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Chapman B, Helmrath S, Derakshan N. Perceived cognitive functioning and its influence on emotional vulnerability in breast cancer. Health Psychol Open 2019; 6:2055102919871661. [PMID: 31489203 PMCID: PMC6710691 DOI: 10.1177/2055102919871661] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
We investigated the relationship between perceived cognitive function and emotional vulnerability of breast cancer survivors while examining the moderating effect of various risk factors. Results confirmed that perceived cognitive function predicted emotional vulnerability with grade of breast cancer moderating this relationship. Age at diagnosis exhibited a trend towards significance for emotional vulnerability, and time since diagnosis as well as grade significantly predicted quality of life. Our findings imply that (younger) women with a higher breast cancer grade are at a greater risk for emotional and cognitive vulnerability and can benefit from interventions designed to reduce emotional vulnerability through training cognitive efficiency.
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252
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Cohen RA, Gullett JM, Woods AJ, Porges EC, Starkweather A, Jackson-Cook CK, Lynch-Kelly DL, Lyon DE. Cytokine-associated fatigue prior to, during, and post-chemotherapy for breast cancer. J Neuroimmunol 2019; 334:577001. [PMID: 31260949 DOI: 10.1016/j.jneuroim.2019.577001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/20/2019] [Accepted: 06/21/2019] [Indexed: 02/06/2023]
Affiliation(s)
- R A Cohen
- Center for Cognitive Aging and Memory, Department of Clinical & Health Psychology, University of Florida, 1225 Center Drive, PO Box 100165, Gainesville, FL 32605-0165, USA.
| | - J M Gullett
- Center for Cognitive Aging and Memory, Department of Clinical & Health Psychology, University of Florida, 1225 Center Drive, PO Box 100165, Gainesville, FL 32605-0165, USA.
| | - A J Woods
- Center for Cognitive Aging and Memory, Department of Clinical & Health Psychology, University of Florida, 1225 Center Drive, PO Box 100165, Gainesville, FL 32605-0165, USA.
| | - E C Porges
- Center for Cognitive Aging and Memory, Department of Clinical & Health Psychology, University of Florida, 1225 Center Drive, PO Box 100165, Gainesville, FL 32605-0165, USA.
| | - A Starkweather
- Center for Advancement in Managing Pain, University of Connecticut, School of Nursing, United States.
| | - C K Jackson-Cook
- Cytogenetic Diagnostics Laboratory, Virginia Commonwealth University, Colleen, United States.
| | - D L Lynch-Kelly
- College of Nursing, University of Florida, 1225 Center Drive, PO Box 100197, Gainesville, FL 32610-0197, USA
| | - D E Lyon
- College of Nursing, University of Florida, 1225 Center Drive, PO Box 100197, Gainesville, FL 32610-0197, USA.
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Witlox L, Schagen SB, de Ruiter MB, Geerlings MI, Peeters PHM, Koevoets EW, van der Wall E, Stuiver M, Sonke G, Velthuis MJ, Palen JAMVD, Jobsen JJ, May AM, Monninkhof EM. Effect of physical exercise on cognitive function and brain measures after chemotherapy in patients with breast cancer (PAM study): protocol of a randomised controlled trial. BMJ Open 2019; 9:e028117. [PMID: 31227537 PMCID: PMC6597001 DOI: 10.1136/bmjopen-2018-028117] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION After treatment with chemotherapy, many patients with breast cancer experience cognitive problems. While limited interventions are available to improve cognitive functioning, physical exercise showed positive effects in healthy older adults and people with mild cognitive impairment. The Physical Activity and Memory study aims to investigate the effect of physical exercise on cognitive functioning and brain measures in chemotherapy-exposed patients with breast cancer with cognitive problems. METHODS AND ANALYTICS One hundred and eighty patients with breast cancer with cognitive problems 2-4 years after diagnosis are randomised (1:1) into an exercise intervention or a control group. The 6-month exercise intervention consists of twice a week 1-hour aerobic and strength exercises supervised by a physiotherapist and twice a week 1-hour Nordic or power walking. The control group is asked to maintain their habitual activity pattern during 6 months. The primary outcome (verbal learning) is measured at baseline and 6 months. Further measurements include online neuropsychological tests, self-reported cognitive complaints, a 3-tesla brain MRI, patient-reported outcomes (quality of life, fatigue, depression, anxiety, work performance), blood sampling and physical fitness. The MRI scans and blood sampling will be used to gain insight into underlying mechanisms. At 18 months online neuropsychological tests, self-reported cognitive complaints and patient-reported outcomes will be repeated. ETHICS AND DISSEMINATION Study results may impact usual care if physical exercise improves cognitive functioning for breast cancer survivors. TRIAL REGISTRATION NUMBER NTR6104.
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Affiliation(s)
- Lenja Witlox
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sanne B Schagen
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Michiel B de Ruiter
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Mirjam I Geerlings
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Petra H M Peeters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Emmie W Koevoets
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Elsken van der Wall
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martijn Stuiver
- Center for Quality of Life, Netherlands Cancer Institute, Amsterdam, The Netherlands
- ACHIEVE Center of Applied Research, Faculty of Health, University of Applied Sciences, Amsterdam, The Netherlands
| | - Gabe Sonke
- Center for Quality of Life, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Miranda J Velthuis
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Job A M van der Palen
- Medical School Twente, Medisch Spectrum Twente, Enschede, The Netherlands
- Department of Research Methodology, Measurement, Universiteit Twente, Enschede, The Netherlands
| | - Jan J Jobsen
- Medical School Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Anne M May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - E M Monninkhof
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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254
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Alhowail AH, Bloemer J, Majrashi M, Pinky PD, Bhattacharya S, Yongli Z, Bhattacharya D, Eggert M, Woodie L, Buabeid MA, Johnson N, Broadwater A, Smith B, Dhanasekaran M, Arnold RD, Suppiramaniam V. Doxorubicin-induced neurotoxicity is associated with acute alterations in synaptic plasticity, apoptosis, and lipid peroxidation. Toxicol Mech Methods 2019; 29:457-466. [PMID: 31010378 DOI: 10.1080/15376516.2019.1600086] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Cognitive deficits are commonly reported by patients following treatment with chemotherapeutic agents. Anthracycline-containing chemotherapy regimens are associated with cognitive impairment and reductions in neuronal connectivity in cancer survivors, and doxorubicin (Dox) is a commonly used anthracycline. Although it has been reported that Dox distribution to the central nervous system (CNS) is limited, considerable Dox concentrations are observed in the brain with co-administration of certain medications. Additionally, pro-inflammatory cytokines, which are overproduced in cancer or in response to chemotherapy, can reduce the integrity of the blood-brain barrier (BBB). Therefore, the aim of this study was to evaluate the acute neurotoxic effects of Dox on hippocampal neurons. In this study, we utilized a hippocampal cell line (H19-7/IGF-IR) along with rodent hippocampal slices to evaluate the acute neurotoxic effects of Dox. Hippocampal slices were used to measure long-term potentiation (LTP), and expression of proteins was determined by immunoblotting. Cellular assays for mitochondrial complex activity and lipid peroxidation were also utilized. We observed reduction in LTP in hippocampal slices with Dox. In addition, lipid peroxidation was increased as measured by thiobarbituric acid reactive substances content indicating oxidative stress. Caspase-3 expression was increased indicating an increased propensity for cell death. Finally, the phosphorylation of signaling molecules which modulate LTP including extracellular signal-regulated kinase 1/2 (ERK1/2), p38 mitogen-activated protein kinase, and Akt were increased. This data indicates that acute Dox exposure dose-dependently impairs synaptic processes associated with hippocampal neurotransmission, induces apoptosis, and increases lipid peroxidation leading to neurotoxicity.
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Affiliation(s)
- Ahmad H Alhowail
- a Department of Drug Discovery and Development , Auburn University , Auburn , AL , USA
| | - Jenna Bloemer
- a Department of Drug Discovery and Development , Auburn University , Auburn , AL , USA
| | - Mohammed Majrashi
- a Department of Drug Discovery and Development , Auburn University , Auburn , AL , USA
| | - Priyanka D Pinky
- a Department of Drug Discovery and Development , Auburn University , Auburn , AL , USA
| | | | - Zhang Yongli
- a Department of Drug Discovery and Development , Auburn University , Auburn , AL , USA.,b Tianjin Huanhu Hospital , Tianjin , PR China
| | - Dwipayan Bhattacharya
- a Department of Drug Discovery and Development , Auburn University , Auburn , AL , USA
| | - Matthew Eggert
- a Department of Drug Discovery and Development , Auburn University , Auburn , AL , USA
| | - Lauren Woodie
- c Department of Nutrition, Dietetics and Hospitality Management , College of Human Sciences, Auburn University , Auburn , AL , USA
| | - Manal A Buabeid
- d College of Pharmacy and Health Sciences , Ajman University , Ajman , UAE
| | - Nathaniel Johnson
- a Department of Drug Discovery and Development , Auburn University , Auburn , AL , USA
| | - Alyssa Broadwater
- a Department of Drug Discovery and Development , Auburn University , Auburn , AL , USA
| | - Bruce Smith
- e Department of Anatomy, Physiology and Pharmacology , College of Veterinary Medicine, Auburn University , Auburn , AL , USA
| | | | - Robert D Arnold
- a Department of Drug Discovery and Development , Auburn University , Auburn , AL , USA
| | - Vishnu Suppiramaniam
- a Department of Drug Discovery and Development , Auburn University , Auburn , AL , USA
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255
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Ospina-Romero M, Abdiwahab E, Kobayashi L, Filshtein T, Brenowitz WD, Mayeda ER, Glymour MM. Rate of Memory Change Before and After Cancer Diagnosis. JAMA Netw Open 2019; 2:e196160. [PMID: 31225893 PMCID: PMC6593639 DOI: 10.1001/jamanetworkopen.2019.6160] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
IMPORTANCE Patients with a history of cancer, even nonfatal cancers, have lower subsequent Alzheimer disease incidence. An inverse biological link between carcinogenesis and neurodegeneration has been hypothesized, although survival and detection biases are possible explanations. OBJECTIVE To compare long-term memory trajectories before and after incident cancer with memory trajectories of similarly aged individuals not diagnosed with cancer. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study included 14 583 US adults born before 1949 with no cancer history from the Health and Retirement Study. Biennial assessments were performed for up to 16 years from 1998 to 2014. Data analysis was performed from January 8 to October 5, 2018. EXPOSURES Self-reported physician diagnosis of any cancer (excluding nonmelanoma skin cancer) during follow-up. MAIN OUTCOMES AND MEASURES A composite memory score standardized to a mean (SD) of 0 (1) at baseline was based on immediate and delayed word-list recall and proxy assessments. The rate of memory change among people diagnosed with cancer during follow-up before and after diagnosis was compared with rate of memory change in individuals who remained cancer free during follow-up using linear mixed-effect models with random intercepts and slopes. RESULTS A total of 14 583 participants were included in the sample (mean [SD] age, 66.4 [10.4] years; 8453 [58.0%] female). The mean (SD) follow-up was 11.5 (5.1) years; 2250 had a cancer diagnosis during follow-up, and 12 333 had no cancer diagnosis during follow-up. The rate of memory decline in the decade before a cancer diagnosis was 10.5% (95% CI, 6.2%-14.9%), which was slower than memory decline in similarly aged cancer-free individuals. For individuals diagnosed at 75 years of age, mean memory function immediately before diagnosis was 0.096 SD units (95% CI, 0.060-0.133 SD units) higher compared with that among similarly aged cancer-free individuals. A new cancer diagnosis was associated with a short-term decline in memory of -0.058 (95% CI, -0.084 to -0.032) SD units compared with memory before diagnosis. After diagnosis, the rate of memory decline was 3.9% (95% CI, 0.9%-6.9%) slower in individuals with cancer than in those without a cancer diagnosis. CONCLUSIONS AND RELEVANCE In this study, older individuals who developed cancer had better memory and slower memory decline than did similarly aged individuals who remained cancer free. These findings support the possibility of a common pathologic process working in opposite directions in cancer and Alzheimer disease.
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Affiliation(s)
- Monica Ospina-Romero
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Ekland Abdiwahab
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Lindsay Kobayashi
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Teresa Filshtein
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Willa D Brenowitz
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Elizabeth R Mayeda
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles
| | - M Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco
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Abstract
Breast cancer-related cognitive impairment (CRCI), a frequent concomitant of cancer diagnosis and management, has been difficult to measure objectively. This study longitudinally investigated cognitive function in an individual before and after breast cancer diagnosis and treatment. Comparison of test scores pre- and post- diagnosis/treatment revealed declines in multiple cognitive domains, including Performance IQ, processing speed, immediate auditory and visual memory, and delayed visual memory. Twelve years later, improvements were noted in domains of processing speed, memory and executive functioning. The results highlight the importance of heeding individuals' subjective reports of cognitive decline, and offer hope that such decrements may not be permanent.
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Affiliation(s)
- Barbara Fischer
- a Clement J. Zablocki VA Medical Center , Milo C. Huempfner VA Health Care Center , Green Bay , WI , USA
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257
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Stewart RL, Updike KL, Factor RE, Henry NL, Boucher KM, Bernard PS, Varley KE. A Multigene Assay Determines Risk of Recurrence in Patients with Triple-Negative Breast Cancer. Cancer Res 2019; 79:3466-3478. [PMID: 31048497 DOI: 10.1158/0008-5472.can-18-3014] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 02/21/2019] [Accepted: 04/29/2019] [Indexed: 12/31/2022]
Abstract
Approximately 40% of patients with stage I-III triple-negative breast cancer (TNBC) recur after standard treatment, whereas the remaining 60% experience long-term disease-free survival (DFS). There are currently no clinical tests to assess the risk of recurrence in TNBC patients. We previously determined that TNBC patients with MHC class II (MHCII) pathway expression in their tumors experienced significantly longer DFS. To translate this discovery into a clinical test, we developed an MHCII Immune Activation assay, which measures expression of 36 genes using NanoString technology. Preanalytical testing confirmed that the assay is accurate and reproducible in formalin-fixed paraffin-embedded (FFPE) tumor specimens. The assay measurements were concordant with RNA-seq, MHCII protein expression, and tumor-infiltrating lymphocyte counts. In a training set of 44 primary TNBC tumors, the MHCII Immune Activation Score was significantly associated with longer DFS (HR = 0.17; P = 0.015). In an independent validation cohort of 56 primary FFPE TNBC tumors, the Immune Activation Score was significantly associated with longer DFS (HR = 0.19; P = 0.011) independent of clinical stage. An Immune Activation Score threshold for identifying patients with very low risk of relapse in the training set provided 100% specificity in the validation cohort. The assay format enables adoption as a standardized clinical prognostic test for identifying TNBC patients with a low risk of recurrence. Correlative data support future studies to determine if the assay can identify patients in whom chemotherapy can be safely deescalated and patients likely to respond to immunotherapy. SIGNIFICANCE: The MHCII Immune Activation assay identifies TNBC patients with a low risk of recurrence, addressing a critical need for prognostic biomarker tests that enable precision medicine for TNBC patients.
