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Zhang Q, Zhang W, Zhang P, Zhao Z, Yang L, Zheng F, Zhang L, Huang G, Zhang J, Zheng W, Ma R, Yao Z, Hu B. Altered dynamic functional connectivity in rectal cancer patients with and without chemotherapy: a resting-state fMRI study. Int J Neurosci 2024; 134:584-594. [PMID: 36178032 DOI: 10.1080/00207454.2022.2130295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/11/2022] [Accepted: 09/01/2022] [Indexed: 10/17/2022]
Abstract
Purpose: Understanding the mechanism of brain functional alterations in rectal cancer (RC) patients is of great significance to improve the prognosis and quality of life of patients. Additionally, the influence of chemotherapy on brain function in RC patients is still unclear. In this study, we aimed to investigate the alterations of brain functional network dynamics in RC patients and explore the effects of chemotherapy on temporal dynamics of dynamic functional connectivity (DFC). Methods: The group independent component analysis (GICA) and sliding window method were applied to investigate abnormalities of DFC based on resting-state functional magnetic resonance imaging (rs-fMRI) of 18 RC patients without chemotherapy (RC_NC), 21 RC patients with chemotherapy (RC_C) and 33 healthy controls (HC). Then, the Spearman correlation between aberrant properties and clinical measures was calculated. Results: Two discrete states were identified. Compared to HC, RC_NC exhibited increased mean dwell time (MDT) and fractional windows (FW) in state 2 and decreased transition numbers between the two states. Notably, three temporal properties in RC_C showed an intermediate trend in comparison with RC_NC and HC. Furthermore, RC_C also demonstrated abnormal intra- and inter-network connections, involving the visual (VIS), default mode (DM), and cognitive control (CC) networks, and most connections related to VIS were correlated with the severity of anxiety and depression. Conclusions: Our study suggested that abnormal DFC patterns could be manifested in RC patients and chemotherapy would further correct abnormalities of network dynamics, which may provide new insights into the brain functional alterations in patients with RC from the time-varying connectivity perspective.
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Affiliation(s)
- Qin Zhang
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Lanzhou, PR China
| | - Wenwen Zhang
- Department of Radiology, Gansu Provincial Hospital, Lanzhou, PRChina
| | - Pengfei Zhang
- Second Clinical School, Lanzhou University, Lanzhou, PRChina
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou, PRChina
- Gansu Province Clinical Research Center for Functional and Molecular Imaging, Lanzhou, PRChina
| | - Ziyang Zhao
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Lanzhou, PR China
| | - Lin Yang
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Lanzhou, PR China
| | - Fang Zheng
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Lanzhou, PR China
| | - Lingyu Zhang
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Lanzhou, PR China
| | - Gang Huang
- Department of Radiology, Gansu Provincial Hospital, Lanzhou, PRChina
| | - Jing Zhang
- Second Clinical School, Lanzhou University, Lanzhou, PRChina
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou, PRChina
- Gansu Province Clinical Research Center for Functional and Molecular Imaging, Lanzhou, PRChina
| | - Weihao Zheng
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Lanzhou, PR China
| | - Rong Ma
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Lanzhou, PR China
| | - Zhijun Yao
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Lanzhou, PR China
| | - Bin Hu
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Lanzhou, PR China
- Joint Research Center for Cognitive Neurosensor Technology of Lanzhou University & Institute of Semiconductors, Chinese Academy of Sciences, Lanzhou, PR China
- Engineering Research Center of Open Source Software and Real-Time System (Lanzhou University), Ministry of Education, Lanzhou, PR China
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Merceur M, Reilly KT, Bonan I, Holé J, Hummel E, Cogné M, Jacquin-Courtois S. A systematic review of rehabilitation programs for cognitive impairment related to breast cancer: Different programs at different times? Ann Phys Rehabil Med 2024; 67:101832. [PMID: 38537525 DOI: 10.1016/j.rehab.2024.101832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 12/04/2023] [Accepted: 02/10/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND "Cancer Related Cognitive Impairment" (CRCI) defines cognitive disorders related to cancer and its treatments. Many people with breast cancer experience signs of CRCI (incidence between 20 and 30 %) and, although several intervention options exist, there is no established standard of care. Our main objective was to provide a detailed description of the methods and results of randomized controlled trials of interventions for CRCI in breast cancer survivors, paying particular attention to the timing of the interventions within the care pathway. METHODS We conducted a systematic literature review following the PRISMA guidelines from 01 to 01-2019 to 16-07-2023 and included randomized controlled trials of interventions for CRCI after breast cancer with at least one objective cognitive assessment as a primary or secondary outcome. RESULTS Among 228 identified studies, 35 (including 2821 participants) were retained for inclusion. The interventions were classified into 4 categories: cognitive rehabilitation, physical activity, complementary therapy and pharmacological treatment. Our analysis revealed that pharmacological interventions have no effect, whereas physical activity interventions proposed in the months following the initial cancer treatment improve Quality of Life and Speed of Information Processing while interventions proposed later improve Memory and Attention (Cognitive Rehabilitation) and Perceived Cognitive Function and Depression/Anxiety/Mood (Complementary Therapies). CONCLUSION CRCI is multifactorial and affected individuals frequently experience high levels of fatigue, pain, anxiety and depression and are most likely to benefit from holistic approaches that include cognition, physical activity, relaxation, psychoeducation, group support and/or psychological counselling. Thus, rehabilitation programs should be designed on multi-modal approaches, using innovative, cost-effective delivery methods that increase access to treatment, and intervention outcomes should be evaluated using measures of participation. DATABASE REGISTRATION The review was recorded on Prospero (01-03-2020), with the registration number 135,627.
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Affiliation(s)
- Marianne Merceur
- Rehabilitation Medicine Unit, University Hospital of Rennes, 2 rue Henri Le Guilloux, 35000 Rennes, France.
| | - Karen T Reilly
- Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, TRAJECTOIRES, 95 Boulevard Pinel, 69500 Bron, France
| | - Isabelle Bonan
- Rehabilitation Medicine Unit, University Hospital of Rennes, 2 rue Henri Le Guilloux, 35000 Rennes, France
| | - Julie Holé
- Physical Medicine and Rehabilitation Department, Henry Gabrielle Hospital, Hospices Civils de Lyon, 20 route de Vourles, 69230 Saint Genis Laval, France
| | - Emilie Hummel
- Hybrid team, Inria, Campus de Beaulieu, 263 Av. Général Leclerc, 35042 Rennes, France
| | - Mélanie Cogné
- Rehabilitation Medicine Unit, University Hospital of Rennes, 2 rue Henri Le Guilloux, 35000 Rennes, France
| | - Sophie Jacquin-Courtois
- Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, TRAJECTOIRES, 95 Boulevard Pinel, 69500 Bron, France; Hybrid team, Inria, Campus de Beaulieu, 263 Av. Général Leclerc, 35042 Rennes, France
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Mohammadi M, Mohammadi S, Hadizadeh H, Olfati M, Moradi F, Tanzifi G, Ghaderi S. Brain metastases from breast cancer using magnetic resonance imaging: A systematic review. J Med Radiat Sci 2024; 71:133-141. [PMID: 37563948 PMCID: PMC10920938 DOI: 10.1002/jmrs.715] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 08/01/2023] [Indexed: 08/12/2023] Open
Abstract
Despite improvements in imaging and treatment approaches, brain metastases (BMs) continue to be the primary cause of mortality and morbidity in about 20% of adult cancer patients. This research aimed to review the magnetic resonance imaging (MRI) and clinical characteristics of BMs resulting from breast cancer (BC). A systematic review of original research articles published from January 2000 to June 2023. We selected studies that reported MRI findings of BMs in BC patients. We excluded reviews, case reports, books/book chapters, animal studies and irrelevant records. We identified 24 studies that included 1580 BC patients with BMs. T1-weighted (T1-w) (pre- and postcontrast), T2-weighted (T2-w), fluid-attenuated inversion recovery (FLAIR) and T2*-weighted (T2*-w) was used to measure the lesion size, shape and area. In other studies, advanced structural techniques including diffusion-weighted imaging (DWI), diffusion tensor imaging (DTI) and susceptibility-weighted imaging (SWI) were used to more precisely and sensitively evaluate the pathological area. Furthermore, functional and metabolic techniques like functional MRI (fMRI), magnetic resonance spectroscopy (MRS) and perfusion-weighted imaging (PWI) have also been utilised. The MRI findings of BMs varied depending on the MRI technique, the BC subtype, the lesion size and shape, the presence of haemorrhage or necrosis and the comparison with other brain tumours. Some MRI findings were associated with prognosis, recurrence or cognitive impairment in BC patients with BMs. MRI detects, characterises and monitors BMs from BC. Findings vary by MRI technique, BC subtype, lesion characteristics and comparison with other brain tumours. More research should validate emerging MRI techniques, determine the clinical implications of findings and explore the underlying mechanisms and biology of BMs from BC. MRI is a valuable tool for diagnosis, targeted therapy and studying BC metastasis.
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Affiliation(s)
- Mahdi Mohammadi
- Department of Medical Physics and Biomedical Engineering, School of MedicineTehran University of Medical SciencesTehranIran
| | - Sana Mohammadi
- Department of Medical Sciences, School of MedicineIran University of Medical SciencesTehranIran
| | - Hojatollah Hadizadeh
- Department of Radiology and Nuclear Medicine, School of ParamedicalKermanshah University of Medical SciencesKermanshahIran
| | - Mahsa Olfati
- Department of Radiology and Nuclear Medicine, School of ParamedicalKermanshah University of Medical SciencesKermanshahIran
| | - Fatemeh Moradi
- Department of Energy Engineering & PhysicsAmirkabir University of Technology (Tehran Polytechnic)TehranIran
| | - Ghazal Tanzifi
- Department of Nuclear EngineeringIslamic Azad University, Central Tehran BranchTehranIran
| | - Sadegh Ghaderi
- Department of Neuroscience and Addiction Studies, School of Advanced Technologies in MedicineTehran University of Medical SciencesTehranIran
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Liang MZ, Tang Y, Chen P, Tang XN, Knobf MT, Hu GY, Sun Z, Liu ML, Yu YL, Ye ZJ. Brain connectomics improve prediction of 1-year decreased quality of life in breast cancer: A multi-voxel pattern analysis. Eur J Oncol Nurs 2024; 68:102499. [PMID: 38199087 DOI: 10.1016/j.ejon.2023.102499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 12/15/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024]
Abstract
PURPOSE Whether brain connectomics can predict 1-year decreased Quality of Life (QoL) in patients with breast cancer are unclear. A longitudinal study was utilized to explore their prediction abilities with a multi-center sample. METHODS 232 breast cancer patients were consecutively enrolled and 214 completed the 1-year QoL assessment (92.2%). Resting state functional magnetic resonance imaging was collected before the treatment and a multivoxel pattern analysis (MVPA) was performed to differentiate whole-brain resting-state connectivity patterns. Net Reclassification Improvement (NRI) as well as Integrated Discrimination Improvement (IDI) were calculated to estimate the incremental value of brain connectomics over conventional risk factors. RESULTS Paracingulate Gyrus, Superior Frontal Gyrus and Frontal Pole were three significant brain areas. Brain connectomics yielded 7.8-17.2% of AUC improvement in predicting 1-year decreased QoL. The NRI and IDI ranged from 20.27 to 54.05%, 13.21-33.34% respectively. CONCLUSION Brain connectomics contribute to a more accurate prediction of 1-year decreased QoL in breast cancer. Significant brain areas in the prefrontal lobe could be used as potential intervention targets (i.e., Cognitive Behavioral Group Therapy) to improve long-term QoL outcomes in breast cancer.
