow-up (FU). Compared to their pretreatment cognitive functioning, 24% of patients decline after treatment and 24% at 1-year FU. Some studies also reported cognitive improvement showing that 15% and 31% of patients improve, respectively. In general, patients undergoing CT have a higher chance of cognitive impairment and decline than no-CT patients and healthy controls. CONCLUSIONS This study shows that one out of four breast cancer patients shows cognitive impairment prior to treatment administration CT and a significant number of patients decline during the course of disease, suggesting that cognitive impairment is not exclusively related to CT and/or no-CT therapies. This study shows that assessment of cognitive functioning, ideally over time, is crucial and may help the implementation of personalized rehabilitation pathways.
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Affiliation(s)
- Aicha B C Dijkshoorn
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Haike E van Stralen
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maurits Sloots
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sanne B Schagen
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Johanna M A Visser-Meily
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands.,Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Vera P M Schepers
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands.,Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
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129
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Relationship of perceived everyday cognitive function and work engagement in breast cancer survivors. Support Care Cancer 2021; 29:4303-4309. [PMID: 33415361 DOI: 10.1007/s00520-020-05950-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 12/15/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Breast cancer survivors (BCS) who represent approximately 3.5 million survivors in the USA frequently report ongoing cognitive dysfunction that may impact work outcomes. However, little is known about how perceived everyday cognitive function may affect work engagement (a measure of work efficacy and work well-being) in BCS who have completed treatment. OBJECTIVES The purpose of this study was to examine the relationship between perceived everyday cognitive function and work engagement in BCS. METHODS A convenience sample of 68 employed BCS seen at a Midwest NCI-Cancer Center who were at least 1-year post-treatment, completed a cross-sectional questionnaire assessing demographic and medical characteristics, and perceived everyday cognitive function (Everyday Cognition Scale) and work engagement (Utrecht Work Engagement Scale). Descriptive statistics, Pearson's r, and separate regression models controlling for age and education were used to analyze the data. RESULTS BCS who were on average 52 (SD = 8.6) years old, 5 (SD = 3.8) years post-treatment, and primarily employed full-time (79%) participated. A subset of BCS (12%) identified poorer everyday cognitive function after BC diagnosis and treatment. Everyday cognition, including subscales vigor and dedication, were correlated with work engagement (p˂0.01), controlling for age and education. CONCLUSIONS Findings indicate the important role of perceived everyday cognitive function in work engagement well into survivorship. Reducing cognitive dysfunction may be an important area for future intervention research to support BCS who return to work. IMPLICATIONS TO PRACTICE Healthcare providers need to assess and address perceived cognitive dysfunction to promote work-related outcomes in BCS well into survivorship.
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130
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van der Willik KD, Hauptmann M, Jóźwiak K, Vinke EJ, Ruiter R, Stricker BH, Compter A, Ikram MA, Schagen SB. Trajectories of Cognitive Function Prior to Cancer Diagnosis: A Population-Based Study. J Natl Cancer Inst 2021; 112:480-488. [PMID: 31498410 DOI: 10.1093/jnci/djz178] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 07/25/2019] [Accepted: 09/04/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND An emerging body of research suggests that noncentral nervous system cancer may negatively impact the brain apart from effects of cancer treatment. However, studies assessing cognitive function in newly diagnosed cancer patients cannot exclude selection bias and psychological effects of cancer diagnosis. To overcome these limitations, we investigated trajectories of cognitive function of patients before cancer diagnosis. METHODS Between 1989 and 2013, a total of 2059 participants from the population-based Rotterdam Study were diagnosed with noncentral nervous system cancer. Cognitive assessments were performed every 3 to 5 years using a neuropsychological battery. The general cognitive factor was composed of individual cognitive tests to assess global cognition. Using linear mixed models, we compared change in cognitive function of cancer case patients before diagnosis with cognitive change of age-matched cancer-free control subjects (1:2). In addition, we performed sensitivity analyses by discarding assessments of control subjects 5 years before the end of follow-up to exclude effects from potential undiagnosed cancer. All statistical tests were two-sided. RESULTS The Word Learning Test immediate recall declined faster among case patients than among control subjects (-0.05, 95% confidence interval = -0.09 to -0.01 vs 0.01, 95% confidence interval = -0.01 to 0.03; P for difference = .003). However, this difference was not statistically significant in sensitivity analyses. Furthermore, no statistically significant differences were observed in change of other individual cognitive tests and of the general cognitive factor. CONCLUSIONS In this study, we evaluated cognitive function in a large group of cancer patients prior to diagnosis, thereby excluding the psychological impact of cancer diagnosis and biased patient selection. In contrast to previous studies shortly after cancer diagnosis, we found no difference in change of cognitive function between cancer patients and control subjects.
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Affiliation(s)
- Kimberly D van der Willik
- Department of Psychosocial Research and Epidemiology.,Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Michael Hauptmann
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Katarzyna Jóźwiak
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Elisabeth J Vinke
- Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Rikje Ruiter
- Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Bruno H Stricker
- Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | - M Arfan Ikram
- Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Sanne B Schagen
- Brain and Cognition, Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
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Brain structure prior to non-central nervous system cancer diagnosis: A population-based cohort study. NEUROIMAGE-CLINICAL 2021; 28:102466. [PMID: 33395962 PMCID: PMC7578754 DOI: 10.1016/j.nicl.2020.102466] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/29/2020] [Accepted: 10/06/2020] [Indexed: 11/21/2022]
Abstract
In a population-based setting we studied brain structure before cancer diagnosis. Brain structure was not altered before non-CNS cancer diagnosis. The effect of cancer on the brain before clinical manifestation is not supported.