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Affiliation(s)
- Rachel L Stewart
- Department of Pathology and Laboratory Medicine and the Markey Cancer Center, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Katherine L Updike
- Department of Oncological Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Rachel E Factor
- Department of Pathology, University of Utah/Huntsman Cancer Institute, Salt Lake City, Utah
| | - N Lynn Henry
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Kenneth M Boucher
- Study Design and Biostatistics Center, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Philip S Bernard
- Department of Pathology, University of Utah/Huntsman Cancer Institute, Salt Lake City, Utah
| | - Katherine E Varley
- Department of Oncological Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah.
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258
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Buskbjerg CDR, Amidi A, Demontis D, Nissen ER, Zachariae R. Genetic risk factors for cancer-related cognitive impairment: a systematic review. Acta Oncol 2019; 58:537-547. [PMID: 30822178 DOI: 10.1080/0284186x.2019.1578410] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background: Cancer-related cognitive impairment (CRCI) is a commonly reported complaint among non-CNS cancer patients. Even subtle CRCI may have detrimental effects on quality of life and identifying patients at increased risk for CRCI to improve survivorship care is important. In the present paper, we systematically reviewed available studies of possible genetic risk factors for developing CRCI. Methods: Keyword-based systematic searches were undertaken on 24 July 2018 in PubMed, Web of Science, The Cochrane Library, and CINAHL. Three authors independently evaluated full-texts of identified papers and excluded studies with registration of reasons. Seventeen studies reporting results from 14 independent samples were included for review. Two authors independently quality assessed the included studies. The review was preregistered with PROSPERO (CRD42018107689). Results: Ten studies investigated apolipoprotein E (APOE), with four studies reporting that carrying at least one risk allele (APOE4 (ε4)) was associated with CRCI, while six studies found no association. The remaining identified genetic risk variants associated with CRCI located in: COMT, four DNA repair genes, five oxidative stress genes, 22 genes related to breast cancer phenotype, and GNB3. No associations were found between CRCI and genes coding for interleukin-6 (IL6), tumor necrosis factor alpha (TNF), interleukin 1 beta (IL1B), and brain-derived neurotropic factor (BDNF). With the exception of APOE, the genetic risk factors had only been investigated in one or two studies each. Conclusions: Overall, the available evidence of possible genetic risk factors for CRCI is limited. While some research suggests a role for the ε4 allele, the literature is generally inconsistent, and the currently available evidence does not allow clear-cut conclusions regarding the role of genetic factors in the development of CRCI. Larger genetic studies and studies investigating additional genetic variants are needed to uncover genetic risk factors for CRCI.
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Affiliation(s)
- Cecilie D. R. Buskbjerg
- Unit for Psychooncology and Health Psychology, Department of Oncology, Aarhus University Hospital, and Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Ali Amidi
- Unit for Psychooncology and Health Psychology, Department of Oncology, Aarhus University Hospital, and Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Ditte Demontis
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Copenhagen, Denmark
- Department of Biomedicine – Human Genetics, Aarhus University, Aarhus, Denmark
| | - Eva R. Nissen
- Unit for Psychooncology and Health Psychology, Department of Oncology, Aarhus University Hospital, and Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Robert Zachariae
- Unit for Psychooncology and Health Psychology, Department of Oncology, Aarhus University Hospital, and Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
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Seo EJ, Klauck SM, Efferth T, Panossian A. Adaptogens in chemobrain (Part II): Effect of plant extracts on chemotherapy-induced cytotoxicity in neuroglia cells. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2019; 58:152743. [PMID: 30901664 DOI: 10.1016/j.phymed.2018.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 11/02/2018] [Accepted: 11/05/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Cancer chemotherapy-induced cognitive impairments are apparently associated with harmful effects on physiological functions of brain cells. Adaptogens, are known to exhibit neuroprotective effects and to increase cognitive functions in clinical studies. In our previous study (Seo et al., 2018), we demonstrated that selected adaptogenic extracts significantly attenuate cytostatic-induced regulation of more than 100 genes involved in the activation of neuronal death and inhibiting neurogenesis. Neuroprotective and cytoprotective activities of adaptogens rise the question about their possible impact on cytostatic effects of a chemotherapeutic combination of 5-fluorouracil, epirubicin and cyclophosphamide (FEC). AIM The aim of this study was to assess the effects of selected adaptogenic herbal extracts, namely of andrographolide (AND), Herba Andrographidis (AP), Radix Eleutherococci (ES) genuine extracts, their fixed combination (AE), and the combination of three adaptogenic herbs, Rhodiola Radix, Shisandra Fructus and Eleutherococci Radix (RSE) on the cytotoxicity of a fixed combination of 5-fluorouracil, epirubicin and cyclophosphamide (FEC) on neuroglia cells. METHODS Cytotoxicity of FEC, adaptogenic extracts and their combination with FEC was tested on isolated T98G cells in a wide range of concentrations of all tested compounds. RESULTS FEC reproducibly inhibited the proliferation of T98G cells by 50% at concentrations of 5 × 10-1 µg/ml epirubicin, 500 × 10-1 µg/ml 5-fluorouracil and 20 × 10-1 µg/ml 4-hydroperoxycyclophosphamide after 24 h incubation of cells. These concentrations were subsequently used for experiments with adaptogenic extracts. The cytotoxic activity of FEC was not significantly changed in the presence of AND, ES and AE. Furthermore, it was potentiated by AP extract and RSE in concentrations of 0.06-6 µg/ml and 17.6-26.4 µg/ml. CONCLUSION The neuroprotective effect of adaptogens did not attenuate the cytotoxic activity of FEC. Application of cytostatic drugs in combination with adaptogenic plant extracts likely have no impact in cytotoxic effect of FEC. Furthermore, AP and RSE potentiated the cytotoxic effects of FEC.
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Affiliation(s)
- Ean-Jeong Seo
- Department of Pharmaceutical Biology, Institute of Pharmacy and Biochemistry, Johannes Gutenberg University, Mainz, Germany
| | - Sabine M Klauck
- Division of Cancer Genome Research, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 460, 69120 Heidelberg, Germany
| | - Thomas Efferth
- Department of Pharmaceutical Biology, Institute of Pharmacy and Biochemistry, Johannes Gutenberg University, Mainz, Germany.
| | - Alexander Panossian
- Phytomed AB, Vaxtorp, Halland, Sweden; EuroPharma USA Inc., 955 Challenger Dr., Green Bay, WI 54311, USA.
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260
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Salerno EA, Rowland K, Kramer AF, McAuley E. Acute aerobic exercise effects on cognitive function in breast cancer survivors: a randomized crossover trial. BMC Cancer 2019; 19:371. [PMID: 31014267 PMCID: PMC6480426 DOI: 10.1186/s12885-019-5589-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 04/09/2019] [Indexed: 11/10/2022] Open
Abstract
Background Many breast cancer survivors (BCS) report deficits in cognitive function. Physical activity (PA) has been associated with better processing speed and memory in healthy adults and thus may be a useful method for improving cognition in BCS. The purpose of this study was to examine the effects of an acute bout of PA on processing speed and spatial working memory in a sample of BCS. Methods Using a repeated measures, crossover design, BCS [N = 27; Mage (SD) = 49.11(8.05)] completed two sessions in counterbalanced order: 30 min of moderate-intensity treadmill walking and 30 min of seated rest. Women completed cognitive tasks immediately before and after each session. Results Within-subjects repeated measures analyses of variance revealed a significant time by session effect for processing speed reaction time [F (1,25) = 5.02, p = .03, η2 = 0.17]. This interaction was driven by significantly reduced reaction time (e.g., faster response) post-exercise and no change post-rest. Further between-subjects analyses indicated a significant time by session by moderate to vigorous physical activity (MVPA) split [F (1,25) = 5.23, p = .03, η2 = 0.17], such that women who engaged in ≥45 min of average daily MVPA reduced their reaction time post-exercise (p = .01) and increased RT post-rest (p = .06). Time by session effects for spatial working memory 3-item accuracy and 4-item reaction time trended towards significance, p = 0.08 and p = 0.10, respectively, again driven by better performance post-exercise. Conclusions The moderate effect of acute exercise on domains of memory and processing speed in BCS is encouraging. Cancer-related cognitive impairment remains largely misunderstood; however, the results from the present study offer preliminary evidence for the positive relationship between acute exercise and cognition in BCS. Trial registration ClinicalTrials.gov NCT02592070. Registered 30 October 2015. Retroactively registered.
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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, 20892, USA. .,University of Illinois at Urbana-Champaign, Champaign, USA.
| | | | - Arthur F Kramer
- University of Illinois at Urbana-Champaign, Champaign, USA.,Northeastern University, Boston, USA
| | - Edward McAuley
- University of Illinois at Urbana-Champaign, Champaign, USA
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261
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Ahles TA, Hurria A. New Challenges in Psycho-Oncology Research IV: Cognition and cancer: Conceptual and methodological issues and future directions. Psychooncology 2019; 27:3-9. [PMID: 29044730 DOI: 10.1002/pon.4564] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 09/29/2017] [Indexed: 01/17/2023]
Affiliation(s)
- Tim A Ahles
- Department of Psychiatry and Behavioral Sciences, Neurocognitive Research Laboratory, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Arti Hurria
- Center for Cancer and Aging, George Tsai Family Chair in Geriatric Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
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262
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Chemotherapy and cognition: comprehensive review on doxorubicin-induced chemobrain. Cancer Chemother Pharmacol 2019; 84:1-14. [PMID: 30955080 DOI: 10.1007/s00280-019-03827-0] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 03/25/2019] [Indexed: 01/11/2023]
Abstract
Chemobrain refers to a common sequela experienced by a substantial subset of cancer patients exposed to chemotherapeutic treatment, a phenomenon that dramatically deteriorates the survivors' quality of life and prevents them from restoring their pre-cancer life. This review is intended to address the current knowledge regarding the mechanisms underlying the pathophysiology of the chemobrain phenomenon, with special focus on the antineoplastic agent ''doxorubicin'', which has been shown to be implicated in strenuous central neurotoxicity despite being-almost entirely-peripherally confined. Moreover, the assessment of the post-chemotherapy cognitive impairment in both human and animal subjects, and the potential pharmacotherapy and behavioral intervention strategies are reviewed.
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263
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Huang Z, Zhao J, Ding K, Lv Y, Zhang C, Chao HH, Li CS, Cheng H. Depression involved in self-reported prospective memory problems in survivors of breast cancer who have received chemotherapy. Medicine (Baltimore) 2019; 98:e15301. [PMID: 31008981 PMCID: PMC6494378 DOI: 10.1097/md.0000000000015301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 02/28/2019] [Accepted: 03/26/2019] [Indexed: 12/17/2022] Open
Abstract
To investigate the relationship between depression and the self-reported prospective memory (SPM) problems in breast cancer survivors who have received chemotherapy.Sixty-three breast cancer patients were administered with self-rating depression scale (SDS) and the prospective memory questionnaire as part of extensive neuropsychological assessments before and after chemotherapy. The performance of SDS and SPM were compared, with the level of significance set at P < .05.Compared with the group before chemotherapy, there is a significant difference on the SPM score (t = 6.069, P = .000) in breast cancer patients after chemotherapy. Further, there is also a significant difference on the SPM score (t = -4.348, P = .000) between the patients with and without depression group after chemotherapy.The present result indicated that the depression in breast cancer survivors after chemotherapy may be involved in their chemotherapy-induced SPM impairment.
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Affiliation(s)
- Zhonglian Huang
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University
| | - Jingjing Zhao
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University
| | - Ke Ding
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University
| | - Yue Lv
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University
| | - Congjun Zhang
- Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui
| | - Herta H. Chao
- Cancer Center, VA Connecticut Healthcare System, West Haven
- Department of Internal Medicine, Yale University School of Medicine
| | - Chiang-Shan Li
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Huaidong Cheng
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
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264
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Henderson FM, Cross AJ, Baraniak AR. 'A new normal with chemobrain': Experiences of the impact of chemotherapy-related cognitive deficits in long-term breast cancer survivors. Health Psychol Open 2019; 6:2055102919832234. [PMID: 30873289 PMCID: PMC6405778 DOI: 10.1177/2055102919832234] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Chemobrain is one of the most commonly reported side-effects of cancer treatment.
However, there is limited research into its psychosocial concomitants. This
study aimed to explore the long-term lived experience of chemobrain.
Interpretative phenomenological analysis allowed an in-depth investigation of 12
breast cancer survivors suffering from perceived cognitive deficits at least
1-year post-treatment. Themes were organised around the illness representations
framework. Commonly reported cognitive deficits related to memory, language and
processing speed, which affected participants’ sense of identity and their
interactions with others. Individual experiences were mediated by health beliefs
regarding controllability, validation and impairment trajectory.