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Affiliation(s)
- Mu Zi Liang
- Guangdong Academy of Population Development, Guangzhou, China
| | - Ying Tang
- Institute of Tumor, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Peng Chen
- Basic Medical School, Guizhou University of Traditional Chinese Medicine, Guiyang, China
| | - Xiao Na Tang
- Shenzhen Bao'an Traditional Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, China
| | - M Tish Knobf
- School of Nursing, Yale University, Orange, CT, United States
| | - Guang Yun Hu
- Army Medical University, Chongqing Municipality, China
| | - Zhe Sun
- The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Mei Ling Liu
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yuan Liang Yu
- South China University of Technology, Guangzhou, China
| | - Zeng Jie Ye
- School of Nursing, Guangzhou Medical University, Guangzhou, Guangdong Province, China.
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Aspelund SG, Halldorsdottir T, Agustsson G, Sigurdardottir Tobin HR, Wu LM, Amidi A, Johannsdottir KR, Lutgendorf SK, Telles R, Daly HF, Sigurdardottir K, Valdimarsdottir HB, Baldursdottir B. Biological and psychological predictors of cognitive function in breast cancer patients before surgery. Support Care Cancer 2024; 32:88. [PMID: 38185720 DOI: 10.1007/s00520-023-08282-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 12/18/2023] [Indexed: 01/09/2024]
Abstract
PURPOSE Research suggests that cancer-related cognitive impairment (CRCI) can occur before breast cancer (BC) treatment. The limited extant evidence suggests the underlying mechanisms could be stress-related. Potential psychological and biological predictors of CRCI prior to any BC treatment were examined. METHODS 112 treatment-naïve women with BC and 67 healthy controls (HC) completed a neuropsychological test battery to assess cognitive impairment and a self-report battery to assess cognitive complaints, cancer-related stress, depressive and anxiety symptoms. Morning and evening cortisol and α-amylase were collected from saliva. Multilinear regressions were conducted. RESULTS Treatment-naïve BC patients were more frequently impaired in verbal memory and processing speed and reported more cognitive complaints (all p < .001) than HC. BC patients and HC did not differ in overall cognitive impairment (p = .21). Steeper α-amylase, lower cancer-related stress and younger age was associated with better overall cognitive function in treatment-naïve BC patients. Higher depressive symptoms predicted higher levels of cognitive complaints in BC patients. CONCLUSION Overall, these findings suggest that stress plays a role in CRCI. This study is the first to associate α-amylase with cognitive function in cancer patients, informing future research. The findings on impairment in processing speed and verbal memory among treatment-naïve BC highlight the need to screen for such impairments among BC patients and indicate that future studies on CRCI should include baseline assessments prior to BC treatment. If replicated, these findings could inform the development and testing of appropriate interventions to decrease CRCI among cancer patients. CLINICAL TRIALS REGISTRATION NUMBER NCT04418856, date of registration: 06.05.2020.
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Affiliation(s)
| | | | - Gudjon Agustsson
- Department of Psychology, School of Social Sciences, Reykjavik University, Reykjavik, Iceland
| | | | - Lisa M Wu
- Department of Psychology, School of Social Sciences, Reykjavik University, Reykjavik, Iceland
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Unit for Psycho-Oncology and Health Psychology, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Ali Amidi
- Unit for Psycho-Oncology and Health Psychology, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Kamilla R Johannsdottir
- Department of Psychology, School of Social Sciences, Reykjavik University, Reykjavik, Iceland
| | - Susan K Lutgendorf
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa, USA
| | - Rachel Telles
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa, USA
| | | | | | - Heiddis B Valdimarsdottir
- Department of Psychology, School of Social Sciences, Reykjavik University, Reykjavik, Iceland
- Department of Population Health Science and Policy, Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Birna Baldursdottir
- Department of Psychology, School of Social Sciences, Reykjavik University, Reykjavik, Iceland.
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Liu J, Tang M, Zhu D, Ruan G, Zou S, Cheng Z, Zhu X, Zhu Y. The remodeling of metabolic brain pattern in patients with extracranial diffuse large B-cell lymphoma. EJNMMI Res 2023; 13:94. [PMID: 37902852 PMCID: PMC10616001 DOI: 10.1186/s13550-023-01046-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/22/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Owing to the advances in diagnosis and therapy, survival or remission rates for lymphoma have improved prominently. Apart from the lymphoma- and chemotherapy-related somatic symptom burden, increasing attention has been drawn to the health-related quality of life. The application of 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET/CT) has been routinely recommended for the staging and response assessment of FDG-avid lymphoma. However, up till now, only a few researches have investigated the brain metabolic impairments in patients with pre-treatment lymphoma. The determination of the lymphoma-related metabolic brain pattern would facilitate exploring the tailored therapeutic regimen to alleviate not only the physiological, but also the psychological symptoms. In this retrospective study, we aimed to establish the diffuse large B-cell lymphoma-related pattern (DLBCLRP) of metabolic brain network and investigate the correlations between DLBCLRP and several indexes of the staging and response assessment. RESULTS The established DLBCLRP was characterized by the increased metabolic activity in bilateral cerebellum, brainstem, thalamus, striatum, hippocampus, amygdala, parahippocampal gyrus and right middle temporal gyrus and by the decreased metabolic activity in bilateral occipital lobe, parietal lobe, anterior cingulate gyrus, midcingulate cortex and medial frontal gyrus. Significant difference in the baseline expression of DLBCLRP was found among complete metabolic response (CMR), partial metabolic response (PMR) and progressive metabolic disease (PMD) groups (P < 0.01). DLBCLRP expressions were also significantly or tended to be positively correlated with international prognostic index (IPI) (rs = 0.306, P < 0.05), lg(total metabolic tumor volume, TMTV) (r = 0.298, P < 0.05) and lg(total lesion glycolysis, TLG) (r = 0.233, P = 0.064). Though no significant correlation of DLBCLRP expression was found with Ann Arbor staging or tumor SUVmax (P > 0.05), the post-treatment declines of DLBCLRP expression were significantly positively correlated with Ann Arbor staging (rs = 0.284, P < 0.05) and IPI (rs = 0.297, P < 0.05). CONCLUSIONS The proposed DLBCLRP would lay the foundation for further investigating the cerebral dysfunction related to DLBCL itself and/or treatments. Besides, the expression of DLBCLRP was associated with the tumor burden of lymphoma, implying a potential biomarker for prognosis.
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Affiliation(s)
- Junyi Liu
- Department of Nuclear Medicine and PET Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Ave, Wuhan, 430030, China
| | - Ming Tang
- Department of Nuclear Medicine and PET Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Ave, Wuhan, 430030, China
| | - Dongling Zhu
- Department of Nuclear Medicine and PET Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Ave, Wuhan, 430030, China
| | - Ge Ruan
- Department of Radiology, Hospital, Hubei University, Wuhan, 430062, China
| | - Sijuan Zou
- Department of Nuclear Medicine and PET Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Ave, Wuhan, 430030, China
| | - Zhaoting Cheng
- Department of Nuclear Medicine and PET Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Ave, Wuhan, 430030, China
| | - Xiaohua Zhu
- Department of Nuclear Medicine and PET Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Ave, Wuhan, 430030, China.
| | - Yuankai Zhu
- Department of Nuclear Medicine and PET Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Ave, Wuhan, 430030, China.
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7
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Kesler SR, Henneghan AM, Prinsloo S, Palesh O, Wintermark M. Neuroimaging based biotypes for precision diagnosis and prognosis in cancer-related cognitive impairment. Front Med (Lausanne) 2023; 10:1199605. [PMID: 37720513 PMCID: PMC10499624 DOI: 10.3389/fmed.2023.1199605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 08/15/2023] [Indexed: 09/19/2023] Open
Abstract
Cancer related cognitive impairment (CRCI) is commonly associated with cancer and its treatments, yet the present binary diagnostic approach fails to capture the full spectrum of this syndrome. Cognitive function is highly complex and exists on a continuum that is poorly characterized by dichotomous categories. Advanced statistical methodologies applied to symptom assessments have demonstrated that there are multiple subclasses of CRCI. However, studies suggest that relying on symptom assessments alone may fail to account for significant differences in the neural mechanisms that underlie a specific cognitive phenotype. Treatment plans that address the specific physiologic mechanisms involved in an individual patient's condition is the heart of precision medicine. In this narrative review, we discuss how biotyping, a precision medicine framework being utilized in other mental disorders, could be applied to CRCI. Specifically, we discuss how neuroimaging can be used to determine biotypes of CRCI, which allow for increased precision in prediction and diagnosis of CRCI via biologic mechanistic data. Biotypes may also provide more precise clinical endpoints for intervention trials. Biotyping could be made more feasible with proxy imaging technologies or liquid biomarkers. Large cross-sectional phenotyping studies are needed in addition to evaluation of longitudinal trajectories, and data sharing/pooling is highly feasible with currently available digital infrastructures.
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Affiliation(s)
- Shelli R. Kesler
- Division of Adult Health, School of Nursing, The University of Texas at Austin, Austin, TX, United States
- Department of Diagnostic Medicine, Dell School of Medicine, The University of Texas at Austin, Austin, TX, United States
- Department of Oncology, Dell School of Medicine, The University of Texas at Austin, Austin, TX, United States
| | - Ashley M. Henneghan
- Division of Adult Health, School of Nursing, The University of Texas at Austin, Austin, TX, United States
- Department of Oncology, Dell School of Medicine, The University of Texas at Austin, Austin, TX, United States
| | - Sarah Prinsloo
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Oxana Palesh
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, United States
| | - Max Wintermark
- Department of Neuroradiology, The University of Texas MD Anderson Cancer, Houston, TX, United States
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8
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Mulholland MM, Prinsloo S, Kvale E, Dula AN, Palesh O, Kesler SR. Behavioral and biologic characteristics of cancer-related cognitive impairment biotypes. Brain Imaging Behav 2023; 17:320-328. [PMID: 37127832 PMCID: PMC10195718 DOI: 10.1007/s11682-023-00774-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 05/03/2023]
Abstract
Psychiatric diagnosis is moving away from symptom-based classification and towards multi-dimensional, biologically-based characterization, or biotyping. We previously identified three biotypes of chemotherapy-related cognitive impairment based on functional brain connectivity. In this follow-up study of 80 chemotherapy-treated breast cancer survivors and 80 non-cancer controls, we evaluated additional factors to help explain biotype expression: neurofunctional stability, brain age, apolipoprotein (APOE) genotype, and psychoneurologic symptoms. We also compared the discriminative ability of a traditional, symptom-based cognitive impairment definition with that of biotypes. We found significant differences in cortical brain age (F = 10.50, p < 0.001), neurofunctional stability (F = 2.83, p = 0.041), APOE e4 genotype (X2 = 7.68, p = 0.050), and psychoneurological symptoms (Pillai = 0.378, p < 0.001) across the three biotypes. The more resilient Biotype 2 demonstrated significantly higher neurofunctional stability compared to the other biotypes. Symptom-based classification of cognitive impairment did not differentiate biologic or other behavioral variables, suggesting that traditional categorization of cancer-related cognitive effects may miss important characteristics which could inform targeted treatment strategies. Additionally, biotyping, but not symptom-typing, was able to distinguish survivors with cognitive versus psychological effects. Our results suggest that Biotype 1 survivors might benefit from first addressing symptoms of anxiety and fatigue, Biotype 3 might benefit from a treatment plan which includes sleep hygiene, and Biotype 2 might benefit most from cognitive skills training or rehabilitation. Future research should include additional demographic and clinical information to further investigate biotype expression related to risk and resilience and examine integration of more clinically feasible imaging approaches.