Purpose Many studies have shown that patients with non-central nervous system (CNS) cancer can have brain abnormalities, such as reduced gray matter volume and cerebral microbleeds. These abnormalities can sometimes be present even before start of treatment, suggesting a potential detrimental effect of non-CNS cancer itself on the brain. In these previous studies, psychological factors associated with a cancer diagnosis and selection bias may have influenced results. To overcome these limitations, we investigated brain structure with magnetic resonance imaging (MRI) prior to cancer diagnosis. Patients and methods Between 2005 and 2014, 4,622 participants from the prospective population-based Rotterdam Study who were free of cancer, dementia, and stroke, underwent brain MRI and were subsequently followed for incident cancer until January 1st, 2015. We investigated the association between brain MRI measurements, including cerebral small vessel disease, volumes of global brain tissue, lobes, and subcortical structures, and global white matter microstructure, and the risk of non-CNS cancer using Cox proportional hazards models. Age was used as time scale. Models were corrected for e.g. sex, intracranial volume, educational level, body mass index, hypertension, diabetes mellitus, smoking status, alcohol use, and depression sum-score. Results During a median (interquartile range) follow-up of 7.0 years (4.9–8.1), 353 participants were diagnosed with non-CNS cancer. Results indicated that persons who develop cancer do not have more brain abnormalities before clinical manifestation of the disease than persons who remain free of cancer. The largest effect estimates were found for the relation between presence of lacunar infarcts and the risk of cancer (hazard ratio [HR] 95% confidence interval [CI] = 1.39 [0.97–1.98]) and for total brain volume (HR [95%CI] per standard deviation increase in total brain volume = 0.76 [0.55–1.04]). Conclusion We did not observe associations between small vessel disease, brain tissue volumes, and global white matter microstructure, and subsequent cancer risk in an unselected population. These findings deviate from previous studies indicating brain abnormalities among patients shortly after cancer diagnosis.
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Bai L, Yu E. A narrative review of risk factors and interventions for cancer-related cognitive impairment. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:72. [PMID: 33553365 PMCID: PMC7859819 DOI: 10.21037/atm-20-6443] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Cancer-related cognitive impairment (CRCI) refers to a series of cognitive impairment symptoms associated with alternations in brain structure and function, caused by a non-central nervous system malignant tumor and its related treatment. CRCI may present as memory loss, impaired concentration, difficulty in multitasking and word retrieval, and reduced comprehension speed. CRCI has become one of the prevalent factors that compromise the quality of life for cancer survivors. Different treatments, including surgery, chemotherapy, radiotherapy, endocrine therapy, and targeted drugs, may contribute to CRCI. Meanwhile, patients’ factors, including emotional challenges and genetic makeup, also contribute to the development of CRCI. The condition can be treated with using stimulants methylphenidate and modafinil, metabolites of nicotine: cotinine, antidepressants of fluoxetine and fluvoxamine, dementia drug of donepezil, and antioxidants ZnSO4, n-acetyl cysteine, propofol, and Chinese herbal of silver leaf medicine. Psychotherapies, including meditation and relaxation, cognitive rehabilitation training, along with physical therapies, including aerobic exercise, resistance training, balance training, yoga, qigong, tai chi electroencephalogram biofeedback, and acupuncture, are also beneficial in alleviating cancer-related cognitive impairment symptoms. In recent years, researchers have focused on factors related to the condition and on the available interventions. However, most research was conducted independently, and no review has yet summarized the latest findings. This review details and discusses the status of related factors and potential treatments for CRCI. We also supply specific recommendations to facilitate future research and integration in this field.
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Affiliation(s)
- Lu Bai
- Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China.,Institute of Cancer and Basic Medicine, Chinese Academy of Sciences, Beijing, China
| | - Enyan Yu
- Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China.,Institute of Cancer and Basic Medicine, Chinese Academy of Sciences, Beijing, China
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John J, Kinra M, Mudgal J, Viswanatha GL, Nandakumar K. Animal models of chemotherapy-induced cognitive decline in preclinical drug development. Psychopharmacology (Berl) 2021; 238:3025-3053. [PMID: 34643772 PMCID: PMC8605973 DOI: 10.1007/s00213-021-05977-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 08/31/2021] [Indexed: 12/23/2022]
Abstract
RATIONALE Chemotherapy-induced cognitive impairment (CICI), chemobrain, and chemofog are the common terms for mental dysfunction in a cancer patient/survivor under the influence of chemotherapeutics. CICI is manifested as short/long term memory problems and delayed mental processing, which interferes with a person's day-to-day activities. Understanding CICI mechanisms help in developing therapeutic interventions that may alleviate the disease condition. Animal models facilitate critical evaluation to elucidate the underlying mechanisms and form an integral part of verifying different treatment hypotheses and strategies. OBJECTIVES A methodical evaluation of scientific literature is required to understand cognitive changes associated with the use of chemotherapeutic agents in different preclinical studies. This review mainly emphasizes animal models developed with various chemotherapeutic agents individually and in combination, with their proposed mechanisms contributing to the cognitive dysfunction. This review also points toward the analysis of chemobrain in healthy animals to understand the mechanism of interventions in absence of tumor and in tumor-bearing animals to mimic human cancer conditions to screen potential drug candidates against chemobrain. RESULTS Substantial memory deficit as a result of commonly used chemotherapeutic agents was evidenced in healthy and tumor-bearing animals. Spatial and episodic cognitive impairments, alterations in neurotrophins, oxidative and inflammatory markers, and changes in long-term potentiation were commonly observed changes in different animal models irrespective of the chemotherapeutic agent. CONCLUSION Dyscognition exists as one of the serious side effects of cancer chemotherapy. Due to differing mechanisms of chemotherapeutic agents with differing tendencies to alter behavioral and biochemical parameters, chemotherapy may present a significant risk in resulting memory impairments in healthy as well as tumor-bearing animals.