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265
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Rambeau A, Beauplet B, Laviec H, Licaj I, Leconte A, Chatel C, Le Bon P, Denhaerynck J, Clarisse B, Frenkiel N, Lange M, Joly F. Prospective comparison of the Montreal Cognitive Assessment (MoCA) and the Mini Mental State Examination (MMSE) in geriatric oncology. J Geriatr Oncol 2019; 10:235-240. [DOI: 10.1016/j.jgo.2018.08.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 06/19/2018] [Accepted: 08/01/2018] [Indexed: 12/22/2022]
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266
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Seo EJ, Klauck SM, Efferth T, Panossian A. Adaptogens in chemobrain (Part I): Plant extracts attenuate cancer chemotherapy-induced cognitive impairment - Transcriptome-wide microarray profiles of neuroglia cells. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2019; 55:80-91. [PMID: 30668446 DOI: 10.1016/j.phymed.2018.10.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 10/17/2018] [Accepted: 10/18/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Cancer chemotherapy-induced cognitive impairments are presumably associated with undesirable effects of chemotherapy on physiological functions of brain cells. Adaptogens are natural compounds or plant extracts increasing an organism's adaptability and survival in stress. They exhibited neuroprotective effects and increased cognitive functions in clinical studies in human beings. HYPOTHESIS We hypothesized that selected adaptogenic plant extracts attenuate or prevent cancer chemotherapy-induced cognitive impairments. AIM We assessed the effects of selected adaptogenic herbal extracts on FEC (fixed combination 5-fluorouracil, epirubicin and cyclophosphamide) induced changes in transcriptome-wide RNA microarray profiles of neuroglia cells. The aim of the study was to predict potential effects of andrographolide, Andrographis herb, Eleutherococcus root genuine extracts, their fixed combination (AE) and the combination of Rhodiola roots, Schisandra berries and Eleutherococcus roots (RSE) on cellular and physiological, mostly cognitive functions. METHODS Gene expression profiling was performed by transcriptome-wide mRNA microarray in the human T98G neuroglia cells after treatment with adaptogens. Interactive pathways downstream analysis was performed with data sets of significantly up- or down-regulated genes and predicted effects on cellular functions and diseases were identified by Ingenuity IPA database software. RESULTS FEC deregulated 67 genes involved in decrease of neuronal development, 37 genes involved in development of the sensory system, 12 genes in extension of axons, and 3 genes in migration of neurons. Co-incubation with Andrographis paniculata (AP) suppressed FEC-induced deregulation of a large number of genes involved in predicted activation of neuronal death and inhibition of neurogenesis, and 16 genes related to inhibition of several functions in the nervous system. Co-incubation with AE suppressed FEC-induced deregulation of a number of genes involved in predicted inhibition of axon extension, migration of T98G neuroglia cells, conduction of nerves and other genes related to regulations of some other functions in the nervous system. CONCLUSION Application of cytostatic drugs in combination with apoptogenic plant extracts induced significant changes in transcriptome-wide mRNA microarray profiles of neuroglial cells. These changes indicate on potential beneficial effects on neuronal functions associated with mild cognitive impairments in cancer chemotherapy.
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Affiliation(s)
- Ean-Jeong Seo
- Department of Pharmaceutical Biology, Institute of Pharmacy and Biochemistry, Johannes Gutenberg University, Staudinger Weg 5, Mainz 55128, Germany
| | - Sabine M Klauck
- Division of Cancer Genome Research, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 460 Heidelberg 69120, Germany
| | - Thomas Efferth
- Department of Pharmaceutical Biology, Institute of Pharmacy and Biochemistry, Johannes Gutenberg University, Staudinger Weg 5, Mainz 55128, Germany.
| | - Alexander Panossian
- EuroPharma USA Inc., 955 Challenger Dr., Green Bay, Wisconsin 54311 United States; Phytomed AB, Vaxtorp, Sweden.
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267
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Chang L, Weiner LS, Hartman SJ, Horvath S, Jeste D, Mischel PS, Kado DM. Breast cancer treatment and its effects on aging. J Geriatr Oncol 2019; 10:346-355. [PMID: 30078714 PMCID: PMC7062379 DOI: 10.1016/j.jgo.2018.07.010] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 06/11/2018] [Accepted: 07/16/2018] [Indexed: 10/28/2022]
Abstract
Breast cancer is the most common cancer of women in the United States. It is also proving to be one of the most treatable. Early detection, surgical intervention, therapeutic radiation, cytotoxic chemotherapies and molecularly targeted agents are transforming the lives of patients with breast cancer, markedly improving their survival. Although current breast cancer treatments are largely successful in producing cancer remission and extending lifespan, there is concern that these treatments may have long lasting detrimental effects on cancer survivors, in part, through their impact on non-tumor cells. Presently, the impact of breast cancer treatment on normal cells, its impact on cellular function and its effect on the overall function of the individual are incompletely understood. In particular, it is unclear whether breast cancer and/or its treatments are associated with an accelerated aging phenotype. In this review, we consider breast cancer survivorship from the perspective of accelerated aging, and discuss the evidence suggesting that women treated for breast cancer may suffer from an increased rate of physical and cognitive decline that likely corresponds with underlying vulnerabilities of genome instability, epigenetic changes, and cellular senescence.
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Affiliation(s)
- Leslie Chang
- Departments of Family Medicine & Public Health, School of Medicine, University of California, San Diego, United States; Department of Internal Medicine, School of Medicine University of California, San Diego, United States
| | - Lauren S Weiner
- Departments of Family Medicine & Public Health, School of Medicine, University of California, San Diego, United States; University of California San Diego, Moores Cancer Center, La Jolla, CA, United States
| | - Sheri J Hartman
- Departments of Family Medicine & Public Health, School of Medicine, University of California, San Diego, United States; University of California San Diego, Moores Cancer Center, La Jolla, CA, United States
| | - Steve Horvath
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, United States; Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, United States
| | - Dilip Jeste
- Departments of Psychiatry & Neuroscience, University of California, San Diego, United States; Sam and Rose Stein Institute for Research on Aging, United States
| | - Paul S Mischel
- Department of Pathology, School of Medicine, University of California, San Diego, United States; Ludwig Institute for Cancer Research, University of California, San Diego, United States
| | - Deborah M Kado
- Departments of Family Medicine & Public Health, School of Medicine, University of California, San Diego, United States; Department of Internal Medicine, School of Medicine University of California, San Diego, United States; Sam and Rose Stein Institute for Research on Aging, United States.
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268
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Nassif EF, Arsène-Henry A, Kirova YM. Brain metastases and treatment: multiplying cognitive toxicities. Expert Rev Anticancer Ther 2019; 19:327-341. [PMID: 30755047 DOI: 10.1080/14737140.2019.1582336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Thirty per cent of cancer patients develop brain metastases, with multiple combination or sequential treatment modalities available, to treat systemic or central nervous system (CNS) disease. Most patients experience toxicities as a result of these treatments, of which cognitive impairment is one of the adverse events most commonly reported, causing major impairment of the patient's quality of life. Areas covered: This article reviews the role of cancer treatments in cognitive decline of patients with brain metastases: surgery, radiotherapy, chemotherapy, targeted therapies, immunotherapies and hormone therapy. Pathological and molecular mechanisms, as well as future directions for limiting cognitive toxicities are also presented. Other causes of cognitive impairment in this population are discussed in order to refine the benefit-risk balance of each treatment modality. Expert opinion: Cumulative cognitive toxicity should be taken into account, and tailored to the patient's cognitive risk in the light of the expected survival benefit. Standardization of cognitive assessment in this context is needed in order to better appreciate each treatment's responsibility in cognitive impairment, keeping in mind disease itself impacts cognition in this context.
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Affiliation(s)
- Elise F Nassif
- a Department of Radiotherapy , Institut Curie , Paris , France
| | | | - Youlia M Kirova
- a Department of Radiotherapy , Institut Curie , Paris , France
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269
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Gregorowitsch ML, Ghedri A, Young-Afat DA, Bijlsma R, Baas IO, van Schaik-van de Mheen C, Agterof MJ, Göker E, Ten Bokkel Huinink D, van den Bongard HJGD, Verkooijen HM. The effect of chemotherapy on subjective cognitive function in younger early-stage breast cancer survivors treated with chemotherapy compared to older patients. Breast Cancer Res Treat 2019; 175:429-441. [PMID: 30746636 PMCID: PMC6533221 DOI: 10.1007/s10549-019-05149-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 01/22/2019] [Indexed: 01/22/2023]
Abstract
Purpose To evaluate the impact of chemotherapy on subjective cognitive functioning according to age in a large cohort of breast cancer patients. Methods Within the UMBRELLA cohort, 715 patients with early-stage primary invasive breast cancer (T1-3N0-1M0) were selected. Subjective cognitive function was assessed by means of the EORTC QLQ-C30 up to 24 months and compared between patients treated with and without chemotherapy, for three different age strata (355 patients < 55 years, 240 patients aged 55–65 years, and 120 patients > 65 years). Differences between chemotherapy and non-chemotherapy patients by age at different time points were assessed by linear mixed-effect models correcting for age, tumor stage, educational level, endocrine therapy, anxiety, and depression. Results In total, 979 patients from the UMBRELLA cohort were included, of which 715 (73%) responded to baseline and at least one follow-up questionnaire. Questionnaire response rates ranged between 92 and 70%. The proportion of patients treated with chemotherapy decreased with age: 64% (n = 277) in patients < 55 years, 45% (n = 107) in patients 55–65 years, and 23% (n = 27) in patients > 65 years. Chemotherapy was associated with reduced subjective cognitive functioning. The impact of chemotherapy on subjective cognitive function was most pronounced in patients < 55 years, followed by those between 55 and 65 years. In the youngest age groups, patients treated with chemotherapy had significantly lower cognitive functioning up to 24 months. In women over 65 years, subjective cognitive functioning was comparable between patients treated with and without chemotherapy. Conclusion This study confirms that chemotherapy is associated with impaired subjective self-reported cognitive functioning in breast cancer patients, and the effect persists at least up to 2 years after diagnosis. The impact of chemotherapy on self-reported cognitive functioning in the first 24 months is most pronounced in younger patients, especially those under 55 years of age. Electronic supplementary material The online version of this article (10.1007/s10549-019-05149-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M L Gregorowitsch
- Department of Radiation Oncology, University Medical Center (UMC) Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - A Ghedri
- University of Utrecht, Utrecht, The Netherlands
| | - D A Young-Afat
- Department of Radiation Oncology, University Medical Center (UMC) Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.,Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands
| | - R Bijlsma
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - I O Baas
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - M J Agterof
- Department of Medical Oncology, St. Antonius, Nieuwegein, The Netherlands
| | - E Göker
- Department of Medical Oncology, Alexander Monro Clinics, Bilthoven, The Netherlands
| | | | - H J G D van den Bongard
- Department of Radiation Oncology, University Medical Center (UMC) Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - H M Verkooijen
- University of Utrecht, Utrecht, The Netherlands.,Imaging Division, University Medical Center Utrecht, Utrecht, The Netherlands
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270
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Trastuzumab Induced Chemobrain, Atorvastatin Rescued Chemobrain with Enhanced Anticancer Effect and without Hair Loss-Side Effect. J Clin Med 2019; 8:jcm8020234. [PMID: 30754707 PMCID: PMC6406319 DOI: 10.3390/jcm8020234] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 02/07/2019] [Accepted: 02/08/2019] [Indexed: 12/29/2022] Open
Abstract
The authors identified that chemo-brain was induced after trastuzumab (TZB) therapy. In addition, atorvastatin (ATV) could rescue chemo-brain during trastuzumab (TZB) therapy. Enhanced therapeutic effect of TZB was confirmed after ATV therapy. We also investigated that there was no hair loss side effect due to ATV therapy. In an animal model, 150 μg TZB and five serial doses of 20 mg/kg ATV were administered. 18F-fluorodeoxyglucose Positron Emission Tomography (PET) and Magnetic Resonance Imaging (MRI) data were acquired. Statistical parametric mapping analysis and voxel-based morphometry analysis were performed to identify differences in glucose metabolism and gray matter concentration. The enhanced therapeutic efficacy of TZB after ATV treatment was assessed using a human epidermal growth factor receptor 2-positive gastric cancer model. We found a decrease in cerebral glucose metabolism and gray matter concentration in the frontal lobe following TZB therapy (p < 0.005). After subsequent ATV administration, glucose metabolism and regional gray matter concentration were rescued (p < 0.005). Cognitive impairment due to TZB and the rescue effect of ATV were confirmed using a passive avoidance test and quantitative real-time reverse transcription PCR. Furthermore, the penetration and accumulation of TZB in tumors increased by 100% after ATV co-administration, which resulted in an enhanced anti-cancer effect. Our study collectively demonstrates that ATV co-administration with TZB rescued the TZB-induced chemo-brain and enhances the therapeutic efficacy of TZB in tumors. We also showed that there was no hair loss during ATV therapy.
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271
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Pharmacologic management of cognitive impairment induced by cancer therapy. Lancet Oncol 2019; 20:e92-e102. [DOI: 10.1016/s1470-2045(18)30938-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 12/04/2018] [Accepted: 12/05/2018] [Indexed: 12/31/2022]
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272
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Dos Santos M, Lange M, Gervais R, Clarisse B, Capel A, Barillet M, Grellard JM, Heutte N, Licaj I, Joly F. Impact of anxio-depressive symptoms and cognitive function on oral anticancer therapies adherence. Support Care Cancer 2019; 27:3573-3581. [PMID: 30690685 DOI: 10.1007/s00520-019-4644-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 01/14/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Oral anticancer therapies have an important place in the therapeutic arsenal, but factors influencing adherence to oral treatment are poorly documented in oncology. The objective of this study was to assess the impact of anxio-depressive symptoms and cognitive functioning on oral medication adherence. METHODS This prospective study included cancer patients initiating a first oral therapy. Before initiation of treatment, an assessment of depression, anxiety, and cognition was performed. Using self-report questionnaires, we collected information on socio-demographic conditions and the non-adherence at 1 (M1) and 3 months (M3) after the beginning of treatment. RESULTS Among 129 patients enrolled, median age was 70 years and 81% of patients were treated for metastatic cancer. Before initiating treatment, 16% and 8% of patients presented respectively depression and anxiety symptoms. Global cognitive impairment was observed in 51% of patients. Ten percent of the patients were non-adherent at M1 and 13% at M3. Depression was strongly associated with non-adherence at M1 (P = 0.046) and M3 (P = 0.014), but not anxiety. Non-adherence was associated with lower working memory (P = 0.037) and digit memory (P = 0.018) at M1 and short-term memory (P = 0.04) at M3. Patients with more than eight co-medications were more often non-adherents (P = 0.055). CONCLUSIONS Non-adherence to oral anticancer therapies was mainly associated to depression. Focusing on depressive symptoms before initiation of oral anticancer therapy could help to identify patient profiles more likely to fail self-management. Working memory, digit memory, and short-term memory also seem to play a role in non-adherence. Further studies should include a more specific population, especially according to age.