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Affiliation(s)
- Michele M Mulholland
- Keeling Center for Comparative Medicine and Research, The University of Texas MD Anderson Cancer Center, Bastrop, TX, USA
| | - Sarah Prinsloo
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elizabeth Kvale
- Department of Geriatrics and Palliative Care, Baylor College of Medicine, Houston, TX, USA
| | - Adrienne N Dula
- Department of Neurology, Dell School of Medicine, The University of Texas at Austin, Austin, TX, USA
| | - Oxana Palesh
- Department of Psychiatry, Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond,, VA, USA
| | - Shelli R Kesler
- Department of Geriatrics and Palliative Care, Baylor College of Medicine, Houston, TX, USA.
- Department of Adult Health, School of Nursing, The University of Texas at Austin, 1710 Red River St, D0100, Austin, TX, 78712, USA.
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9
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Sleurs C, Amidi A, Wu LM, Kiesl D, Zimmer P, Lange M, Rogiers A, Giffard B, Binarelli G, Borghgraef C, Deprez S, Duivon M, De Ruiter M, Schagen S, Ahmed-Lecheheb D, Castel H, Buskbjerg CR, Dos Santos M, Joly F, Perrier J. Cancer-related cognitive impairment in non-CNS cancer patients: Targeted review and future action plans in Europe. Crit Rev Oncol Hematol 2022; 180:103859. [DOI: 10.1016/j.critrevonc.2022.103859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/07/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022] Open
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10
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Bradley-Garcia M, Winocur G, Sekeres MJ. Episodic Memory and Recollection Network Disruptions Following Chemotherapy Treatment in Breast Cancer Survivors: A Review of Neuroimaging Findings. Cancers (Basel) 2022; 14:4752. [PMID: 36230678 PMCID: PMC9563268 DOI: 10.3390/cancers14194752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/14/2022] [Accepted: 09/16/2022] [Indexed: 11/17/2022] Open
Abstract
Long-term memory disturbances are amongst the most common and disruptive cognitive symptoms experienced by breast cancer survivors following chemotherapy. To date, most clinical assessments of long-term memory dysfunction in breast cancer survivors have utilized basic verbal and visual memory tasks that do not capture the complexities of everyday event memories. Complex event memories, including episodic memory and autobiographical memory, critically rely on hippocampal processing for encoding and retrieval. Systemic chemotherapy treatments used in breast cancer commonly cause neurotoxicity within the hippocampus, thereby creating a vulnerability to memory impairment. We review structural and functional neuroimaging studies that have identified disruptions in the recollection network and related episodic memory impairments in chemotherapy-treated breast cancer survivors, and argue for the need to better characterize hippocampally mediated memory dysfunction following chemotherapy treatments. Given the importance of autobiographical memory for a person's sense of identity, ability to plan for the future, and general functioning, under-appreciation of how this type of memory is impacted by cancer treatment can lead to overlooking or minimizing the negative experiences of breast cancer survivors, and neglecting a cognitive domain that may benefit from intervention strategies.
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Affiliation(s)
| | - Gordon Winocur
- Rotman Research Institute, Baycrest Centre, Toronto, ON M6A 2E1, Canada
- Department of Psychology, Department of Psychiatry, University of Toronto, Toronto, ON M5S 3G3, Canada
- Department of Psychology, Trent University, Peterborough, ON K9J 7B8, Canada
| | - Melanie J Sekeres
- School of Psychology, University of Ottawa, Ottawa, ON K1N 6N5, Canada
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11
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Allemann-Su YY, Vetter M, Koechlin H, Paul SM, Cooper BA, Oppegaard K, Melisko M, Levine JD, Conley Y, Miaskowski C, Katapodi MC. Pre-Surgery Demographic, Clinical, and Symptom Characteristics Associated with Different Self-Reported Cognitive Processes in Patients with Breast Cancer. Cancers (Basel) 2022; 14:cancers14133281. [PMID: 35805053 PMCID: PMC9265628 DOI: 10.3390/cancers14133281] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 06/28/2022] [Accepted: 07/04/2022] [Indexed: 02/01/2023] Open
Abstract
Cancer related cognitive impairment (CRCI) is a common and persistent symptom in breast cancer patients. The Attentional Function Index (AFI) is a self-report measure that assesses CRCI. AFI includes three subscales, namely effective action, attentional lapses, and interpersonal effectiveness, that are based on working memory, inhibitory control, and cognitive flexibility. Previously, we identified three classes of patients with distinct CRCI profiles using the AFI total scores. The purpose of this study was to expand our previous work using latent class growth analysis (LCGA), to identify distinct cognitive profiles for each of the AFI subscales in the same sample (i.e., 397 women who were assessed seven times from prior to through to 6 months following breast cancer surgery). For each subscale, parametric and non-parametric statistics were used to determine differences in demographic, clinical, and pre-surgical psychological and physical symptoms among the subgroups. Three-, four-, and two-classes were identified for the effective action, attentional lapses, and interpersonal effectiveness subscales, respectively. Across all three subscales, lower functional status, higher levels of anxiety, depression, fatigue, and sleep disturbance, and worse decrements in energy were associated with worse cognitive performance. These and other modifiable characteristics may be potential targets for personalized interventions for CRCI.
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Affiliation(s)
- Yu-Yin Allemann-Su
- Department of Clinical Research, University of Basel, 4055 Basel, Switzerland;
| | - Marcus Vetter
- Department of Oncology, Cantonal Hospital Basel-Land, 4410 Listel, Switzerland;
| | - Helen Koechlin
- Division of Child and Adolescent Health Psychology, Department of Psychology, University of Zurich, 8050 Zurich, Switzerland;
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, 4055 Basel, Switzerland
- Department of Anaesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Steven M. Paul
- School of Nursing, University of California San Francisco, San Francisco, CA 94143, USA; (S.M.P.); (B.A.C.); (K.O.); (C.M.)
| | - Bruce A. Cooper
- School of Nursing, University of California San Francisco, San Francisco, CA 94143, USA; (S.M.P.); (B.A.C.); (K.O.); (C.M.)
| | - Kate Oppegaard
- School of Nursing, University of California San Francisco, San Francisco, CA 94143, USA; (S.M.P.); (B.A.C.); (K.O.); (C.M.)
| | - Michelle Melisko
- School of Medicine, University of California San Francisco, San Francisco, CA 94143, USA; (M.M.); (J.D.L.)
| | - Jon D. Levine
- School of Medicine, University of California San Francisco, San Francisco, CA 94143, USA; (M.M.); (J.D.L.)
| | - Yvette Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA 15261, USA;
| | - Christine Miaskowski
- School of Nursing, University of California San Francisco, San Francisco, CA 94143, USA; (S.M.P.); (B.A.C.); (K.O.); (C.M.)
- School of Medicine, University of California San Francisco, San Francisco, CA 94143, USA; (M.M.); (J.D.L.)
| | - Maria C. Katapodi
- Department of Clinical Research, University of Basel, 4055 Basel, Switzerland;
- Correspondence: ; Tel.: +41-61-207-0430
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12
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McDonald BC, Van Dyk K, Deardorff RL, Bailey JN, Zhai W, Carroll JE, Root JC, Ahles TA, Mandelblatt JS, Saykin AJ. Multimodal MRI examination of structural and functional brain changes in older women with breast cancer in the first year of antiestrogen hormonal therapy. Breast Cancer Res Treat 2022; 194:113-126. [PMID: 35476252 PMCID: PMC9255382 DOI: 10.1007/s10549-022-06597-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/05/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Cancer patients are concerned about treatment-related cognitive problems. We examined effects of antiestrogen hormonal therapy on brain imaging metrics in older women with breast cancer. METHODS Women aged 60 + treated with hormonal therapy only and matched non-cancer controls (n = 29/group) completed MRI and objective and self-reported cognitive assessment at pre-treatment/enrollment and 12 months later. Gray matter was examined using voxel-based morphometry (VBM), FreeSurfer, and brain age calculations. Functional MRI (fMRI) assessed working memory-related activation. Analyses examined cross-sectional and longitudinal differences and tested associations between brain metrics, cognition, and days on hormonal therapy. RESULTS The cancer group showed regional reductions over 12 months in frontal, temporal, and parietal gray matter on VBM, reduced FreeSurfer cortical thickness in prefrontal, parietal, and insular regions, and increased working memory-related fMRI activation in frontal, cingulate, and visual association cortex. Controls showed only reductions in fusiform gyrus on VBM and FreeSurfer temporal and parietal cortex thickness. Women with breast cancer showed higher estimated brain age and lower regional gray matter volume than controls at both time points. The cancer group showed a trend toward lower performance in attention, processing speed, and executive function at follow-up. There were no significant associations between brain imaging metrics and cognition or days on hormonal therapy. CONCLUSION Older women with breast cancer showed brain changes in the first year of hormonal therapy. Increased brain activation during working memory processing may be a sign of functional compensation for treatment-related structural changes. This hypothesis should be tested in larger samples over longer time periods. CLINICALTRIALS GOV IDENTIFIER NCT03451383.
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Affiliation(s)
- Brenna C McDonald
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine and Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN, USA.
| | - Kathleen Van Dyk
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and UCLA Jonnson Comprehensive Cancer Center, University of California at Los Angeles, Los Angeles, CA, USA
| | - Rachael L Deardorff
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine and Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN, USA
| | - Jessica N Bailey
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine and Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN, USA
| | - Wanting Zhai
- Georgetown University and Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Judith E Carroll
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and UCLA Jonnson Comprehensive Cancer Center, University of California at Los Angeles, Los Angeles, CA, USA
| | - James C Root
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tim A Ahles
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jeanne S Mandelblatt
- Georgetown University and Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Andrew J Saykin
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine and Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN, USA
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13
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Zhang W, Zou Y, Zhao F, Yang Y, Mao N, Li Y, Huang G, Yao Z, Hu B. Brain Network Alterations in Rectal Cancer Survivors With Depression Tendency: Evaluation With Multimodal Magnetic Resonance Imaging. Front Neurol 2022; 13:791298. [PMID: 35847225 PMCID: PMC9277124 DOI: 10.3389/fneur.2022.791298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 05/09/2022] [Indexed: 11/15/2022] Open
Abstract
Surgery and chemotherapy may increase depression tendency in patients with rectal cancer (RC). Nevertheless, few comprehensive studies are conducted on alterations of brain network induced by depression tendency in patients with RC. Resting-state functional magnetic resonance imaging (rs-fMRI) and diffusion tensor imaging (DTI) data were collected from 42 patients with RC with surgery and chemotherapy and 38 healthy controls (HCs). Functional network (FN) was constructed from extracting average time courses in brain regions, and structural network (SN) was established by deterministic tractography. Graph theoretical analysis was used to calculate network properties. Networks resilient of two networks were assessed. Clinical correlation analysis was explored between altered network parameters and Hamilton depression scale (HAMD) score. This study revealed impaired FN and SN at both local and global levels and changed nodal efficiency and abnormal small-worldness property in patients with RC. On the whole, all FNs are more robust than SN. Moreover, compared with HC, patients with RC show less robustness in both networks. Regions with decreased nodal efficiency were associated with HAMD score. These cognitive dysfunctions are mainly attributable to depression-related brain functional and structural network alterations. Brain network reorganization is to prevent patients with RC from more serious depression after surgery and chemotherapy.