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Affiliation(s)
- Jeena John
- Department of Pharmacology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka India 576104
| | - Manas Kinra
- Department of Pharmacology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka India 576104
| | - Jayesh Mudgal
- Department of Pharmacology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka India 576104
| | - G. L. Viswanatha
- Independent Researcher, Kengeri, Bangalore, Karnataka India 560060
| | - K. Nandakumar
- Department of Pharmacology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka India 576104
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Chang A, Chung NC, Lawther AJ, Ziegler AI, Shackleford DM, Sloan EK, Walker AK. The Anti-Inflammatory Drug Aspirin Does Not Protect Against Chemotherapy-Induced Memory Impairment by Paclitaxel in Mice. Front Oncol 2020; 10:564965. [PMID: 33381448 PMCID: PMC7768078 DOI: 10.3389/fonc.2020.564965] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 11/11/2020] [Indexed: 11/22/2022] Open
Abstract
Inflammation has been proposed to play a causal role in chemobrain which—if true—would represent an opportunity to repurpose existing anti-inflammatory drugs for the prevention and treatment of chemobrain. Here, we show that the chemoagent paclitaxel induces memory impairment and anhedonia in mice within 24 h of treatment cessation, but inflammation is not present until 2 weeks after treatment. We find no evidence of brain inflammation as measured by cytokine analysis at any time point. Furthermore, treating with aspirin to block inflammation did not affect paclitaxel-induced memory impairment. These findings suggest that inflammation may not be responsible for memory impairment induced by paclitaxel. These results contrast with recent findings of a causal role for inflammation in cancer-induced memory deficits in mice that were prevented by treatment with oral aspirin, suggesting that cognitive impairment in cancer patients undergoing treatment may arise from multiple convergent mechanisms.
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Affiliation(s)
- Aeson Chang
- Drug Discovery Biology Theme, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia
| | - Ni-Chun Chung
- Drug Discovery Biology Theme, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia
| | - Adam J Lawther
- Laboratory of ImmunoPsychiatry, Neuroscience Research Australia, Randwick, NSW, Australia
| | - Alexandra I Ziegler
- Drug Discovery Biology Theme, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia
| | - David M Shackleford
- Centre for Drug Candidate Optimisation, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia
| | - Erica K Sloan
- Drug Discovery Biology Theme, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia.,Division of Cancer Surgery, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia
| | - Adam K Walker
- Drug Discovery Biology Theme, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia.,Laboratory of ImmunoPsychiatry, Neuroscience Research Australia, Randwick, NSW, Australia.,Division of Cancer Surgery, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia.,School of Psychiatry, University of New South Wales, Randwick, NSW, Australia
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Abstract
PURPOSE OF REVIEW This article reviews neurologic complications associated with chemotherapy, radiation therapy, antiangiogenic therapy, and immunotherapy. RECENT FINDINGS Cancer therapies can cause a wide range of neurologic adverse effects and may result in significant patient morbidity and mortality. Although some treatment-associated neurologic complications manifest acutely and are often reversible and transient, others occur with delayed onset, can be progressive, and are uniquely challenging to patient management. With an increase in multimodality and combination therapies, including targeted therapies and immunotherapies, and prolonged patient survival, novel and unique patterns of neurologic complications have emerged. SUMMARY Both conventional and novel cancer therapies can adversely affect the nervous system, thereby producing a wide range of neurologic complications. Increased awareness among neurologists and early recognition of cancer therapy-induced neurotoxic syndromes is critically important to minimize patient morbidity, prevent permanent injury, and improve patient outcomes.
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136
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Koppelmans V, van der Willik KD, Aleman BMP, van Leeuwen FE, Kavousi M, Arshi B, Vernooij MW, Ikram MA, Schagen SB. Long-term effects of adjuvant treatment for breast cancer on carotid plaques and brain perfusion. Breast Cancer Res Treat 2020; 186:167-176. [PMID: 33151443 PMCID: PMC7940271 DOI: 10.1007/s10549-020-05990-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 10/05/2020] [Indexed: 12/05/2022]
Abstract
Purpose Breast cancer treatment has been associated with vascular pathology. It is unclear if such treatment is also associated with long-term cerebrovascular changes. We studied the association between radiotherapy and chemotherapy with carotid pathology and brain perfusion in breast cancer survivors. Methods We included 173 breast cancer survivors exposed to radiotherapy and chemotherapy, assessed ± 21.2 years after cancer diagnosis, and 346 age-matched cancer-free women (1:2) selected from the population-based Rotterdam Study. Outcome measures were carotid plaque score, intima-media thickness (IMT), total cerebral blood flow (tCBF), and brain perfusion. Additionally, we investigated the association between inclusion of the carotid artery in the radiation field (no/small/large part), tumor location, and these outcome measures within cancer survivors. Results Cancer survivors had lower tCBF (− 19.6 ml/min, 95%CI − 37.3;− 1.9) and brain perfusion (− 2.5 ml/min per 100 ml, 95%CI − 4.3;− 0.7) than cancer-free women. No statistically significant group differences were observed regarding plaque score or IMT. Among cancer survivors, a large versus a small part of the carotid artery in the radiation field was associated with a higher IMT (0.05, 95%CI0.01;0.09). Also, survivors with a right-sided tumor had lower left carotid plaque score (− 0.31, 95%CI − 0.60;− 0.02) and higher brain perfusion (3.5 ml/min per 100 ml, 95%CI 0.7;6.2) than those with a left-sided tumor. Conclusions On average two decades post-diagnosis, breast cancer survivors had lower tCBF and brain perfusion than cancer-free women. Also, survivors with a larger area of the carotid artery within the radiation field had a larger IMT. Future studies should confirm if these cerebrovascular changes underlie the frequently observed cognitive problems in cancer survivors.