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Affiliation(s)
- Mélanie Dos Santos
- Clinical Research Department, Centre François Baclesse, 14000, Caen, France. .,Department of Medicine, Hospital University, 14000, Caen, France. .,Department of Medical Oncology, Centre François Baclesse, 3 Avenue du Général Harris, 14000, Caen, France. .,INSERM, U1086, ANTICIPE, 14000, Caen, France.
| | - M Lange
- Clinical Research Department, Centre François Baclesse, 14000, Caen, France.,INSERM, U1086, ANTICIPE, 14000, Caen, France
| | - R Gervais
- Department of Medical Oncology, Centre François Baclesse, 3 Avenue du Général Harris, 14000, Caen, France
| | - B Clarisse
- Clinical Research Department, Centre François Baclesse, 14000, Caen, France
| | - A Capel
- Clinical Research Department, Centre François Baclesse, 14000, Caen, France
| | - M Barillet
- Clinical Research Department, Centre François Baclesse, 14000, Caen, France
| | - J M Grellard
- Clinical Research Department, Centre François Baclesse, 14000, Caen, France
| | - N Heutte
- Clinical Research Department, Centre François Baclesse, 14000, Caen, France.,INSERM, U1086, ANTICIPE, 14000, Caen, France
| | - I Licaj
- Clinical Research Department, Centre François Baclesse, 14000, Caen, France.,INSERM, U1086, ANTICIPE, 14000, Caen, France
| | - F Joly
- Clinical Research Department, Centre François Baclesse, 14000, Caen, France.,Department of Medicine, Hospital University, 14000, Caen, France.,Department of Medical Oncology, Centre François Baclesse, 3 Avenue du Général Harris, 14000, Caen, France.,INSERM, U1086, ANTICIPE, 14000, Caen, France
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273
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Mineyeva OA, Bezriadnov DV, Kedrov AV, Lazutkin AA, Anokhin KV, Enikolopov GN. Radiation Induces Distinct Changes in Defined Subpopulations of Neural Stem and Progenitor Cells in the Adult Hippocampus. Front Neurosci 2019; 12:1013. [PMID: 30686979 PMCID: PMC6333747 DOI: 10.3389/fnins.2018.01013] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 12/17/2018] [Indexed: 11/13/2022] Open
Abstract
While irradiation can effectively treat brain tumors, this therapy also causes cognitive impairments, some of which may stem from the disruption of hippocampal neurogenesis. To study how radiation affects neurogenesis, we combine phenotyping of subpopulations of hippocampal neural stem and progenitor cells with double- and triple S-phase labeling paradigms. Using this approach, we reveal new features of division, survival, and differentiation of neural stem and progenitor cells after exposure to gamma radiation. We show that dividing neural stem cells, while susceptible to damage induced by gamma rays, are less vulnerable than their rapidly amplifying progeny. We also show that dividing stem and progenitor cells that survive irradiation are suppressed in their ability to replicate 0.5–1 day after the radiation exposure. Suppression of division is also observed for cells that entered the cell cycle after irradiation or were not in the S phase at the time of exposure. Determining the longer term effects of irradiation, we found that 2 months after exposure, radiation-induced suppression of division is partially relieved for both stem and progenitor cells, without evidence for compensatory symmetric divisions as a means to restore the normal level of neurogenesis. By that time, most mature young neurons, born 2–4 weeks after the irradiation, still bear the consequences of radiation exposure, unlike younger neurons undergoing early stages of differentiation without overt signs of deficient maturation. Later, 6 months after an exposure to 5 Gy, cell proliferation and neurogenesis are further impaired, though neural stem cells are still available in the niche, and their pool is preserved. Our results indicate that various subpopulations of stem and progenitor cells in the adult hippocampus have different susceptibility to gamma radiation, and that neurogenesis, even after a temporary restoration, is impaired in the long term after exposure to gamma rays. Our study provides a framework for investigating critical issues of neural stem cell maintenance, aging, interaction with their microenvironment, and post-irradiation therapy.
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Affiliation(s)
- Olga A Mineyeva
- Moscow Institute of Physics and Technology, Dolgoprudny, Russia.,P. K. Anokhin Research Institute of Normal Physiology, Moscow, Russia.,National Research Center "Kurchatov Institute," Moscow, Russia
| | - Dmitri V Bezriadnov
- Moscow Institute of Physics and Technology, Dolgoprudny, Russia.,P. K. Anokhin Research Institute of Normal Physiology, Moscow, Russia
| | - Alexander V Kedrov
- Moscow Institute of Physics and Technology, Dolgoprudny, Russia.,P. K. Anokhin Research Institute of Normal Physiology, Moscow, Russia
| | - Alexander A Lazutkin
- Moscow Institute of Physics and Technology, Dolgoprudny, Russia.,P. K. Anokhin Research Institute of Normal Physiology, Moscow, Russia.,N.N. Burdenko Neurosurgery Institute, Moscow, Russia
| | - Konstantin V Anokhin
- Moscow Institute of Physics and Technology, Dolgoprudny, Russia.,P. K. Anokhin Research Institute of Normal Physiology, Moscow, Russia.,National Research Center "Kurchatov Institute," Moscow, Russia
| | - Grigori N Enikolopov
- Moscow Institute of Physics and Technology, Dolgoprudny, Russia.,Center for Developmental Genetics, Department of Anesthesiology, Stony Brook University, Stony Brook, NY, United States
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274
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Underwood EA, Jerzak KJ, Lebovic G, Rochon PA, Elser C, Pritchard KI, Tierney MC. Cognitive effects of adjuvant endocrine therapy in older women treated for early-stage breast cancer: a 1-year longitudinal study. Support Care Cancer 2019; 27:3035-3043. [PMID: 30610433 DOI: 10.1007/s00520-018-4603-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 12/10/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE Evidence suggests endocrine therapy (ET) for breast cancer (BC) has adverse cognitive effects, but its specific effects on older women are unknown. This is despite the fact that older women are at increased risk of both breast cancer (BC) and cognitive decline relative to younger women. This study prospectively examined the cognitive effects of ET in a cohort of older BC patients. Our primary outcome measure was change in verbal memory, the cognitive domain most consistently affected by estrogen deprivation. METHODS Forty-two chemotherapy-naïve women age 60+, without dementia and recently diagnosed with hormone receptor-positive BC, completed neuropsychological tests at the time of ET initiation and after 1 year of treatment. Change in age-standardized verbal memory performance was examined using paired t tests. To assess a broader range of potential cognitive effects, we also examined changes in visual memory, processing speed, frontal executive function, and perceptual reasoning. RESULTS Participants exhibited significant decline from baseline to 1 year in verbal memory (p = 0.01). This decline was small to moderate in effect size (d = - 0.40). Performance on other domains did not change significantly over the year (all p > 0.05). CONCLUSIONS Our findings suggest potentially detrimental effects of ET on verbal memory in older women after just 1 year of treatment. Given that ET is prescribed for courses of 5 to 10 years, additional studies examining longer-term effects of treatment in older women are critical.
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Affiliation(s)
- E A Underwood
- Primary Care Research Unit, Department of Family and Community Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Suite E349, Toronto, ON, Canada.,Sunnybrook Research Institute, Toronto, ON, Canada
| | - K J Jerzak
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - G Lebovic
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Applied Health Research Centre, St. Michael's Hospital, Toronto, ON, Canada
| | - P A Rochon
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - C Elser
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Princess Margaret Hospital Cancer Centre, Toronto, ON, Canada.,Sinai Health System, Toronto, ON, Canada
| | - K I Pritchard
- Sunnybrook Research Institute, Toronto, ON, Canada.,Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - M C Tierney
- Primary Care Research Unit, Department of Family and Community Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Suite E349, Toronto, ON, Canada. .,Sunnybrook Research Institute, Toronto, ON, Canada. .,Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada.
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Boukelmoune N, Chiu GS, Kavelaars A, Heijnen CJ. Mitochondrial transfer from mesenchymal stem cells to neural stem cells protects against the neurotoxic effects of cisplatin. Acta Neuropathol Commun 2018; 6:139. [PMID: 30541620 PMCID: PMC6292021 DOI: 10.1186/s40478-018-0644-8] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 12/02/2018] [Indexed: 12/11/2022] Open
Abstract
Mesenchymal stem cells (MSCs) transfer healthy mitochondria to damaged acceptor cells via actin-based intercellular structures. In this study, we tested the hypothesis that MSCs transfer mitochondria to neural stem cells (NSCs) to protect NSCs against the neurotoxic effects of cisplatin treatment. Our results show that MSCs donate mitochondria to NSCs damaged in vitro by cisplatin. Transfer of healthy MSC-derived mitochondria decreases cisplatin-induced NSC death. Moreover, mitochondrial transfer from MSCs to NSCs reverses the cisplatin-induced decrease in mitochondrial membrane potential. Blocking the formation of actin-based intercellular structures inhibited the transfer of mitochondria to NSCs and abrogated the positive effects of MSCs on NSC survival. Conversely, overexpression of the mitochondrial motor protein Rho-GTPase 1 (Miro1) in MSCs increased mitochondrial transfer and further improved survival of cisplatin-treated NSCs. In vivo, MSC administration prevented the loss of DCX+ neural progenitor cells in the subventricular zone and hippocampal dentate gyrus which occurs as a result of cisplatin treatment. We propose mitochondrial transfer as one of the mechanisms via which MSCs exert their therapeutic regenerative effects after cisplatin treatment.
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276
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Abstract
Patients with cancer may report neuropsychiatric abnormalities including cognitive impairment, behavioral disturbances, and psychiatric disorders that potentially worsen their quality of life, reduce their treatment response, and aggravate their overall prognosis. Neuropsychiatric disturbances have a different pathophysiology, including immuno-inflammatory and neuroendocrine mechanisms, as a consequence of oncologic treatments (chemo- and radio-therapy). Among clinicians involved in the management of such patients, psychiatrists need to pay particular attention in recognizing behavioral disturbances that arise in oncologic patients, and determining those that may be effectively treated with psychotropic medications, psychotherapeutic interventions, and an integration of them. Through the contribution of different clinicians actively involved in the management of oncological patients, the present review is ultimately aimed at updating psychiatrists in relation to the pathophysiological mechanisms responsible for the onset of cognitive, affective, and behavioral syndromes in these patients, along with epidemiologic and clinical considerations and therapeutic perspectives.
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277
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Gokal K, Munir F, Ahmed S, Kancherla K, Wallis D. Does walking protect against decline in cognitive functioning among breast cancer patients undergoing chemotherapy? Results from a small randomised controlled trial. PLoS One 2018; 13:e0206874. [PMID: 30485297 PMCID: PMC6261560 DOI: 10.1371/journal.pone.0206874] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 10/21/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Cancer related cognitive impairments have been subjectively reported and objectively detected in breast cancer patients treated with chemotherapy and are known to have a profound negative impact on productivity, psychosocial well-being and overall quality of life. Moderate levels of walking are known to be of benefit to the psychosocial well-being of those affected by breast cancer and for managing cognitive impairment in healthy adults, children, and the elderly. The purpose of this study is to investigate the effects of a home-based, self-managed, moderate intensity walking intervention on subjective and objective cognitive functioning in breast cancer patients undergoing chemotherapy. METHODS A home-based, self-managed intervention that consisted of moderate levels of walking was compared to usual care among breast cancer patients treated with chemotherapy in a randomised controlled trial. Outcome measures included changes in subjective (CFQ) and objectively detected cognitive functioning (Stroop, SART and two subscales from the WAIS- Digit Span and Block Design). Fifty participants were randomised to either the intervention group (n = 25), who completed 12 weeks of moderate intensity walking, or to the control group (n = 25) mid-way through chemotherapy. RESULTS Compared with the control group, the self-managed walking intervention had positive effects on perceived cognitive function but not on sustained attention, executive function, memory or visual spatial skills when assessed objectively using neuropsychological measures. CONCLUSION This home-based, self-managed intervention is beneficial for protecting against perceived cognitive decline in breast cancer patients treated with chemotherapy. There is a need for further research to objectively assess cognitive decline within this population with larger sample sizes of patients. TRIAL REGISTRATION Current Controlled Trials ISRCTN50709297.
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Affiliation(s)
- Kajal Gokal
- School of Sport, Exercise & Health Sciences, Loughborough University, Loughborough, Leicestershire, United Kingdom
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, Leicestershire, United Kingdom
| | - Fehmidah Munir
- School of Sport, Exercise & Health Sciences, Loughborough University, Loughborough, Leicestershire, United Kingdom
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, Leicestershire, United Kingdom
| | - Samreen Ahmed
- Leicester Royal Infirmary, University Hospitals of Leicester, Leicestershire, United Kingdom
| | - Kiran Kancherla
- Leicester Royal Infirmary, University Hospitals of Leicester, Leicestershire, United Kingdom
| | - Deborah Wallis
- School of Sport, Exercise & Health Sciences, Loughborough University, Loughborough, Leicestershire, United Kingdom
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, Leicestershire, United Kingdom
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278
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van der Willik KD, Koppelmans V, Hauptmann M, Compter A, Ikram MA, Schagen SB. Inflammation markers and cognitive performance in breast cancer survivors 20 years after completion of chemotherapy: a cohort study. Breast Cancer Res 2018; 20:135. [PMID: 30442190 PMCID: PMC6238315 DOI: 10.1186/s13058-018-1062-3] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 10/12/2018] [Indexed: 12/20/2022] Open
Abstract
Background Inflammation is an important candidate mechanism underlying cancer and cancer treatment-related cognitive impairment. We investigated levels of blood cell–based inflammatory markers in breast cancer survivors on average 20 years after chemotherapy and explored the relation between these markers and global cognitive performance. Methods One hundred sixty-six breast cancer survivors who received post-surgical radiotherapy and six cycles of adjuvant cyclophosphamide, methotrexate, and fluorouracil (CMF) chemotherapy on average 20 years before enrollment were compared with 1344 cancer-free women from a population-based sample (50–80 years old). Breast cancer survivors were excluded if they used adjuvant hormonal therapy or if they developed relapse, metastasis, or second primary malignancies. Systemic inflammation status was assessed by the granulocyte-to-lymphocyte ratio (GLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII). Cognitive performance was assessed using an extensive neuropsychological test battery from which the general cognitive factor was derived to evaluate global cognitive performance. We examined the association between cancer, the general cognitive factor, and inflammatory markers using linear regression models. Results Breast cancer survivors had a lower general cognitive factor than non-exposed participants from the comparator group (mean difference = −0.21; 95% confidence interval (CI) −0.35 to −0.06). Inflammatory markers were higher in cancer survivors compared with non-exposed participants (mean difference for log(GLR) = 0.31; 95% CI 0.24 to 0.37, log(PLR) = 0.14; 95% CI 0.09 to 0.19, log(SII) = 0.31; 95% CI 0.24 to 0.39). The association between higher levels of inflammatory markers and lower general cognitive factor was statistically significant in cancer survivors but not among non-exposed participants. We found a group-by-inflammatory marker interaction; cancer survivors showed additional lower general cognitive factor per standard deviation increase in inflammatory markers (P for interaction for GLR = 0.038, PLR = 0.003, and SII = 0.033). Conclusions This is the first study to show that (1) cancer survivors have increased levels of inflammation on average 20 years after treatment and (2) these inflammatory levels are associated with lower cognitive performance. Although this association needs verification by a prospective study to determine causality, our findings can stimulate research on the role of inflammation in long-term cognitive problems and possibilities to diminish such problems.
