301
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Pan K, Hurria A, Chlebowski RT. Breast cancer survivorship: state of the science. Breast Cancer Res Treat 2018; 168:593-600. [PMID: 29332134 DOI: 10.1007/s10549-017-4650-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 12/26/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE Only recently has breast cancer survivorship earned formal recognition as a research discipline. Complicating survivorship research is the frequent overlap between aging and treatment sequelae. The ACS/ASCO 2016 Breast Cancer Survivorship Care Guideline (Guideline) reflects comprehensive literature review through April 2015, while the jointly sponsored, inaugural Cancer Survivorship Symposium in 2016 (Symposium) reflects ongoing research activity in the area. Together, these platforms provide an opportunity to examine the use of randomized trials and controlled studies in survivorship care research. METHODS All 236 citations from the Guideline and all 250 abstracts from the Symposium were reviewed independently by two authors and assigned to prospectively determined categories. RESULTS Guideline citations were most frequently reviews (n = 88, 37.3%) and non-randomized, non-controlled studies (n = 51, 21.6%). Thirty-seven (15.7%) randomized trials were cited. Only 9% of Guideline recommendations were based on randomized clinical trial evidence, while 64% were based on evidence level "0" (expert opinion, clinical practice, etc.). Symposium abstracts consisted largely of non-randomized, non-controlled studies (n = 113, 45.2%), with ten completed randomized trials (4%). Few Guideline citations or Symposium abstracts incorporated matched, cancer-free controls. CONCLUSIONS Based on the literature underlying the ASCO Guideline as well as a survey of the Cancer Survivorship Symposium abstracts, a significant proportion of the survivorship literature at least through 2015 consisted of non-randomized, non-controlled studies. To optimally address survivorship issues, cancer therapy sequelae need to be distinguished from normal aging in studies incorporating cancer-free controls, and randomized clinical trials are needed to inform intervention strategies.
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Affiliation(s)
- Kathy Pan
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, 1124 W. Carson St., N16, Torrance, CA, 90502, USA.
| | - Arti Hurria
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, CA, USA
| | - Rowan T Chlebowski
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, CA, USA
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302
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Kurita K, Reid MC, Siegler EL, Diamond EL, Prigerson HG. Associations between Mild Cognitive Dysfunction and End-of-Life Outcomes in Patients with Advanced Cancer. J Palliat Med 2018; 21:536-540. [PMID: 29298104 DOI: 10.1089/jpm.2017.0385] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Cognitive function of patients with advanced cancer is frequently compromised. OBJECTIVE To determine the extent that patients' cognitive screening scores was associated with their end-of-life (EoL) treatment preferences, advance care planning (ACP), and care. DESIGN Patients were interviewed at baseline and administered a cognitive screen. Caregivers completed a postmortem assessment. SETTING/SUBJECTS Patients with distant metastases and disease progression after first-line chemotherapy and their caregivers (n = 609) were recruited from outpatient clinics and completed baseline and postmortem assessments. MEASUREMENTS In logistic regression models adjusting for patients' age, education level, and performance status, patients' scores on the Pfeiffer Short Portable Mental Status exam at baseline predicted ACP, treatments, and treatment preferences at baseline, and location of death and caregiver perceptions of the patients' death in a postmortem assessment. RESULTS For each additional error, patients were less likely to consider the intensive care unit a bad place to die (adjusted odds ratio [AOR] = 0.81; confidence interval [95% CI]: 0.66-0.98; p = 0.03) and less likely to have an inpatient hospice stay (AOR = 0.63; 95% CI: 0.40-1.00; p = 0.05). After death (n = 318), caregivers were more likely to perceive that patients died at patients' preferred location (AOR = 1.38; 95% CI: 1.01-1.88; p = 0.04) and less likely to perceive that patients preferred to extend life over relieving discomfort (AOR = 0.63; 95% CI: 0.40-0.99; p = 0.05). CONCLUSIONS Patient cognitive screening scores were associated with EoL outcomes. Rather than avoid patients who are cognitively impaired, oncologists should consider ACP with them.
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Affiliation(s)
- Keiko Kurita
- 1 Center for Research on End-of-Life Care , Weill Cornell Medicine, New York, New York.,2 Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medicine , New York, New York
| | - M Cary Reid
- 2 Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medicine , New York, New York
| | - Eugenia L Siegler
- 2 Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medicine , New York, New York
| | - Eli L Diamond
- 3 Department of Neurology, Memorial Sloan Kettering Cancer Center , New York, New York
| | - Holly G Prigerson
- 1 Center for Research on End-of-Life Care , Weill Cornell Medicine, New York, New York.,2 Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medicine , New York, New York
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303
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Hartman SJ, Nelson SH, Myers E, Natarajan L, Sears DD, Palmer BW, Weiner LS, Parker BA, Patterson RE. Randomized controlled trial of increasing physical activity on objectively measured and self-reported cognitive functioning among breast cancer survivors: The memory & motion study. Cancer 2018; 124:192-202. [PMID: 28926676 PMCID: PMC5735009 DOI: 10.1002/cncr.30987] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 07/17/2017] [Accepted: 08/16/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Increasing physical activity can improve cognition in healthy and cognitively impaired adults; however, the benefits for cancer survivors are unknown. The current study examined a 12-week physical activity intervention, compared with a control condition, on objective and self-reported cognition among breast cancer survivors. METHODS Sedentary breast cancer survivors were randomized to an exercise arm (n = 43) or a control arm (n = 44). At baseline and at 12 weeks, objective cognition was measured with the National Institutes of Health Cognitive Toolbox, and self-reported cognition using the Patient-Reported Outcomes Measurement Information System scales. Linear mixed-effects regression models tested intervention effects for changes in cognition scores. RESULTS On average, participants (n = 87) were aged 57 years (standard deviation, 10.4 years) and were 2.5 years (standard deviation, 1.3 years) post surgery. Scores on the Oral Symbol Digit subscale (a measure of processing speed) evidenced differential improvement in the exercise arm versus the control arm (b = 2.01; P < .05). The between-group differences in improvement on self-reported cognition were not statistically significant but were suggestive of potential group differences. Time since surgery moderated the correlation, and participants who were ≤2 years post surgery had a significantly greater improvement in Oral Symbol Digit score (exercise vs control (b = 4.00; P < .01), but no significant improvement was observed in patients who were >2 years postsurgery (b = -1.19; P = .40). A significant dose response was observed with greater increased physical activity associated with objective and self-reported cognition in the exercise arm. CONCLUSIONS The exercise intervention significantly improved processing speed, but only among those who had been diagnosed with breast cancer within the past 2 years. Slowed processing speed can have substantial implications for independent functioning, supporting the potential importance of early implementation of an exercise intervention among patients with breast cancer. Cancer 2018;124:192-202. © 2017 American Cancer Society.
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Affiliation(s)
- Sheri J. Hartman
- Department of Family Medicine and Public Health, UC San Diego, La Jolla, CA, USA
- UC San Diego Moores Cancer Center, UC San Diego, La Jolla, CA, USA
| | - Sandahl H. Nelson
- Department of Family Medicine and Public Health, UC San Diego, La Jolla, CA, USA
- UC San Diego Moores Cancer Center, UC San Diego, La Jolla, CA, USA
| | - Emily Myers
- UC San Diego Moores Cancer Center, UC San Diego, La Jolla, CA, USA
| | - Loki Natarajan
- Department of Family Medicine and Public Health, UC San Diego, La Jolla, CA, USA
- UC San Diego Moores Cancer Center, UC San Diego, La Jolla, CA, USA
| | - Dorothy D. Sears
- Department of Family Medicine and Public Health, UC San Diego, La Jolla, CA, USA
- UC San Diego Moores Cancer Center, UC San Diego, La Jolla, CA, USA
- Department of Medicine, UC San Diego, La Jolla, CA, USA
| | - Barton W. Palmer
- Department of Psychiatry, UC San Diego, La Jolla, CA, USA
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Lauren S. Weiner
- Department of Family Medicine and Public Health, UC San Diego, La Jolla, CA, USA
- UC San Diego Moores Cancer Center, UC San Diego, La Jolla, CA, USA
| | - Barbara A. Parker
- UC San Diego Moores Cancer Center, UC San Diego, La Jolla, CA, USA
- Department of Medicine, UC San Diego, La Jolla, CA, USA
| | - Ruth E. Patterson
- Department of Family Medicine and Public Health, UC San Diego, La Jolla, CA, USA
- UC San Diego Moores Cancer Center, UC San Diego, La Jolla, CA, USA
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304
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Yang Y, Hendrix CC. Cancer-Related Cognitive Impairment in Breast Cancer Patients: Influences of Psychological Variables. Asia Pac J Oncol Nurs 2018; 5:296-306. [PMID: 29963592 PMCID: PMC5996591 DOI: 10.4103/apjon.apjon_16_18] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Approximately 3.1 million women in the US are living with breast cancer and up to 75% of these women experience cancer-related cognitive impairment (CRCI). CRCI is described as impairments in memory, verbal fluency, thought processes, and attention span. Despite the high prevalence of breast cancer, only a few studies have been published on CRCI and most of these studies primarily focused on its pathophysiological mechanism. However, recent evidence has demonstrated that breast cancer patients with CRCI are more likely to have high level of psychologic distress, suggesting a possible relationship between CRCI and psychologic distress. This review aims to examine existing literature that describes CRCI in relation to psychological distress among breast cancer patients. One thousand four hundred and ninety-eight articles were searched using PubMed, CINAHL, and PsycINFO. Thirteen studies met inclusion criteria, and one article was additionally pulled from article reference lists. Of these19 studies, psychologic distress has been operationalized in varied ways such as anxiety (n = 3), depression (n = 2), both anxiety and depression (n = 4), stress (n = 4), worry (n = 2), mental fatigue (n = 1), and undefined psychological distress (n = 2). Except for six studies designed as a longitudinal study, the rest of studies used a cross-sectional design. Twelve studies used both subjective and objective measures to assess cognitive function. We found that the patients with high psychological distress displayed lower performance on cognitive function tests. Our finding indicates that psychological variables contributed to CRCI that breast cancer patients experienced. Areas for further investigation are proposed that will advance the care of breast cancer patients with CRCI.
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Affiliation(s)
- Yesol Yang
- Division of Health Systems and Analytics, School of Nursing, Duke University, Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Cristina C Hendrix
- Division of Health Systems and Analytics, School of Nursing, Duke University, Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, NC, USA
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305
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Ringash J, Bernstein LJ, Devins G, Dunphy C, Giuliani M, Martino R, McEwen S. Head and Neck Cancer Survivorship: Learning the Needs, Meeting the Needs. Semin Radiat Oncol 2018; 28:64-74. [DOI: 10.1016/j.semradonc.2017.08.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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306
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Tanimukai H. Prevalence of cognitive impairments following chemotherapy and its relationship to depression in Japanese breast cancer survivors: an exploratory study. ACTA ACUST UNITED AC 2018. [DOI: 10.15406/ijcam.2018.11.00364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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307
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Green HJ, Tefay M, Mihuta ME. Feasibility of small group cognitive rehabilitation in a clinical cancer setting. Psychooncology 2017; 27:1341-1343. [PMID: 29216417 DOI: 10.1002/pon.4600] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 10/16/2017] [Accepted: 11/23/2017] [Indexed: 11/12/2022]
Affiliation(s)
- Heather J Green
- Menzies Health Institute Queensland and School of Applied Psychology, Griffith University, Southport, QLD, Australia
| | | | - Mary E Mihuta
- Menzies Health Institute Queensland and School of Applied Psychology, Griffith University, Southport, QLD, Australia
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308
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Underwood EA, Rochon PA, Moineddin R, Lee PE, Wu W, Pritchard KI, Tierney MC. Cognitive sequelae of endocrine therapy in women treated for breast cancer: a meta-analysis. Breast Cancer Res Treat 2017; 168:299-310. [PMID: 29264751 DOI: 10.1007/s10549-017-4627-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 12/11/2017] [Indexed: 12/29/2022]
Abstract
PURPOSE Evidence suggests anti-estrogen endocrine therapy (ET) is associated with adverse cognitive effects; however, findings are based on small samples and vary in the cognitive abilities affected. We conducted a meta-analysis to quantitatively synthesize the evidence. METHODS Electronic databases were searched in November 2016. Fourteen studies totaling 911 BC patients on aromatase inhibitors (AIs) or tamoxifen (TAM) and 911 controls (i.e., non-cancer controls and BC controls not using ET) were included. Neuropsychological tests were categorized into six domains. Effect sizes were computed to compare (1) ET patients versus controls and (2) TAM patients versus AI patients. RESULTS In cross-sectional comparisons, ET patients performed worse than control groups on verbal learning/memory, visual learning/memory, frontal executive function, and processing speed, but did not differ on psychomotor efficiency or visuospatial function. Subgroup analyses revealed that verbal learning/memory was the only domain where ET patients performed worse than both non-cancer and BC controls. In other domains, ET patients and BC controls performed equivalently. Regarding change from pre-treatment performance, ET patients did not differ from controls on any domain. TAM and AI patients did not from one another differ overall; however, subgroup analyses indicated that TAM patients performed better than non-steroidal AI patients on several domains, but showed few performance differences relative to steroidal AI patients. CONCLUSIONS Verbal learning/memory was the only domain where ET patients performed worse than both non-cancer and BC controls, suggesting specific adverse effects on this domain. Additional studies assessing change from pre-treatment performance and differences between steroidal and non-steroidal AIs are warranted.
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Affiliation(s)
- E A Underwood
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Primary Care Research Unit, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Suite E349, Toronto, ON, M4N 3M5, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - P A Rochon
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - R Moineddin
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - P E Lee
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - W Wu
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - K I Pritchard
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - M C Tierney
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada. .,Institute of Medical Science, University of Toronto, Toronto, ON, Canada. .,Primary Care Research Unit, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Suite E349, Toronto, ON, M4N 3M5, Canada. .,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
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309
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Vega JN, Dumas J, Newhouse PA. Cognitive Effects of Chemotherapy and Cancer-Related Treatments in Older Adults. Am J Geriatr Psychiatry 2017; 25:1415-1426. [PMID: 28495470 PMCID: PMC5630507 DOI: 10.1016/j.jagp.2017.04.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 03/22/2017] [Accepted: 04/03/2017] [Indexed: 12/20/2022]
Abstract
Advances in cancer treatment are producing a growing number of cancer survivors; therefore, issues surrounding quality of life during and following cancer treatment have become increasingly important. Chemotherapy-related cognitive impairment (CRCI) is a problem that is commonly reported following the administration of chemotherapy treatment in patients with cancer. Research suggests that CRCI can persist for months to years after completing treatment, which has implications for the trajectory of normal and pathologic cognitive aging for the growing number of long-term cancer survivors. These problems are particularly relevant for older individuals, given that cancer is largely a disease of older age, and the number of patients with cancer who are aged 65 years or older will increase dramatically over the coming decades. This review will briefly summarize empirical findings related to CRCI, discuss CRCI in older patients with cancer, propose potential causative hypotheses, and provide a canonical patient case to illustrate how CRCI presents clinically. Finally, potential intervention strategies for CRCI will be highlighted and issues to consider when evaluating older patients with a history of cancer will be discussed.