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Affiliation(s)
- Vincent Koppelmans
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Psychosocial Research & Epidemiology, Netherlands Cancer Institute/Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Department of Psychiatry, University of Utah, Salt Lake City, USA
| | - Kimberly D. van der Willik
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Psychosocial Research & Epidemiology, Netherlands Cancer Institute/Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Berthe M. P. Aleman
- Department of Radiation Oncology, Netherlands Cancer Institute/Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Flora E. van Leeuwen
- Department of Psychosocial Research & Epidemiology, Netherlands Cancer Institute/Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Banafsheh Arshi
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Meike W. Vernooij
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - M. Arfan Ikram
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Sanne B. Schagen
- Department of Psychosocial Research & Epidemiology, Netherlands Cancer Institute/Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Department of Psychology, Brain and Cognition, University of Amsterdam, Nieuwe Achtergracht 129-B, 1018 WS Amsterdam, The Netherlands
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Chapman B, Swainston J, Grunfeld EA, Derakshan N. COVID-19 Outbreak Effects on Job Security and Emotional Functioning Amongst Women Living With Breast Cancer. Front Psychol 2020; 11:582014. [PMID: 33192902 PMCID: PMC7658194 DOI: 10.3389/fpsyg.2020.582014] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 09/29/2020] [Indexed: 12/22/2022] Open
Abstract
The outbreak of Coronavirus disease 2019 (COVID-19) has negatively impacted global economies and employment. In the UK, it is predicted that approximately eight million jobs were furloughed as a result of the outbreak and the associated restriction of movement or shielding measures. This study aimed to investigate the impact of changes in employment status on cognitive and emotional health as well as perceptions of work. Furthermore, it examined the relationships between women's job security and anxiety, depression and cognitive function. Women living with breast cancer (N = 234) completed online questionnaires to measure their cognitive function, general emotional well-being, COVID-19 related emotional vulnerability (COVID-EMV), work ability and COVID-19 related perceptions of work. Our results revealed that threat to job security was predictive of depression and cognitive function in the entire sample Such that those with higher levels of perceived job security had lower depression and better cognitive function. Further, women who were furloughed or unable to continue work reported higher job insecurity compared to those who had worked throughout the pandemic. Greater rumination was also associated with worse anxiety and depression as well as poorer cognitive function. Finally, moderation analysis highlighted that women who had better cognitive functioning were less likely to experience anxiety when their job security was high. Given our findings, we suggest that employers provide women with accessible interventions to enhance cognitive and emotional resilience and thus help protect against the detrimental effects of job insecurity created by the COVID-19 outbreak.
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Affiliation(s)
- Bethany Chapman
- Department of Psychological Sciences, Birkbeck, University of London, London, United Kingdom
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Jia M, Zhang X, Wei L, Gao J. Measurement, outcomes and interventions of cognitive function after breast cancer treatment: A narrative review. Asia Pac J Clin Oncol 2020; 17:321-329. [PMID: 33079484 DOI: 10.1111/ajco.13484] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 09/19/2020] [Indexed: 11/29/2022]
Abstract
Cancer-related cognitive impairment (CRCI) is a common complaint in breast cancer patients, especially related to chemotherapy. It is characterized as cognitive disorders in areas of memory, attention and executive function, which can negatively affect patients' quality of life and their ability to work. While various assessment methods of CRCI cause highly diverse results in CRCI-related studies. Currently, it is not clear how cerebral structure and function change in breast cancer patients and underlying mechanisms of developing CRCI are still undefined. Intervention research is limited. This article reviews the results of CRCI-related studies and research progress and discusses the advantages and limits of various methods. Besides, the mechanisms and intervention strategies are reviewed.
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Affiliation(s)
- Miaomiao Jia
- Department of Breast Surgery, Shanxi Bethune Hospital, Taiyuan, Shanxi, China
| | - Xiaojun Zhang
- Department of Breast Surgery, Shanxi Bethune Hospital, Taiyuan, Shanxi, China
| | - Liyuan Wei
- Department of Breast Surgery, Shanxi Bethune Hospital, Taiyuan, Shanxi, China
| | - Jinnan Gao
- Department of Breast Surgery, Shanxi Bethune Hospital, Taiyuan, Shanxi, China
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Niu R, Du M, Ren J, Qing H, Wang X, Xu G, Lei D, Zhou P. Chemotherapy-induced grey matter abnormalities in cancer survivors: a voxel-wise neuroimaging meta-analysis. Brain Imaging Behav 2020; 15:2215-2227. [PMID: 33047236 DOI: 10.1007/s11682-020-00402-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 07/21/2020] [Accepted: 09/15/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Findings regarding chemotherapy-induced grey matter abnormalities are heterogeneous, and no meta-analysis has quantitatively assessed brain structural alterations in cancer survivors treated with chemotherapy. PURPOSE To investigate the grey matter abnormalities in non-CNS (central nervous system) cancer survivors treated with chemotherapy using Anisotropic Effect Size Signed Differential Mapping (AES-SDM) software. METHOD We identified studies published up to Sep 2018 that compared grey matter in non-CNS cancer survivors treated with chemotherapy (CT+, 10 data sets including 433 individuals) and cancer survivors not treated with chemotherapy (CT-, 7 data sets including 210 individuals) or healthy controls (HC, 3 data sets including 407 individuals) using whole-brain VBM. We used statistical maps from the studies included where available and reported peak coordinates otherwise. RESULTS Compared with both CT- and HC, the CT + groups exhibited a reduced grey matter volume (GMV), mainly in the prefrontal and anterior cingulate cortex (ACC) and right fusiform gyrus (FG). A smaller GMV in the FG and prefrontal cortex were found in the CT + compared with the CT-groups and in the CT + groups with impaired cognition. GMV in two areas was positively associated with the time since chemotherapy. CONCLUSIONS The present results suggest that non-CNS cancer survivors treated with chemotherapy exhibit grey matter abnormalities in the brain, especially in the prefrontal and ACC cortex. Grey matter volume changes after chemotherapy may contribute to cognitive impairments in cancer survivors that can be observed after chemotherapy.