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Affiliation(s)
- Kimberly D van der Willik
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands.,Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Vincent Koppelmans
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands.,Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, the Netherlands.,Department of Psychiatry, The University of Utah, 501 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - Michael Hauptmann
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands
| | - Annette Compter
- Department of Neuro-oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Sanne B Schagen
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands. .,Brain and Cognition, Department of Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, 1018 WS, Amsterdam, the Netherlands.
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279
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Rafie C, Ning Y, Wang A, Gao X, Houlihan R. Impact of physical activity and sleep quality on quality of life of rural residents with and without a history of cancer: findings of the Day and Night Study. Cancer Manag Res 2018; 10:5525-5535. [PMID: 30519100 PMCID: PMC6234991 DOI: 10.2147/cmar.s160481] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Lifestyle behaviors may impact quality of life (QoL). The relative impact of physical activity and sleep quality on QoL of individuals with and without a history of cancer living in underserved rural communities requires further study to inform health care and public health initiatives. METHODS Individuals with and without a history of cancer were recruited from rural Virginia. We collected information on physical activity level (PAL), sleep quality (Pittsburgh Sleep Quality Index), and QoL (Short Form-36). Additional dimensions of physical activity and sleep were measured including ambient light exposure and sleep duration via Actiwatch2, and serum vitamin D and urine melatonin, which are markers of outdoor activity and sleep. RESULTS A total of 124 cancer survivors and 48 cancer-free individuals were enrolled in the study. Mean age was 59 years, with the majority being women (89%) and Caucasian (76%). Breast cancer was the most common cancer (72%), and mean time from diagnosis to the survey was 8.1 years. Survivors were significantly less active, more likely to be inactive, and had significantly worse sleep quality and physical and mental health relative to cancer-free individuals (P<0.05). Quality of sleep and average sleep time were associated with physical (r=-0.371, P<0.001; r=-0.327, P<0.000) and mental health (r=-0.442, P=<0.001; r=-0.265, P<0.004), as was PAL (r=0.181, P=0.019; r=0.288, P=0.003). Self-reported outdoor activity was associated with mental health (r=0.233, P=0.003) and vitamin D3 (r=0.193, P=0.015). No association was found between melatonin, sleep quality, and QoL. Sleep quality, cancer status, body mass index, and sleep time were predictive of physical health, while sleep quality, sleep time, and outdoor activity were predictive of mental health. CONCLUSION Quality of sleep is a significant predictor of mental and physical health, and important for cancer survivors who experience poorer QoL. Outdoor activity should be encouraged to improve mental health and vitamin D status, and interventions to improve sleep for those with poor sleep quality should be considered in cancer survivorship planning.
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Affiliation(s)
- Carlin Rafie
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA,
| | - Yi Ning
- GlaxoSmithKline Institute of Infectious Disease and Public Health, Beijing, China
| | | | - Xiang Gao
- Department of Nutritional Sciences, Pennsylvania State University, University Park, PA, USA
| | - Robert Houlihan
- Department of Nutritional Sciences, Pennsylvania State University, University Park, PA, USA
- UF Health Cancer Center, University of Florida, Gainesville, FL, USA
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280
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van der Willik KD, Schagen SB, Ikram MA. Cancer and dementia: Two sides of the same coin? Eur J Clin Invest 2018; 48:e13019. [PMID: 30112764 PMCID: PMC6220770 DOI: 10.1111/eci.13019] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 08/13/2018] [Indexed: 12/12/2022]
Abstract
Noncentral nervous system cancer and the brain share an interesting and complex relation, with an emerging body of evidence showing that cancer patients are at an increased risk of developing cognitive problems. In contrast, population-based studies consistently find an inverse link between cancer and dementia, that is patients with dementia having a lower risk of subsequently developing cancer, and cancer patients being less often diagnosed with dementia. Different biological processes such as inversely activated cell proliferation and survival pathways have been suggested to have an important role underlying this inverse association. However, the effect of methodological biases including surveillance or survival bias has not been completely ruled out, calling into question the inverse direction of the association between cancer and dementia. In fact, emerging evidence now suggests that cancer and dementia might share a positive association. This narrative review summarises the current literature on cancer, cognitive problems and dementia. Moreover, different strategies will be discussed to reduce the impact of potential methodological biases on the association between cancer and dementia, trying to reveal the true direction of this link.
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Affiliation(s)
- Kimberly D. van der Willik
- Department of Psychosocial Research and EpidemiologyNetherlands Cancer InstituteAmsterdamThe Netherlands
- Department of EpidemiologyErasmus Medical CenterRotterdamThe Netherlands
| | - Sanne B. Schagen
- Department of Psychosocial Research and EpidemiologyNetherlands Cancer InstituteAmsterdamThe Netherlands
- Brain and CognitionDepartment of PsychologyUniversity of AmsterdamAmsterdamThe Netherlands
| | - M. Arfan Ikram
- Department of EpidemiologyErasmus Medical CenterRotterdamThe Netherlands
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281
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Mandelblatt JS, Small BJ, Luta G, Hurria A, Jim H, McDonald BC, Graham D, Zhou X, Clapp J, Zhai W, Breen E, Carroll JE, Denduluri N, Dilawari A, Extermann M, Isaacs C, Jacobsen PB, Kobayashi LC, Holohan Nudelman K, Root J, Stern RA, Tometich D, Turner R, VanMeter JW, Saykin AJ, Ahles T. Cancer-Related Cognitive Outcomes Among Older Breast Cancer Survivors in the Thinking and Living With Cancer Study. J Clin Oncol 2018; 36:JCO1800140. [PMID: 30281396 PMCID: PMC7237199 DOI: 10.1200/jco.18.00140] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine treatment and aging-related effects on longitudinal cognitive function in older breast cancer survivors. METHODS Newly diagnosed nonmetastatic breast cancer survivors (n = 344) and matched controls without cancer (n = 347) 60 years of age and older without dementia or neurologic disease were recruited between August 2010 and December 2015. Data collection occurred during presystemic treatment/control enrollment and at 12 and 24 months through biospecimens; surveys; self-reported Functional Assessment of Cancer Therapy-Cognitive Function; and neuropsychological tests that measured attention, processing speed, and executive function (APE) and learning and memory (LM). Linear mixed-effects models tested two-way interactions of treatment group (control, chemotherapy with or without hormonal therapy, and hormonal therapy) and time and explored three-way interactions of ApoE (ε4+ v not) by group by time; covariates included baseline age, frailty, race, and cognitive reserve. RESULTS Survivors and controls were 60 to 98 years of age, were well educated, and had similar baseline cognitive scores. Treatment was related to longitudinal cognition scores, with survivors who received chemotherapy having increasingly worse APE scores ( P = .05) and those initiating hormonal therapy having lower LM scores at 12 months ( P = .03) than other groups. These group-by-time differences varied by ApoE genotype, where only ε4+ survivors receiving hormone therapy had short-term decreases in adjusted LM scores (three-way interaction P = .03). For APE, the three-way interaction was not significant ( P = .14), but scores were significantly lower for ε4+ survivors exposed to chemotherapy (-0.40; 95% CI, -0.79 to -0.01) at 24 months than ε4+ controls (0.01; 95% CI, 0.16 to 0.18; P < .05). Increasing age was associated with lower baseline scores on all cognitive measures ( P < .001); frailty was associated with baseline APE and self-reported decline ( P < .001). CONCLUSION Breast cancer systemic treatment and aging-related phenotypes and genotypes are associated with longitudinal decreases in cognitive function scores in older survivors. These data could inform treatment decision making and survivorship care planning.
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Affiliation(s)
- Jeanne S. Mandelblatt
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Brent J. Small
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Gheorghe Luta
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Arti Hurria
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Heather Jim
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Brenna C. McDonald
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Deena Graham
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Xingtao Zhou
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Jonathan Clapp
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Wanting Zhai
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Elizabeth Breen
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Judith E. Carroll
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Neelima Denduluri
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Asma Dilawari
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Martine Extermann
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Claudine Isaacs
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Paul B. Jacobsen
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Lindsay C. Kobayashi
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Kelly Holohan Nudelman
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - James Root
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Robert A. Stern
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Danielle Tometich
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Raymond Turner
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - John W. VanMeter
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Andrew J. Saykin
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Tim Ahles
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
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Janelsins MC, Heckler CE, Peppone LJ, Ahles TA, Mohile SG, Mustian KM, Palesh O, O’Mara AM, Minasian LM, Williams AM, Magnuson A, Geer J, Dakhil SR, Hopkins JO, Morrow GR. Longitudinal Trajectory and Characterization of Cancer-Related Cognitive Impairment in a Nationwide Cohort Study. J Clin Oncol 2018; 36:JCO2018786624. [PMID: 30240328 PMCID: PMC6225503 DOI: 10.1200/jco.2018.78.6624] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Cancer-related cognitive impairment (CRCI) is an important clinical problem in patients with breast cancer receiving chemotherapy. Nationwide longitudinal studies are needed to understand the trajectory and severity of CRCI in specific cognitive domains. PATIENTS AND METHODS The overall objective of this nationwide, prospective, observational study conducted within the National Cancer Institute Community Clinical Oncology Research Program was to assess trajectories in specific cognitive domains in patients with breast cancer (stage I-IIIC) receiving chemotherapy, from pre- (A1) to postchemotherapy (A2) and from prechemotherapy to 6 months postchemotherapy (A3); controls were assessed at the same time-equivalent points. The primary aim assessed visual memory using the Cambridge Neuropsychological Test Automated Battery Delayed Match to Sample test by longitudinal mixed models including A1, A2, and A3 and adjusting for age, education, race, cognitive reserve score, and baseline anxiety and depressive symptoms. We also assessed trajectories of CRCI in other aspects of memory as well as in attention and executive function with computerized, paper-based, and telephone-based cognitive tests. RESULTS In total, 580 patients with breast cancer (mean age, 53.4 years) and 363 controls (mean age, 52.6 years) were assessed. On the Delayed Match to Sample test, the longitudinal mixed model results revealed a significant group-by-time effect ( P < .005); patients declined over time from prechemotherapy (A1) to 6 months postchemotherapy (A3; P = .005), but controls did not change ( P = .426). The group difference between patients and controls was also significant, revealing declines in patients but not controls ( P = .017). Several other models of computerized, standard, and telephone tests indicated significantly worse performance by patients compared with controls from pre- to postchemotherapy and from prechemotherapy to 6 months postchemotherapy. CONCLUSION This nationwide study showed CRCI in patients with breast cancer affects multiple cognitive domains for at least 6 months postchemotherapy.