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Affiliation(s)
- Jennifer N Vega
- Center for Cognitive Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University School of Medicine, Nashville, TN
| | - Julie Dumas
- Clinical Neuroscience Research Unit, Department of Psychiatry, University of Vermont Robert Larner M.D. College of Medicine, Burlington, VT
| | - Paul A Newhouse
- Center for Cognitive Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University School of Medicine, Nashville, TN; Geriatric Research, Education, and Clinical Center, Veterans Affairs Tennessee Valley Health System, Nashville, TN.
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310
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Cognitive impairment in breast cancer survivors treated with chemotherapy depends on control group type and cognitive domains assessed: A multilevel meta-analysis. Neurosci Biobehav Rev 2017; 83:417-428. [DOI: 10.1016/j.neubiorev.2017.10.028] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 05/01/2017] [Accepted: 10/27/2017] [Indexed: 01/21/2023]
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311
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Santos DA, Alseidi A, Shannon VR, Messick C, Song G, Ledet CR, Lee H, Ngo-Huang A, Francis GJ, Asher A. Management of surgical challenges in actively treated cancer patients. Curr Probl Surg 2017; 54:612-654. [DOI: 10.1067/j.cpsurg.2017.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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312
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Moruno-Manchon JF, Uzor NE, Kesler SR, Wefel JS, Townley DM, Nagaraja AS, Pradeep S, Mangala LS, Sood AK, Tsvetkov AS. Peroxisomes contribute to oxidative stress in neurons during doxorubicin-based chemotherapy. Mol Cell Neurosci 2017; 86:65-71. [PMID: 29180229 DOI: 10.1016/j.mcn.2017.11.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 11/21/2017] [Accepted: 11/23/2017] [Indexed: 12/14/2022] Open
Abstract
Doxorubicin, a commonly used anti-neoplastic agent, causes severe neurotoxicity. Doxorubicin promotes thinning of the brain cortex and accelerates brain aging, leading to cognitive impairment. Oxidative stress induced by doxorubicin contributes to cellular damage. In addition to mitochondria, peroxisomes also generate reactive oxygen species (ROS) and promote cell senescence. Here, we investigated if doxorubicin affects peroxisomal homeostasis in neurons. We demonstrate that the number of peroxisomes is increased in doxorubicin-treated neurons and in the brains of mice which underwent doxorubicin-based chemotherapy. Pexophagy, the specific autophagy of peroxisomes, is downregulated in neurons, and peroxisomes produce more ROS. 2-hydroxypropyl-β-cyclodextrin (HPβCD), an activator of the transcription factor TFEB, which regulates expression of genes involved in autophagy and lysosome function, mitigates damage of pexophagy and decreases ROS production induced by doxorubicin. We conclude that peroxisome-associated oxidative stress induced by doxorubicin may contribute to neurotoxicity, cognitive dysfunction, and accelerated brain aging in cancer patients and survivors. Peroxisomes might be a valuable new target for mitigating neuronal damage caused by chemotherapy drugs and for slowing down brain aging in general.
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Affiliation(s)
- Jose F Moruno-Manchon
- Department of Neurobiology and Anatomy, The University of Texas, Houston Medical School, Houston, TX, United States
| | - Ndidi-Ese Uzor
- Department of Neurobiology and Anatomy, The University of Texas, Houston Medical School, Houston, TX, United States; The University of Texas Graduate School of Biomedical Sciences, Houston, TX, United States
| | - Shelli R Kesler
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jeffrey S Wefel
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Debra M Townley
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, United States
| | - Archana Sidalaghatta Nagaraja
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States; Center for RNA Interference and Non-Coding RNA, The University of Texas MD Anderson Cancer Center, Houston, TX, United States; Department of Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Sunila Pradeep
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Lingegowda S Mangala
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States; Center for RNA Interference and Non-Coding RNA, The University of Texas MD Anderson Cancer Center, Houston, TX, United States; Department of Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Anil K Sood
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States; Center for RNA Interference and Non-Coding RNA, The University of Texas MD Anderson Cancer Center, Houston, TX, United States; Department of Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Andrey S Tsvetkov
- Department of Neurobiology and Anatomy, The University of Texas, Houston Medical School, Houston, TX, United States; The University of Texas Graduate School of Biomedical Sciences, Houston, TX, United States.
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313
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Recent cancer treatment and memory decline in older adults: An analysis of the 2002-2012 Health and Retirement Study. J Geriatr Oncol 2017; 9:186-193. [PMID: 29174632 DOI: 10.1016/j.jgo.2017.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 09/19/2017] [Accepted: 10/27/2017] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Few studies have examined the impact of cancer treatment on cognitive trajectories in the growing population of older adults diagnosed with and surviving cancer. This study examined whether recent cancer and its treatment accelerated memory decline in older adults. MATERIALS AND METHODS We conducted a secondary analysis of observations drawn from the Health and Retirement Study (2002-2012), a population-based sample of older adults in the United States. Changes in immediate (IWR) and delayed word recall (DWR) scores were estimated by latent growth modeling in individuals who never had cancer (n=10,939) or had been diagnosed with cancer between 2000 and 2002 and received treatment with some combination of radiation and/or surgery (n=240), chemotherapy only (n=34), or chemotherapy and some combination of radiation and/or surgery (n=64). RESULTS In the period immediately following treatment, individuals reporting a recent cancer treated with chemotherapy and surgery/radiation experienced significantly more rapid decline in IWR (b =-0.34, SE =0.17, p=0.047) and DWR (b=-0.38, SE=0.19, p=0.049) than the non-cancer group. Sensitivity analyses addressing mortality selection and memory-related disease at baseline attenuated the strength of these associations. There were no other statistically significant differences in estimated linear or quadratic slope by cancer status or treatment. CONCLUSION Our results support a potential association between recent cancer treatment and trajectories of memory decline in older adults and provide guidance on the interpretation of statistical estimates from panel studies of health and aging.
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314
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Henneghan A, Stuifbergen A, Becker H, Kesler S, King E. Modifiable correlates of perceived cognitive function in breast cancer survivors up to 10 years after chemotherapy completion. J Cancer Surviv 2017; 12:224-233. [PMID: 29116555 DOI: 10.1007/s11764-017-0661-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 10/22/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND Cognitive changes following breast cancer treatment are likely multifactorial and have been linked to emotional factors, biophysiological factors, and fatigue, among others. Little is known about the contributions of modifiable factors such as stress, loneliness, and sleep quality. The purpose of this study was to explore the direct and indirect effects of perceived stress, loneliness, and sleep quality on perceived cognitive function (PCF) in breast cancer survivors (BCS) after chemotherapy completion. METHODS In this observational study, BCS 6 months to 10 years post chemotherapy were recruited from the community. We measured perceived stress, loneliness, sleep quality, anxiety, depression, fatigue, and PCF. Data analyses included descriptive statistics, correlations, and mediation analyses utilizing ordinary least square regression. RESULTS Ninety women who were on average 3 years post chemotherapy completion participated in the study. Moderate to largely negative correlations were found between PCF and the psychosocial and sleep variables (r values ranged from - 0.31 to - 0.70, p values < .0009). Mediation analyses revealed that stress and daytime sleepiness both directly and indirectly impact PCF and that loneliness and sleep quality only have indirect effects (through anxiety and fatigue). CONCLUSION Our findings suggest that perceived cognitive changes following breast cancer treatment are multifactorial and that higher stress levels, loneliness, daytime sleepiness, and poorer sleep quality are linked to worse perceived cognitive functioning. Also, stress, loneliness, and sleep quality may affect cognitive functioning through a shared psychobiological pathway. IMPLICATIONS FOR CANCER SURVIVORS Interventions targeting stress, loneliness, and sleep quality may improve perceived cognitive functioning in breast cancer survivors.
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Affiliation(s)
- Ashley Henneghan
- School of Nursing, University of Texas at Austin, 1710 Red River, Austin, TX, 78701, USA.
| | - Alexa Stuifbergen
- School of Nursing, University of Texas at Austin, 1710 Red River, Austin, TX, 78701, USA
| | - Heather Becker
- School of Nursing, University of Texas at Austin, 1710 Red River, Austin, TX, 78701, USA
| | - Shelli Kesler
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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315
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Kovalchuk A, Rodriguez-Juarez R, Ilnytskyy Y, Byeon B, Shpyleva S, Melnyk S, Pogribny I, Kolb B, Kovalchuk O. Sex-specific effects of cytotoxic chemotherapy agents cyclophosphamide and mitomycin C on gene expression, oxidative DNA damage, and epigenetic alterations in the prefrontal cortex and hippocampus - an aging connection. Aging (Albany NY) 2017; 8:697-711. [PMID: 27032448 PMCID: PMC4925823 DOI: 10.18632/aging.100920] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 01/30/2016] [Indexed: 01/21/2023]
Abstract
Recent research shows that chemotherapy agents can be more toxic to healthy brain cells than to the target cancer cells. They cause a range of side effects, including memory loss and cognitive dysfunction that can persist long after the completion of treatment. This condition is known as chemo brain. The molecular and cellular mechanisms of chemo brain remain obscure. Here, we analyzed the effects of two cytotoxic chemotherapy drugs—cyclophosphamide (CPP) and mitomycin C (MMC) - on transcriptomic and epigenetic changes in the murine prefrontal cortex (PFC) and hippocampal regions. We for the first time showed that CPP and MMC treatments led to profound sex- and brain region-specific alterations in gene expression profiles. Gene expression changes were most prominent in the PFC tissues of female mice 3 weeks after MMC treatment, and the gene expression response was much greater for MCC than CPP exposure. MMC exposure resulted in oxidative DNA damage, evidenced by accumulation of 8-oxo-2′-deoxyguanosine (8-oxodG) and a decrease in the level of 8-oxodG repair protein OGG1 in the PFC of female animals 3 weeks after treatment. MMC treatment decreased global DNA methylation and increased DNA hydroxymethylation in the PFC tissues of female mice. The majority of the changes induced by chemotherapy in the PFC tissues of female mice resembled those that occur during the brain's aging processes. Therefore, our study suggests a link between chemotherapy-induced chemo brain and brain aging, and provides an important roadmap for future analysis.
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Affiliation(s)
- Anna Kovalchuk
- Department of Neuroscience, University of Lethbridge, Lethbridge, AB, T1K3M4, Canada
| | - Rocio Rodriguez-Juarez
- Department of Biological Sciences, University of Lethbridge, Lethbridge, AB, T1K3M4, Canada
| | - Yaroslav Ilnytskyy
- Department of Biological Sciences, University of Lethbridge, Lethbridge, AB, T1K3M4, Canada
| | - Boseon Byeon
- Department of Biological Sciences, University of Lethbridge, Lethbridge, AB, T1K3M4, Canada
| | - Svitlana Shpyleva
- Division of Biochemical Toxicology, Food and Drug Administration National Center for Toxicological Research, Jefferson, AR 72079, USA.,Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR 72202, USA
| | - Stepan Melnyk
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR 72202, USA
| | - Igor Pogribny
- Division of Biochemical Toxicology, Food and Drug Administration National Center for Toxicological Research, Jefferson, AR 72079, USA
| | - Bryan Kolb
- Department of Neuroscience, University of Lethbridge, Lethbridge, AB, T1K3M4, Canada.,Alberta Epigenetics Network, Calgary, AB, T2L 2A6, Canada.,Canadian Institute for Advanced Research, Toronto, ON, M5G 1Z8, Canada
| | - Olga Kovalchuk
- Department of Biological Sciences, University of Lethbridge, Lethbridge, AB, T1K3M4, Canada.,Alberta Epigenetics Network, Calgary, AB, T2L 2A6, Canada
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316
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Brewster KK, Shalev D, Levenson JA. Chemotherapy-Related Cognitive Impairment #342. J Palliat Med 2017; 20:1407-1408. [PMID: 29091520 DOI: 10.1089/jpm.2017.0524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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317
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McGinnis GJ, Raber J. CNS side effects of immune checkpoint inhibitors: preclinical models, genetics and multimodality therapy. Immunotherapy 2017; 9:929-941. [PMID: 29338610 PMCID: PMC6161123 DOI: 10.2217/imt-2017-0056] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 08/09/2017] [Indexed: 02/06/2023] Open
Abstract
Following cancer treatment, patients often report behavioral and cognitive changes. Novel cancer immunotherapeutics have the potential to produce sustained cancer survivorship, meaning patients will live longer with the side effects of treatment. Given the role of inflammatory pathways in mediating behavioral and cognitive impairments seen in cancer, we aim in this review to discuss emerging evidence for the contribution of immune checkpoint blockade to exacerbate these CNS effects. We discuss ongoing studies regarding the ability of immune checkpoint inhibitors to reach the brain and how treatment responses to checkpoint inhibitors may be modulated by genetic factors. We further consider the use of preclinical tumor-models to study the role of tumor status in CNS effects of immune checkpoint inhibitors and multimodality therapy.
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Affiliation(s)
- Gwendolyn J McGinnis
- Department of Radiation Medicine, Oregon Health & Science University, OR, USA
- Department of Behavioral Neuroscience, Oregon Health & Science University, OR, USA
| | - Jacob Raber
- Department of Radiation Medicine, Oregon Health & Science University, OR, USA
- Department of Behavioral Neuroscience, Oregon Health & Science University, OR, USA
- Department of Neurology, Oregon Health & Science University, OR, USA
- Division of Neuroscience, Oregon National Primate Research Center, 505 NW 185th Ave, Beaverton, OR 97006, USA
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318
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Palesh O, Scheiber C, Kesler S, Mustian K, Koopman C, Schapira L. Management of side effects during and post-treatment in breast cancer survivors. Breast J 2017; 24:167-175. [DOI: 10.1111/tbj.12862] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 06/06/2017] [Accepted: 06/07/2017] [Indexed: 01/06/2023]
Affiliation(s)
- Oxana Palesh
- Department of Psychiatry and Behavioral Sciences; Stanford University; Stanford CA USA
| | - Caroline Scheiber
- Department of Psychiatry and Behavioral Sciences; Stanford University; Stanford CA USA
| | | | - Karen Mustian
- Department of Surgery; University of Rochester; Rochester NY USA
| | - Cheryl Koopman
- Department of Psychiatry and Behavioral Sciences; Stanford University; Stanford CA USA
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319
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Baxter MF, Newman R, Longpré SM, Polo KM. Occupational Therapy's Role in Cancer Survivorship as a Chronic Condition. Am J Occup Ther 2017; 71:7103090010P1-7103090010P7. [PMID: 28422624 DOI: 10.5014/ajot.2017.713001] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Improved medical care has resulted in a documented increase in cancer survivors in the United States. Cancer survivors face challenges in participation across all facets of life as a result of the cancer and subsequent cancer treatments. Long-term and late-term sequelae can result in impairments in neurological systems, decreased stamina, loss of range of motion, and changes in sensation and cognition. These impairments are often long lasting, which categorizes cancer survivorship as a chronic condition. This categorization presents treatment challenges, especially in creating rehabilitation and habilitation service options that support cancer survivors. Occupational therapy provides a unique focus that can benefit cancer survivors as they face limitations in participation in all aspects of daily living. Research, advocacy, and education efforts are needed to focus on the specific rehabilitation and habilitation needs of cancer survivors to increase access to occupational therapy's distinct value.