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Affiliation(s)
- Wenwen Zhang
- Department of Radiology, Gansu Provincial Hospital, Lanzhou, China
| | - Ying Zou
- Department of Information Engineering, Yantai Vocational College, Yantai, China
| | - Feng Zhao
- School of Computer Science and Technology, Shandong Technology and Business University, Yantai, China
| | - Yongqing Yang
- School of Management Science and Engineering, Shandong Technology and Business University, Yantai, China
| | - Ning Mao
- Department of Radiology, Yantai Yuhuangding Hospital, Yantai, China
- Big data and Artificial Intelligence Laboratory, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Yuan Li
- School of Management Science and Engineering, Shandong Technology and Business University, Yantai, China
- *Correspondence: Yuan Li
| | - Gang Huang
- Department of Radiology, Gansu Provincial Hospital, Lanzhou, China
- Gang Huang
| | - Zhijun Yao
- School of Information Science and Engineering, Lanzhou University, Lanzhou, China
- Zhijun Yao
| | - Bin Hu
- School of Information Science and Engineering, Lanzhou University, Lanzhou, China
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Lanzhou, China
- CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China
- Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
- Bin Hu
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14
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Luijendijk MJ, Bekele BM, Schagen SB, Douw L, de Ruiter MB. Temporal Dynamics of Resting-state Functional Networks and Cognitive Functioning following Systemic Treatment for Breast Cancer. Brain Imaging Behav 2022; 16:1927-1937. [PMID: 35705764 PMCID: PMC9581823 DOI: 10.1007/s11682-022-00651-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2022] [Indexed: 11/13/2022]
Abstract
Many women with breast cancer suffer from a decline in memory and executive function, particularly after treatment with chemotherapy. Recent neuroimaging studies suggest that changes in network dynamics are fundamental in decline in these cognitive functions. This has, however, not yet been investigated in breast cancer patients. Using resting state functional magnetic resonance imaging, we prospectively investigated whether changes in dynamic functional connectivity were associated with changes in memory and executive function. We examined 34 breast cancer patients that received chemotherapy, 32 patients that did not receive chemotherapy, and 35 no-cancer controls. All participants were assessed prior to treatment and six months after completion of chemotherapy, or at similar intervals for the other groups. To assess memory and executive function, we used the Hopkins Verbal Learning Test – Immediate Recall and the Trail Making Test B, respectively. Using a sliding window approach, we then evaluated dynamic functional connectivity of resting state networks supporting memory and executive function, i.e. the default mode network and frontoparietal network, respectively. Next, we directly investigated the association between cognitive performance and dynamic functional connectivity. We found no group differences in cognitive performance or connectivity measures. The association between dynamic functional connectivity of the default mode network and memory differed significantly across groups. This was not the case for the frontoparietal network and executive function. This suggests that cancer and chemotherapy alter the role of dynamic functional connectivity in memory function. Further implications of these findings are discussed.
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Affiliation(s)
- Maryse J Luijendijk
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands.,Brain and Cognition Group, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Biniam M Bekele
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands.,Department of Anatomy and Neurosciences, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Sanne B Schagen
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands. .,Brain and Cognition Group, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands.
| | - Linda Douw
- Department of Anatomy and Neurosciences, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Michiel B de Ruiter
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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15
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Zhou W, Tian W, Xia J, Li Y, Li X, Yao T, Bi J, Zhu Z. Alterations in degree centrality and cognitive function in breast cancer patients after chemotherapy. Brain Imaging Behav 2022; 16:2248-2257. [PMID: 35689165 DOI: 10.1007/s11682-022-00695-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 05/21/2022] [Accepted: 06/01/2022] [Indexed: 11/26/2022]
Abstract
The goal of this study was to determine the presence or absence of persistent functional impairments in specific brain regions in breast cancer patients during the recovery period after chemotherapy. We calculated degree centrality (DC) and explored the correlation between brain changes and cognitive scores in 29 female patients with breast cancer who had completed chemotherapy within 1-6 years (C + group) and in 28 age-matched patients with breast cancer who did not receive chemotherapy (C- group). All patients underwent rs-fMRI and cognitive testing. Differences in brain functional activity were explored using DC parameters. Correlations between brain features and cognitive scores were analyzed via correlation analysis. Compared with the C- group, the C + group obtained significantly lower motor and cognitive subscores on the Fatigue Scale for Motor and Cognitive Functions and four subscale scores of the Functional Assessment of Cancer Therapy-Cognitive Function (P < 0.05). Furthermore, the C + group exhibited a significantly higher DC z-score (zDC) in the right superior temporal gyrus and left postcentral gyrus (P < 0.01, FWE-corrected), and a lower zDC in the left caudate nucleus (P < 0.01, FWE-corrected). We found a positive correlation between digit symbol test (DST) scores and zDC values in the right superior temporal gyrus (r = 0.709, P < 0.001), and a negative correlation between DST scores and zDC values in the right angular gyrus (r = -0.784, P < 0.001) and left superior parietal gyrus (r = -0.739, P < 0.001). Chemotherapy can cause abnormal brain activity and cognitive decline in patients with breast cancer, and these effects are likely to persist. DC can be used as an imaging marker for chemotherapy-related cognitive impairment after chemotherapy in breast cancer patients.
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Affiliation(s)
- Wensu Zhou
- Graduate School of Dalian Medical University, 116044, Dalian, China
| | - Weizhong Tian
- Department of Radiology, Taizhou People's Hospital, 225300, Taizhou, Jiangsu, China.
| | - Jianguo Xia
- Department of Radiology, Taizhou People's Hospital, 225300, Taizhou, Jiangsu, China.
| | - Yuan Li
- Department of Radiology, Taizhou People's Hospital, 225300, Taizhou, Jiangsu, China
| | - Xiaolu Li
- Graduate School of Dalian Medical University, 116044, Dalian, China
| | - Tianyi Yao
- Department of Breast and Thyroid Surgery, Taizhou People's Hospital, 225300, Taizhou, Jiangsu, China
| | - Jingcheng Bi
- Department of Breast and Thyroid Surgery, Taizhou People's Hospital, 225300, Taizhou, Jiangsu, China
| | - Zhengcai Zhu
- Department of Breast and Thyroid Surgery, Taizhou People's Hospital, 225300, Taizhou, Jiangsu, China
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16
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Phillips NS, Rao V, Kmetz L, Vela R, Medick S, Krull K, Kesler SR. Changes in Brain Functional and Effective Connectivity After Treatment for Breast Cancer and Implications for Intervention Targets. Brain Connect 2022; 12:385-397. [PMID: 34210168 PMCID: PMC9131353 DOI: 10.1089/brain.2021.0049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Patients with breast cancer frequently report cognitive impairment both during and after completion of therapy. Evidence suggests that cancer-related cognitive impairments are related to widespread neural network dysfunction. The default mode network (DMN) is a large conserved network that plays a critical role in integrating the functions of various neural systems. Disruption of the network may play a key role in the development of cognitive impairment. Methods: We compared neuroimaging and neurocognitive data from 43 newly diagnosed primary breast cancer patients (mean age = 48, standard deviation [SD] = 8.9 years) and 50 frequency-matched healthy female controls (mean age = 50, SD = 10 years) before treatment and 1 year after treatment completion. Functional and effective connectivity measures of the DMN were obtained using graph theory and Bayesian network analysis methods, respectively. Results: Compared with healthy females, the breast cancer group displayed higher global efficiency and path length post-treatment (p < 0.03, corrected). Breast cancer survivors showed significantly lower performance on measures of verbal memory, attention, and verbal fluency (p < 0.05) at both time points. Within the DMN, local brain network organization, as measured by edge-betweenness centralities, was significantly altered in the breast cancer group compared with controls at both time points (p < 0.0001, corrected), with several connections showing a significant group-by-time effect (p < 0.003, corrected). Effective connectivity demonstrated significantly altered patterns of neuronal coupling in patients with breast cancer (p < 0.05). Significant correlations were seen between hormone blockade therapy, radiation therapy, chemotherapy cycles, memory, and verbal fluency test and edge-betweenness centralities. Discussion: This pattern of altered network organization in the default mode is believed to result in reduced network efficiency and disrupted communication. Subregions of the DMN, the orbital prefrontal cortex and posterior memory network, appear to be at the center of this disruption and this could inform future interventions. Impact statement This prospective study is the first to investigate how post-treatment changes in functional and effective connectivity in the regions of default mode network are related to cancer therapy and measures of memory and verbal learning in breast cancer patients. We demonstrate that the interactions between treatment, brain connectivity, and neurocognitive outcomes coalesce around a subgroup of brain structures in the orbital frontal and parietal lobe. This would suggest that interventions that target these regions may improve neurocognitive outcomes in breast cancer survivors.
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Affiliation(s)
- Nicholas S. Phillips
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Vikram Rao
- School of Nursing, University of Texas at Austin, Austin, Texas, USA
| | - Lorie Kmetz
- School of Nursing, University of Texas at Austin, Austin, Texas, USA
| | - Ruben Vela
- School of Nursing, University of Texas at Austin, Austin, Texas, USA
- Department of Diagnostic Medicine, Dell School of Medicine, University of Texas at Austin, Austin, Texas, USA
| | - Sarah Medick
- School of Nursing, University of Texas at Austin, Austin, Texas, USA
| | - Kevin Krull
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Shelli R. Kesler
- School of Nursing, University of Texas at Austin, Austin, Texas, USA
- Department of Diagnostic Medicine, Dell School of Medicine, University of Texas at Austin, Austin, Texas, USA
- Center for Computational Oncology, Oden Institute for Computational Engineering and Sciences, University of Texas at Austin, Austin, Texas, USA
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17
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Mentzelopoulos A, Karanasiou I, Papathanasiou M, Kelekis N, Kouloulias V, Matsopoulos GK. A Comparative Analysis of White Matter Structural Networks on SCLC Patients After Chemotherapy. Brain Topogr 2022; 35:352-362. [PMID: 35212837 DOI: 10.1007/s10548-022-00892-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 02/02/2022] [Indexed: 12/16/2022]
Abstract
Previous sMRI, DTI and rs-fMRI studies in small cell lung cancer (SCLC) patients have reported that patients after chemotherapy had gray and white matter structural alterations along with functional deficits. Nonetheless, few are known regarding the potential alterations in the topological organization of the WM structural network in SCLC patients after chemotherapy. In this context, the scope of the present study is to evaluate the WM structural network of 20 SCLC patients after chemotherapy and to 14 healthy controls, by applying a combination of DTI with graph theory. The results revealed that both SCLC and healthy controls groups demonstrated small world properties. The SCLC patients had decreased values in the clustering coefficient, local efficiency and degree metrics as well as increased shortest path length when compared to the healthy controls. Moreover, the two groups reported different topological reorganization of hub distribution. Lastly, the SCLC patients exhibited significantly decreased structural connectivity in comparison to the healthy group. These results underline that the topological organization of the WM structural network in SCLC patients was disrupted and hence constitute new vital information regarding the effects that chemotherapy and cancer may have in the patients' brain at network level.