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Affiliation(s)
- Running Niu
- Department of Radiology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Mingying Du
- Department of Radiology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jing Ren
- Department of Radiology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Haomiao Qing
- Department of Radiology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiaodong Wang
- Department of Radiology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Guohui Xu
- Department of Radiology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Du Lei
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, 260 Stetson St., Suite 3326, Cincinnati, OH, USA.
| | - Peng Zhou
- Department of Radiology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
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Mounier NM, Abdel-Maged AES, Wahdan SA, Gad AM, Azab SS. Chemotherapy-induced cognitive impairment (CICI): An overview of etiology and pathogenesis. Life Sci 2020. [DOI: https://doi.org/10.1016/j.lfs.2020.118071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Bellens A, Roelant E, Sabbe B, Peeters M, van Dam PA. A video-game based cognitive training for breast cancer survivors with cognitive impairment: A prospective randomized pilot trial. Breast 2020; 53:23-32. [PMID: 32554133 PMCID: PMC7375646 DOI: 10.1016/j.breast.2020.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/29/2020] [Accepted: 06/05/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION We investigated whether a web-based cognitive training video game is an effective approach to improve cognitive decline in combination with our standard of care for rehabilitation of breast cancer (BC) patients. MATERIALS AND METHODS Self-selected BC patients between 18 and 71 years old complaining of disturbing cognitive impairment were studied. The patients received access to a web-based internet video game and online cognitive assessments (Aquasnap, Cambridge, MyCQ™). The early intervention group (n = 23) had a training program of 6 months of at least three times a week for a minimum of 60 min of game playing per week at home in addition to standard of care rehabilitation. The delayed intervention (n = 23) received standard of care for three months, followed by three months of similar MyCQ training. Outcome measures were the MyCQ (sub)scores and Activity of Daily Life (ADL), mood, subjective cognition and functional cognitive status measured by classic neuropsychological tests. RESULTS At baseline the means for CFQ (a measure of self-reported cognitive failure), anxiety, PSQI and self-reflectiveness were beyond normal range in both groups. CFQ improved significantly better in the intervention group (p = 0.029). Combining the evolution over time in the entire population a significant improvement was seen for overall MyCQ score, level of fear, physical and emotional role limitation, and health change (all p < 0.05), but self-reflectivess deteriorated (p < 0.05)). Significant differences in the various MyCQ subtests over time were: improved speed in choice reaction time, visual memory recognition, N back 1 and 2, coding, trail making test B, improved accuracy of N back 1 and 2 (all p < 0.05). CONCLUSION A program of cognitive training improves cognitive functioning over time. "Aquasnap" has a beneficial effect on the perception of subjective cognitive functioning (CFQ) but the exact role of video gaming in this process remains uncertain.
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Affiliation(s)
- Anne Bellens
- Multidisciplinary Oncologic Center Antwerp (MOCA), Antwerp University Hospital, Edegem, B2650, Belgium; Centre for Oncological Research (CORE), University of Antwerp, Wilrijk, B2610, Belgium
| | - Ella Roelant
- Clinical Trial Center (CTC), CRC Antwerp, Antwerp University Hospital, University of Antwerp, Edegem, B2650, Belgium; StatUa, Center for Statistics, University of Antwerp, Antwerp, B2000, Belgium
| | - Bernard Sabbe
- Department of Psychiatry, Antwerp University, Wilrijk, Belgium
| | - Marc Peeters
- Multidisciplinary Oncologic Center Antwerp (MOCA), Antwerp University Hospital, Edegem, B2650, Belgium; Centre for Oncological Research (CORE), University of Antwerp, Wilrijk, B2610, Belgium
| | - Peter A van Dam
- Multidisciplinary Oncologic Center Antwerp (MOCA), Antwerp University Hospital, Edegem, B2650, Belgium; Centre for Oncological Research (CORE), University of Antwerp, Wilrijk, B2610, Belgium.
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Gates P, Gough K, Dhillon H, Wilson C, Hawkes E, Dore V, Perchyonok Y, Rowe CC, Walker AK, Vardy JL, de Ruiter M, Krishnasamy M. Longitudinal exploration of cancer-related cognitive impairment in patients with newly diagnosed aggressive lymphoma: protocol for a feasibility study. BMJ Open 2020; 10:e038312. [PMID: 32994248 PMCID: PMC7526311 DOI: 10.1136/bmjopen-2020-038312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/11/2020] [Accepted: 08/06/2020] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Cancer-related cognitive impairment (CRCI) is a distressing and disabling side-effect of cancer treatments affecting up to 75% of patients. For some patients, their cognitive impairment may be transient, but for a subgroup, these symptoms can be long-standing and have a major impact on the quality of life. This paper describes the protocol for a study: (1) to assess the feasibility of collecting longitudinal data on cognition via self-report, neuropsychological testing, peripheral markers of inflammation and neuroimaging and (2) to explore and describe patterns of cancer-related cognitive impairment over the course of treatment and recovery in patients with newly diagnosed, aggressive lymphoma undergoing standard therapy with curative intent. METHODS AND ANALYSIS This is a prospective, longitudinal, feasibility study in which 30 newly diagnosed, treatment-naive patients with aggressive lymphoma will be recruited over a 12-month period. Patients will complete comprehensive assessments at three time points: baseline (time 1, pre-treatment) and two post-baseline follow-up assessments (time 2, mid-treatment and time 3, 6-8 weeks post-treatment completion). All patients will be assessed for self-reported cognitive difficulties and objective cognitive function using Stroop Colour and Word, Trail Making Test Part A and B, Hopkins Verbal Learning Test-Revised, Controlled Oral Word Association and Digit Span. Blood cell-based inflammatory markers and neuroimaging including a positron emission tomography (PET) with 18F-labelled fluoro-2-deoxyglucose (18F-FDG) and CT (18F-FDG-PET/CT) and a MRI will explore potential inflammatory and neuroanatomical or functional mechanisms and biomarkers related to CRCI. The primary intent of analysis will be to assess the feasibility of collecting longitudinal data on cognition using subjective reports and objective tasks from patients during treatment and recovery for lymphoma. These data will inform the design of a larger-scale investigation into the patterns of cognitive change over the course of treatment and recovery, adding to an underexplored area of cancer survivorship research. ETHICS AND DISSEMINATION Ethical approval has been granted by Austin Health Human Rights Ethics Committee (HREC) in Victoria Australia. Peer reviewed publications and conference presentations will report the findings of this novel study. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ACTRN12619001649101).