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Affiliation(s)
- Mary Frances Baxter
- Mary Frances Baxter, PhD, FAOTA, is Professor, School of Occupational Therapy, Texas Woman's University, Houston;
| | - Robin Newman
- Mary Frances Baxter, PhD, FAOTA, is Professor, School of Occupational Therapy, Texas Woman's University, Houston;
| | - Sheila M Longpré
- Mary Frances Baxter, PhD, FAOTA, is Professor, School of Occupational Therapy, Texas Woman's University, Houston;
| | - Katie M Polo
- Mary Frances Baxter, PhD, FAOTA, is Professor, School of Occupational Therapy, Texas Woman's University, Houston;
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320
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Lycke M, Lefebvre T, Pottel L, Pottel H, Ketelaars L, Stellamans K, Eygen KV, Vergauwe P, Werbrouck P, Goethals L, Schofield P, Boterberg T, Debruyne PR. The distress thermometer predicts subjective, but not objective, cognitive complaints six months after treatment initiation in cancer patients. J Psychosoc Oncol 2017; 35:741-757. [DOI: 10.1080/07347332.2017.1365798] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Michelle Lycke
- Division of Medical Oncology, Cancer Centre, General Hospital Groeninge, Kortrijk, Belgium
- Department of Radiation Oncology and Experimental Cancer Research, Ghent University, Ghent, Belgium
| | - Tessa Lefebvre
- Division of Medical Oncology, Cancer Centre, General Hospital Groeninge, Kortrijk, Belgium
- Department of Radiation Oncology and Experimental Cancer Research, Ghent University, Ghent, Belgium
| | - Lies Pottel
- Division of Medical Oncology, Cancer Centre, General Hospital Groeninge, Kortrijk, Belgium
| | - Hans Pottel
- Department of Public Health and Primary Care @ Kulak, Catholic University Leuven Kulak, Kortrijk, Belgium
| | - Lore Ketelaars
- Department of Neuropsychology, General Hospital Groeninge, Kortrijk, Belgium
| | - Karin Stellamans
- Division of Radiotherapy, Cancer Centre, General Hospital Groeninge, Kortrijk, Belgium
| | - Koen Van Eygen
- Division of Medical Oncology, Cancer Centre, General Hospital Groeninge, Kortrijk, Belgium
- Division of Haematology, Cancer Centre, General Hospital Groeninge, Kortrijk, Belgium
| | - Philippe Vergauwe
- Department of Gastro-Enterology, General Hospital Groeninge, Kortrijk, Belgium
| | - Patrick Werbrouck
- Department of Urology, General Hospital Groeninge, Kortrijk, Belgium
| | - Laurence Goethals
- Division of Radiotherapy, Cancer Centre, General Hospital Groeninge, Kortrijk, Belgium
| | - Patricia Schofield
- Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, UK
| | - Tom Boterberg
- Department of Radiation Oncology and Experimental Cancer Research, Ghent University, Ghent, Belgium
| | - Philip R. Debruyne
- Division of Medical Oncology, Cancer Centre, General Hospital Groeninge, Kortrijk, Belgium
- Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, UK
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321
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Ciavarella S, Minoia C, Quinto AM, Oliva S, Carbonara S, Cormio C, Cox MC, Bravo E, Santoro F, Napolitano M, Spina M, Loseto G, Guarini A. Improving Provision of Care for Long-term Survivors of Lymphoma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2017; 17:e1-e9. [PMID: 28916153 DOI: 10.1016/j.clml.2017.08.097] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 07/21/2017] [Accepted: 08/07/2017] [Indexed: 12/11/2022]
Abstract
The progressive improvement of lymphoma therapies has led to a significant prolongation of patient survival and life expectancy. However, lymphoma survivors are at high risk of experiencing a range of early and late adverse effects associated with the extent of treatment exposure. Among these, second malignancies and cardiopulmonary diseases can be fatal, and neurocognitive dysfunction, endocrinopathy, muscle atrophy, and persistent fatigue can affect patients' quality of life for decades after treatment. Early recognition and reduction of risk factors and proper monitoring and treatment of these complications require well-defined follow-up criteria, close coordination among specialists of different disciplines, and a tailored model of survivorship care. We have summarized the major aspects of therapy-related effects in lymphoma patients, reviewed the current recommendations for follow-up protocols, and described a new hospital-based model of survivorship care provision from a recent multicenter Italian experience.
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Affiliation(s)
- Sabino Ciavarella
- Hematology and Cell Therapy Unit, IRCCS-Istituto Tumori "Giovanni Paolo II", Bari, Italy.
| | - Carla Minoia
- Hematology and Cell Therapy Unit, IRCCS-Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Angela Maria Quinto
- Hematology and Cell Therapy Unit, IRCCS-Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Stefano Oliva
- Cardiology Unit, IRCCS-Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Santa Carbonara
- Cardiology Unit, IRCCS-Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Claudia Cormio
- Psycho-oncology Service, IRCCS-Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Maria Christina Cox
- Hematology Unit, Azienda Ospedaliera-Universitaria "Sant'Andrea", Rome, Italy
| | - Elena Bravo
- Research Coordination and Support Service, Istituto Superiore di Sanità, Rome, Italy
| | - Filippo Santoro
- Research Coordination and Support Service, Istituto Superiore di Sanità, Rome, Italy
| | | | - Michele Spina
- IRCCS-Centro di Riferimento Oncologico di Aviano, Aviano, Italy
| | - Giacomo Loseto
- Hematology and Cell Therapy Unit, IRCCS-Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Attilio Guarini
- Hematology and Cell Therapy Unit, IRCCS-Istituto Tumori "Giovanni Paolo II", Bari, Italy
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322
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Finke C, Bartels F, Lütt A, Prüss H, Harms L. High prevalence of neuronal surface autoantibodies associated with cognitive deficits in cancer patients. J Neurol 2017; 264:1968-1977. [PMID: 28785798 DOI: 10.1007/s00415-017-8582-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 07/25/2017] [Accepted: 07/26/2017] [Indexed: 02/07/2023]
Abstract
The recent discovery of neuronal cell-surface antibodies profoundly expanded the clinical spectrum of paraneoplastic neurological syndromes. Many of these syndromes are associated with impaired cognitive function, a clinical symptom that is of increasing concern in cancer patients. However, the frequency of these antibodies in cancer patients and their relation to clinical syndromes is currently unknown. Here, we investigated the prevalence of neuronal cell-surface antibodies and associated paraneoplastic neurological syndromes in 323 patients with different cancer types and in 105 controls. Cerebrospinal fluid and serum samples were analysed for a large panel of anti-neuronal antibodies and all patients were screened for cognitive deficits. Blood-brain barrier integrity was assessed using the age-normalized albumin cerebrospinal fluid/serum ratio. Anti-neuronal autoantibodies were observed in 24.5% of cancer patients (in contrast to 3.1% in neurological control patients without cancer and 2.5% in healthy controls) and were almost exclusively detected in serum. The majority of antibodies were directed against cell-surface antigens (75.9%), most frequently IgA/IgM isotypes targeting the N-methyl-D-aspartate (NMDA) receptor. Cognitive deficits and cerebellar syndromes were significantly more prevalent in antibody-positive in comparison with antibody-negative patients (21 vs. 7%, p = 2.7 × 10-4; 11 vs. 2%, p = 3.0 × 10-3). Antibody-positive patients with cognitive deficits had a significantly increased albumin cerebrospinal fluid/serum ratio in comparison with antibody-positive patients with other neurological deficits, indicating blood-brain barrier dysfunction (49.1 × 10-3 vs. 12.0 × 10-3; p = 0.036). Our results show that anti-neuronal antibodies have a high prevalence in a wide range of different tumour types and are associated with distinct neurological deficits. Specifically, the results suggest a so far undefined cognitive paraneoplastic syndrome in patients with antibodies targeting neuronal surface antigens and concurrent blood-brain barrier dysfunction. Anti-neuronal antibodies might thus serve as a biomarker for potentially treatment-responsive cognitive impairments in cancer patients.
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Affiliation(s)
- Carsten Finke
- Department of Neurology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany.
| | - Frederik Bartels
- Department of Neurology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Alva Lütt
- Department of Neurology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
- German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany
| | - Harald Prüss
- Department of Neurology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
- German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany
| | - Lutz Harms
- Department of Neurology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
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323
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Hoogland AI, Nelson AM, Small BJ, Hyland KA, Gonzalez BD, Booth-Jones M, Anasetti C, Jacobsen PB, Jim HSL. The Role of Age in Neurocognitive Functioning among Adult Allogeneic Hematopoietic Cell Transplant Recipients. Biol Blood Marrow Transplant 2017; 23:1974-1979. [PMID: 28797784 DOI: 10.1016/j.bbmt.2017.08.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 08/02/2017] [Indexed: 01/02/2023]
Abstract
Improvements in supportive care have enabled allogeneic hematopoietic cell transplantation (HCT) to be performed in increasingly older patients. HCT is associated with neurocognitive impairment, which may be exacerbated in older adults due to normal neurocognitive decline associated with aging. The goal of this study was to evaluate whether increasing age of allogeneic HCT recipients is associated with worse neurocognitive outcomes over time relative to a matched sample of individuals without cancer. Patients (n = 140; 42% female; M age, 51 years; range, 20 to 76 years; 31% with acute myelogenous leukemia) completed neurocognitive assessments before transplantation and 3 months and 1 year after transplantation. Controls (n = 75; 56% female; M age, 53 years; range, 21 to 74 years) completed assessments at comparable time intervals. Linear mixed models revealed that regardless of age, patients demonstrated worse performance than controls before transplantation in verbal memory, visual memory, and total neuropsychological performance, and over time in executive functioning. In addition, older age was associated with worse performance in verbal memory (P = .02) and verbal fluency (P = .05) over time in patients compared with controls. Specifically, older (65+ years) patients had worse verbal memory and verbal fluency than older and younger (<65 years) controls post-transplantation (Cohen's d = .22 to .39). These data indicate that age may be a risk factor for worse neurocognitive outcomes after allogeneic HCT. If replicated, our results suggest that older candidates for allogeneic HCT should be counseled regarding the risk of cognitive problems after transplantation.
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Affiliation(s)
- Aasha I Hoogland
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida; Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Ashley M Nelson
- Department of Psychology, University of South Florida, Tampa, Florida
| | - Brent J Small
- School of Aging Studies, University of South Florida, Tampa, Florida
| | - Kelly A Hyland
- Department of Psychology, University of South Florida, Tampa, Florida
| | - Brian D Gonzalez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Margaret Booth-Jones
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Claudio Anasetti
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Paul B Jacobsen
- Healthcare Delivery Research Program, National Cancer Institute, Bethesda, Maryland
| | - Heather S L Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida.
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324
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Huehnchen P, Boehmerle W, Springer A, Freyer D, Endres M. A novel preventive therapy for paclitaxel-induced cognitive deficits: preclinical evidence from C57BL/6 mice. Transl Psychiatry 2017; 7:e1185. [PMID: 28763058 PMCID: PMC5611721 DOI: 10.1038/tp.2017.149] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 05/18/2017] [Accepted: 06/07/2017] [Indexed: 12/11/2022] Open
Abstract
Chemotherapy-induced central nervous system (CNS) neurotoxicity presents an unmet medical need. Patients often report a cognitive decline in temporal correlation to chemotherapy, particularly for hippocampus-dependent verbal and visuo-spatial abilities. We treated adult C57Bl/6 mice with 12 × 20 mg kg-1 paclitaxel (PTX), mimicking clinical conditions of dose-dense chemotherapy, followed by a pulse of bromodesoxyuridine (BrdU) to label dividing cells. In this model, mice developed visuo-spatial memory impairments, and we measured peak PTX concentrations in the hippocampus of 230 nm l-1, which was sevenfold higher compared with the neocortex. Histologic analysis revealed a reduced hippocampal cell proliferation. In vitro, we observed severe toxicity in slowly proliferating neural stem cells (NSC) as well as human neuronal progenitor cells after 2 h exposure to low nanomolar concentrations of PTX. In comparison, mature post-mitotic hippocampal neurons and cell lines of malignant cells were less vulnerable. In PTX-treated NSC, we observed an increase of intracellular calcium levels, as well as an increased activity of calpain- and caspase 3/7, suggesting a calcium-dependent mechanism. This cell death pathway could be specifically inhibited with lithium, but not glycogen synthase kinase 3 inhibitors, which protected NSC in vitro. In vivo, preemptive treatment of mice with lithium prevented PTX-induced memory deficits and abnormal adult hippocampal neurogenesis. In summary, we identified a molecular pathomechanism, which invokes PTX-induced cytotoxicity in NSC independent of cell cycle status. This pathway could be pharmacologically inhibited with lithium without impairing paclitaxel's tubulin-dependent cytostatic mode of action, enabling a potential translational clinical approach.
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Affiliation(s)
- P Huehnchen
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik und Hochschulambulanz für Neurologie, Berlin, Germany,Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Neurocure Cluster of Excellence, Berlin, Germany,Berlin Institute of Health (BIH), Berlin, Germany
| | - W Boehmerle
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik und Hochschulambulanz für Neurologie, Berlin, Germany,Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Neurocure Cluster of Excellence, Berlin, Germany,Berlin Institute of Health (BIH), Berlin, Germany,Klinik und Hochschulambulanz für Neurologie, Charité Universitätsmedizin Berlin, Chariteplatz 1, Berlin 10117, Germany. E-mail:
| | - A Springer
- Großgerätezentrum BioSupraMol, Department of Biology, Chemistry and Pharmacy, Institute of Chemistry and Biochemistry, Freie Universität Berlin, Berlin, Germany
| | - D Freyer
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik und Hochschulambulanz für Neurologie, Berlin, Germany,Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Stroke Research Berlin, Berlin, Germany
| | - M Endres
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik und Hochschulambulanz für Neurologie, Berlin, Germany,Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Neurocure Cluster of Excellence, Berlin, Germany,Berlin Institute of Health (BIH), Berlin, Germany,Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Stroke Research Berlin, Berlin, Germany,German Centre for Neurodegenerative Diseases (DZNE), Berlin, Germany,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
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325
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Myers JS, Koleck TA, Sereika SM, Conley YP, Bender CM. Perceived cognitive function for breast cancer survivors: association of genetic and behaviorally related variables for inflammation. Support Care Cancer 2017; 25:2475-2484. [PMID: 28247126 PMCID: PMC5481483 DOI: 10.1007/s00520-017-3654-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 02/20/2017] [Indexed: 12/11/2022]
Abstract
PURPOSE We explored relationships between genetic variability and behaviorally related variables (body mass index and exercise frequency) for inflammation, and perceived cognitive function (PCF) for breast cancer survivors (BCS). Our primary aim was to explore relationships between select single-nucleotide polymorphisms (SNPs) for IL1R1, IL6, TNF genes, and PCF. Our secondary aim was to explore whether body mass index (BMI) and exercise frequency moderate these relationships. METHODS We conducted an exploratory candidate gene substudy. Saliva samples from participants (N = 101) in a larger, cross-sectional study were genotyped. Multiple linear regression analysis was used to explore relationships between SNPs and PCF, controlling for age, education level, fatigue, and distress. Hierarchical expansion of regression models included main effects for BMI and exercise frequency and interaction effects between BMI, exercise frequency, and each SNP. RESULTS The most parsimonious regression model included fatigue, exercise frequency, and IL1R1rs2287047 minor alleles (AA+GG) (R 2 = 0.244, adjusted R 2 = 0.220, p = 0.013). No other SNPs were significant. Higher exercise frequency (b = 7.300, p = 0.013) and IL1R1rs2287047 (AA+AG) (b = 6.512, p = 0.025) predicted better PCF. Greater fatigue predicted poorer PCF (b = -2.359, p < 0.01). No interaction was demonstrated between BMI and exercise related to PCF or between BMI, exercise, and SNPs. CONCLUSIONS Our results suggest a protective relationship between IL1R1rs2287047 (AA+AG) and PCF and provide further evidence supporting exercise as a potential intervention for poorer PCF. Ours is the first study to investigate genetic variability associated with inflammation, behaviorally related variables, and PCF for BCS.