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Affiliation(s)
- Anastasios Mentzelopoulos
- School of Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece.
| | | | - Matilda Papathanasiou
- Radiotherapy Unit, 2nd Department of Radiology, ATTIKON University Hospital, Athens, Greece
| | - Nikolaos Kelekis
- Radiotherapy Unit, 2nd Department of Radiology, ATTIKON University Hospital, Athens, Greece
| | - Vasileios Kouloulias
- Radiotherapy Unit, 2nd Department of Radiology, ATTIKON University Hospital, Athens, Greece
| | - George K Matsopoulos
- School of Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece
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18
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Grusdat NP, Stäuber A, Tolkmitt M, Schnabel J, Schubotz B, Wright PR, Heydenreich M, Zermann DH, Schulz H. Cancer treatment regimens and their impact on the patient-reported outcome measures health-related quality of life and perceived cognitive function. J Patient Rep Outcomes 2022; 6:16. [PMID: 35190938 PMCID: PMC8861246 DOI: 10.1186/s41687-022-00422-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 02/09/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE Breast cancer can be a significant challenge for those affected. Knowledge of physical function, social-emotional challenges, and perceived cognitive function based on the cancer treatment regimens may help to inform adequate support. METHODS For this prospective observational pilot study, we collected data of seventy-nine women (mean age 54.6 ± 9.5 years) before (T0) and after (T1) initial breast cancer treatment. Functional Assessment of Cancer Therapy-Breast (FACT-B) and Functional Assessment of Cancer Therapy-Cognitive-Function (FACT-Cog) were used to collect data of four treatment subgroups: SCR = Surgery + Chemotherapy + Radiation Therapy; SC = Surgery + Chemotherapy; SR = Surgery + Radiation Therapy; S = Surgery. A mixed ANOVA and posthoc analysis (Tukey, Games-Howell) were used to detect interactions (group by time) and the main effect. A repeated-measures ANOVA displayed individual group differences (time). RESULTS Significant interaction showed more deterioration was experienced with SC and SCR than SR and S for FACT-B (p < 0.01) and FACT-Cog (p < 0.001). The longitudinal comparison between T0 and T1 indicated a significant group main effect on all subscales (p < 0.001) except for Emotional Well-Being. Significant reductions (p < 0.05) in FACT-B, (- 19%); FACT-Cog, (- 21%) with most pronounced effect in Physical Well-Being (- 30%), Functional Well-Being (- 20%), Breast Cancer Subscale (- 20%), Perceived Cognitive Impairments (- 18%) and Impact of Cognitive Impairments on Quality of Life (- 39%) were detected for SCR. CONCLUSION Our study showed that the extent of change in health-related quality of life (HRQoL) and perceived cognitive function (PCF) depends on the treatment regimen. Multidisciplinary support initiated early in breast cancer therapy is needed, especially for women undergoing combined cancer treatment. Routine assessment of patient-reported outcomes (PROs) in oncology practice may increase the transparency of patients' perceived circumstances, leading to personalized and optimized acute and survivorship care.
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Affiliation(s)
- Niklas Paul Grusdat
- Professorship of Sports Medicine/Sports Biology, Institute of Human Movement Science and Health, Faculty of Behavioral and Social Sciences, Chemnitz University of Technology, Thüringer Weg 11, 09126, Chemnitz, Saxony/Sachsen, Germany.
| | - Alexander Stäuber
- Professorship of Sports Medicine/Sports Biology, Institute of Human Movement Science and Health, Faculty of Behavioral and Social Sciences, Chemnitz University of Technology, Thüringer Weg 11, 09126, Chemnitz, Saxony/Sachsen, Germany
| | - Marion Tolkmitt
- Rotes Kreuz Krankenhaus, Red Cross Hospital, Chemnitz-Rabenstein, Germany
| | - Jens Schnabel
- Rotes Kreuz Krankenhaus, Red Cross Hospital, Chemnitz-Rabenstein, Germany
| | - Birgit Schubotz
- Clinical Cancer Registry, Tumorzentrum Chemnitz e.V., Chemnitz, Germany
| | - Peter Richard Wright
- Department of Sport, Health Sciences and Social Work, Oxford Brookes University, Oxford, UK
| | - Marc Heydenreich
- Department of Urology and Urooncology, Vogtland-Klinik, Bad Elster, Germany
| | | | - Henry Schulz
- Professorship of Sports Medicine/Sports Biology, Institute of Human Movement Science and Health, Faculty of Behavioral and Social Sciences, Chemnitz University of Technology, Thüringer Weg 11, 09126, Chemnitz, Saxony/Sachsen, Germany
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19
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Dynamic functional network connectivity reveals the brain functional alterations in lung cancer patients after chemotherapy. Brain Imaging Behav 2021; 16:1040-1048. [PMID: 34718941 DOI: 10.1007/s11682-021-00575-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 09/28/2021] [Indexed: 10/19/2022]
Abstract
This study aimed to investigate alterations of brain functional network connectivity (FNC) in lung cancer patients after chemotherapy and explore links between these FNC differences and cognitive impairment. Twenty-two lung cancer patients receiving chemotherapy and 26 healthy controls (HCs) underwent resting-state functional MRI (rs-fMRI) and neuropsychological testing. Group independent component analysis (GICA) was applied to rs-fMRI data to extract whole-brain resting state networks (RSNs). Static and dynamic FNC (dFNC) were constructed to reveal RSNs connectivity alterations between lung cancer patients and HCs group, and the correlations between the group differences in RSNs and cognitive performance were analyzed. Our findings revealed that chemotherapeutics can produce widespread connectivity abnormalities in RSNs, mainly focused on default mode network (DMN) and executive control network. Furthermore, the dFNC analysis help identify network configurations of each state and capture more chemotherapy-induced disorders of interactions between and within RSNs, which mainly includes sensorimotor network, attentional network and auditory network. In addition, after chemotherapy, the lung cancer patients spend shorter mean dwell time (MDT) in state 2. The decreased dFNC between DMN [independent component 5 (IC5)] and DMN (IC6) in the lung cancer patients after chemotherapy in state 4 was negatively correlated with Montreal Cognitive Assessment (MoCA) scores (r=-0.447, p=0.042). The dFNC analysis enrich our understanding of the neural mechanisms underlying the chemobrain, and suggested that the temporal dynamics of FNC could be a potential effective method to detect cognitive changes in lung cancer patients receiving chemotherapy.
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20
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Grusdat NP, Stäuber A, Tolkmitt M, Schnabel J, Schubotz B, Schulz H. Routine Cancer Treatment Regimens and Its Impact on Fine Motor Dexterity in Breast Cancer. Oncol Res Treat 2021; 45:37-44. [PMID: 34644712 DOI: 10.1159/000519829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/22/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Breast cancer can be a major challenge for those affected. Knowledge of changes in fine motor dexterity in affected women due to routine cancer therapies can help guide effective support. METHODS For this prospective observational study, we collected data of 79 women with a mean age 54.6 ± 9.5 years prior to, after breast cancer therapy (T1), and at 3-month follow-up. The fine motor dexterity was assessed for 4 treatment subgroups: SC = Surgery + Chemotherapy, SCR = Surgery + Chemotherapy + Radiotherapy Therapy, SR = Surgery + Radiotherapy, and S = Surgery. RESULTS Over time, women with breast cancer showed significant decreases in fine motor dexterity across all treatment groups (p < 0.001). The strongest negative effect was seen in the treatment groups receiving additional chemotherapy. SCR group showed pronounced limitations for dominant hand (DH) -12%; non-dominant hand (NDH) -15%; both hands (BH) -17%; assembly (ASSY) -11% at T1. Significant interaction was noticeable in DH (F = 5.59, p < 0.001), NDH (F = 6.61, p < 0.001), BH (F = 13.11 p < 0.001), and ASSY (F = 5.84 p < 0.001). DISCUSSION/CONCLUSION Our study showed that the extent of change in fine motor dexterity depends on the treatment regimen. The detection of unmet care needs could help to personalize and optimize clinical and survivorship care. Based on our findings, multidisciplinary support initiated early in breast cancer therapy is required.
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Affiliation(s)
- Niklas Paul Grusdat
- Professorship of Sports Medicine/Sports Biology, Chemnitz University of Technology, Chemnitz, Germany
| | - Alexander Stäuber
- Professorship of Sports Medicine/Sports Biology, Chemnitz University of Technology, Chemnitz, Germany
| | - Marion Tolkmitt
- Deutsches Rotes Kreuz Krankenhaus Chemnitz-Rabenstein, German Red Cross Hospital, Chemnitz, Germany
| | - Jens Schnabel
- Deutsches Rotes Kreuz Krankenhaus Chemnitz-Rabenstein, German Red Cross Hospital, Chemnitz, Germany
| | - Birgit Schubotz
- Tumorzentrum Chemnitz e.V., Clinical Cancer Registry Chemnitz, Chemnitz, Germany
| | - Henry Schulz
- Professorship of Sports Medicine/Sports Biology, Chemnitz University of Technology, Chemnitz, Germany
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21
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Bekele BM, Luijendijk M, Schagen SB, de Ruiter M, Douw L. Fatigue and resting-state functional brain networks in breast cancer patients treated with chemotherapy. Breast Cancer Res Treat 2021; 189:787-796. [PMID: 34259949 PMCID: PMC8505321 DOI: 10.1007/s10549-021-06326-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/05/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE This longitudinal study aimed to disentangle the impact of chemotherapy on fatigue and hypothetically associated functional brain network alterations. METHODS In total, 34 breast cancer patients treated with chemotherapy (BCC +), 32 patients not treated with chemotherapy (BCC -), and 35 non-cancer controls (NC) were included. Fatigue was assessed using the EORTC QLQ-C30 fatigue subscale at two time points: baseline (T1) and six months after completion of chemotherapy or matched intervals (T2). Participants also underwent resting-state functional magnetic resonance imaging (rsfMRI). An atlas spanning 90 cortical and subcortical brain regions was used to extract time series, after which Pearson correlation coefficients were calculated to construct a brain network per participant per timepoint. Network measures of local segregation and global integration were compared between groups and timepoints and correlated with fatigue. RESULTS As expected, fatigue increased over time in the BCC + group (p = 0.025) leading to higher fatigue compared to NC at T2 (p = 0.023). Meanwhile, fatigue decreased from T1 to T2 in the BCC - group (p = 0.013). The BCC + group had significantly lower local efficiency than NC at T2 (p = 0.033), while a negative correlation was seen between fatigue and local efficiency across timepoints and all participants (T1 rho = - 0.274, p = 0.006; T2 rho = - 0.207, p = 0.039). CONCLUSION Although greater fatigue and lower local functional network segregation co-occur in breast cancer patients after chemotherapy, the relationship between the two generalized across participant subgroups, suggesting that local efficiency is a general neural correlate of fatigue.