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Affiliation(s)
- Priscilla Gates
- Department of Clinical Haematology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Melbourne, Victoria, Australia
- Department of Nursing, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Karla Gough
- Department of Nursing, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Cancer Experiences, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Haryana Dhillon
- Centre for Medical Psychology & Evidence-based Decision-making, School of Psychology, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
| | - Carlene Wilson
- Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Melbourne, Victoria, Australia
- School of Psychology and Public Health, LaTrobe University, Melbourne, Victoria, Australia
| | - Eliza Hawkes
- Department of Clinical Haematology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Melbourne, Victoria, Australia
- Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Vincent Dore
- Biomedical Imaging, Health & Biosecurity Flagship, The Australian e-Health Research Centre, CSIRO Health & Biosecurity, Melbourne, Victoria, Australia
- Department of Molecular Imaging and Therapy, Austin Health, Melbourne, Victoria, Australia
| | - Yuliya Perchyonok
- Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Radiology, Austin Health, Melbourne, Victoria, Australia
| | - Christopher C Rowe
- Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Molecular Imaging and Therapy, Austin Health, Melbourne, Victoria, Australia
| | - Adam K Walker
- Laboratory of ImmunoPsychiatry, Neuroscience Research Australia, Sydney, New South Wales, Australia
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Janette L Vardy
- Concord Cancer Centre, Concord Repatriation and General Hospital, Concord, New South Wales, Australia
- Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Michiel de Ruiter
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Meinir Krishnasamy
- Cancer Nursing Research Group, Department of Nursing/Centre for Cancer Research, School of Health Sciences/University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Academic Nursing Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Research and Education Nursing, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia
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The associations between late effects of cancer treatment, work ability and job resources: a systematic review. Int Arch Occup Environ Health 2020; 94:147-189. [PMID: 32929528 PMCID: PMC7873002 DOI: 10.1007/s00420-020-01567-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 08/25/2020] [Indexed: 01/11/2023]
Abstract
Objective The aim of this review is to evaluate associations between possible late effects of cancer treatment (i.e. physical complaints, fatigue, or cognitive complaints) and work ability among workers beyond 2 years after cancer diagnosis who returned to work. The role of job resources (social support, autonomy, leadership style, coaching, and organizational culture) is also evaluated. Methods The search for studies was conducted in PsycINFO, Medline, Business Source Premier, ABI/Inform, CINAHL, Cochrane Library and Web of Science. A quality assessment was used to clarify the quality across studies. Results The searches included 2303 records. Finally, 36 studies were included. Work ability seemed to decline shortly after cancer treatment and recover in the first 2 years after diagnosis, although it might still be lower than among healthy workers. No data were available on the course of work ability beyond the first 2 years. Late physical complaints, fatigue and cognitive complaints were negatively related with work ability across all relevant studies. Furthermore, social support and autonomy were associated with higher work ability, but no data were available on a possible buffering effect of these job resources on the relationship between late effects and work ability. As far as reported, most research was carried out among salaried workers. Conclusion It is unknown if late effects of cancer treatment diminish work ability beyond two years after being diagnosed with cancer. Therefore, more longitudinal research into the associations between possible late effects of cancer treatment and work ability needs to be carried out. Moreover, research is needed on the buffering effect of job resources, both for salaried and self-employed workers. Electronic supplementary material The online version of this article (10.1007/s00420-020-01567-w) contains supplementary material, which is available to authorized users.
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Schroyen G, Meylaers M, Deprez S, Blommaert J, Smeets A, Jacobs S, Sunaert S, Sleurs C, Uyttebroeck A. Prevalence of leukoencephalopathy and its potential cognitive sequelae in cancer patients. J Chemother 2020; 32:327-343. [PMID: 32799637 DOI: 10.1080/1120009x.2020.1805239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Due to the rising use of chemotherapy treatment in cancer patients and growing survival rates, therapy-induced neurotoxic side effects are increasingly reported. Given the ambiguity about the prevalence and severity of leukoencephalopathy, one of such toxic side effects, in non-central nervous system (CNS) cancer patients, we performed a systematic literature search using the PubMed/Medline database to summarize existing literature regarding leukoencephalopathy epidemiology in non-CNS cancer patients and its potential cognitive sequelae. The search was based on the following terms: ('MRI' OR 'T2-weighted MRI' OR 'FLAIR') AND ('cancer' OR 'tumour' OR 'leukaemia' OR 'neoplasms') AND ('chemotherapy' OR 'radiotherapy') AND ('posterior reversible encephalopathy' OR 'leukoencephalopathy' OR 'cerebral ischaemia' OR 'stroke'). Thirty-two studies discussing the occurrence of leukoencephalopathy in cancer patients were included, of which the majority investigated Acute Lymphoblastic Leukaemia (ALL) patients (n = 22).Regularly scanned ALL patients showed a prevalence of leukoencephalopathy between 17 - 87%, and 15 - 83% of patients presented with leukoencephalopathy when only scanned after a CNS event. When diagnosed with posterior reversible encephalopathy syndrome, 100% of patients showed leukoencephalopathy because its diagnosis is based in part on observable lesions. An increased prevalence was observed in ALL patients treated with higher doses of methotrexate (5 g/m2 MTX, 42 - 87%) when compared to lower doses (< 5 g/m2, 32 - 67%). By contrast, in breast cancer patients, white matter lesions were mainly detected in case of neurological symptoms, but not (yet) clearly associated with chemotherapy administration. However, chemotherapy treatment was associated with more infratentorial microbleeds in breast cancer patients . Up to 50% of other (neurologically asymptomatic) solid tumour patients presented white matter lesions, even years after treatment. When cognitive data were investigated, lesioned patients showed lower scores on neurocognitive tests in 50% of studies, years after ending therapy.In conclusion, leukoencephalopathy is well-documented for ALL patients (with a focus on methotrexate), but there is a lack of knowledge for other intravenous chemotherapeutics, other oncological populations, wider age ranges and possible risk factors (e.g. history of CNS event). Furthermore, the long-term neuropsychological impact and potential risk for neurodegenerative processes due to leukoencephalopathy remains inconclusive. Hence, large international databanks, epidemiological and prospective case-control studies are necessary to stratify risk groups for CNS-related side effects.