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Affiliation(s)
- Jamie S Myers
- School of Nursing, University of Kansas, Kansas City, KS, USA.
| | | | - Susan M Sereika
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
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326
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Hodes RJ, Sierra F, Austad SN, Epel E, Neigh GN, Erlandson KM, Schafer MJ, LeBrasseur NK, Wiley C, Campisi J, Sehl ME, Scalia R, Eguchi S, Kasinath BS, Halter JB, Cohen HJ, Demark-Wahnefried W, Ahles TA, Barzilai N, Hurria A, Hunt PW. Disease drivers of aging. Ann N Y Acad Sci 2017; 1386:45-68. [PMID: 27943360 DOI: 10.1111/nyas.13299] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 10/25/2016] [Indexed: 12/14/2022]
Abstract
It has long been known that aging, at both the cellular and organismal levels, contributes to the development and progression of the pathology of many chronic diseases. However, much less research has examined the inverse relationship-the contribution of chronic diseases and their treatments to the progression of aging-related phenotypes. Here, we discuss the impact of three chronic diseases (cancer, HIV/AIDS, and diabetes) and their treatments on aging, putative mechanisms by which these effects are mediated, and the open questions and future research directions required to understand the relationships between these diseases and aging.
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Affiliation(s)
| | | | - Steven N Austad
- Department of Biology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Elissa Epel
- Department of Psychiatry, University of California, San Francisco, San Francisco, California
| | | | | | - Marissa J Schafer
- Robert and Arlene Kogod Center on Aging and Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Nathan K LeBrasseur
- Robert and Arlene Kogod Center on Aging and Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Rochester, Minnesota
| | | | - Judith Campisi
- Buck Institute for Research on Aging, Novato, California
| | - Mary E Sehl
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Rosario Scalia
- Department of Physiology and Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Satoru Eguchi
- Department of Physiology and Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Balakuntalam S Kasinath
- Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center, South Texas Veterans Health Care System, San Antonio, Texas
| | - Jeffrey B Halter
- Division of Geriatric and Palliative Medicine, University of Michigan, Ann Arbor, Michigan
| | | | | | - Tim A Ahles
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nir Barzilai
- Institute for Aging Research, Albert Einstein College of Medicine, New York, New York
| | - Arti Hurria
- City of Hope National Medical Center, Duarte, California
| | - Peter W Hunt
- University of California, San Francisco, School of Medicine, San Francisco, California
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327
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Van Dyk K, Hunter AM, Ercoli L, Petersen L, Leuchter AF, Ganz PA. Evaluating cognitive complaints in breast cancer survivors with the FACT-Cog and quantitative electroencephalography. Breast Cancer Res Treat 2017; 166:157-166. [PMID: 28707203 DOI: 10.1007/s10549-017-4390-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 07/07/2017] [Indexed: 12/14/2022]
Abstract
PURPOSE Targeted methods for evaluating cognitive dysfunction in breast cancer survivors are needed to effectively address this important survivorship issue. To address this need, we examined the validity of a self-report instrument (The functional assessment of cancer therapy: cognitive function; FACT-Cog) regarding correspondence with neuropsychological performance versus depression and evaluated neurophysiological biomarkers of cognition and depressed mood in a sample of breast cancer survivors several years from diagnosis. METHODS This is a cross-sectional study sample from the prospective observational Mind Body Study. Recruited participants were breast cancer survivors at least 3 years from cancer diagnosis who were part of a longitudinal cohort, and were without current psychiatric disorder or history of a neurological or cognitive disorder at baseline (after completion of primary cancer treatment). Exploratory analysis of the FACT-Cog and quantitative electroencephalography (qEEG) were conducted, with respect to their association with neuropsychological domain scores and depressive symptoms as measured by the Beck Depression Inventory, 2nd edition (BDI-II). RESULTS Self-reported cognitive abilities and the impact of cognitive dysfunction on quality of life were associated with memory function in addition to depressive symptoms in our sample of breast cancer survivors. qEEG measures exhibit differential patterns of association with neuropsychological performance and mood. CONCLUSIONS Our findings indicate that perceived cognitive abilities and the impact of cognitive difficulties on quality of life are valid indicators of objective cognitive function, independent of depressive symptoms. Neurophysiological correlates of cognitive function and depressive symptoms represent promising biomarkers of these behavioral difficulties in survivorship.
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Affiliation(s)
- Kathleen Van Dyk
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
- UCLA Jonsson Comprehensive Cancer Center, 650 Charles Young Drive South, Room A2-125 CHS, Los Angeles, CA, 90095-6900, USA
| | - Aimee M Hunter
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
- UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Linda Ercoli
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
- UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Laura Petersen
- UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Andrew F Leuchter
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
- UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Patricia A Ganz
- UCLA Jonsson Comprehensive Cancer Center, 650 Charles Young Drive South, Room A2-125 CHS, Los Angeles, CA, 90095-6900, USA.
- UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
- UCLA Fielding School of Public Health, Los Angeles, CA, USA.
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328
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Frain L, Swanson D, Cho K, Gagnon D, Lu KP, Betensky RA, Driver J. Association of cancer and Alzheimer's disease risk in a national cohort of veterans. Alzheimers Dement 2017; 13:1364-1370. [PMID: 28711346 DOI: 10.1016/j.jalz.2017.04.012] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 04/04/2017] [Accepted: 04/29/2017] [Indexed: 12/20/2022]
Abstract
INTRODUCTION To examine the risk of Alzheimer's disease (AD) among cancer survivors in a national database. METHODS Retrospective cohort of 3,499,378 mostly male US veterans aged ≥65 years were followed between 1996 and 2011. We used Cox models to estimate risk of AD and alternative outcomes (non-AD dementia, osteoarthritis, stroke, and macular degeneration) in veterans with and without a history of cancer. RESULTS Survivors of a wide variety of cancers had modestly lower AD risk, but increased risk of the alternative outcomes. Survivors of screened cancers, including prostate cancer, had a slightly increased AD risk. Cancer treatment was independently associated with decreased AD risk; those who received chemotherapy had a lower risk than those who did not. DISCUSSION Survivors of some cancers have a lower risk of AD but not other age-related conditions, arguing that lower AD diagnosis is not simply due to bias. Cancer treatment may be associated with decreased risk of AD.
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Affiliation(s)
- Laura Frain
- Division of Aging, Brigham and Women's Hospital, Boston, MA, USA
| | - David Swanson
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Kelly Cho
- Division of Aging, Brigham and Women's Hospital, Boston, MA, USA; Massachusetts Veterans Epidemiology and Resource Information Center (MAVERIC), VA Boston Healthcare System (VABHS), Jamaica Plain, MA, USA
| | - David Gagnon
- Massachusetts Veterans Epidemiology and Resource Information Center (MAVERIC), VA Boston Healthcare System (VABHS), Jamaica Plain, MA, USA; Boston University School of Public Health, Boston, MA, USA
| | - Kun Ping Lu
- Division of Hematology-Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Rebecca A Betensky
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jane Driver
- Division of Aging, Brigham and Women's Hospital, Boston, MA, USA; Massachusetts Veterans Epidemiology and Resource Information Center (MAVERIC), VA Boston Healthcare System (VABHS), Jamaica Plain, MA, USA; Geriatric Research Education and Clinical Center, VABHS, Jamaica Plain, MA, USA.
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329
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O’Connell ME, Tuokko H, Voll S, Simard M, Griffith LE, Taler V, Wolfson C, Kirkland S, Raina P. An evidence-based approach to the creation of normative data: base rates of impaired scores within a brief neuropsychological battery argue for age corrections, but against corrections for medical conditions. Clin Neuropsychol 2017; 31:1188-1203. [DOI: 10.1080/13854046.2017.1349931] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
| | - Holly Tuokko
- Institute on Aging & Lifelong Health, University of Victoria, Victoria, Canada
| | - Stacey Voll
- Institute on Aging & Lifelong Health, University of Victoria, Victoria, Canada
| | - Martine Simard
- School of Psychology, Laval University and Centre de recherche de l’Institut universitaire en santé mentale de Québec, Québec City, Canada
| | - Lauren E. Griffith
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Vanessa Taler
- School of Psychology, University of Ottawa & Bruyère Research Institute, Ottawa, Canada
| | - Christina Wolfson
- Department of Epidemiology and Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Susan Kirkland
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada
| | - Parminder Raina
- Faculty of Health Sciences, Department of Health Research Methods, Evidence and Impact, McMaster Institute for Research on Aging & Labarge Centre for Mobility in Aging, McMaster University, Hamilton, Canada
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330
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Ehlers DK, Aguiñaga S, Cosman J, Severson J, Kramer AF, McAuley E. The effects of physical activity and fatigue on cognitive performance in breast cancer survivors. Breast Cancer Res Treat 2017; 165:699-707. [PMID: 28677009 DOI: 10.1007/s10549-017-4363-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 06/26/2017] [Indexed: 10/19/2022]
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331
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Ulfers SS, Berg C. Occupational Therapists With Oncology Exposure: Perceived Needs on Adults and Older Adults With Cancer-Related Cognitive Impairments. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2017. [PMID: 28621217 DOI: 10.1177/1539449217698105] [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: 11/17/2022]
Abstract
Cancer-related cognitive impairments (CRCI) can limit participation in meaningful activities before, during, and after cancer treatment. This study explored occupational therapists' perceived knowledge gaps and needs regarding CRCI in adults and older adults. An online survey was sent to a convenience sample of 60 practitioners at facilities throughout the continuum of care and 176 directors and faculty in accredited occupational therapy programs. Using a snowball sampling approach, recipients were asked to forward the survey to other occupational therapists. One hundred seven occupational therapists participated. The majority (92%) responded that it would be beneficial to attend a face-to-face continuing education program; preferences for the content and design of a continuing competency seminar are described. These findings support the development and delivery of continuing competence programs tailored toward occupational therapists' CRCI knowledge needs.
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332
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Cognitive and Affective Symptoms Experienced by Cancer Patients Receiving High-Dose Intravenous Interleukin 2 Therapy: An Integrative Literature Review. Cancer Nurs 2017; 39:349-57. [PMID: 26632878 DOI: 10.1097/ncc.0000000000000317] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Alterations in cognitive/affective functioning are among the most challenging adverse effects experienced by 80% of patients with metastatic melanoma and metastatic renal cell carcinoma undergoing high-dose interleukin 2 (IL-2) therapy. OBJECTIVE The purpose of this literature review is to describe what is known about IL-2-induced cognitive/affective symptoms, their prevalence, and level of severity and synthesize findings to determine areas for future research to address symptom management challenges. This review describes the IL-2 patient experience and the pathophysiology leading to these changes. METHODS An online electronic search using PubMed was performed to identify relevant literature published between 1992 and 2015. Of the original 113 articles, information was extracted from 9 articles regarding cognitive symptoms, affective symptoms, sample size, research design, reliability, and validity. RESULTS Our review suggests that the trajectories, breadth, and depth of cognitive/affective symptoms have yet to be described. Despite intervention studies designed to address the psychosocial complications of IL-2, an understanding of the level of altered cognitive/affective symptoms experienced by IL-2 patients remains unclear. CONCLUSION Our literature review reveals a lack of standardization when assessing, reporting, and managing cognitive/affective symptoms. Patients/family members have reported cognitive/affective symptoms to be the most alarming and difficult symptoms, yet these symptoms are not adequately screened for, and patients were not informed about potential changes. IMPLICATIONS FOR PRACTICE Assessing patients for cognitive/affective alterations is important to reduce anxiety while improving outcomes. Education about the illness trajectory (what to expect during/after treatment) can help care partners/patients set realistic shared expectations and increase coping.
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333
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Wirkner J, Weymar M, Löw A, Hamm C, Struck AM, Kirschbaum C, Hamm AO. Cognitive functioning and emotion processing in breast cancer survivors and controls: An ERP pilot study. Psychophysiology 2017; 54:1209-1222. [PMID: 28432781 DOI: 10.1111/psyp.12874] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 02/07/2017] [Accepted: 03/15/2017] [Indexed: 01/13/2023]
Abstract
Diagnosis and treatment of breast cancer is a very emotionally aversive and stressful life event, which can lead to impaired cognitive functioning and mental health. Breast cancer survivors responding with repressive emotion regulation strategies often show less adaptive coping and adverse outcomes. We investigated cognitive functioning and neural correlates of emotion processing using ERPs. Self-report measures of depression, anxiety, and fatigue, as well as hair cortisol as an index of chronic stress, were assessed. Twenty breast cancer survivors (BCS) and 31 carefully matched healthy controls participated in the study. After neuropsychological testing and subjective assessments, participants viewed 30 neutral, 30 unpleasant, and 30 pleasant pictures, and ERPs were recorded. Recognition memory was tested 1 week later. BCS reported stronger complaints about cognitive impairments and more symptoms of depression, anxiety, and fatigue. Moreover, they showed elevated hair cortisol levels. Except for verbal memory, cognitive functioning was predominantly in the normative range. Recognition memory performance was decreased in cancer survivors, especially for emotional contents. In ERPs, survivors showed smaller late positive potential amplitudes for unpleasant pictures relative to controls in a later time window, which may indicate less elaborative processing of this material. Taken together, we found cognitive impairments in BCS in verbal memory, impaired emotional picture memory accuracy, and reduced neural activity when breast cancer survivors were confronted with unpleasant materials. Further studies and larger sample sizes, however, are needed to evaluate the relationship between altered emotion processing and reduced memory in BCS in order to develop new treatment strategies.