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Affiliation(s)
- Michelle C. Janelsins
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Supriya G. Mohile, Karen M. Mustian, Annalynn M. Williams, Allison Magnuson, and Gary R. Morrow, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Oxana Palesh, Stanford Cancer Center, Stanford, CA; Ann M. O’Mara and Lori M. Minasian, National Cancer Institute (NCI), National Institutes of Health, Rockville, MD; Jodi Geer, Metro Minnesota NCI Community Oncology Research Program (NCORP), Saint Louis Park, MN; Shaker R. Dakhil, Wichita NCORP, Wichita, KS; and Judith O. Hopkins, Southeast Clinical Oncology Research Consortium NCORP, Winston-Salem, NC
| | - Charles E. Heckler
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Supriya G. Mohile, Karen M. Mustian, Annalynn M. Williams, Allison Magnuson, and Gary R. Morrow, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Oxana Palesh, Stanford Cancer Center, Stanford, CA; Ann M. O’Mara and Lori M. Minasian, National Cancer Institute (NCI), National Institutes of Health, Rockville, MD; Jodi Geer, Metro Minnesota NCI Community Oncology Research Program (NCORP), Saint Louis Park, MN; Shaker R. Dakhil, Wichita NCORP, Wichita, KS; and Judith O. Hopkins, Southeast Clinical Oncology Research Consortium NCORP, Winston-Salem, NC
| | - Luke J. Peppone
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Supriya G. Mohile, Karen M. Mustian, Annalynn M. Williams, Allison Magnuson, and Gary R. Morrow, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Oxana Palesh, Stanford Cancer Center, Stanford, CA; Ann M. O’Mara and Lori M. Minasian, National Cancer Institute (NCI), National Institutes of Health, Rockville, MD; Jodi Geer, Metro Minnesota NCI Community Oncology Research Program (NCORP), Saint Louis Park, MN; Shaker R. Dakhil, Wichita NCORP, Wichita, KS; and Judith O. Hopkins, Southeast Clinical Oncology Research Consortium NCORP, Winston-Salem, NC
| | - Tim A. Ahles
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Supriya G. Mohile, Karen M. Mustian, Annalynn M. Williams, Allison Magnuson, and Gary R. Morrow, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Oxana Palesh, Stanford Cancer Center, Stanford, CA; Ann M. O’Mara and Lori M. Minasian, National Cancer Institute (NCI), National Institutes of Health, Rockville, MD; Jodi Geer, Metro Minnesota NCI Community Oncology Research Program (NCORP), Saint Louis Park, MN; Shaker R. Dakhil, Wichita NCORP, Wichita, KS; and Judith O. Hopkins, Southeast Clinical Oncology Research Consortium NCORP, Winston-Salem, NC
| | - Supriya G. Mohile
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Supriya G. Mohile, Karen M. Mustian, Annalynn M. Williams, Allison Magnuson, and Gary R. Morrow, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Oxana Palesh, Stanford Cancer Center, Stanford, CA; Ann M. O’Mara and Lori M. Minasian, National Cancer Institute (NCI), National Institutes of Health, Rockville, MD; Jodi Geer, Metro Minnesota NCI Community Oncology Research Program (NCORP), Saint Louis Park, MN; Shaker R. Dakhil, Wichita NCORP, Wichita, KS; and Judith O. Hopkins, Southeast Clinical Oncology Research Consortium NCORP, Winston-Salem, NC
| | - Karen M. Mustian
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Supriya G. Mohile, Karen M. Mustian, Annalynn M. Williams, Allison Magnuson, and Gary R. Morrow, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Oxana Palesh, Stanford Cancer Center, Stanford, CA; Ann M. O’Mara and Lori M. Minasian, National Cancer Institute (NCI), National Institutes of Health, Rockville, MD; Jodi Geer, Metro Minnesota NCI Community Oncology Research Program (NCORP), Saint Louis Park, MN; Shaker R. Dakhil, Wichita NCORP, Wichita, KS; and Judith O. Hopkins, Southeast Clinical Oncology Research Consortium NCORP, Winston-Salem, NC
| | - Oxana Palesh
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Supriya G. Mohile, Karen M. Mustian, Annalynn M. Williams, Allison Magnuson, and Gary R. Morrow, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Oxana Palesh, Stanford Cancer Center, Stanford, CA; Ann M. O’Mara and Lori M. Minasian, National Cancer Institute (NCI), National Institutes of Health, Rockville, MD; Jodi Geer, Metro Minnesota NCI Community Oncology Research Program (NCORP), Saint Louis Park, MN; Shaker R. Dakhil, Wichita NCORP, Wichita, KS; and Judith O. Hopkins, Southeast Clinical Oncology Research Consortium NCORP, Winston-Salem, NC
| | - Ann M. O’Mara
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Supriya G. Mohile, Karen M. Mustian, Annalynn M. Williams, Allison Magnuson, and Gary R. Morrow, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Oxana Palesh, Stanford Cancer Center, Stanford, CA; Ann M. O’Mara and Lori M. Minasian, National Cancer Institute (NCI), National Institutes of Health, Rockville, MD; Jodi Geer, Metro Minnesota NCI Community Oncology Research Program (NCORP), Saint Louis Park, MN; Shaker R. Dakhil, Wichita NCORP, Wichita, KS; and Judith O. Hopkins, Southeast Clinical Oncology Research Consortium NCORP, Winston-Salem, NC
| | - Lori M. Minasian
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Supriya G. Mohile, Karen M. Mustian, Annalynn M. Williams, Allison Magnuson, and Gary R. Morrow, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Oxana Palesh, Stanford Cancer Center, Stanford, CA; Ann M. O’Mara and Lori M. Minasian, National Cancer Institute (NCI), National Institutes of Health, Rockville, MD; Jodi Geer, Metro Minnesota NCI Community Oncology Research Program (NCORP), Saint Louis Park, MN; Shaker R. Dakhil, Wichita NCORP, Wichita, KS; and Judith O. Hopkins, Southeast Clinical Oncology Research Consortium NCORP, Winston-Salem, NC
| | - Annalynn M. Williams
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Supriya G. Mohile, Karen M. Mustian, Annalynn M. Williams, Allison Magnuson, and Gary R. Morrow, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Oxana Palesh, Stanford Cancer Center, Stanford, CA; Ann M. O’Mara and Lori M. Minasian, National Cancer Institute (NCI), National Institutes of Health, Rockville, MD; Jodi Geer, Metro Minnesota NCI Community Oncology Research Program (NCORP), Saint Louis Park, MN; Shaker R. Dakhil, Wichita NCORP, Wichita, KS; and Judith O. Hopkins, Southeast Clinical Oncology Research Consortium NCORP, Winston-Salem, NC
| | - Allison Magnuson
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Supriya G. Mohile, Karen M. Mustian, Annalynn M. Williams, Allison Magnuson, and Gary R. Morrow, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Oxana Palesh, Stanford Cancer Center, Stanford, CA; Ann M. O’Mara and Lori M. Minasian, National Cancer Institute (NCI), National Institutes of Health, Rockville, MD; Jodi Geer, Metro Minnesota NCI Community Oncology Research Program (NCORP), Saint Louis Park, MN; Shaker R. Dakhil, Wichita NCORP, Wichita, KS; and Judith O. Hopkins, Southeast Clinical Oncology Research Consortium NCORP, Winston-Salem, NC
| | - Jodi Geer
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Supriya G. Mohile, Karen M. Mustian, Annalynn M. Williams, Allison Magnuson, and Gary R. Morrow, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Oxana Palesh, Stanford Cancer Center, Stanford, CA; Ann M. O’Mara and Lori M. Minasian, National Cancer Institute (NCI), National Institutes of Health, Rockville, MD; Jodi Geer, Metro Minnesota NCI Community Oncology Research Program (NCORP), Saint Louis Park, MN; Shaker R. Dakhil, Wichita NCORP, Wichita, KS; and Judith O. Hopkins, Southeast Clinical Oncology Research Consortium NCORP, Winston-Salem, NC
| | - Shaker R. Dakhil
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Supriya G. Mohile, Karen M. Mustian, Annalynn M. Williams, Allison Magnuson, and Gary R. Morrow, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Oxana Palesh, Stanford Cancer Center, Stanford, CA; Ann M. O’Mara and Lori M. Minasian, National Cancer Institute (NCI), National Institutes of Health, Rockville, MD; Jodi Geer, Metro Minnesota NCI Community Oncology Research Program (NCORP), Saint Louis Park, MN; Shaker R. Dakhil, Wichita NCORP, Wichita, KS; and Judith O. Hopkins, Southeast Clinical Oncology Research Consortium NCORP, Winston-Salem, NC
| | - Judith O. Hopkins
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Supriya G. Mohile, Karen M. Mustian, Annalynn M. Williams, Allison Magnuson, and Gary R. Morrow, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Oxana Palesh, Stanford Cancer Center, Stanford, CA; Ann M. O’Mara and Lori M. Minasian, National Cancer Institute (NCI), National Institutes of Health, Rockville, MD; Jodi Geer, Metro Minnesota NCI Community Oncology Research Program (NCORP), Saint Louis Park, MN; Shaker R. Dakhil, Wichita NCORP, Wichita, KS; and Judith O. Hopkins, Southeast Clinical Oncology Research Consortium NCORP, Winston-Salem, NC
| | - Gary R. Morrow
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Supriya G. Mohile, Karen M. Mustian, Annalynn M. Williams, Allison Magnuson, and Gary R. Morrow, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Oxana Palesh, Stanford Cancer Center, Stanford, CA; Ann M. O’Mara and Lori M. Minasian, National Cancer Institute (NCI), National Institutes of Health, Rockville, MD; Jodi Geer, Metro Minnesota NCI Community Oncology Research Program (NCORP), Saint Louis Park, MN; Shaker R. Dakhil, Wichita NCORP, Wichita, KS; and Judith O. Hopkins, Southeast Clinical Oncology Research Consortium NCORP, Winston-Salem, NC
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Merriman JD, Sereika SM, Conley YP, Koleck TA, Zhu Y, Phillips ML, Bertocci MA, Brufsky AM, Bender CM. Exploratory Study of Associations Between DNA Repair and Oxidative Stress Gene Polymorphisms and Cognitive Problems Reported by Postmenopausal Women With and Without Breast Cancer. Biol Res Nurs 2018; 21:50-60. [PMID: 30213196 DOI: 10.1177/1099800418799964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Women with breast cancer report varying frequencies of cognitive problems during adjuvant systemic therapy. This variability suggests latent subgroups. Therefore, we identified latent subgroups of self-reported cognitive problems among postmenopausal women with and without breast cancer. We explored associations between membership in these subgroups and (a) demographic, clinical, and symptom characteristics and (b) variations in candidate gene polymorphisms. METHODS We evaluated frequency of cognitive problems using the Patient Assessment of Own Functioning Inventory. Growth mixture modeling identified latent subgroups over 18 months of adjuvant systemic therapy and at matched time points for women without cancer ( N = 331). We evaluated for differences among subgroups in demographic, clinical, and symptom characteristics and in 41 single nucleotide polymorphisms in 10 candidate genes involved in DNA repair and oxidative stress pathways ( n = 199). We modeled associations between genotypes and subgroup membership using multinomial logistic regression. RESULTS We identified three latent subgroups: more frequent, persistent, and almost never. Receipt of chemotherapy plus anastrozole, depressive symptoms, and baseline neuropathic symptoms increased the odds of belonging to the more frequent subgroup. Anxiety and depressive symptoms increased the odds of belonging to the persistent subgroup. With covariates controlled for, carrying the ERCC5 rs873601 G minor allele increased the odds of reporting more frequent cognitive problems. CONCLUSIONS Chemotherapy plus anastrozole, depressive symptoms, and presence of neuropathic symptoms may predict more frequent cognitive problems during systemic therapy that later resolve. Mood dysregulation before therapy may predict persistent cognitive problems during therapy. ERCC5 genotype may influence frequency of cognitive problems after controlling for these risk factors.
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Affiliation(s)
- John D Merriman
- 1 New York University Meyers College of Nursing, New York, NY, USA
| | - Susan M Sereika
- 2 School of Nursing, University of Pittsburgh, Pittsburgh, USA.,3 Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yvette P Conley
- 2 School of Nursing, University of Pittsburgh, Pittsburgh, USA.,3 Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Yehui Zhu
- 2 School of Nursing, University of Pittsburgh, Pittsburgh, USA
| | - Mary L Phillips
- 5 School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Adam M Brufsky
- 5 School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,6 University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - Catherine M Bender
- 2 School of Nursing, University of Pittsburgh, Pittsburgh, USA.,6 University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
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284
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Stouten-Kemperman MM, de Ruiter MB, Boogerd W, Kerst JM, Kirschbaum C, Reneman L, Schagen SB. Brain Hyperconnectivity >10 Years After Cisplatin-Based Chemotherapy for Testicular Cancer. Brain Connect 2018; 8:398-406. [DOI: 10.1089/brain.2017.0569] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Myrle M. Stouten-Kemperman
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Michiel B. de Ruiter
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Willem Boogerd
- Department of Neuro-Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - J. Martijn Kerst
- Department of Medical Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Clemens Kirschbaum
- Department of Biological Psychology, Technische Universität Dresden, Dresden, Germany
| | - Liesbeth Reneman
- Department of Radiology and Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Sanne B. Schagen
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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285
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Long-term influence of adjuvant breast radiotherapy on cognitive function in breast cancer patients treated with conservation therapy. Int J Clin Oncol 2018; 24:68-77. [DOI: 10.1007/s10147-018-1330-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 08/01/2018] [Indexed: 12/22/2022]
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286
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Utne I, Løyland B, Grov EK, Rasmussen HL, Torstveit AH, Cooper BA, Mastick J, Mazor M, Wong M, Paul SM, Conley YP, Jahan T, Ritchie C, Levine JD, Miaskowski C. Distinct attentional function profiles in older adults receiving cancer chemotherapy. Eur J Oncol Nurs 2018; 36:32-39. [PMID: 30322507 DOI: 10.1016/j.ejon.2018.08.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/25/2018] [Accepted: 08/17/2018] [Indexed: 01/26/2023]
Abstract
PURPOSE While attentional function is an extremely important patient outcome for older adults, research on changes in function in this group is extremely limited. The purposes of this study were to: identify subgroups of older patients (i.e., latent growth classes) based on changes in their level of self-reported attentional function; determine which demographic and clinical characteristics were associated with subgroup membership; and determine if these subgroups differed on quality of life (QOL) outcomes. METHODS Older oncology outpatients (n = 365) who were assessed for changes in attention and working memory using the Attentional Function Index a total of six times over two cycles of chemotherapy (CTX). QOL was assessed using the Medical Outcomes Study-Short Form 12 and the QOL-Patient Version Scale. Latent profile analysis (LPA) was used to identify subgroups of older adults with distinct attentional function profiles. RESULTS Three distinct attentional functional profiles were identified (i.e., low, moderate, and high attentional function). Compared to the high class, older adults in the low and moderate attentional function classes had lower functional status scores, a worse comorbidity profile and were more likely to be diagnosed with depression. In addition, QOL scores followed an expected pattern (low class < moderate class < high attentional function class). CONCLUSIONS Three distinct attentional function profiles were identified among a relatively large sample of older adults undergoing CTX. The phenotypic characteristics associated with membership in the low and moderate latent classes can be used by clinicians to identify high risk patients.
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Affiliation(s)
- Inger Utne
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Borghild Løyland
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Ellen Karine Grov
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Hege Lund Rasmussen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Ann Helen Torstveit
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Bruce A Cooper
- Schools of Nursing, University of California, San Francisco, CA, USA
| | - Judy Mastick
- Schools of Nursing, University of California, San Francisco, CA, USA
| | - Melissa Mazor
- Schools of Nursing, University of California, San Francisco, CA, USA
| | - Melisa Wong
- Schools of Medicine, University of California, San Francisco, CA, USA
| | - Steven M Paul
- Schools of Nursing, University of California, San Francisco, CA, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Thierry Jahan
- Schools of Medicine, University of California, San Francisco, CA, USA
| | - Christine Ritchie
- Schools of Medicine, University of California, San Francisco, CA, USA
| | - Jon D Levine
- Schools of Medicine, University of California, San Francisco, CA, USA
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287
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Bail J, Nolan TS, Vo JB, Gisiger-Camata S, Meneses K. Engaging an Urban African American Community to Deliver Cognitive Health Education to Breast Cancer Survivors. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:870-874. [PMID: 28032260 DOI: 10.1007/s13187-016-1155-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Little is known about cognitive changes among African American (AA) breast cancer survivors (BCS). Here, we report our experience with engagement of leaders of urban AA churches in Birmingham, Alabama to deliver and evaluate Think Well: Healthy Living to Improve Cognitive Function, an educational cognitive health program for BCS. The Think Well team engaged leaders of urban AA churches using a 7-step process: 1) identify leaders, 2) develop connection with leaders, 3) assess AA community preferences, 4) tailor for cultural relevance, 5) plan seminars, 6) deliver seminars, and 7) evaluate cultural relevance and overall program quality. Program evaluation was via a 22-item survey and sociodemographic questionnaire. Data from AA participants were analyzed using SPSS. The engagement process resulted in sustained partnerships with three urban AA churches and delivery of three Think Well seminars to 172 participants. Of the 172 participants, 138 (80%) AA participants (40 BCS, 98 co-survivors) returned the program survey. Respondents reported Think Well to be culturally relevant (90%) and of high quality (94%). Think Well was developed and evaluated with the collaboration of urban AA church leaders. Engaging church leaders facilitated reach of AA BCS. Partnership facilitated a culturally relevant, high quality program for AA BCS and co-survivors.