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Affiliation(s)
- Gwen Schroyen
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | | | - Sabine Deprez
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | | | - Ann Smeets
- Department of Oncology, KU Leuven, Leuven, Belgium.,Department of Surgical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Sandra Jacobs
- Department of Oncology, KU Leuven, Leuven, Belgium.,Department of Pediatric Hemato-Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Stefan Sunaert
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium.,Department of Radiology University Hospitals Leuven, Leuven, Belgium
| | - Charlotte Sleurs
- Department of Oncology, KU Leuven, Leuven, Belgium.,Department of Pediatric Hemato-Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Anne Uyttebroeck
- Department of Oncology, KU Leuven, Leuven, Belgium.,Department of Pediatric Hemato-Oncology, University Hospitals Leuven, Leuven, Belgium
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145
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Psychoneurological symptom cluster in breast cancer: the role of inflammation and diet. Breast Cancer Res Treat 2020; 184:1-9. [DOI: 10.1007/s10549-020-05808-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 07/15/2020] [Indexed: 12/20/2022]
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146
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Effects of Yoga-Based Interventions on Cancer-Associated Cognitive Decline: a Systematic Review. Curr Oncol Rep 2020; 22:100. [DOI: 10.1007/s11912-020-00960-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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147
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Subramaniam CB, Bowen JM, Gladman MA, Lustberg MB, Mayo SJ, Wardill HR. The microbiota-gut-brain axis: An emerging therapeutic target in chemotherapy-induced cognitive impairment. Neurosci Biobehav Rev 2020; 116:470-479. [PMID: 32681936 DOI: 10.1016/j.neubiorev.2020.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 05/05/2020] [Accepted: 07/06/2020] [Indexed: 12/16/2022]
Abstract
Chemotherapy-induced cognitive impairment (CICI) is an ill-defined complication of chemotherapy treatment that places a significant psychosocial burden on survivors of cancer and has a considerable impact on the activities of daily living. CICI pathophysiology has not been clearly defined, with candidate mechanisms relating to both the direct cytotoxicity of chemotherapy drugs on the central nervous system (CNS) and more global, indirect mechanisms such as neuroinflammation and blood brain barrier (BBB) damage. A growing body of research demonstrates that changes to the composition of the gastrointestinal microbiota is an initiating factor in numerous neurocognitive conditions, profoundly influencing both CNS immunity and BBB integrity. Importantly, chemotherapy causes significant disruption to the gastrointestinal microbiota. While microbial disruption is a well-established factor in the development of chemotherapy-induced gastrointestinal toxicities (largely diarrhoea), its role in CICI remains unknown, limiting microbial-based therapeutics or risk prediction strategies. Therefore, this review aims to synthesise and critically evaluate the evidence addressing the microbiota-gut-brain axis as a critical factor influencing the development of CICI.
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Affiliation(s)
- Courtney B Subramaniam
- Discipline of Physiology, Adelaide Medical School, University of Adelaide, SA, Australia.
| | - Joanne M Bowen
- Discipline of Physiology, Adelaide Medical School, University of Adelaide, SA, Australia
| | - Marc A Gladman
- Discipline of Anatomy & Pathology, Adelaide Medical School, University of Adelaide, SA Australia
| | - Maryam B Lustberg
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University Medical Center, Columbus, OH, USA
| | - Samantha J Mayo
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Hannah R Wardill
- Discipline of Physiology, Adelaide Medical School, University of Adelaide, SA, Australia; Department of Pediatric Oncology/Hematology, University of Groningen, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, the Netherlands
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148
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Jung MS, Visovatti MA, Sohn EH, Yoo HS, Kim M, Kim JR, Lee JS. Impact of changes in perceived attentional function on postsurgical health-related quality of life in breast cancer patients awaiting adjuvant treatment. Health Qual Life Outcomes 2020; 18:230. [PMID: 32664976 PMCID: PMC7362443 DOI: 10.1186/s12955-020-01485-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 07/08/2020] [Indexed: 12/03/2022] Open
Abstract
PURPOSE Few studies have assessed pre-surgery cognitive impairment or the impact of pre-surgery cognitive impairment on quality of life. The purpose of this study was to assess changes in perceived cognitive function from pre-surgery to 1 month post-surgery and to determine whether cognitive function predicted health-related quality of life in women who awaited adjuvant treatment for breast cancer. METHODS This study used a descriptive pre-post design to assess women newly diagnosed with breast cancer prior to any treatment (N = 132). Cognition was assessed using the Attentional Function Index (AFI) and health-related quality of life was assessed using the Functional Assessment of Cancer Therapy-General (FACT-G). Statistical methods included descriptive, comparative and regression analyses. Covariates assessed and controlled for in analyses included depressed mood, fatigue, disturbed sleep, surgery-related symptoms (lymphedema/decreased mobility), and cultural tendency. RESULTS Perceived attention and memory function decreased from pre-surgery to 1 month post-surgery alongside alterations in arm function and a decrease in depressed mood (p < 0.05). Regression analysis indicated that, after controlling for covariates, poorer perceived attention and memory function, surgery-specific symptoms, and a greater tendency toward collectivism predicted poorer quality of life. CONCLUSION Perceived function on tasks requiring attention and working memory 1 month post-surgery was poorer compared to pre-surgery suggesting that the mental and physical demands of a new diagnosis of breast cancer and surgery may effect cognitive function. Additionally, changes in perceived cognitive function significantly predicted perceived quality of life in women awaiting adjuvant treatment for breast cancer. Findings suggest that breast cancer patients are at risk for an early decline in cognitive function and that interventions aimed at supporting and optimizing function may improve quality of life early in the disease trajectory.