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Affiliation(s)
- Janine Wirkner
- Department of Biological and Clinical Psychology, University of Greifswald, Greifswald, Germany
| | - Mathias Weymar
- Department of Psychology, University of Potsdam, Potsdam, Germany
| | - Andreas Löw
- University of the Federal Armed Forces Hamburg, Hamburg, Germany
| | - Carmen Hamm
- Psycho-oncological Outpatient Unit, Greifswald, Germany
| | - Anne-Marie Struck
- Department of Biological and Clinical Psychology, University of Greifswald, Greifswald, Germany
| | - Clemens Kirschbaum
- Department of Psychology, Faculty of Science, Technische Universität Dresden, Dresden, Germany
| | - Alfons O Hamm
- Department of Biological and Clinical Psychology, University of Greifswald, Greifswald, Germany
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334
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Ehlers DK, Rogers LQ, Courneya KS, Robbs RS, McAuley E. Effects of BEAT Cancer randomized physical activity trial on subjective memory impairments in breast cancer survivors. Psychooncology 2017; 27:687-690. [PMID: 28414894 DOI: 10.1002/pon.4438] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 02/10/2017] [Accepted: 04/07/2017] [Indexed: 01/03/2023]
Affiliation(s)
- Diane K Ehlers
- University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Laura Q Rogers
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Randall S Robbs
- Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Edward McAuley
- University of Illinois at Urbana-Champaign, Champaign, IL, USA
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335
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Frailty and long-term mortality of older breast cancer patients: CALGB 369901 (Alliance). Breast Cancer Res Treat 2017; 164:107-117. [PMID: 28364214 DOI: 10.1007/s10549-017-4222-8] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 03/24/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Breast cancer patients aged 65+ ("older") vary in frailty status. We tested whether a deficits accumulation frailty index predicted long-term mortality. METHODS Older patients (n = 1280) with non-metastatic, invasive breast cancer were recruited from 78 Alliance sites from 2004 to 2011, with follow-up to 2015. Frailty categories (robust, pre-frail, and frail) were based on 35 baseline illness and function items. Cox proportional hazards and competing risk models were used to calculate all-cause and breast cancer-specific mortality for up to 7 years, respectively. Potential covariates included demographic, psychosocial, and clinical factors, diagnosis year, and care setting. RESULTS Patients were 65-91 years old. Most (76.6%) were robust; 18.3% were pre-frail, and 5.1% frail. Robust patients tended to receive more chemotherapy ± hormonal therapy (vs. hormonal) than pre-frail or frail patients (45% vs. 37 and 36%, p = 0.06), and had the highest adherence to hormonal therapy. The adjusted hazard ratios for all-cause mortality (n = 209 deaths) were 1.7 (95% CI 1.2-2.4) and 2.4 (95% CI 1.5-4.0) for pre-frail and frail versus robust women, respectively, with an absolute mortality difference of 23.5%. The adjusted hazard of breast cancer death (n-99) was 3.1 (95% CI 1.6-5.8) times higher for frail versus robust patients (absolute difference of 14%). Treatment differences did not account for the relationships between frailty and mortality. CONCLUSIONS Most older breast cancer patients are robust and could consider chemotherapy where otherwise indicated. Patients who are frail or pre-frail have elevated long-term all-cause and breast cancer mortality. Frailty indices could be useful for treatment decision-making and care planning with older patients.
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336
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Cheng H, Li W, Gong L, Xuan H, Huang Z, Zhao H, Wang LS, Wang K. Altered resting-state hippocampal functional networks associated with chemotherapy-induced prospective memory impairment in breast cancer survivors. Sci Rep 2017; 7:45135. [PMID: 28327626 PMCID: PMC5361087 DOI: 10.1038/srep45135] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 02/15/2017] [Indexed: 11/21/2022] Open
Abstract
In this study, we aimed to investigate the intrinsic hippocampal functional connectivity (FC) network and its relationship with prospective memory in patients with breast cancer suffering from chemotherapy-induced cognitive impairment (CICI). Thirty-four breast cancer patients before and after adjuvant chemotherapy (CB and CC, respectively) and 31 age- and education-matched cognitively normal (CN) women were recruited and subjected to a prospective memory task and a resting-state functional magnetic resonance imaging scan. Seed-based functional connectivity analysis was used to compare the hippocampal FC networks between CC and CN groups. Partial correction analysis was used to examine the association between the hippocampal FC network and prospective memory in the CC group. The cancer group that underwent chemotherapy obtained significantly poorer scores than the CN group on mini-mental state examination, verbal fluency test, digit span, and prospective memory examination. Compared to the CN group, CC group showed increased hippocampal connectivity in the frontal and parietal cortex, precuneus, posterior cingulate cortex, and the cerebellum. In addition, the increasing hippocampal FC networks were negatively correlated with prospective memory performance in the CC group. These findings suggest maladaptive hippocampal functioning as a mechanism underlying the impairment of prospective memory in patients experiencing CICI.
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Affiliation(s)
- Huaidong Cheng
- Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230601, China
| | - Wen Li
- Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230601, China
| | - Liang Gong
- Department of Neurology, Affiliated Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, China
| | - Han Xuan
- Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230601, China
| | - Zhonglian Huang
- Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230601, China
| | - Hong Zhao
- Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230601, China
| | - Long Sheng Wang
- Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230601, China
| | - Kai Wang
- Collaborative Innovation Centre of Neuropsychiatric Disorders and Mental Health, Neuropsychological Laboratory, Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, China
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337
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Durá-Ferrandis E, Mandelblatt JS, Clapp J, Luta G, Faul L, Kimmick G, Cohen HJ, Yung RL, Hurria A. Personality, coping, and social support as predictors of long-term quality-of-life trajectories in older breast cancer survivors: CALGB protocol 369901 (Alliance). Psychooncology 2017; 26:1914-1921. [PMID: 28219113 DOI: 10.1002/pon.4404] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 01/21/2017] [Accepted: 02/15/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND To determine long-term quality-of-life (QOL) trajectories among breast cancer survivors aged 65+ (older) evaluating the effects of personality and social support. METHODS Older women (N = 1280) newly examined with invasive, nonmetastatic breast cancer completed baseline assessments. Follow-up data were collected 6 and 12 months later and then annually for up to 7 years (median 4.5 years). Quality of life was assessed using EORTC-QLQ-C30 emotional, physical, and cognitive scales. Optimism (Life Orientation Test), Coping (Brief COPE), and social support (Medical Outcomes Study) were assessed at baseline. Group-based trajectory modeling identified QOL trajectories; multinomial regression evaluated effects of predictors on trajectory groups. Age, education, systemic therapy, comorbidity, and reported precancer function (SF-12) were considered as controlling variables. RESULTS Three trajectories were identified for each QOL domain: "maintained high," "phase shift" (lower but parallel scores to "maintained high" group), and "accelerated decline" (lowest baseline scores and steepest decline). Accelerated decline in emotional, physical, and cognitive function was seen in 6.9%, 31.8%, and 7.6% of older survivors, respectively. Maladaptive coping and lower social support increased adjusted odds of being in the accelerated decline group for all QOL domains; lower optimism was only related to decline in emotional function. Chemotherapy was related to physical and cognitive but not emotional function trajectories. CONCLUSIONS Personality and social resources affect the course of long-term emotional well-being of older breast cancer survivors; treatment is more important for physical and cognitive than emotional function. Early identification of those vulnerable to deterioration could facilitate clinical and psychological support.
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Affiliation(s)
- Estrella Durá-Ferrandis
- Polibienestar Research Institute, University of Valencia, Valencia, Spain.,Visiting Researcher, Georgetown University, Washington, DC, USA
| | - Jeanne S Mandelblatt
- Department of Oncology, Georgetown University School of Medicine and Lombardi Comprehensive Cancer Center, Prevention and Control Program, Washington, DC, USA
| | - Jonathan Clapp
- Department of Oncology, Georgetown University School of Medicine and Lombardi Comprehensive Cancer Center, Prevention and Control Program, Washington, DC, USA
| | - George Luta
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University Medical Center, and Lombardi Comprehensive Cancer Center, Prevention and Control Program, Washington, DC, USA
| | - LeighAnne Faul
- Department of Oncology, Georgetown University School of Medicine and Lombardi Comprehensive Cancer Center, Prevention and Control Program, Washington, DC, USA
| | - Gretchen Kimmick
- Department of Oncology, Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - Harvey Jay Cohen
- Department of Medicine, Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA
| | | | - Arti Hurria
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
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338
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Koleck TA, Bender CM, Clark BZ, Ryan CM, Ghotkar P, Brufsky A, McAuliffe PF, Rastogi P, Sereika SM, Conley YP. An exploratory study of host polymorphisms in genes that clinically characterize breast cancer tumors and pretreatment cognitive performance in breast cancer survivors. BREAST CANCER (DOVE MEDICAL PRESS) 2017; 9:95-110. [PMID: 28424560 PMCID: PMC5344452 DOI: 10.2147/bctt.s123785] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE Inspired by the hypothesis that heterogeneity in the biology of breast cancers at the cellular level may account for cognitive dysfunction symptom variability in survivors, the current study explored relationships between host single-nucleotide polymorphisms (SNPs) in 25 breast cancer-related candidate genes (AURKA, BAG1, BCL2, BIRC5, CCNB1, CD68, CENPA, CMC2, CTSL2, DIAPH3, ERBB2, ESR1, GRB7, GSTM1, MELK, MKI67, MMP11, MYBL2, NDC80, ORC6, PGR, RACGAP1, RFC4, RRM2, and SCUBE2), identified from clinically relevant prognostic multigene-expression profiles for breast cancer, and pretreatment cognitive performance. PATIENTS AND METHODS The sample (n=220) was comprised of 138 postmenopausal women newly diagnosed with early stage breast cancer and 82 postmenopausal age- and education-matched healthy controls without breast cancer. Cognitive performance was assessed after primary surgery but prior to initiation of adjuvant chemotherapy and/or hormonal therapy using a comprehensive battery of neuropsychological tests encompassing eight cognitive function composite domains: attention, concentration, executive function, mental flexibility, psychomotor speed, verbal memory, visual memory, and visual working memory. In total, 131 SNPs were included in the analysis. Standard and robust multiple linear regression modeling was used to examine relationships between each domain and the presence or absence of one or more minor alleles for each SNP. Genetic risk/protection scores (GRSs) were calculated for each domain to evaluate the collective effect of possession of multiple risk/protective alleles. RESULTS With the exception of CMC2, MMP11, and RACGAP1, significant (P<0.05) SNP main effect and/or SNP by future prescribed treatment group interactions were observed for every gene between at least one domain and one or more SNPs. All GRSs were found to be significantly (P<0.001) associated with each respective domain score. CONCLUSION Associations between host SNPs and computed GRSs and variability in pretreatment cognitive function performance support the study hypothesis, and warrant further investigations to identify biomarkers for breast cancer-related cognitive dysfunction.
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Affiliation(s)
- Theresa A Koleck
- School of Nursing, University of Pittsburgh, Pittsburgh, PA
- School of Nursing, Columbia University, New York, NY
| | | | - Beth Z Clark
- Division of Gynecologic Pathology, Magee-Womens Hospital of University of Pittsburgh Medical Center (UPMC)
- School of Medicine
| | - Christopher M Ryan
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
- Department of Psychiatry, University of California San Francisco, San Francisco, CA
| | - Puja Ghotkar
- School of Nursing, University of Pittsburgh, Pittsburgh, PA
| | - Adam Brufsky
- School of Medicine
- Division of Hematology/Oncology, Magee-Womens Hospital of UPMC
- University of Pittsburgh Cancer Institute
| | - Priscilla F McAuliffe
- School of Medicine
- University of Pittsburgh Cancer Institute
- Division of Breast Surgical Oncology, Magee-Womens Hospital of UPMC
| | - Priya Rastogi
- School of Medicine
- Division of Hematology/Oncology, Magee-Womens Hospital of UPMC
| | - Susan M Sereika
- School of Nursing, University of Pittsburgh, Pittsburgh, PA
- Department of Biostatistics
- Department of Epidemiology
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA
- Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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340
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Snyder HM, Ahles T, Calderwood S, Carrillo MC, Chen H, Chang CCH, Craft S, De Jager P, Driver JA, Fillit H, Knopman D, Lotze M, Tierney MC, Petanceska S, Saykin A, Seshadri S, Shineman D, Ganguli M. Exploring the nexus of Alzheimer's disease and related dementias with cancer and cancer therapies: A convening of the Alzheimer's Association & Alzheimer's Drug Discovery Foundation. Alzheimers Dement 2017; 13:267-273. [PMID: 27998721 PMCID: PMC5548424 DOI: 10.1016/j.jalz.2016.11.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 11/16/2016] [Indexed: 12/29/2022]
Abstract
Recent population studies suggest an intriguing inverse relationship between several types of cancer and neurodegenerative diseases, including Alzheimer's disease. Understanding the intersection of the underlying biology for these two distinct families of diseases with one another may offer novel approaches to identify new therapeutic approaches and possible opportunities to repurpose existing drug candidates. The Alzheimer's Association and the Alzheimer's Drug Discovery Foundation convened a one-day workshop to delve into this discussion. Workshop participants outlined research focus areas, potential collaborations, and partnerships for future action.
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Affiliation(s)
- Heather M Snyder
- Division of Medical and Scientific Relations, Alzheimer's Association, Chicago, IL, USA.
| | - Tim Ahles
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Stuart Calderwood
- Radiation Oncology, Harvard University Medical School, Boston, MA, USA
| | - Maria C Carrillo
- Division of Medical and Scientific Relations, Alzheimer's Association, Chicago, IL, USA
| | - Honglei Chen
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Chung-Chou H Chang
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA; Department of Biostatistics, University of Pittsburgh Medical School, Pittsburgh, PA, USA; Clinical and Translational Science, University of Pittsburgh Medical School, Pittsburgh, PA, USA
| | - Suzanne Craft
- Division of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest University of Medicine, Winston-Salem, NC, USA
| | - Philip De Jager
- Geriatric Research Education and Clinical Center, VA Boston HealthCare System, Boston, MA, USA
| | - Jane A Driver
- Division of Aging, Brigham and Women's Hospital, Boston, MA, USA; Department of Medicine, Harvard University Medical School, Boston, MA, USA
| | - Howard Fillit
- Scientific Affairs, Alzheimer's Drug Discovery Foundation, New York, NY, USA
| | - David Knopman
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Michael Lotze
- Departments of Surgery, Immunology and Bioengineering, University of Pittsburgh Medical School, Pittsburgh, PA, USA
| | - Mary C Tierney
- Department of Family and Community Medicine, Sunnybrook Health Science Center, Toronto, Ontario, Canada
| | - Suzana Petanceska
- Division of Neurosciences, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Andrew Saykin
- Department of Radiology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sudha Seshadri
- Division of Neurology, Boston University Medical School, Boston, MA, USA
| | - Diana Shineman
- Scientific Affairs, Alzheimer's Drug Discovery Foundation, New York, NY, USA
| | - Mary Ganguli
- Professor of Psychiatry, Neurology, and Epidemiology, University of Pittsburgh School of Medicine and Graduate School of Public Health, Pittsburgh, PA, USA
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Huang Z, Zheng Y, Bao P, Cai H, Hong Z, Ding D, Jackson J, Shu XO, Dai Q. Aging, obesity, and post-therapy cognitive recovery in breast cancer survivors. Oncotarget 2017; 8:12364-12373. [PMID: 27738306 PMCID: PMC5355351 DOI: 10.18632/oncotarget.12565] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 10/03/2016] [Indexed: 12/22/2022] Open
Abstract
Therapy-induced cognitive impairment is prevalent and long-lasting in cancer survivors, but factors affecting post-therapy cognitive recovery are unclear. We conducted this study to evaluate the associations of age, body mass index (BMI), waist-to-hip ratio (WHR), and physical activity (PA) with post-therapy cognitive changes in a population-based breast cancer (BC) survivor cohort. We collected information on PA, weight, height, waist and hip circumferences of 1286 BC survivors aged 20-75. We assessed their cognitive functions, including immediate memory, delayed memory, verbal fluency, and attention, at 18 and 36 months after cancer diagnosis. Linear regression models were used to examine the associations of age, BMI, WHR and PA with mean changes in cognitive scores from 18- to 36-month follow-up interview. We found that the post-therapy cognitive changes differed by age and obesity status. Verbal fluency and attention improved in younger patients aged <60 and non-abdominally obese patients, but deteriorated in older patients aged ≥60 (i.e. verbal fluency and attention) and abdominally obese patients (i.e. verbal fluency). Memory improved in all patients, with a smaller improvement in obese patients compared with normal-weight patients. No significant association was found between PA and post-therapy cognitive change. Due to the novelty of our findings and the limitations of our study, further research, including intervention trials, is warranted to confirm the causal relationship between obesity and cognitive impairments.