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Affiliation(s)
- Jennifer Bail
- School of Nursing, University of Alabama at Birmingham, MT 504,1720 2nd Avenue South, Birmingham, AL, 35294-1210, USA.
| | - Timiya S Nolan
- School of Nursing, University of Alabama at Birmingham, MT 504,1720 2nd Avenue South, Birmingham, AL, 35294-1210, USA
| | - Jacqueline B Vo
- School of Nursing, University of Alabama at Birmingham, MT 504,1720 2nd Avenue South, Birmingham, AL, 35294-1210, USA
| | - Silvia Gisiger-Camata
- University of Alabama at Birmingham, MT 504G,1720 2nd Avenue South, Birmingham, AL, 35294-1210, USA
| | - Karen Meneses
- School of Nursing, University of Alabama at Birmingham, MT 502H1,1720 2nd Avenue South, Birmingham, AL, 35294-1210, USA
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288
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Jim HSL, Jennewein SL, Quinn GP, Reed DR, Small BJ. Cognition in Adolescent and Young Adults Diagnosed With Cancer: An Understudied Problem. J Clin Oncol 2018; 36:2752-2754. [PMID: 30040524 DOI: 10.1200/jco.2018.78.0627] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Heather S L Jim
- Heather S.L. Jim and Sarah L. Jennewein, Moffitt Cancer Center, Tampa, FL; Gwendolyn P. Quinn, New York University, New York, NY; Damon R. Reed, Moffitt Cancer Center, Tampa, FL; and Brent J. Small, University of South Florida, Tampa, FL
| | - Sarah L Jennewein
- Heather S.L. Jim and Sarah L. Jennewein, Moffitt Cancer Center, Tampa, FL; Gwendolyn P. Quinn, New York University, New York, NY; Damon R. Reed, Moffitt Cancer Center, Tampa, FL; and Brent J. Small, University of South Florida, Tampa, FL
| | - Gwendolyn P Quinn
- Heather S.L. Jim and Sarah L. Jennewein, Moffitt Cancer Center, Tampa, FL; Gwendolyn P. Quinn, New York University, New York, NY; Damon R. Reed, Moffitt Cancer Center, Tampa, FL; and Brent J. Small, University of South Florida, Tampa, FL
| | - Damon R Reed
- Heather S.L. Jim and Sarah L. Jennewein, Moffitt Cancer Center, Tampa, FL; Gwendolyn P. Quinn, New York University, New York, NY; Damon R. Reed, Moffitt Cancer Center, Tampa, FL; and Brent J. Small, University of South Florida, Tampa, FL
| | - Brent J Small
- Heather S.L. Jim and Sarah L. Jennewein, Moffitt Cancer Center, Tampa, FL; Gwendolyn P. Quinn, New York University, New York, NY; Damon R. Reed, Moffitt Cancer Center, Tampa, FL; and Brent J. Small, University of South Florida, Tampa, FL
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289
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Lange M, Joly F. How to Identify and Manage Cognitive Dysfunction After Breast Cancer Treatment. J Oncol Pract 2018; 13:784-790. [PMID: 29232539 DOI: 10.1200/jop.2017.026286] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Attention and memory dysfunction is a common complaint among patients with breast cancer that can be reported during and up to several years after treatment. It can negatively affect patients' quality of life and their ability to work. This phenomenon has mainly been studied in patients with breast cancer who are treated with adjuvant chemotherapy. Women describe concentration problems and difficulties with word finding, multitasking, or remembering new information, as well as more effort and time needed to accomplish these tasks. Such cognitive dysfunction is subtle or moderate and occurs in 15% to 25% of patients. Older patients seem more likely to experience cognitive decline with chemotherapy than do young women with breast cancer. Patients who report that cognitive dysfunction has affected their daily lives for 6 to 12 months after the end of chemotherapy or during hormone therapy may need referral to a neuropsychologist. During the cognitive assessment, the etiology of their cognitive complaints is sought and neuropsychological tests are administered to assess objective cognitive functioning. Psychological factors-fatigue and pain-should be assessed systematically with cognitive complaints to identify precisely the cause of the problems. A nonpharmacologic approach-mainly cognitive rehabilitation-seems to be the most promising for the management of these difficulties, but these preliminary results require confirmation. In the future, early detection of cognitive impairment and cognitive rehabilitation should be included in the portfolio of oncology supportive care to facilitate the return to work of young women and to avoid potential repercussions on adherence to oral treatments and on autonomy in older patients.
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Affiliation(s)
- Marie Lange
- Centre François Baclesse; Normandie University, UNICAEN, Institut National de la Santé et de la Recherche Médicale U1086, ANTICIPE; and Centre Hospitalier Universitaire de Caen, Caen, France
| | - Florence Joly
- Centre François Baclesse; Normandie University, UNICAEN, Institut National de la Santé et de la Recherche Médicale U1086, ANTICIPE; and Centre Hospitalier Universitaire de Caen, Caen, France
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290
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Apple AC, Schroeder MP, Ryals AJ, Wagner LI, Cella D, Shih PA, Reilly J, Penedo FJ, Voss JL, Wang L. Hippocampal functional connectivity is related to self-reported cognitive concerns in breast cancer patients undergoing adjuvant therapy. NEUROIMAGE-CLINICAL 2018; 20:110-118. [PMID: 30094161 PMCID: PMC6077172 DOI: 10.1016/j.nicl.2018.07.010] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 06/28/2018] [Accepted: 07/10/2018] [Indexed: 02/06/2023]
Abstract
Nearly three out of four survivors experience Cancer-Related Cognitive Impairment (CRCI) for months or years following treatment. Both clinical and animal studies point to the hippocampus as a likely brain region affected in CRCI, however no previous study has investigated the functional connectivity of the hippocampus in CRCI. We compared hippocampal connectivity in cancer survivors and healthy controls and tested the relationship between functional connectivity differences and measures of objective and subjective cognition. Exploratory analysis of inflammatory markers was conducted in a small subset of participants as well. FMRI data were acquired during a memory task from 16 breast cancer survivors and 17 controls. The NIH Toolbox was used to assess cognitive performance and Neuro-QoL was used to measure self-reported cognitive concerns. Whole-brain group-level comparisons identified clusters with different connectivity to the hippocampus in survivors versus controls during task. Average connectivity was extracted from clusters of significant difference between the groups and correlated with cognitive performance and subjective report. Survivors performed worse on a test of episodic memory and reported greater cognitive concern than controls. Exploratory analysis found higher IL6 in cancer survivors compared to controls. Cancer survivors demonstrated higher connectivity of hippocampus with left cuneus, left lingual, left precuneus, and right middle prefrontal gyrus compared with controls. In survivors, higher task-related hippocampal-cortical connectivity was related to worse subjective measures of cognitive concern. Of the four significant clusters, higher connectivity of the precuneus with hippocampus was significantly associated with worse cognitive concern in survivors. The observed greater hippocampal-cortical connectivity in survivors compared to controls is the first reported fMRI biomarker of subjective concern, and may represent a compensatory response to cancer and its treatments. This compensation could explain, in part, the subjective feelings of cognitive impairment that were reported by survivors. Cancer survivors performed worse on a test of episodic memory and reported greater cognitive concern than controls Cancer survivors demonstrated significantly higher hippocampal-cortical connectivity Higher functional connectivity was associated with worse self-reported cognitive functioning in cancer survivors
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Affiliation(s)
- Alexandra C Apple
- Division of Clinical Psychology, Northwestern University Feinberg School of Medicine, United States; Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, United States.
| | - Matthew P Schroeder
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, United States
| | - Anthony J Ryals
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, United States
| | - Lynne I Wagner
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, United States
| | - David Cella
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, United States; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, United States; Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, United States
| | - Pei-An Shih
- Department of Psychiatry, University of California, San Diego, United States
| | - James Reilly
- Division of Clinical Psychology, Northwestern University Feinberg School of Medicine, United States; Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, United States
| | - Frank J Penedo
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, United States
| | - Joel L Voss
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, United States; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, United States; Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, United States
| | - Lei Wang
- Division of Clinical Psychology, Northwestern University Feinberg School of Medicine, United States; Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, United States; Department of Radiology, Northwestern University Feinberg School of Medicine, United States
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291
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Brain structure and function in patients with ovarian cancer treated with first-line chemotherapy: a pilot study. Brain Imaging Behav 2018; 11:1652-1663. [PMID: 27766586 DOI: 10.1007/s11682-016-9608-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Women with ovarian cancer often undergo chemotherapy involving multiple agents. However, little is known about treatment-related central neurotoxicity in this population. The goal of this cross-sectional study was to assess brain structure and function and neurocognitive abilities in patients with ovarian cancer following first-line chemotherapy. Eighteen patients with ovarian, peritoneal and fallopian tube cancer and eighteen healthy controls matched for gender, age and education participated in the study. The patients were evaluated 1-4 months following completion of first-line taxane/platinum chemotherapy. All participants underwent structural and functional magnetic resonance imaging (MRI), and completed neuropsychological tests of attention, memory and executive functions. Neuroimaging assessments included voxel-based morphometry (VBM) for measuring gray matter (GM) volume, and functional MRI (fMRI) during the N-back working memory task. The results of VBM showed that patients had significantly reduced GM volume compared to healthy controls in the right middle/superior frontal gyrus, and in the left supramarginal gyrus and left inferior parietal lobule. fMRI results indicated significantly decreased activation in patients relative to healthy controls in the left middle frontal gyrus and left inferior parietal lobule during the N-back task (1/2/3-back >0-back). There were no statistically significant differences between the two groups on the neuropsychological tests. This is the first study showing structural and functional alterations involving frontal and parietal regions in patients with ovarian cancer treated with first-line chemotherapy. These findings are congruent with studies involving women with breast cancer, and provide additional supporting evidence for central neurotoxicity associated with taxane/platinum chemotherapy.
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292
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Ehlers DK, Fanning J, Salerno EA, Aguiñaga S, Cosman J, Severson J, Kramer AF, McAuley E. Replacing sedentary time with physical activity or sleep: effects on cancer-related cognitive impairment in breast cancer survivors. BMC Cancer 2018; 18:685. [PMID: 29940894 PMCID: PMC6019533 DOI: 10.1186/s12885-018-4603-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 06/18/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Evidence suggests reallocating daily sedentary time to physical activity or sleep confers important health benefits in cancer survivors. Despite emerging research suggesting physical activity as a treatment for cancer-related cognitive impairment (CRCI), little is known about the interactive effects of behaviors across the 24-h period. The present purpose was to examine the cognitive effects of reallocating sedentary time to light-intensity physical activity, moderate-to-vigorous physical activity (MVPA), or sleep in breast cancer survivors. METHODS Breast cancer survivors (N = 271, Mage = 57.81 ± 9.50 years) completed iPad-based questionnaires and cognitive tasks assessing demographics, health history, executive function, and processing speed (Task-Switch, Trail Making). Participants wore an accelerometer for seven consecutive days to measure their sedentary, physical activity, and sleep behaviors. Single effects (each behavior individually) and partition (controlling for other behaviors) models were used to examine associations among behaviors and cognitive performance. Isotemporal substitution models were used to test the cognitive effects of substituting 30 min of sedentary time with 30 min of light-intensity activity, MVPA, and sleep. RESULTS MVPA was associated with faster Task-switch reaction time in the partition models (stay: B = - 35.31, p = 0.02; switch: B = - 48.24, p = 0.004). Replacing 30 min of sedentary time with 30 min of MVPA yielded faster reaction times on Task-Switch stay (B = - 29.37, p = 0.04) and switch (B = - 39.49, p = 0.02) trials. In Trails A single effects models, sedentary behavior was associated with faster completion (B = - 0.97, p = 0.03) and light-intensity activity with slower completion (B = 1.25, p = 0.006). No single effects were observed relative to Trails B completion (all p > 0.05). Only the effect of MVPA was significant in the partition models (Trails A: B = - 3.55, p = 0.03; Trails B: B = - 4.46, p = 0.049). Replacing sedentary time with light-intensity activity was associated with slower Trails A (B = 1.55 p = 0.002) and Trails B (B = 1.69, p = 0.02) completion. Replacing light activity with MVPA yielded faster Trails A (B = - 4.35, p = 0.02) and Trails B (B = - 5.23, p = 0.03) completion. CONCLUSIONS Findings support previous research suggesting MVPA may be needed to improve cognitive function in breast cancer survivors. Trails findings underscore the need to dissect sedentary contexts to better understand the impact of daily behavioral patterns on CRCI. Additional research investigating the cognitive impacts of behaviors across the 24-h period is warranted. TRIAL REGISTRATION This study is registered with United States ClinicalTrials.gov ( NCT02523677 ; 8/14/2015).
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Affiliation(s)
| | - Jason Fanning
- Wake Forest School of Medicine, Winston-Salem, NC USA
| | | | - Susan Aguiñaga
- University of Illinois at Urbana-Champaign, Urbana, IL USA
| | | | | | - Arthur F. Kramer
- University of Illinois at Urbana-Champaign, Urbana, IL USA
- Northeastern University, Boston, MA USA
| | - Edward McAuley
- University of Illinois at Urbana-Champaign, Urbana, IL USA
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293
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Santos JC, Pyter LM. Neuroimmunology of Behavioral Comorbidities Associated With Cancer and Cancer Treatments. Front Immunol 2018; 9:1195. [PMID: 29930550 PMCID: PMC6001368 DOI: 10.3389/fimmu.2018.01195] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 05/14/2018] [Indexed: 12/27/2022] Open
Abstract
Behavioral comorbidities (depression, anxiety, fatigue, cognitive disturbances, and neuropathic pain) are prevalent in cancer patients and survivors. These mental and neurological health issues reduce quality-of-life, which is a significant societal concern given the increasing rates of long-term survival after various cancers. Hypothesized causes of behavioral comorbidities with cancer include tumor biology, stress associated with the cancer experience, and cancer treatments. A relatively recent leading mechanism by which these causes contribute to changes in neurobiology that underlie behavior is inflammation. Indeed, both basic and clinical research indicates that peripheral inflammation leads to central inflammation and behavioral changes in other illness contexts. Given the limitations of assessing neuroimmunology in clinical populations, this review primarily synthesizes evidence of neuroimmune and neuroinflammatory changes due to two components of cancer (tumor biology and cancer treatments) that are associated with altered affective-like or cognitive behaviors in rodents. Specifically, alterations in microglia, neuroinflammation, and immune trafficking to the brain are compiled in models of tumors, chemotherapy, and/or radiation. Evidence-based neuronal mechanisms by which these neuroimmune changes may lead to changes in behavior are proposed. Finally, converging evidence in clinical cancer populations is discussed.