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Affiliation(s)
- Biniam Melese Bekele
- Department of Anatomy and Neurosciences, Amsterdam Neuroscience, Cancer Center Amsterdam, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Maryse Luijendijk
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Brain and Cognition, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Sanne B Schagen
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Brain and Cognition, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Michiel de Ruiter
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Linda Douw
- Department of Anatomy and Neurosciences, Amsterdam Neuroscience, Cancer Center Amsterdam, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
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22
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Bernstein LJ, Edelstein K, Sharma A, Alain C. Chemo-brain: An activation likelihood estimation meta-analysis of functional magnetic resonance imaging studies. Neurosci Biobehav Rev 2021; 130:314-325. [PMID: 34454915 DOI: 10.1016/j.neubiorev.2021.08.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 07/24/2021] [Accepted: 08/23/2021] [Indexed: 11/17/2022]
Abstract
Adults with non-central nervous system (CNS) cancers frequently report problems in attention, memory and executive function during or after chemotherapy, referred to as cancer-related cognitive dysfunction (CRCD). Despite numerous studies investigating CRCD, there is no consensus regarding the brain areas implicated. We sought to determine if there are brain areas that consistently show either hyper- or hypo-activation in people treated with chemotherapy for non-CNS cancer (Chemo+). Using activation likelihood estimation on brain coordinates from 14 fMRI studies yielding 25 contrasts from 375 Chemo+ and 429 chemotherapy-naive controls while they performed cognitive tasks, the meta-analysis yielded two significant clusters which are part of the frontoparietal attention network, both showing lower activation in Chemo+. One cluster peaked in the left superior parietal cortex, extending into precuneus, inferior parietal lobule, and angular gyrus. The other peaked in the right superior prefrontal areas, extending into inferior prefrontal cortex. We propose that these observed lower activations reflect a dysfunction in mobilizing and/or sustaining attention due to depletion of cognitive resources. This could explain higher level of mental fatigue reported by Chemo+ and why cancer survivors report problems in a wide variety of cognitive domains.
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Affiliation(s)
- Lori J Bernstein
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Canada.
| | - Kim Edelstein
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Canada
| | - Alisha Sharma
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Claude Alain
- Rotman Research Institute, Baycrest Health Centre, Canada; Department of Psychology, University of Toronto, Canada
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23
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Gu Z, Jamison KW, Sabuncu MR, Kuceyeski A. Heritability and interindividual variability of regional structure-function coupling. Nat Commun 2021; 12:4894. [PMID: 34385454 PMCID: PMC8361191 DOI: 10.1038/s41467-021-25184-4] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 07/16/2021] [Indexed: 02/07/2023] Open
Abstract
White matter structural connections are likely to support flow of functional activation or functional connectivity. While the relationship between structural and functional connectivity profiles, here called SC-FC coupling, has been studied on a whole-brain, global level, few studies have investigated this relationship at a regional scale. Here we quantify regional SC-FC coupling in healthy young adults using diffusion-weighted MRI and resting-state functional MRI data from the Human Connectome Project and study how SC-FC coupling may be heritable and varies between individuals. We show that regional SC-FC coupling strength varies widely across brain regions, but was strongest in highly structurally connected visual and subcortical areas. We also show interindividual regional differences based on age, sex and composite cognitive scores, and that SC-FC coupling was highly heritable within certain networks. These results suggest regional structure-function coupling is an idiosyncratic feature of brain organisation that may be influenced by genetic factors.
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Affiliation(s)
- Zijin Gu
- School of Electrical and Computer Engineering, Cornell University, Ithaca, NY, USA
| | | | - Mert Rory Sabuncu
- School of Electrical and Computer Engineering, Cornell University, Ithaca, NY, USA
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Amy Kuceyeski
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA.
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24
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Wurz A, Ayson G, Smith AM, Brunet J. A proof-of-concept sub-study exploring feasibility and preliminary evidence for the role of physical activity on neural activity during executive functioning tasks among young adults after cancer treatment. BMC Neurol 2021; 21:300. [PMID: 34344355 PMCID: PMC8336393 DOI: 10.1186/s12883-021-02280-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 06/10/2021] [Indexed: 11/28/2022] Open
Abstract
Background Executive functioning (EF) deficits are troubling for adolescents and young adults (AYAs) after cancer treatment. Physical activity (PA) may enhance neural activity underlying EF among older adults affected by cancer. Establishing whether PA enhances neural activity among AYAs is warranted. As part of a two-arm, mixed-methods pilot randomized controlled trial (RCT), this proof-of-concept sub-study sought to answer the following questions: (1) is it feasible to use neuroimaging with EF tasks to assess neural activity changes following a 12-week PA intervention? And (2) is there preliminary evidence that a 12-week PA intervention enhances neural activity among AYAs after cancer treatment? Methods AYAs in the pilot RCT were approached for enrollment into this sub-study. Those who were eligible and enrolled, completed functional magnetic resonance imaging (fMRI) with EF tasks (letter n-back, Go/No Go) pre- and post-PA intervention. Sub-study enrollment, adherence to scheduled fMRI scans, outliers, missing data, and EF task performance data were collected. Data were analyzed with descriptive statistics, blood oxygen level dependent (BOLD) analyses, and paired sample t-tests. Results Nine eligible participants enrolled into this sub-study; six attended scheduled fMRI scans. One outlier was identified and was subsequently removed from the analytical sample. Participants showed no differences in EF task performance from pre- to post-PA intervention. Increases in neural activity in brain regions responsible for motor control, information encoding and processing, and decision-making were observed post-PA intervention (p < 0.05; n = 5). Conclusions Findings show that fMRI scans during EF tasks detected neural activity changes (as assessed by the BOLD signal) from pre- to post-PA intervention. Results thus suggest future trials confirming that PA enhances neural activity underlying EF are needed, though feasibility issues require careful consideration to ensure trial success. Trial registration clinicaltrials.gov, NCT03016728. Registered January 11, 2017, clinicaltrials.gov/ct2/show/NCT03016728. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02280-y.
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Affiliation(s)
- Amanda Wurz
- School of Human Kinetics, University of Ottawa, 125 University Private, Montpetit Hall, Room 339, K1N 6N5, Ottawa, Ontario, Canada.,Present affiliation: Faculty of Kinesiology, University of Calgary, Alberta, Calgary, Canada
| | - Gladys Ayson
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Andra M Smith
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Jennifer Brunet
- School of Human Kinetics, University of Ottawa, 125 University Private, Montpetit Hall, Room 339, K1N 6N5, Ottawa, Ontario, Canada. .,Cancer Therapeutic Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada. .,Institut du savoir Montfort, Hôpital Montfort, Ottawa, Ontario, Canada.
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25
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van der Willik KD, Jóźwiak K, Hauptmann M, van de Velde EED, Compter A, Ruiter R, Stricker BH, Ikram MA, Schagen SB. Change in cognition before and after non-central nervous system cancer diagnosis: A population-based cohort study. Psychooncology 2021; 30:1699-1710. [PMID: 34004035 DOI: 10.1002/pon.5734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Clinical studies showing that non-central nervous system cancer patients can develop cognitive impairment have primarily focused on patients with specific cancer types and intensive treatments. To better understand the course of cognitive function in the general population of cancer patients, we assessed cognitive trajectories of patients before and after cancer diagnosis in a population-based setting. METHODS Between 1989 and 2014, 2211 participants from the population-based Rotterdam study had been diagnosed with cancer of whom 718 (32.5%) had undergone ≥1 cognitive assessment before and after diagnosis. Cognition was measured every 3 to 6 years using a neuropsychological battery. Linear mixed models were used to compare cognitive trajectories of patients before and after diagnosis with those of age-matched cancer-free controls (1:3). RESULTS Median age at cancer diagnosis was 70.3 years and 47.1% were women. Most patients (68.1%) had received local treatment only. Cognitive trajectories of patients before and after cancer diagnosis were largely similar to those of controls. After diagnosis, the largest difference was found on a memory test (patients declined with 0.14 units per year on the Word Learning Test: delayed recall [95% CI = -0.35; 0.07] and controls with 0.09 units [95% CI = -0.18;-0.00], p for difference = .59). CONCLUSIONS In this longitudinal cohort, cancer did not appear to alter the trajectory of change in cognitive test results over time from that seen in similar individuals without cancer, although most cancer patients did not receive systemic therapies. Future studies should focus on identifying subgroups of patients who are at high risk for developing cognitive impairment.
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Affiliation(s)
- Kimberly D van der Willik
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Katarzyna Jóźwiak
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Michael Hauptmann
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Edolie E D van de Velde
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Annette Compter
- Department of Neuro-oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Rikje Ruiter
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Bruno H Stricker
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sanne B Schagen
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Psychology, Brain and Cognition, University of Amsterdam, Amsterdam, The Netherlands
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26
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Zhang Y, Chen YC, Hu L, You J, Gu W, Li Q, Chen H, Mao C, Yin X. Chemotherapy-induced functional changes of the default mode network in patients with lung cancer. Brain Imaging Behav 2021; 14:847-856. [PMID: 30617783 DOI: 10.1007/s11682-018-0030-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Previous studies have demonstrated that cognitive impairment is associated with neurophysiological changes in lung cancer following chemotherapy. This study aimed to investigate the intrinsic functional connectivity (FC) pattern within the default mode network (DMN) and its associations with cognitive impairment in patients with lung cancer revealed by resting-state functional magnetic resonance imaging (fMRI). Resting-state fMRI scans were acquired from 21 post-chemotherapy and 27 non-chemotherapy lung cancer patients and 30 healthy controls. All groups were age, gender and education-matched. The posterior cingulate cortex (PCC) was chosen as the seed region to detect the FC patterns and then determine whether these changes were related with specific cognitive performance. Compared with non-chemotherapy lung cancer patients, chemotherapy patients revealed decreased FC between the PCC and the right anterior cingulate cortex (ACC), left inferior parietal lobule (IPL), and left medial prefrontal cortex (mPFC), as well as increased FC with the left postcentral gyrus (PoCG). Relative to healthy controls, post-chemotherapy patients exhibited reduced FC between the PCC and the left ACC and left temporal lobe, as well as increased FC with the right PoCG. Moreover, the decreased FC of the PCC to bilateral ACC in post-chemotherapy patients was positively associated with reduced MoCA scores (left: r = 0.529, p = 0.029; right: r = 0.577, p = 0.015). The current study mainly demonstrated reduced resting-state FC pattern within the DMN regions that was linked with impaired cognitive function in lung cancer patients after chemotherapy. These findings illustrated the potential role of the DMN in lung cancer patients that will provide novel insight into the underlying neuropathological mechanisms in chemotherapy-induced cognitive impairment.
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Affiliation(s)
- Yujie Zhang
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing, 210006, China
| | - Yu-Chen Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing, 210006, China.
| | - Lanyue Hu
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing, 210006, China
| | - Jia You
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing, 210006, China
| | - Wei Gu
- Department of Respiratory Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Qian Li
- Department of Respiratory Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Huiyou Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing, 210006, China
| | - Cunnan Mao
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing, 210006, China
| | - Xindao Yin
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing, 210006, China.