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Affiliation(s)
- Zhezhou Huang
- Department of Elderly Health, Division of Noncommunicable Disease and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Ying Zheng
- Department of Cancer Control and Prevention, Division of Noncommunicable Disease and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Pingping Bao
- Department of Noncommunicable Disease Surveillance, Division of Noncommunicable Disease and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Hui Cai
- Department of Medicine, Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Zhen Hong
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Ding Ding
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - James Jackson
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Xiao-Ou Shu
- Department of Medicine, Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Qi Dai
- Department of Medicine, Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
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A Precision Medicine Approach to Improve Cancer Rehabilitation’s Impact and Integration with Cancer Care and Optimize Patient Wellness. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2017. [DOI: 10.1007/s40141-017-0145-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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343
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Janelsins MC, Heckler CE, Peppone LJ, Kamen C, Mustian KM, Mohile SG, Magnuson A, Kleckner IR, Guido JJ, Young KL, Conlin AK, Weiselberg LR, Mitchell JW, Ambrosone CA, Ahles TA, Morrow GR. Cognitive Complaints in Survivors of Breast Cancer After Chemotherapy Compared With Age-Matched Controls: An Analysis From a Nationwide, Multicenter, Prospective Longitudinal Study. J Clin Oncol 2017. [PMID: 28029304 DOI: 10.1200/jco.2016.68.5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023] Open
Abstract
Purpose Cancer-related cognitive impairment is an important problem for patients with breast cancer, yet its trajectory is not fully understood. Some previous cancer-related cognitive impairment research is limited by heterogeneous populations, small samples, lack of prechemotherapy and longitudinal assessments, use of normative data, and lack of generalizability. We addressed these limitations in a large prospective, longitudinal, nationwide study. Patients and Methods Patients with breast cancer from community oncology clinics and age-matched noncancer controls completed the Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog) at prechemotherapy and postchemotherapy and at a 6-month follow-up as an a priori exploratory aim. Longitudinal models compared FACT-Cog scores between patients and controls at the three assessments and adjusted for age, education, race, menopausal status, and baseline reading ability, anxiety, and depressive symptoms. A minimal clinically important difference cutoff determined percentages of impairment over time. Results Of patients, 581 patients with breast cancer (mean age, 53 years; 48% anthracycline-based regimens) and 364 controls (mean age, 53 years) were assessed. Patients reported significantly greater cognitive difficulties on the FACT-Cog total score and four subscales from prechemotherapy to postchemotherapy compared with controls as well as from prechemotherapy to 6-month follow-up (all P < .001). Increased baseline anxiety, depression, and decreased cognitive reserve were significantly associated with lower FACT-Cog total scores. Treatment regimen, hormone, or radiation therapy was not significantly associated with FACT-Cog total scores in patients from postchemotherapy to 6-month follow-up. Patients were more likely to report a clinically significant decline in self-reported cognitive function than were controls from prechemotherapy to postchemotherapy (45.2% v 10.4%) and from prechemotherapy to 6-month follow-up (36.5% v 13.6%). Conclusion Patients with breast cancer who were treated in community oncology clinics report substantially more cognitive difficulties up to 6 months after treatment with chemotherapy than do age-matched noncancer controls.
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Affiliation(s)
- Michelle C Janelsins
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Charles Kamen, Karen M. Mustian, Supriya G. Mohile, Allison Magnuson, Ian R. Kleckner, Joseph J. Guido, and Gary R. Morrow, University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester; Lora R. Weiselberg, North Shore LIJ Health System-National Cancer Institute Community Clinical Oncology Research Program (NCORP), Lake Success; Christine A. Ambrosone, Roswell Park Cancer Institute, Buffalo; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Kelley L. Young, Kansas City Clinical Oncology Program, Kansas City, MO; Alison K. Conlin, Pacific Cancer Research Consortium NCORP, Seattle, WA; and Jerry W. Mitchell, Columbus NCORP, Columbus, OH
| | - Charles E Heckler
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Charles Kamen, Karen M. Mustian, Supriya G. Mohile, Allison Magnuson, Ian R. Kleckner, Joseph J. Guido, and Gary R. Morrow, University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester; Lora R. Weiselberg, North Shore LIJ Health System-National Cancer Institute Community Clinical Oncology Research Program (NCORP), Lake Success; Christine A. Ambrosone, Roswell Park Cancer Institute, Buffalo; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Kelley L. Young, Kansas City Clinical Oncology Program, Kansas City, MO; Alison K. Conlin, Pacific Cancer Research Consortium NCORP, Seattle, WA; and Jerry W. Mitchell, Columbus NCORP, Columbus, OH
| | - Luke J Peppone
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Charles Kamen, Karen M. Mustian, Supriya G. Mohile, Allison Magnuson, Ian R. Kleckner, Joseph J. Guido, and Gary R. Morrow, University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester; Lora R. Weiselberg, North Shore LIJ Health System-National Cancer Institute Community Clinical Oncology Research Program (NCORP), Lake Success; Christine A. Ambrosone, Roswell Park Cancer Institute, Buffalo; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Kelley L. Young, Kansas City Clinical Oncology Program, Kansas City, MO; Alison K. Conlin, Pacific Cancer Research Consortium NCORP, Seattle, WA; and Jerry W. Mitchell, Columbus NCORP, Columbus, OH
| | - Charles Kamen
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Charles Kamen, Karen M. Mustian, Supriya G. Mohile, Allison Magnuson, Ian R. Kleckner, Joseph J. Guido, and Gary R. Morrow, University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester; Lora R. Weiselberg, North Shore LIJ Health System-National Cancer Institute Community Clinical Oncology Research Program (NCORP), Lake Success; Christine A. Ambrosone, Roswell Park Cancer Institute, Buffalo; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Kelley L. Young, Kansas City Clinical Oncology Program, Kansas City, MO; Alison K. Conlin, Pacific Cancer Research Consortium NCORP, Seattle, WA; and Jerry W. Mitchell, Columbus NCORP, Columbus, OH
| | - Karen M Mustian
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Charles Kamen, Karen M. Mustian, Supriya G. Mohile, Allison Magnuson, Ian R. Kleckner, Joseph J. Guido, and Gary R. Morrow, University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester; Lora R. Weiselberg, North Shore LIJ Health System-National Cancer Institute Community Clinical Oncology Research Program (NCORP), Lake Success; Christine A. Ambrosone, Roswell Park Cancer Institute, Buffalo; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Kelley L. Young, Kansas City Clinical Oncology Program, Kansas City, MO; Alison K. Conlin, Pacific Cancer Research Consortium NCORP, Seattle, WA; and Jerry W. Mitchell, Columbus NCORP, Columbus, OH
| | - Supriya G Mohile
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Charles Kamen, Karen M. Mustian, Supriya G. Mohile, Allison Magnuson, Ian R. Kleckner, Joseph J. Guido, and Gary R. Morrow, University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester; Lora R. Weiselberg, North Shore LIJ Health System-National Cancer Institute Community Clinical Oncology Research Program (NCORP), Lake Success; Christine A. Ambrosone, Roswell Park Cancer Institute, Buffalo; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Kelley L. Young, Kansas City Clinical Oncology Program, Kansas City, MO; Alison K. Conlin, Pacific Cancer Research Consortium NCORP, Seattle, WA; and Jerry W. Mitchell, Columbus NCORP, Columbus, OH
| | - Allison Magnuson
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Charles Kamen, Karen M. Mustian, Supriya G. Mohile, Allison Magnuson, Ian R. Kleckner, Joseph J. Guido, and Gary R. Morrow, University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester; Lora R. Weiselberg, North Shore LIJ Health System-National Cancer Institute Community Clinical Oncology Research Program (NCORP), Lake Success; Christine A. Ambrosone, Roswell Park Cancer Institute, Buffalo; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Kelley L. Young, Kansas City Clinical Oncology Program, Kansas City, MO; Alison K. Conlin, Pacific Cancer Research Consortium NCORP, Seattle, WA; and Jerry W. Mitchell, Columbus NCORP, Columbus, OH
| | - Ian R Kleckner
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Charles Kamen, Karen M. Mustian, Supriya G. Mohile, Allison Magnuson, Ian R. Kleckner, Joseph J. Guido, and Gary R. Morrow, University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester; Lora R. Weiselberg, North Shore LIJ Health System-National Cancer Institute Community Clinical Oncology Research Program (NCORP), Lake Success; Christine A. Ambrosone, Roswell Park Cancer Institute, Buffalo; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Kelley L. Young, Kansas City Clinical Oncology Program, Kansas City, MO; Alison K. Conlin, Pacific Cancer Research Consortium NCORP, Seattle, WA; and Jerry W. Mitchell, Columbus NCORP, Columbus, OH
| | - Joseph J Guido
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Charles Kamen, Karen M. Mustian, Supriya G. Mohile, Allison Magnuson, Ian R. Kleckner, Joseph J. Guido, and Gary R. Morrow, University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester; Lora R. Weiselberg, North Shore LIJ Health System-National Cancer Institute Community Clinical Oncology Research Program (NCORP), Lake Success; Christine A. Ambrosone, Roswell Park Cancer Institute, Buffalo; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Kelley L. Young, Kansas City Clinical Oncology Program, Kansas City, MO; Alison K. Conlin, Pacific Cancer Research Consortium NCORP, Seattle, WA; and Jerry W. Mitchell, Columbus NCORP, Columbus, OH
| | - Kelley L Young
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Charles Kamen, Karen M. Mustian, Supriya G. Mohile, Allison Magnuson, Ian R. Kleckner, Joseph J. Guido, and Gary R. Morrow, University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester; Lora R. Weiselberg, North Shore LIJ Health System-National Cancer Institute Community Clinical Oncology Research Program (NCORP), Lake Success; Christine A. Ambrosone, Roswell Park Cancer Institute, Buffalo; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Kelley L. Young, Kansas City Clinical Oncology Program, Kansas City, MO; Alison K. Conlin, Pacific Cancer Research Consortium NCORP, Seattle, WA; and Jerry W. Mitchell, Columbus NCORP, Columbus, OH
| | - Alison K Conlin
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Charles Kamen, Karen M. Mustian, Supriya G. Mohile, Allison Magnuson, Ian R. Kleckner, Joseph J. Guido, and Gary R. Morrow, University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester; Lora R. Weiselberg, North Shore LIJ Health System-National Cancer Institute Community Clinical Oncology Research Program (NCORP), Lake Success; Christine A. Ambrosone, Roswell Park Cancer Institute, Buffalo; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Kelley L. Young, Kansas City Clinical Oncology Program, Kansas City, MO; Alison K. Conlin, Pacific Cancer Research Consortium NCORP, Seattle, WA; and Jerry W. Mitchell, Columbus NCORP, Columbus, OH
| | - Lora R Weiselberg
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Charles Kamen, Karen M. Mustian, Supriya G. Mohile, Allison Magnuson, Ian R. Kleckner, Joseph J. Guido, and Gary R. Morrow, University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester; Lora R. Weiselberg, North Shore LIJ Health System-National Cancer Institute Community Clinical Oncology Research Program (NCORP), Lake Success; Christine A. Ambrosone, Roswell Park Cancer Institute, Buffalo; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Kelley L. Young, Kansas City Clinical Oncology Program, Kansas City, MO; Alison K. Conlin, Pacific Cancer Research Consortium NCORP, Seattle, WA; and Jerry W. Mitchell, Columbus NCORP, Columbus, OH
| | - Jerry W Mitchell
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Charles Kamen, Karen M. Mustian, Supriya G. Mohile, Allison Magnuson, Ian R. Kleckner, Joseph J. Guido, and Gary R. Morrow, University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester; Lora R. Weiselberg, North Shore LIJ Health System-National Cancer Institute Community Clinical Oncology Research Program (NCORP), Lake Success; Christine A. Ambrosone, Roswell Park Cancer Institute, Buffalo; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Kelley L. Young, Kansas City Clinical Oncology Program, Kansas City, MO; Alison K. Conlin, Pacific Cancer Research Consortium NCORP, Seattle, WA; and Jerry W. Mitchell, Columbus NCORP, Columbus, OH
| | - Christine A Ambrosone
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Charles Kamen, Karen M. Mustian, Supriya G. Mohile, Allison Magnuson, Ian R. Kleckner, Joseph J. Guido, and Gary R. Morrow, University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester; Lora R. Weiselberg, North Shore LIJ Health System-National Cancer Institute Community Clinical Oncology Research Program (NCORP), Lake Success; Christine A. Ambrosone, Roswell Park Cancer Institute, Buffalo; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Kelley L. Young, Kansas City Clinical Oncology Program, Kansas City, MO; Alison K. Conlin, Pacific Cancer Research Consortium NCORP, Seattle, WA; and Jerry W. Mitchell, Columbus NCORP, Columbus, OH
| | - Tim A Ahles
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Charles Kamen, Karen M. Mustian, Supriya G. Mohile, Allison Magnuson, Ian R. Kleckner, Joseph J. Guido, and Gary R. Morrow, University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester; Lora R. Weiselberg, North Shore LIJ Health System-National Cancer Institute Community Clinical Oncology Research Program (NCORP), Lake Success; Christine A. Ambrosone, Roswell Park Cancer Institute, Buffalo; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Kelley L. Young, Kansas City Clinical Oncology Program, Kansas City, MO; Alison K. Conlin, Pacific Cancer Research Consortium NCORP, Seattle, WA; and Jerry W. Mitchell, Columbus NCORP, Columbus, OH
| | - Gary R Morrow
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Charles Kamen, Karen M. Mustian, Supriya G. Mohile, Allison Magnuson, Ian R. Kleckner, Joseph J. Guido, and Gary R. Morrow, University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester; Lora R. Weiselberg, North Shore LIJ Health System-National Cancer Institute Community Clinical Oncology Research Program (NCORP), Lake Success; Christine A. Ambrosone, Roswell Park Cancer Institute, Buffalo; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Kelley L. Young, Kansas City Clinical Oncology Program, Kansas City, MO; Alison K. Conlin, Pacific Cancer Research Consortium NCORP, Seattle, WA; and Jerry W. Mitchell, Columbus NCORP, Columbus, OH
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Campbell KL, Kam JWY, Neil-Sztramko SE, Liu Ambrose T, Handy TC, Lim HJ, Hayden S, Hsu L, Kirkham AA, Gotay CC, McKenzie DC, Boyd LA. Effect of aerobic exercise on cancer-associated cognitive impairment: A proof-of-concept RCT. Psychooncology 2017; 27:53-60. [PMID: 28075038 DOI: 10.1002/pon.4370] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 12/15/2016] [Accepted: 01/06/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Change in cognitive ability is a commonly reported adverse effect by breast cancer survivors. The underlying etiology of cognitive complaints is unclear and to date, there is limited evidence for effective intervention strategies. Exercise has been shown to improve cognitive function in older adults and animal models treated with chemotherapy. This proof-of-concept randomized controlled trial tested the effect of aerobic exercise versus usual lifestyle on cognitive function in postmenopausal breast cancer survivors. METHODS Women, aged 40 to 65 years, postmenopausal, stages I to IIIA breast cancer, and who self-reported cognitive dysfunction following chemotherapy treatment, were recruited and randomized to a 24-week aerobic exercise intervention (EX; n = 10) or usual lifestyle control (CON; n = 9). Participants completed self-report measures of the impact of cognitive issues on quality of life (Functional Assessment of Cancer Therapy-Cognitive version 3), objective neuropsychological testing, and functional magnetic resonance imaging at baseline and 24 weeks. RESULTS Compared to CON, EX had a reduced time to complete a processing speed test (trail making test-A) (-14.2 seconds, P < .01; effect size 0.35). Compared to CON, there was no improvement in self-reported cognitive function and effect sizes were small. Interestingly, lack of between-group differences in Stroop behavioral performance was accompanied by functional changes in several brain regions of interest in EX compared to CON at 24 weeks. CONCLUSION These findings provide preliminary proof-of-concept results for the potential of aerobic exercise to improve cancer-related cognitive impairment and will serve to inform the development of future trials.