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Affiliation(s)
- Jessica C Santos
- Department of Basic and Applied Immunology, School of Medicine of Ribeirao Preto, University of Sao Paulo, Sao Paulo, Brazil
| | - Leah M Pyter
- Departments of Psychiatry and Behavioral Health and Neuroscience, The Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus, OH, United States
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294
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Yang L, Koyanagi A, Smith L, Hu L, Colditz GA, Toriola AT, López Sánchez GF, Vancampfort D, Hamer M, Stubbs B, Waldhör T. Hand grip strength and cognitive function among elderly cancer survivors. PLoS One 2018; 13:e0197909. [PMID: 29864112 PMCID: PMC5986134 DOI: 10.1371/journal.pone.0197909] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 05/10/2018] [Indexed: 11/18/2022] Open
Abstract
Background We evaluated the associations of handgrip strength and cognitive function in cancer survivors ≥ 60 years old using data from the National Health and Nutrition Examination Survey (NHANES). Methods Data in two waves of NHANES (2011–2014) were aggregated. Handgrip strength in kilogram (kg) was defined as the maximum value achieved using either hand. Two cognitive function tests were conducted among adults 60 years and older. The Animal Fluency Test (AFT) examines categorical verbal fluency (a component of executive function), and the Digital Symbol Substitution test (DSST) assesses processing speed, sustained attention, and working memory. Survey analysis procedures were used to account for the complex sampling design of the NHANES. Multiple linear regression models were used to estimate associations of handgrip strength with cognitive test scores, adjusting for confounders (age, gender, race/ethnicity, education, marital status, smoking status, depressive symptoms and leisure time physical activity). Results Among 383 cancer survivors (58.5% women, mean age = 70.9 years, mean BMI = 29.3 kg/m2), prevalent cancer types were breast (22.9%), prostate (16.4%), colon (6.9%) and cervix (6.2%). In women, each increase in kg of handgrip strength was associated with 0.20 (95% CI: 0.08 to 0.33) higher score on AFT and 0.83 (95% CI: 0.30 to 1.35) higher score on DSST. In men, we observed an inverted U-shape association where cognitive function peaked at handgrip strength of 40–42 kg. Conclusions Handgrip strength, a modifiable factor, appears to be associated with aspects of cognitive functions in cancer survivors. Prospective studies are needed to address their causal relationship.
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Affiliation(s)
- Lin Yang
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona,Fundació Sant Joan de Déu, Dr. Antoni Pujadas, Sant Boi de Llobregat, Barcelona, Spain.,Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Lee Smith
- The Cambridge Centre for Sports & Exercise Sciences, Anglia Ruskin University, Cambridge, United Kingdom
| | - Liang Hu
- Department of Sport Science, Zhejiang University, Hangzhou, China
| | - Graham A Colditz
- Division of Public Health Sciences, Washington University School of Medicine, St. Louis, United States of America
| | - Adetunji T Toriola
- Division of Public Health Sciences, Washington University School of Medicine, St. Louis, United States of America
| | | | - Davy Vancampfort
- University Psychiatric Centre Catholic University Leuven, Kortenberg, Belgium
| | - Mark Hamer
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, United Kingdom.,Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Thomas Waldhör
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria
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295
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Chemotherapy and cognition: International cognition and cancer task force recommendations for harmonising preclinical research. Cancer Treat Rev 2018; 69:72-83. [PMID: 29909223 DOI: 10.1016/j.ctrv.2018.05.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 05/30/2018] [Accepted: 05/31/2018] [Indexed: 12/22/2022]
Abstract
Cancer survivors who undergo chemotherapy for non-CNS tumours often report substantial cognitive disturbances that adversely affect quality of life, during and after treatment. The neurotoxic effects of anti-cancer drugs have been confirmed in clinical and pre-clinical research. Work with animals has also identified a range of factors and underlying mechanisms that contribute to chemotherapy-induced cognitive impairment. However, there is a continuing need to develop standard cognitive testing procedures for validation and comparison purposes, broaden the search for biological and neurochemical mechanisms, and develop improved animal models for investigating the combined effects of treatment, the disease, and other potential factors (e.g., age, stress). In this paper, a working group, formed under the auspices of the International Cognition and Cancer Task Force, reviews the state of pre-clinical research, formulates strategic priorities, and provides recommendations to guide animal research that meaningfully informs clinical investigations.
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296
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Henneghan AM, Carter P, Stuifbergan A, Parmelee B, Kesler S. Relationships between self-reported sleep quality components and cognitive functioning in breast cancer survivors up to 10 years following chemotherapy. Psychooncology 2018; 27:1937-1943. [PMID: 29683228 DOI: 10.1002/pon.4745] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 03/22/2018] [Accepted: 04/16/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Links have been made between aspects of sleep quality and cognitive function in breast cancer survivors (BCS), but findings are heterogeneous. The objective of this study is to examine relationships between specific sleep quality components (latency, duration, efficiency, daytime sleepiness, sleep disturbance, use of sleep aids) and cognitive impairment (performance and perceived), and determine which sleep quality components are the most significant contributors to cognitive impairments in BCS 6 months to 10 years post chemotherapy. METHODS Women 21 to 65 years old with a history of non-metastatic breast cancer following chemotherapy completion were recruited. Data collection included surveys to evaluate sleep quality and perceived cognitive impairments, and neuropsychological testing to evaluate verbal fluency and memory. Descriptive statistics, bivariate correlations, and hierarchical multiple regression were calculated. RESULTS Ninety women (mean age 49) completed data collection. Moderate significant correlations were found between daytime dysfunction, sleep efficiency, sleep latency, and sleep disturbance and perceived cognitive impairment (Rs = -0.37 to -0.49, Ps < .00049), but not objective cognitive performance of verbal fluency, memory, or attention. After accounting for individual and clinical characteristics, the strongest predictors of perceived cognitive impairments were daytime dysfunction, sleep efficiency, and sleep disturbance. CONCLUSIONS Findings support links between sleep quality and perceived cognitive impairments in BCS and suggest specific components of sleep quality (daytime dysfunction, sleep efficiency, and sleep disturbance) are associated with perceived cognitive functioning in this population. Findings can assist clinicians in guiding survivors to manage sleep and cognitive problems and aid in the design of interventional research.
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Affiliation(s)
- Ashley M Henneghan
- School of Nursing, University of Texas at Austin, Austin, TX, USA.,University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Patricia Carter
- School of Nursing, University of Texas at Austin, Austin, TX, USA
| | | | - Brennan Parmelee
- School of Nursing, University of Texas Health Science Center Houston, Houston, TX, USA
| | - Shelli Kesler
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
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297
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Hardy SJ, Krull KR, Wefel JS, Janelsins M. Cognitive Changes in Cancer Survivors. Am Soc Clin Oncol Educ Book 2018; 38:795-806. [PMID: 30231372 DOI: 10.1200/edbk_201179] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Advances in cancer treatments have led to substantially improved survival for patients with cancer. However, many patients experience changes in cognition as a side effect of both cancer and cancer treatment. This occurs with both central nervous system (CNS) tumors and non-CNS tumors and in both children and adults. Studies of patients with non-CNS cancer have shown that cancer-related cognitive impairment (CRCI), which can include changes in memory, executive function, attention, and processing speed, occurs in up to 30% of patients prior to any treatment and in up to 75% of patients during treatment. A subset of patients with non-CNS and CNS cancer appear to be at higher risk for CRCI, so much research has gone into identifying who is vulnerable. Risk factors for CRCI in adults include cognitive reserve, age, genetic factors, and ethnicity; risk factors for children include genetic factors, female sex, younger age at diagnosis, chemotherapy dose, and both dose and field size for radiation. Although the field has made substantial strides in understanding and treating CRCI, more research is still needed to improve outcomes for both pediatric and adult cancer survivors.
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Affiliation(s)
- Sara J Hardy
- From the University of Rochester Medical Center, Rochester, NY; St. Jude Children's Research Hospital, Memphis, TN; The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kevin R Krull
- From the University of Rochester Medical Center, Rochester, NY; St. Jude Children's Research Hospital, Memphis, TN; The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jeffrey S Wefel
- From the University of Rochester Medical Center, Rochester, NY; St. Jude Children's Research Hospital, Memphis, TN; The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michelle Janelsins
- From the University of Rochester Medical Center, Rochester, NY; St. Jude Children's Research Hospital, Memphis, TN; The University of Texas MD Anderson Cancer Center, Houston, TX
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298
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Huang Z, Shi Y, Bao P, Cai H, Hong Z, Ding D, Jackson J, Shu XO, Dai Q. Associations of dietary intake and supplement use with post-therapy cognitive recovery in breast cancer survivors. Breast Cancer Res Treat 2018; 171:189-198. [PMID: 29744676 DOI: 10.1007/s10549-018-4805-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 04/28/2018] [Indexed: 12/28/2022]
Abstract
PURPOSE Cognitive impairment induced by cancer therapy is common and can be long lasting after completion of therapy. Little is known on factors that influence recovery from the impairment. We evaluated the associations of dietary intake and supplement use with post-therapy cognitive recovery in a large cohort of breast cancer survivors. METHODS This study included 1047 breast cancer patients aged 20-75 who were recruited to the Shanghai Breast Cancer Survival Study between 2002 and 2006 at approximately 6.5 months post-cancer diagnosis. Two cognitive assessments covering immediate memory, delayed memory, verbal fluency, and attention, were conducted at 18 and 36 months post-diagnosis. We used food frequency questionnaire to collect information on their dietary intake and supplement use between 18 and 36 months post-diagnosis. Linear regression models were used to examine the associations of dietary intake and supplement use with mean cognitive scores at 36 months post-diagnosis and with differences in cognitive scores between 18 and 36 months post-diagnosis. RESULTS Higher vegetable, fruit and fish intake, supplementation with vitamin B and vitamin E, and tea drinking were associated with higher cognitive scores, while alcohol drinking was associated with lower cognitive scores at 36 months post-diagnosis. Vegetable intake was positively associated with improvement in verbal fluency, while tea drinking and fish oil supplementation were associated with greater improvements in delayed memory between 18 and 36 months post-diagnosis. CONCLUSIONS Our results indicate that higher vegetable intake, tea drinking, and fish oil supplementation may help post-therapy cognitive recovery for cancer patients.
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Affiliation(s)
- Zhezhou Huang
- Division of Non-communicable Disease and Injury, Shanghai Municipal Center for Disease Control and Prevention, 1380 Zhongshan West Road, 200336, Shanghai, China
| | - Yan Shi
- Division of Non-communicable Disease and Injury, Shanghai Municipal Center for Disease Control and Prevention, 1380 Zhongshan West Road, 200336, Shanghai, China.
| | - Pingping Bao
- Division of Non-communicable Disease and Injury, Shanghai Municipal Center for Disease Control and Prevention, 1380 Zhongshan West Road, 200336, Shanghai, China
| | - Hui Cai
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, 37203-1738, USA
| | - Zhen Hong
- Department of Neurology, Huashan Hospital, Fudan University, 200040, Shanghai, China
| | - Ding Ding
- Department of Neurology, Huashan Hospital, Fudan University, 200040, Shanghai, China
| | - James Jackson
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, 37203-1738, USA
| | - Xiao-Ou Shu
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, 37203-1738, USA
| | - Qi Dai
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, 37203-1738, USA
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299
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Abstract
As the population of cancer survivors has grown into the millions, there has been increasing emphasis on understanding how the late effects of treatment affect survivors' ability to return to work/school, their capacity to function and live independently, and their overall quality of life. This review focuses on cognitive change associated with cancer and cancer treatments. Research in this area has progressed from a pharmacotoxicology perspective to a view of the cognitive change as a complex interaction of aspects of the treatment, vulnerability factors that increase risk for posttreatment cognitive decline, cancer biology, and the biology of aging. Methodological advances include the development of (a) measurement approaches that assess more fine-grained subcomponents of cognition based on cognitive neuroscience and (b) advanced statistical approaches. Conceptual issues that arise from this multidimensional perspective are described in relation to future directions, understanding of mechanisms, and development of innovative interventions.
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Affiliation(s)
- Tim A Ahles
- Neurocognitive Research Lab, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA; ,
| | - James C Root
- Neurocognitive Research Lab, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA; ,
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300
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Kovalchuk A, Ilnytskyy Y, Rodriguez-Juarez R, Shpyleva S, Melnyk S, Pogribny I, Katz A, Sidransky D, Kovalchuk O, Kolb B. Chemo brain or tumor brain - that is the question: the presence of extracranial tumors profoundly affects molecular processes in the prefrontal cortex of TumorGraft mice. Aging (Albany NY) 2018; 9:1660-1676. [PMID: 28758896 PMCID: PMC5559168 DOI: 10.18632/aging.101243] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 05/22/2017] [Indexed: 01/17/2023]
Abstract
Cancer chemotherapy causes numerous persistent central nervous system complications. This condition is known as chemo brain. Cognitive impairments occur even before treatment, and hence are referred to as cancer associated cognitive changes, or tumor brain. There is much yet to be learned about the mechanisms of both chemo brain and tumor brain. The frequency and timing of chemo brain and tumor brain occurrence and persistence strongly suggest they may be epigenetic in nature and associated with altered gene expression. Here we used TumorGraftTM models wherein part of a patient's tumor is removed and grafted into immune-deficient mice and conducted global gene expression and DNA methylation analysis. We show that malignant non-central nervous system tumor growth causes profound molecular alterations in the brain. Mice harbouring triple negative or progesterone positive breast cancer TumorGrafts exhibited altered gene expression, decreased levels of DNA methylation, increased levels of DNA hydroxymethylation, and oxidative stress in the prefrontal cortex. Interestingly, chemotherapy did not have any additional synergistic effects on the analyzed processes. The molecular changes observed in this study are known signs of neurodegeneration and brain aging. This study provides an important roadmap for future large-scale analysis of the molecular and cellular mechanisms of tumor brain.
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Affiliation(s)
- Anna Kovalchuk
- Department of Neuroscience, University of Lethbridge, Lethbridge, AB T1K 6T5, Canada.,Leaders in Medicine Program, Cumming School of Medicine, University of Calgary, Calgary, T2N 1N4, Canada
| | - Yaroslav Ilnytskyy
- Department of Biological Sciences, University of Lethbridge, Lethbridge, AB T1K 6T5, Canada
| | - Rocio Rodriguez-Juarez
- Department of Biological Sciences, University of Lethbridge, Lethbridge, AB T1K 6T5, Canada
| | - Svitlana Shpyleva
- Division of Biochemical Toxicology, National Center for Toxicological Research, FDA, Jefferson, AR 72079, USA.,Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Stepan Melnyk
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Igor Pogribny
- Division of Biochemical Toxicology, National Center for Toxicological Research, FDA, Jefferson, AR 72079, USA
| | - Amanda Katz
- Department of Oncology, Champions Oncology, Baltimore, MD 21205, USA
| | - David Sidransky
- Department of Oncology, Champions Oncology, Baltimore, MD 21205, USA
| | - Olga Kovalchuk
- Department of Biological Sciences, University of Lethbridge, Lethbridge, AB T1K 6T5, Canada
| | - Bryan Kolb
- Department of Neuroscience, University of Lethbridge, Lethbridge, AB T1K 6T5, Canada
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