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27
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Postchemotherapy hippocampal functional connectivity patterns in patients with breast cancer: a longitudinal resting state functional MR imaging study. Brain Imaging Behav 2021; 14:1456-1467. [PMID: 30877468 DOI: 10.1007/s11682-019-00067-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The hippocampus plays a key role in cognitive function and emotion regulation due to its wide connection with the whole brain. This study examined the acute effect of chemotherapy on hippocampal and subfield functional connectivity and neuropsychological status in breast cancer patients (BC). This IRB approved study included 29 BC and 25 age matched healthy controls (HCs) who underwent resting state functional magnetic resonance imaging (Rs-fMRI), neuropsychological tests and blood examinations at baseline and one week after completing chemotherapy or in the same time interval. Within-group comparisons and group-by-time interactions analysis of hippocampus- and subregion- based functional connectivity were performed between the two groups. Functional connectivity changes were correlated with changes of blood examination and neuropsychological test scores in the BC group. The BC group had higher depression and anxiety scores, poorer performance on visual mobility, auditory memory and executive function than HCs (p < 0.05), and significantly abnormal estrodiol, total cholesterol and triglycerides (p < 0.05). BC survivors showed significant hippocampal functional connectivity changes mainly in the left insula, temporal lobe (Gaussian Random Field theory correction, P < 0.001) and the left inferior frontal gyrus (P < 0.01). The functional connections from the anterior hippocampus to the left temporal lobe were greater than the posterior hippocampus (P < 0.05). The hippocampus functional connectivity alterations were closely related to changes in depression scores, estrodiol and triglycerides (all p < 0.05). Chemotherapy induced especially anterior hippocampal functional connectivity abnormality, which is related to depression symptom, estrodiol and triglycerides disorders.
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28
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Sleurs C, Blommaert J, Batalle D, Verly M, Sunaert S, Peeters R, Lemiere J, Uyttebroeck A, Deprez S. Cortical thinning and altered functional brain coherence in survivors of childhood sarcoma. Brain Imaging Behav 2021; 15:677-688. [PMID: 32335825 DOI: 10.1007/s11682-020-00276-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
High-dose chemotherapy is increasingly evidenced to be neurotoxic and result in long-term neurocognitive sequelae. However, research investigating grey matter alterations in childhood cancer patients remains limited. As childhood sarcoma patients receive high-dose chemotherapy, we aimed to investigate cortical brain alterations in adult survivors. We analyzed high-resolution structural (T1-weighted) MRI and resting-state functional MRI (rsfMRI), to derive structural and functional cortical information in survivors of childhood sarcoma, treated with high-dose intravenous chemotherapy (n = 33). These scans were compared to age- and gender- matched controls (n = 34). Cortical volume and thickness were investigated using voxel-based morphometry and vertex-wise surface-based morphometry. Brain regions showing significant group differences in volume or thickness were implemented as seeds of interest to estimate their resting state co-activity with other areas (i.e. functional coherence). We explored whether structural measures were associated with potential risk factors, such as age at diagnosis, and cumulative doses of chemotherapeutic agents (methotrexate, ifosfamide). Finally, we investigated the link between functional regional strength, neurocognitive assessments and daily life complaints. In patients relative to controls we observed lower grey matter volumes in cerebellar and frontal areas, as well as frontal cortical thinning. Cerebellar volume and orbitofrontal thickness appeared dose- and age-related, respectively. Cortical thickness of the parahippocampal area appeared lower, only if the group comparison was not adjusted for depression. This region specifically showed lower functional coherence, which was associated with lower processing speed. This study suggests cortical thinning as well as decreased functional coherence in survivors of childhood sarcoma, which could be important for both long-term attentional functioning and emotional distress in daily life. Frontal areas might be specifically vulnerable during adolescence.
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Affiliation(s)
| | | | - Dafnis Batalle
- Department of Forensic & Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College, London, UK.,Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Marjolein Verly
- Department of Neurosciences, ExpORL, KU Leuven, Leuven, Belgium
| | - Stefan Sunaert
- Department of Radiology, University Hospital Leuven, Leuven, Belgium.,Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Ron Peeters
- Department of Radiology, University Hospital Leuven, Leuven, Belgium
| | - Jurgen Lemiere
- Department of Pediatric Hematology and Oncology, University Hospital Leuven, Leuven, Belgium
| | - Anne Uyttebroeck
- Department of Oncology, KU Leuven, Leuven, Belgium.,Department of Pediatric Hematology and Oncology, University Hospital Leuven, Leuven, Belgium
| | - Sabine Deprez
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
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29
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McDonald BC. Structural Neuroimaging Findings Related to Adult Non-CNS Cancer and Treatment: Review, Integration, and Implications for Treatment of Cognitive Dysfunction. Neurotherapeutics 2021; 18:792-810. [PMID: 34402034 PMCID: PMC8423886 DOI: 10.1007/s13311-021-01096-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2021] [Indexed: 12/13/2022] Open
Abstract
Cancer- and treatment-related cognitive dysfunction (CRCD) is a common challenge faced by patients diagnosed with non-central nervous system (CNS) cancer. It has become increasingly recognized that multiple factors likely play a role in these symptoms, including the cancer disease process, systemic treatments (e.g., chemotherapy and endocrine therapies), and risk factors that may predispose an individual to both cancer and cognitive dysfunction. As the field has evolved, advanced neuroimaging techniques have been applied to better understand the neural correlates of CRCD. This review focuses on structural neuroimaging findings related to CRCD in adult non-CNS cancer populations, including examination of gray matter volume/density and white matter integrity differences between cancer patients and comparison groups, as well as emerging findings regarding structural network abnormalities. Overall, this literature has demonstrated consistent findings of reduced gray matter volume/density and white matter integrity in cancer patients relative to comparison groups. These are most prominent in individuals treated with chemotherapy, though alterations have also been noted in those treated with anti-estrogen and androgen-deprivation therapies. Alterations in gray and white matter structural network connectivity have also been identified. These structural abnormalities have been observed most prominently in frontal and temporal brain regions, and have been shown to correlate with subjective and objective cognitive function, as well as with physiological and clinical variables, helping to inform understanding of CRCD mechanisms. To date, however, structural neuroimaging techniques have not been utilized in systematic studies of potential CRCD treatments, suggesting a potentially fruitful avenue for future research.
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Affiliation(s)
- Brenna C McDonald
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine and Indiana University Melvin and Bren Simon Comprehensive Cancer Center, 355 W. 16th St., GH Suite 4100, Indianapolis, IN, 46202, USA.
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30
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The association of genetic polymorphisms with neuroconnectivity in breast cancer patients. Sci Rep 2021; 11:6169. [PMID: 33731765 PMCID: PMC7971072 DOI: 10.1038/s41598-021-85768-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 03/02/2021] [Indexed: 11/21/2022] Open
Abstract
Genetic polymorphisms in select genes, including APOE (apolipoprotein E), COMT (Catechol-O-Methyltransferase), MDR1 (multi-drug resistance 1), BDNF (brain derived neurotrophic factor), and GST (glutathione-S-transferase), have been associated with vulnerability to cognitive impairment. In this study, we evaluated the relationship of these genetic variants to measures of brain health in patients with breast cancer, including neurocognitive testing and functional connectome analysis. Women with breast cancer (n = 83) and female healthy controls (n = 53) were evaluated. They underwent resting-state functional MRI scans and neurocognitive testing. Polymerase chain reaction (PCR) was performed on saliva samples to identify single nucleotide polymorphisms (SNPs) in candidate genes: APOE, COMT, MDR1, BDNF, and GST. Breast cancer patients treated with chemotherapy had slower processing speed (p = 0.04) and poorer reported executive function (p < 0.0001) than healthy controls. Those chemotherapy-treated patients that were APOE e4 carriers had significantly slower processing speed. A greater number of risk-related alleles was associated with poorer connectivity in the regions of the left cuneus and left calcarine. While breast cancer patients that are APOE e4 carriers may have a select vulnerability to processing speed impairments, other risk-related alleles were not found to influence cognitive test performance in this population. Conversely, regions of impaired functional connectivity appeared to be related to risk-related genetic polymorphisms in breast cancer patients. This suggests that a cancer patient’s SNPs in candidate genes may influence the risk of neurotoxicity. Further study evaluating the impact of genotype on biomarkers of brain health in cancer survivors is warranted.
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31
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van der Willik KD, Hauptmann M, Jóźwiak K, Vinke EJ, Ruiter R, Stricker BH, Compter A, Ikram MA, Schagen SB. Trajectories of Cognitive Function Prior to Cancer Diagnosis: A Population-Based Study. J Natl Cancer Inst 2021; 112:480-488. [PMID: 31498410 DOI: 10.1093/jnci/djz178] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 07/25/2019] [Accepted: 09/04/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND An emerging body of research suggests that noncentral nervous system cancer may negatively impact the brain apart from effects of cancer treatment. However, studies assessing cognitive function in newly diagnosed cancer patients cannot exclude selection bias and psychological effects of cancer diagnosis. To overcome these limitations, we investigated trajectories of cognitive function of patients before cancer diagnosis. METHODS Between 1989 and 2013, a total of 2059 participants from the population-based Rotterdam Study were diagnosed with noncentral nervous system cancer. Cognitive assessments were performed every 3 to 5 years using a neuropsychological battery. The general cognitive factor was composed of individual cognitive tests to assess global cognition. Using linear mixed models, we compared change in cognitive function of cancer case patients before diagnosis with cognitive change of age-matched cancer-free control subjects (1:2). In addition, we performed sensitivity analyses by discarding assessments of control subjects 5 years before the end of follow-up to exclude effects from potential undiagnosed cancer. All statistical tests were two-sided. RESULTS The Word Learning Test immediate recall declined faster among case patients than among control subjects (-0.05, 95% confidence interval = -0.09 to -0.01 vs 0.01, 95% confidence interval = -0.01 to 0.03; P for difference = .003). However, this difference was not statistically significant in sensitivity analyses. Furthermore, no statistically significant differences were observed in change of other individual cognitive tests and of the general cognitive factor. CONCLUSIONS In this study, we evaluated cognitive function in a large group of cancer patients prior to diagnosis, thereby excluding the psychological impact of cancer diagnosis and biased patient selection. In contrast to previous studies shortly after cancer diagnosis, we found no difference in change of cognitive function between cancer patients and control subjects.
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Affiliation(s)
- Kimberly D van der Willik
- Department of Psychosocial Research and Epidemiology.,Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Michael Hauptmann
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Katarzyna Jóźwiak
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Elisabeth J Vinke
- Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Rikje Ruiter
- Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Bruno H Stricker
- Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | - M Arfan Ikram
- Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Sanne B Schagen
- Brain and Cognition, Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
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Brain structure prior to non-central nervous system cancer diagnosis: A population-based cohort study. NEUROIMAGE-CLINICAL 2021; 28:102466. [PMID: 33395962 PMCID: PMC7578754 DOI: 10.1016/j.nicl.2020.102466] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/29/2020] [Accepted: 10/06/2020] [Indexed: 11/21/2022]
Abstract
In a population-based setting we studied brain structure before cancer diagnosis. Brain structure was not altered before non-CNS cancer diagnosis. The effect of cancer on the brain before clinical manifestation is not supported.