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Affiliation(s)
- K L Campbell
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - J W Y Kam
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - S E Neil-Sztramko
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - T Liu Ambrose
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - T C Handy
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - H J Lim
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,British Columbia Cancer Agency, Vancouver, BC, Canada
| | - S Hayden
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - L Hsu
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - A A Kirkham
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - C C Gotay
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,British Columbia Cancer Agency, Vancouver, BC, Canada
| | - D C McKenzie
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - L A Boyd
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Koleck TA, Bender CM, Sereika SM, Ryan CM, Ghotkar P, Brufsky AM, Jankowitz RC, McAuliffe PF, Clark BZ, Conley YP. Associations between pathologic tumor features and preadjuvant therapy cognitive performance in women diagnosed with breast cancer. Cancer Med 2017; 6:339-348. [PMID: 28083945 PMCID: PMC5313647 DOI: 10.1002/cam4.964] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 09/27/2016] [Accepted: 10/23/2016] [Indexed: 12/13/2022] Open
Abstract
Intertumor heterogeneity has been proposed as a potential mechanism to account for variability in cognitive performance in women diagnosed with breast cancer. The purpose of this study was to explore associations between variation in pathologic tumor features (PTFs) and variability in preadjuvant therapy cognitive performance in postmenopausal women newly diagnosed with early-stage breast cancer. Participants (N = 329) completed a comprehensive battery of neuropsychological tests to evaluate cognitive performance after primary surgery but prior to initiation of adjuvant anastrozole±chemotherapy. PTF data were abstracted from medical records. Robust multiple linear regression models were fit to estimate associations between individual PTFs and the cognitive function composite domain scores. All models controlled for age, estimated intelligence, and levels of depressive symptoms, anxiety, fatigue, and pain. Diagnosis of a HER2-positive tumor contributed to poorer verbal (b = -0.287, P = 0.018), visual (b = -0.270, P = 0.001), and visual working (b = -0.490, P < 0.001) memory performance compared to diagnosis of a HER2-negative tumor. Similarly, as HER2 immunohistochemistry classification score increased, verbal (b = -0.072, P = 0.093), visual (b = -0.081, P = 0.003), and visual working (b = -0.170, P < 0.001) memory performance score decreased. Associations with performance were also noted between location, focality/centricity, hormone receptor expression, cellular proliferation (i.e., Ki67), and Oncotype DX® Breast Cancer Assay Recurrence Score® .) Our results suggest that certain PTFs related to more aggressive tumor phenotypes or inferior breast cancer prognosis may be implicated in poorer preadjuvant therapy cognitive performance. Follow-up studies that include a cognitive assessment before primary surgery should be conducted to further delineate the role of intertumor heterogeneity on cognitive performance.
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Affiliation(s)
- Theresa A. Koleck
- University of Pittsburgh School of NursingPittsburghPennsylvania
- Columbia University School of NursingNew YorkNew York
| | | | - Susan M. Sereika
- University of Pittsburgh School of NursingPittsburghPennsylvania
- Departments of Biostatistics and EpidemiologyUniversity of Pittsburgh Graduate School of Public HealthPittsburghPennsylvania
| | - Christopher M. Ryan
- Department of PsychiatryUniversity of California San FranciscoSan FranciscoCalifornia
- Department of PsychiatryUniversity of PittsburghPittsburghPennsylvania
| | - Puja Ghotkar
- University of Pittsburgh School of NursingPittsburghPennsylvania
| | - Adam M. Brufsky
- Division of Hematology/OncologyMagee‐Womens Hospital of UPMCPittsburghPennsylvania
- University of Pittsburgh Cancer InstitutePittsburghPennsylvania
- University of Pittsburgh School of MedicinePittsburghPennsylvania
| | - Rachel C. Jankowitz
- University of Pittsburgh Cancer InstitutePittsburghPennsylvania
- University of Pittsburgh School of MedicinePittsburghPennsylvania
- Magee‐Womens Hospital of UPMCCancerCenterPittsburghPennsylvania
| | - Priscilla F. McAuliffe
- University of Pittsburgh Cancer InstitutePittsburghPennsylvania
- University of Pittsburgh School of MedicinePittsburghPennsylvania
- Division of Breast Surgical OncologyMagee‐Womens Hospital of UPMCPittsburghPennsylvania
| | - Beth Z. Clark
- University of Pittsburgh School of MedicinePittsburghPennsylvania
- Division of Gynecologic PathologyMagee‐Womens Hospital of UPMCPittsburghPennsylvania
| | - Yvette P. Conley
- University of Pittsburgh School of NursingPittsburghPennsylvania
- Department of Human GeneticsUniversity of Pittsburgh Graduate School of Public HealthPittsburghPennsylvania
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Yao C, Rich JB, Tirona K, Bernstein LJ. Intraindividual variability in reaction time before and after neoadjuvant chemotherapy in women diagnosed with breast cancer. Psychooncology 2017; 26:2261-2268. [DOI: 10.1002/pon.4351] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 11/27/2016] [Accepted: 12/15/2016] [Indexed: 12/23/2022]
Affiliation(s)
- Christie Yao
- Department of Psychology; York University; Toronto Ontario Canada
| | - Jill B. Rich
- Department of Psychology; York University; Toronto Ontario Canada
| | - Kattleya Tirona
- Department of Supportive Care; Princess Margaret Cancer Centre; Toronto Ontario Canada
| | - Lori J. Bernstein
- Department of Supportive Care; Princess Margaret Cancer Centre; Toronto Ontario Canada
- Department of Psychiatry; University of Toronto; Toronto Ontario Canada
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Bray VJ, Dhillon HM, Bell ML, Kabourakis M, Fiero MH, Yip D, Boyle F, Price MA, Vardy JL. Evaluation of a Web-Based Cognitive Rehabilitation Program in Cancer Survivors Reporting Cognitive Symptoms After Chemotherapy. J Clin Oncol 2017; 35:217-225. [DOI: 10.1200/jco.2016.67.8201] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Cognitive impairment is reported frequently by cancer survivors. There are no proven treatments. We evaluated a cognitive rehabilitation program (Insight) and compared it with standard care in cancer survivors self-reporting cognitive symptoms. Patients and Methods We recruited adult cancer survivors with a primary malignancy (excluding central nervous system malignancies) who had completed three or more cycles of adjuvant chemotherapy in the previous 6 to 60 months and reported persistent cognitive symptoms. All participants received a 30-minute telephone consultation and were then randomly assigned to the 15-week, home-based intervention or to standard care. Primary outcome was self-reported cognitive function (Functional Assessment of Cancer Therapy Cognitive Function [FACT-COG] perceived cognitive impairment [PCI] subscale): difference between groups after intervention (T2) and 6 months later (T3). Results A total of 242 participants were randomly assigned: median age, 53 years; 95% female. The primary outcome of difference in FACT-COG PCI was significant, with less PCI in the intervention group at T2 ( P < .001). This difference was sustained at T3 ( P < .001). At T2, there was a significant difference in all FACT-COG subscales, favoring the intervention. Neuropsychological results were not significantly different between the groups at T2 or T3. There were significantly lower levels of anxiety/depression and fatigue in the intervention group at T2. There were significant improvements in stress in the intervention group at both time points. There was no significant difference in quality of life between the groups at T2, but the intervention group had better quality of life at T3. Conclusion The intervention, Insight, led to improvements in cognitive symptoms compared with standard care. To our knowledge, this is the first large randomized controlled trial showing an improvement in self-reported cognitive function in cancer survivors, indicating that this intervention is a feasible treatment.
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Affiliation(s)
- Victoria J. Bray
- Victoria J. Bray, Liverpool Hospital; University of Sydney; Haryana M. Dhillon, Melanie L. Bell, and Michael Kabourakis, Centre for Medical Psychology & Evidence-based Decision-making, School of Psychology, University of Sydney; Frances Boyle and Melanie A. Price, University of Sydney; Frances Boyle, Patricia Ritchie Centre for Cancer Care and Research; Janette L. Vardy, Concord Cancer Centre; Sydney Medical School, University of Sydney, Sydney, New South Wales; Desmond Yip, Australian National
| | - Haryana M. Dhillon
- Victoria J. Bray, Liverpool Hospital; University of Sydney; Haryana M. Dhillon, Melanie L. Bell, and Michael Kabourakis, Centre for Medical Psychology & Evidence-based Decision-making, School of Psychology, University of Sydney; Frances Boyle and Melanie A. Price, University of Sydney; Frances Boyle, Patricia Ritchie Centre for Cancer Care and Research; Janette L. Vardy, Concord Cancer Centre; Sydney Medical School, University of Sydney, Sydney, New South Wales; Desmond Yip, Australian National
| | - Melanie L. Bell
- Victoria J. Bray, Liverpool Hospital; University of Sydney; Haryana M. Dhillon, Melanie L. Bell, and Michael Kabourakis, Centre for Medical Psychology & Evidence-based Decision-making, School of Psychology, University of Sydney; Frances Boyle and Melanie A. Price, University of Sydney; Frances Boyle, Patricia Ritchie Centre for Cancer Care and Research; Janette L. Vardy, Concord Cancer Centre; Sydney Medical School, University of Sydney, Sydney, New South Wales; Desmond Yip, Australian National
| | - Michael Kabourakis
- Victoria J. Bray, Liverpool Hospital; University of Sydney; Haryana M. Dhillon, Melanie L. Bell, and Michael Kabourakis, Centre for Medical Psychology & Evidence-based Decision-making, School of Psychology, University of Sydney; Frances Boyle and Melanie A. Price, University of Sydney; Frances Boyle, Patricia Ritchie Centre for Cancer Care and Research; Janette L. Vardy, Concord Cancer Centre; Sydney Medical School, University of Sydney, Sydney, New South Wales; Desmond Yip, Australian National
| | - Mallorie H. Fiero
- Victoria J. Bray, Liverpool Hospital; University of Sydney; Haryana M. Dhillon, Melanie L. Bell, and Michael Kabourakis, Centre for Medical Psychology & Evidence-based Decision-making, School of Psychology, University of Sydney; Frances Boyle and Melanie A. Price, University of Sydney; Frances Boyle, Patricia Ritchie Centre for Cancer Care and Research; Janette L. Vardy, Concord Cancer Centre; Sydney Medical School, University of Sydney, Sydney, New South Wales; Desmond Yip, Australian National
| | - Desmond Yip
- Victoria J. Bray, Liverpool Hospital; University of Sydney; Haryana M. Dhillon, Melanie L. Bell, and Michael Kabourakis, Centre for Medical Psychology & Evidence-based Decision-making, School of Psychology, University of Sydney; Frances Boyle and Melanie A. Price, University of Sydney; Frances Boyle, Patricia Ritchie Centre for Cancer Care and Research; Janette L. Vardy, Concord Cancer Centre; Sydney Medical School, University of Sydney, Sydney, New South Wales; Desmond Yip, Australian National
| | - Frances Boyle
- Victoria J. Bray, Liverpool Hospital; University of Sydney; Haryana M. Dhillon, Melanie L. Bell, and Michael Kabourakis, Centre for Medical Psychology & Evidence-based Decision-making, School of Psychology, University of Sydney; Frances Boyle and Melanie A. Price, University of Sydney; Frances Boyle, Patricia Ritchie Centre for Cancer Care and Research; Janette L. Vardy, Concord Cancer Centre; Sydney Medical School, University of Sydney, Sydney, New South Wales; Desmond Yip, Australian National
| | - Melanie A. Price
- Victoria J. Bray, Liverpool Hospital; University of Sydney; Haryana M. Dhillon, Melanie L. Bell, and Michael Kabourakis, Centre for Medical Psychology & Evidence-based Decision-making, School of Psychology, University of Sydney; Frances Boyle and Melanie A. Price, University of Sydney; Frances Boyle, Patricia Ritchie Centre for Cancer Care and Research; Janette L. Vardy, Concord Cancer Centre; Sydney Medical School, University of Sydney, Sydney, New South Wales; Desmond Yip, Australian National
| | - Janette L. Vardy
- Victoria J. Bray, Liverpool Hospital; University of Sydney; Haryana M. Dhillon, Melanie L. Bell, and Michael Kabourakis, Centre for Medical Psychology & Evidence-based Decision-making, School of Psychology, University of Sydney; Frances Boyle and Melanie A. Price, University of Sydney; Frances Boyle, Patricia Ritchie Centre for Cancer Care and Research; Janette L. Vardy, Concord Cancer Centre; Sydney Medical School, University of Sydney, Sydney, New South Wales; Desmond Yip, Australian National
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Alibhai SMH, Timilshina N, Duff-Canning S, Breunis H, Tannock IF, Naglie G, Fleshner NE, Krahn MD, Warde P, Marzouk S, Tomlinson GA. Effects of long-term androgen deprivation therapy on cognitive function over 36 months in men with prostate cancer. Cancer 2017; 123:237-244. [PMID: 27583806 DOI: 10.1002/cncr.30320] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 06/07/2016] [Accepted: 07/21/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND Many men with prostate cancer (PC) require long-term androgen deprivation therapy (ADT), but to the authors' knowledge, its effects on cognitive function beyond 1 year are not described. METHODS Three groups of men aged ≥50 years who were matched based on age and education were enrolled: 77 patients with nonmetastatic PC who initiated continuous ADT, 82 patients with PC who were not receiving ADT (PC controls), and 82 healthy controls. A battery of 14 neuropsychological tests, examining 8 cognitive domains, was administered on 5 occasions over 36 months. Changes in cognitive scores over time were analyzed using 3 approaches: linear mixed effects regression, the percentage of participants per group with declines in ≥1/2 cognitive tests, and a global summary of cognitive change. RESULTS The mean age of the study subjects was 68.9 years, with a median of 16 years of education. In mixed effects models adjusted for age and education, ADT use was not found to be associated with significant changes over time in any cognitive test compared with healthy controls. The percentage of participants declining by ≥1.5 standard deviations in ≥2 tests or ≥2 standard deviations in ≥1 tests was similar across groups. A global summary of cognitive change found no statistically significant worsening of cognitive function among ADT users compared with controls. Sensitivity analyses adjusting for duration of ADT and using multiple imputation for missing data did not materially alter the study findings. CONCLUSIONS The ongoing use of ADT for up to 36 months does not appear to be associated with cognitive decline. Cancer 2017;123:237-244. © 2016 American Cancer Society.