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Affiliation(s)
- Mi Sook Jung
- College of Nursing, Chungnam National University, 266 Minhwa-ro, Jung-gu, Daejeon, 35015 South Korea
| | - Moira A. Visovatti
- School of Nursing, University of Michigan, 400 N. Ingalls St, Ann Arbor, MI 48109 USA
| | - Eun Hee Sohn
- Department of Neurology, Chungnam National University Hospital, 33 Munwha-ro, Jung-gu, Daejoen, South Korea
| | - Hwa-Seung Yoo
- East-West Cancer Center, Daejeon University Korean Medicine Hospital, 176 Bun-gil, Daedeok-ro, Seo-gu, Daejeon, South Korea
| | - Mijung Kim
- College of Nursing, Chungnam National University, 266 Minhwa-ro, Jung-gu, Daejeon, 35015 South Korea
| | - Je Ryong Kim
- Department of Surgery and Research Institute for Medicinal Sciences, College of Medicine, Chungnam National University, 33 Munwha-ro, Jung-gu, Daejoen, South Korea
| | - Jin Sun Lee
- Department of Surgery and Research Institute for Medicinal Sciences, College of Medicine, Chungnam National University, 33 Munwha-ro, Jung-gu, Daejoen, South Korea
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149
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Salerno EA, Rowland K, Hillman CH, Trinh L, Kramer AF, McAuley E. Dose-Response Effects of Acute Aerobic Exercise Duration on Cognitive Function in Patients With Breast Cancer: A Randomized Crossover Trial. Front Psychol 2020; 11:1500. [PMID: 32760319 PMCID: PMC7371984 DOI: 10.3389/fpsyg.2020.01500] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/05/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To examine the differential effects of acute exercise duration on domains of executive function and processing speed in patients with breast cancer. METHODS Participants (N = 48, M age = 56.02 ± 10.99) completed two sessions in counterbalanced order: moderate-intensity treadmill walking and sitting. Participants were also randomized to one of three duration conditions: 10 (n = 15), 20 (n = 16), or 30 (n = 17) min, reflecting the length of time spent walking and sitting. Immediately before and after each session, women completed a battery of cognitive tasks (e.g., inhibition, cognitive flexibility, spatial working memory, and processing speed). RESULTS Within- and between-subjects repeated-measures analyses of variance revealed time by condition interactions on both processing speed (p = 0.02) and spatial working memory (ps < 0.07), such that women demonstrated improved cognitive functioning regardless of the time spent walking. There were also several moderately sized three-way (e.g., time by condition by duration) interactions driven by declines in cognitive functioning after sitting on cognitive flexibility in the 10 (d = -0.96) and 30-min (d = -0.52) groups and inhibition in the 20-min group (d = 0.75). On the processing speed task, women performed significantly faster after walking compared with after sitting in the 20-min group (d = -0.24). CONCLUSIONS For select cognitive domains, walking anywhere from 10 to 30 min is associated with significant benefits. Our findings suggest the need for further research into the mechanisms and dose-response relationships between acute exercise and cognition as well as how such acute bouts may be accumulated for larger, lasting cognitive benefits after breast cancer. CLINICAL TRIAL REGISTRATION www.ClinicalTrials.gov, identifier NCT04255225.
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Affiliation(s)
- Elizabeth A. Salerno
- Cancer Prevention Fellowship Program, Division of Cancer Epidemiology & Genetics, Metabolic Epidemiology Branch, National Cancer Institute, Bethesda, MD, United States
- Department of Kinesiology & Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, United States
| | | | | | - Linda Trinh
- Department of Kinesiology & Physical Education, University of Toronto, Toronto, ON, Canada
| | - Arthur F. Kramer
- College of Science, Northeastern University, Boston, MA, United States
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Champaign, IL, United States
| | - Edward McAuley
- Department of Kinesiology & Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, United States
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Champaign, IL, United States
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150
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Chemotherapy-induced cognitive impairment (CICI): An overview of etiology and pathogenesis. Life Sci 2020; 258:118071. [PMID: 32673664 DOI: 10.1016/j.lfs.2020.118071] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/26/2020] [Accepted: 07/06/2020] [Indexed: 02/08/2023]
Abstract
Many cancer patients treated with chemotherapy develop chemotherapy-induced cognitive impairment (CICI), often referred to as chemo-brain, which manifest during or post-treatment with variable degrees, onset and duration thereby affecting the patients' quality of life. Several chemotherapeutic agents have been studied to determine its possible association with cognitive impairment and to fully comprehend their contribution to CICI. A vast number of studies have emerged proposing several candidate underlying mechanisms and etiologies contributing to CICI such as direct neurotoxicity, BBB disruption, decreased hippocampal neurogenesis, white matter abnormalities, secondary neuro-inflammatory response and increased oxidative stress; however, the exact underlying mechanisms are still not well defined. This review summarizes CICI associated with most commonly used chemotherapeutic agents with emphasizes the possible underlying pathogenesis in both animal and clinical studies.
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