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Affiliation(s)
- Shabbir M H Alibhai
- Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Narhari Timilshina
- Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Duff-Canning
- Krembil Neuroscience Program, Division of Neurology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Henriette Breunis
- Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ian F Tannock
- Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Gary Naglie
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine and Rotman Research Institute, Baycrest Health Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Neil E Fleshner
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Murray D Krahn
- Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Padraig Warde
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Shireen Marzouk
- Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - George A Tomlinson
- Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada
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Janelsins MC, Heckler CE, Peppone LJ, Kamen C, Mustian KM, Mohile SG, Magnuson A, Kleckner IR, Guido JJ, Young KL, Conlin AK, Weiselberg LR, Mitchell JW, Ambrosone CA, Ahles TA, Morrow GR. Cognitive Complaints in Survivors of Breast Cancer After Chemotherapy Compared With Age-Matched Controls: An Analysis From a Nationwide, Multicenter, Prospective Longitudinal Study. J Clin Oncol 2016; 35:506-514. [PMID: 28029304 DOI: 10.1200/jco.2016.68.5826] [Citation(s) in RCA: 215] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Purpose Cancer-related cognitive impairment is an important problem for patients with breast cancer, yet its trajectory is not fully understood. Some previous cancer-related cognitive impairment research is limited by heterogeneous populations, small samples, lack of prechemotherapy and longitudinal assessments, use of normative data, and lack of generalizability. We addressed these limitations in a large prospective, longitudinal, nationwide study. Patients and Methods Patients with breast cancer from community oncology clinics and age-matched noncancer controls completed the Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog) at prechemotherapy and postchemotherapy and at a 6-month follow-up as an a priori exploratory aim. Longitudinal models compared FACT-Cog scores between patients and controls at the three assessments and adjusted for age, education, race, menopausal status, and baseline reading ability, anxiety, and depressive symptoms. A minimal clinically important difference cutoff determined percentages of impairment over time. Results Of patients, 581 patients with breast cancer (mean age, 53 years; 48% anthracycline-based regimens) and 364 controls (mean age, 53 years) were assessed. Patients reported significantly greater cognitive difficulties on the FACT-Cog total score and four subscales from prechemotherapy to postchemotherapy compared with controls as well as from prechemotherapy to 6-month follow-up (all P < .001). Increased baseline anxiety, depression, and decreased cognitive reserve were significantly associated with lower FACT-Cog total scores. Treatment regimen, hormone, or radiation therapy was not significantly associated with FACT-Cog total scores in patients from postchemotherapy to 6-month follow-up. Patients were more likely to report a clinically significant decline in self-reported cognitive function than were controls from prechemotherapy to postchemotherapy (45.2% v 10.4%) and from prechemotherapy to 6-month follow-up (36.5% v 13.6%). Conclusion Patients with breast cancer who were treated in community oncology clinics report substantially more cognitive difficulties up to 6 months after treatment with chemotherapy than do age-matched noncancer controls.
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Affiliation(s)
- Michelle C Janelsins
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Charles Kamen, Karen M. Mustian, Supriya G. Mohile, Allison Magnuson, Ian R. Kleckner, Joseph J. Guido, and Gary R. Morrow, University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester; Lora R. Weiselberg, North Shore LIJ Health System-National Cancer Institute Community Clinical Oncology Research Program (NCORP), Lake Success; Christine A. Ambrosone, Roswell Park Cancer Institute, Buffalo; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Kelley L. Young, Kansas City Clinical Oncology Program, Kansas City, MO; Alison K. Conlin, Pacific Cancer Research Consortium NCORP, Seattle, WA; and Jerry W. Mitchell, Columbus NCORP, Columbus, OH
| | - Charles E Heckler
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Charles Kamen, Karen M. Mustian, Supriya G. Mohile, Allison Magnuson, Ian R. Kleckner, Joseph J. Guido, and Gary R. Morrow, University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester; Lora R. Weiselberg, North Shore LIJ Health System-National Cancer Institute Community Clinical Oncology Research Program (NCORP), Lake Success; Christine A. Ambrosone, Roswell Park Cancer Institute, Buffalo; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Kelley L. Young, Kansas City Clinical Oncology Program, Kansas City, MO; Alison K. Conlin, Pacific Cancer Research Consortium NCORP, Seattle, WA; and Jerry W. Mitchell, Columbus NCORP, Columbus, OH
| | - Luke J Peppone
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Charles Kamen, Karen M. Mustian, Supriya G. Mohile, Allison Magnuson, Ian R. Kleckner, Joseph J. Guido, and Gary R. Morrow, University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester; Lora R. Weiselberg, North Shore LIJ Health System-National Cancer Institute Community Clinical Oncology Research Program (NCORP), Lake Success; Christine A. Ambrosone, Roswell Park Cancer Institute, Buffalo; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Kelley L. Young, Kansas City Clinical Oncology Program, Kansas City, MO; Alison K. Conlin, Pacific Cancer Research Consortium NCORP, Seattle, WA; and Jerry W. Mitchell, Columbus NCORP, Columbus, OH
| | - Charles Kamen
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Charles Kamen, Karen M. Mustian, Supriya G. Mohile, Allison Magnuson, Ian R. Kleckner, Joseph J. Guido, and Gary R. Morrow, University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester; Lora R. Weiselberg, North Shore LIJ Health System-National Cancer Institute Community Clinical Oncology Research Program (NCORP), Lake Success; Christine A. Ambrosone, Roswell Park Cancer Institute, Buffalo; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Kelley L. Young, Kansas City Clinical Oncology Program, Kansas City, MO; Alison K. Conlin, Pacific Cancer Research Consortium NCORP, Seattle, WA; and Jerry W. Mitchell, Columbus NCORP, Columbus, OH
| | - Karen M Mustian
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Charles Kamen, Karen M. Mustian, Supriya G. Mohile, Allison Magnuson, Ian R. Kleckner, Joseph J. Guido, and Gary R. Morrow, University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester; Lora R. Weiselberg, North Shore LIJ Health System-National Cancer Institute Community Clinical Oncology Research Program (NCORP), Lake Success; Christine A. Ambrosone, Roswell Park Cancer Institute, Buffalo; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Kelley L. Young, Kansas City Clinical Oncology Program, Kansas City, MO; Alison K. Conlin, Pacific Cancer Research Consortium NCORP, Seattle, WA; and Jerry W. Mitchell, Columbus NCORP, Columbus, OH
| | - Supriya G Mohile
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Charles Kamen, Karen M. Mustian, Supriya G. Mohile, Allison Magnuson, Ian R. Kleckner, Joseph J. Guido, and Gary R. Morrow, University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester; Lora R. Weiselberg, North Shore LIJ Health System-National Cancer Institute Community Clinical Oncology Research Program (NCORP), Lake Success; Christine A. Ambrosone, Roswell Park Cancer Institute, Buffalo; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Kelley L. Young, Kansas City Clinical Oncology Program, Kansas City, MO; Alison K. Conlin, Pacific Cancer Research Consortium NCORP, Seattle, WA; and Jerry W. Mitchell, Columbus NCORP, Columbus, OH
| | - Allison Magnuson
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Charles Kamen, Karen M. Mustian, Supriya G. Mohile, Allison Magnuson, Ian R. Kleckner, Joseph J. Guido, and Gary R. Morrow, University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester; Lora R. Weiselberg, North Shore LIJ Health System-National Cancer Institute Community Clinical Oncology Research Program (NCORP), Lake Success; Christine A. Ambrosone, Roswell Park Cancer Institute, Buffalo; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Kelley L. Young, Kansas City Clinical Oncology Program, Kansas City, MO; Alison K. Conlin, Pacific Cancer Research Consortium NCORP, Seattle, WA; and Jerry W. Mitchell, Columbus NCORP, Columbus, OH
| | - Ian R Kleckner
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Charles Kamen, Karen M. Mustian, Supriya G. Mohile, Allison Magnuson, Ian R. Kleckner, Joseph J. Guido, and Gary R. Morrow, University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester; Lora R. Weiselberg, North Shore LIJ Health System-National Cancer Institute Community Clinical Oncology Research Program (NCORP), Lake Success; Christine A. Ambrosone, Roswell Park Cancer Institute, Buffalo; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Kelley L. Young, Kansas City Clinical Oncology Program, Kansas City, MO; Alison K. Conlin, Pacific Cancer Research Consortium NCORP, Seattle, WA; and Jerry W. Mitchell, Columbus NCORP, Columbus, OH
| | - Joseph J Guido
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Charles Kamen, Karen M. Mustian, Supriya G. Mohile, Allison Magnuson, Ian R. Kleckner, Joseph J. Guido, and Gary R. Morrow, University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester; Lora R. Weiselberg, North Shore LIJ Health System-National Cancer Institute Community Clinical Oncology Research Program (NCORP), Lake Success; Christine A. Ambrosone, Roswell Park Cancer Institute, Buffalo; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Kelley L. Young, Kansas City Clinical Oncology Program, Kansas City, MO; Alison K. Conlin, Pacific Cancer Research Consortium NCORP, Seattle, WA; and Jerry W. Mitchell, Columbus NCORP, Columbus, OH
| | - Kelley L Young
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Charles Kamen, Karen M. Mustian, Supriya G. Mohile, Allison Magnuson, Ian R. Kleckner, Joseph J. Guido, and Gary R. Morrow, University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester; Lora R. Weiselberg, North Shore LIJ Health System-National Cancer Institute Community Clinical Oncology Research Program (NCORP), Lake Success; Christine A. Ambrosone, Roswell Park Cancer Institute, Buffalo; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Kelley L. Young, Kansas City Clinical Oncology Program, Kansas City, MO; Alison K. Conlin, Pacific Cancer Research Consortium NCORP, Seattle, WA; and Jerry W. Mitchell, Columbus NCORP, Columbus, OH
| | - Alison K Conlin
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Charles Kamen, Karen M. Mustian, Supriya G. Mohile, Allison Magnuson, Ian R. Kleckner, Joseph J. Guido, and Gary R. Morrow, University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester; Lora R. Weiselberg, North Shore LIJ Health System-National Cancer Institute Community Clinical Oncology Research Program (NCORP), Lake Success; Christine A. Ambrosone, Roswell Park Cancer Institute, Buffalo; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Kelley L. Young, Kansas City Clinical Oncology Program, Kansas City, MO; Alison K. Conlin, Pacific Cancer Research Consortium NCORP, Seattle, WA; and Jerry W. Mitchell, Columbus NCORP, Columbus, OH
| | - Lora R Weiselberg
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Charles Kamen, Karen M. Mustian, Supriya G. Mohile, Allison Magnuson, Ian R. Kleckner, Joseph J. Guido, and Gary R. Morrow, University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester; Lora R. Weiselberg, North Shore LIJ Health System-National Cancer Institute Community Clinical Oncology Research Program (NCORP), Lake Success; Christine A. Ambrosone, Roswell Park Cancer Institute, Buffalo; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Kelley L. Young, Kansas City Clinical Oncology Program, Kansas City, MO; Alison K. Conlin, Pacific Cancer Research Consortium NCORP, Seattle, WA; and Jerry W. Mitchell, Columbus NCORP, Columbus, OH
| | - Jerry W Mitchell
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Charles Kamen, Karen M. Mustian, Supriya G. Mohile, Allison Magnuson, Ian R. Kleckner, Joseph J. Guido, and Gary R. Morrow, University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester; Lora R. Weiselberg, North Shore LIJ Health System-National Cancer Institute Community Clinical Oncology Research Program (NCORP), Lake Success; Christine A. Ambrosone, Roswell Park Cancer Institute, Buffalo; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Kelley L. Young, Kansas City Clinical Oncology Program, Kansas City, MO; Alison K. Conlin, Pacific Cancer Research Consortium NCORP, Seattle, WA; and Jerry W. Mitchell, Columbus NCORP, Columbus, OH
| | - Christine A Ambrosone
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Charles Kamen, Karen M. Mustian, Supriya G. Mohile, Allison Magnuson, Ian R. Kleckner, Joseph J. Guido, and Gary R. Morrow, University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester; Lora R. Weiselberg, North Shore LIJ Health System-National Cancer Institute Community Clinical Oncology Research Program (NCORP), Lake Success; Christine A. Ambrosone, Roswell Park Cancer Institute, Buffalo; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Kelley L. Young, Kansas City Clinical Oncology Program, Kansas City, MO; Alison K. Conlin, Pacific Cancer Research Consortium NCORP, Seattle, WA; and Jerry W. Mitchell, Columbus NCORP, Columbus, OH
| | - Tim A Ahles
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Charles Kamen, Karen M. Mustian, Supriya G. Mohile, Allison Magnuson, Ian R. Kleckner, Joseph J. Guido, and Gary R. Morrow, University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester; Lora R. Weiselberg, North Shore LIJ Health System-National Cancer Institute Community Clinical Oncology Research Program (NCORP), Lake Success; Christine A. Ambrosone, Roswell Park Cancer Institute, Buffalo; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Kelley L. Young, Kansas City Clinical Oncology Program, Kansas City, MO; Alison K. Conlin, Pacific Cancer Research Consortium NCORP, Seattle, WA; and Jerry W. Mitchell, Columbus NCORP, Columbus, OH
| | - Gary R Morrow
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Charles Kamen, Karen M. Mustian, Supriya G. Mohile, Allison Magnuson, Ian R. Kleckner, Joseph J. Guido, and Gary R. Morrow, University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester; Lora R. Weiselberg, North Shore LIJ Health System-National Cancer Institute Community Clinical Oncology Research Program (NCORP), Lake Success; Christine A. Ambrosone, Roswell Park Cancer Institute, Buffalo; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Kelley L. Young, Kansas City Clinical Oncology Program, Kansas City, MO; Alison K. Conlin, Pacific Cancer Research Consortium NCORP, Seattle, WA; and Jerry W. Mitchell, Columbus NCORP, Columbus, OH
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Van Dyk K, Ganz PA. Doctor, Now That My Chemotherapy Treatment Is Over, When Will My "Chemofog" Lift? J Clin Oncol 2016; 35:482-484. [PMID: 28029322 DOI: 10.1200/jco.2016.70.7497] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Kathleen Van Dyk
- Kathleen Van Dyk and Patricia A. Ganz, University of California Los Angeles, Los Angeles, CA
| | - Patricia A Ganz
- Kathleen Van Dyk and Patricia A. Ganz, University of California Los Angeles, Los Angeles, CA
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