Purpose Many studies have shown that patients with non-central nervous system (CNS) cancer can have brain abnormalities, such as reduced gray matter volume and cerebral microbleeds. These abnormalities can sometimes be present even before start of treatment, suggesting a potential detrimental effect of non-CNS cancer itself on the brain. In these previous studies, psychological factors associated with a cancer diagnosis and selection bias may have influenced results. To overcome these limitations, we investigated brain structure with magnetic resonance imaging (MRI) prior to cancer diagnosis. Patients and methods Between 2005 and 2014, 4,622 participants from the prospective population-based Rotterdam Study who were free of cancer, dementia, and stroke, underwent brain MRI and were subsequently followed for incident cancer until January 1st, 2015. We investigated the association between brain MRI measurements, including cerebral small vessel disease, volumes of global brain tissue, lobes, and subcortical structures, and global white matter microstructure, and the risk of non-CNS cancer using Cox proportional hazards models. Age was used as time scale. Models were corrected for e.g. sex, intracranial volume, educational level, body mass index, hypertension, diabetes mellitus, smoking status, alcohol use, and depression sum-score. Results During a median (interquartile range) follow-up of 7.0 years (4.9–8.1), 353 participants were diagnosed with non-CNS cancer. Results indicated that persons who develop cancer do not have more brain abnormalities before clinical manifestation of the disease than persons who remain free of cancer. The largest effect estimates were found for the relation between presence of lacunar infarcts and the risk of cancer (hazard ratio [HR] 95% confidence interval [CI] = 1.39 [0.97–1.98]) and for total brain volume (HR [95%CI] per standard deviation increase in total brain volume = 0.76 [0.55–1.04]). Conclusion We did not observe associations between small vessel disease, brain tissue volumes, and global white matter microstructure, and subsequent cancer risk in an unselected population. These findings deviate from previous studies indicating brain abnormalities among patients shortly after cancer diagnosis.
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Winnard PT, Bharti SK, Sharma RK, Krishnamachary B, Mironchik Y, Penet MF, Goggins MG, Maitra A, Kamel I, Horton KM, Jacobs MA, Bhujwalla ZM. Brain metabolites in cholinergic and glutamatergic pathways are altered by pancreatic cancer cachexia. J Cachexia Sarcopenia Muscle 2020; 11:1487-1500. [PMID: 33006443 PMCID: PMC7749557 DOI: 10.1002/jcsm.12621] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/12/2020] [Accepted: 08/23/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Cachexia is a major cause of morbidity in pancreatic ductal adenocarcinoma (PDAC) patients. Our purpose was to understand the impact of PDAC-induced cachexia on brain metabolism in PDAC xenograft studies, to gain new insights into the causes of cachexia-induced morbidity. Changes in mouse and human plasma metabolites were characterized to identify underlying causes of brain metabolic changes. METHODS We quantified metabolites, detected with high-resolution 1 H magnetic resonance spectroscopy, in the brain and plasma of normal mice (n = 10) and mice bearing cachexia (n = 10) or non-cachexia (n = 9) inducing PDAC xenografts as well as in human plasma obtained from normal individuals (n = 24) and from individuals with benign pancreatic disease (n = 20) and PDAC (n = 20). Statistical significance was defined as a P value ≤0.05. RESULTS The brain metabolic signature of cachexia-inducing PDAC was characterized by a significant depletion of choline of -27% and -21% as well as increases of glutamine of 13% and 9% and formate of 21% and 14%, relative to normal controls and non-cachectic tumour-bearing mice, respectively. Good to moderate correlations with percent weight change were found for choline (r = 0.70), glutamine (r = -0.58), and formate (r = -0.43). Significant choline depletion of -38% and -30%, relative to normal controls and non-cachectic tumour-bearing mice, respectively, detected in the plasma of cachectic mice likely contributed to decreased brain choline in cachectic mice. Similarly, relative to normal controls and patients with benign disease, choline levels in human plasma samples of PDAC patients were significantly lower by -12% and -20% respectively. A comparison of plasma metabolites from PDAC patients with and without weight loss identified significant changes in glutamine metabolism. CONCLUSIONS Disturbances in metabolites of the choline/cholinergic and glutamine/glutamate/glutamatergic neurotransmitter pathways may contribute to morbidity. Metabolic normalization may provide strategies to reduce morbidity. The human plasma metabolite changes observed may lead to the development of companion diagnostic markers to detect PDAC and PDAC-induced cachexia.
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Affiliation(s)
- Paul T Winnard
- Division of Cancer Imaging Research, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Santosh Kumar Bharti
- Division of Cancer Imaging Research, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Raj Kumar Sharma
- Division of Cancer Imaging Research, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Balaji Krishnamachary
- Division of Cancer Imaging Research, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yelena Mironchik
- Division of Cancer Imaging Research, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Marie-France Penet
- Division of Cancer Imaging Research, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael G Goggins
- Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anirban Maitra
- Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,MD Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | - Ihab Kamel
- Division of Cancer Imaging Research, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Karen M Horton
- Division of Cancer Imaging Research, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael A Jacobs
- Division of Cancer Imaging Research, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Zaver M Bhujwalla
- Division of Cancer Imaging Research, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Hardy-Leger I, Charles C, Lange M, Joly F, Roux P, Capel A, Petrucci J, Rigal O, Le Fel J, Vanlemmens L, Everhard S, Martin AL, Vaz Luis I, Coutant C, Cottu P, Levy C, Lerebours F, Andre F, Licaj I, Dauchy S. Differentiation of groups of patients with cognitive complaints at breast cancer diagnosis: Results from a sub-study of the French CANTO cohort. Psychooncology 2020; 30:463-470. [PMID: 33052613 DOI: 10.1002/pon.5572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Cognitive complaints are more frequent in women with breast cancer (BC) than in healthy controls and can be present before any treatment. Findings regarding contributive factors remain inconsistent. This study aimed to identify different groups of patients with cognitive complaints at BC diagnosis and to determine whether these different groups were associated with demographic, medical, or psychological characteristics. METHODS Cognitive complaints were assessed in a subset of 264 women from the French multicenter prospective CANTO cohort, at baseline before any treatment. Clustering analyzes were performed using the six-cognitive dimension Costa's scoring of the FACT-Cog V3. Univariable analyses were used to study how cognitive function (standardized neuropsychological tests, ICCTF), anxiety, depression, fatigue, and quality of life (HADS, FA12, QLQ-C30) were associated with specific cognitive complaints groups. RESULTS Results included 263 women (54±11 years), newly diagnosed with BC (69% stages I-III). Four distinct groups emerged, ranged from "no complaints" (22.8%), "low complaints" (55.1), "mixed complaints" (14.5%), to "consistent complaints" (7.6%). No significant differences were found in terms of demographic and medical factors between the four groups. However, the groups with higher proportions of patients with complaints were found to have more impairment in executive function, higher scores of anxiety, depressive symptoms, and fatigue, and lower quality of life, than the groups with lower proportions of cognitive complaints. CONCLUSION Using complete cognitive assessment prior to BC treatment, we identified four distinct cognitive complaints groups with specific characteristics. This work provides valuable clinical basis to further investigations for a better understanding of cognitive complaints and their associates.
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Affiliation(s)
- Isabelle Hardy-Leger
- Département Interdisciplinaire d'Organisation des Parcours Patients, Gustave Roussy, Université Paris-Saclay, Villejuif, France.,Service de médecine interne et d'immunologie clinique, Unité des maladies neurovirales, CHU de Bicêtre, Le Kremlin-Bicêtre, France
| | - Cécile Charles
- Département Interdisciplinaire d'Organisation des Parcours Patients, Gustave Roussy, Université Paris-Saclay, Villejuif, France.,Laboratoire de Psychopathologie et Processus de Santé (EA 4057), Université Paris Descartes- Sorbonne Paris Cité, Boulogne-Billancourt, France
| | - Marie Lange
- Département de recherche clinique, Centre François Baclesse, Caen, France.,Université de Normandie, UNICAEN, INSERM, ANTICIPE, Caen, France.,Cancer & Cognition Platform, Ligue Contre le Cancer, Caen, France
| | - Florence Joly
- Département de recherche clinique, Centre François Baclesse, Caen, France.,Université de Normandie, UNICAEN, INSERM, ANTICIPE, Caen, France.,Cancer & Cognition Platform, Ligue Contre le Cancer, Caen, France.,Département d'Oncologie Médicale, CHU de Caen, Caen, France
| | - Pauline Roux
- Département Interdisciplinaire d'Organisation des Parcours Patients, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Aurélie Capel
- Département d'Oncologie Médicale, CHU de Caen, Caen, France
| | - Jean Petrucci
- Département Interdisciplinaire d'Organisation des Parcours Patients, Gustave Roussy, Université Paris-Saclay, Villejuif, France.,AP-HP, hôpital Henri-Mondor - Albert Chenevier, Créteil, France.,Fondation FondaMental, fondation de coopération scientifique, Créteil, France
| | | | | | | | | | | | - Ines Vaz Luis
- Gustave Roussy, Université Paris-Saclay, Inserm, Biomarqueurs prédictifs et nouvelles stratégies thérapeutiques en oncologie, Villejuif, France
| | | | - Paul Cottu
- Institut Curie, Paris-Saint Cloud, Paris, France
| | - Christelle Levy
- Institut Normand du Sein, Centre François Baclesse, Caen, France
| | | | - Fabrice Andre
- Gustave Roussy, Université Paris-Saclay, Inserm, Biomarqueurs prédictifs et nouvelles stratégies thérapeutiques en oncologie, Villejuif, France
| | - Idlir Licaj
- Département de recherche clinique, Centre François Baclesse, Caen, France.,Cancer & Cognition Platform, Ligue Contre le Cancer, Caen, France.,Department of Community Medicine, Faculty of Health Sciences, The UiT Arctic University of Norway, Tromsø, Norway
| | - Sarah Dauchy
- Département Interdisciplinaire d'Organisation des Parcours Patients, Gustave Roussy, Université Paris-Saclay, Villejuif, France
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Feng Y, Wang YF, Zheng LJ, Shi Z, Huang W, Zhang LJ. Network-level functional connectivity alterations in chemotherapy treated breast cancer patients: a longitudinal resting state functional MRI study. Cancer Imaging 2020; 20:73. [PMID: 33066822 PMCID: PMC7565338 DOI: 10.1186/s40644-020-00355-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 10/07/2020] [Indexed: 01/18/2023] Open
Abstract
Background Previous studies have found abnormal structural and functional brain alterations in breast cancer survivors undergoing chemotherapy. However, the network-level brain changes following chemotherapy remain unknown. The purpose of this study was to investigate the dynamic changes of large-scale within- and between-network functional connectivity in chemotherapy-treated breast cancer patients. Methods Seventeen breast cancer patients were evaluated with resting state functional MRI (rs-fMRI), neuropsychological tests and blood examination before postoperative chemotherapy (t0), one week after completing chemotherapy (t1) and six months after completing chemotherapy (t2). Nineteen age- and education level-matched healthy controls (HC) were also recruited. Independent components analysis (ICA) was performed to assess network component using rs-fMRI data. The functional network changes were then correlated with cognitive assessment scores and blood biochemical indexes. Results One-way repeated measures ANOVA revealed significantly changed within-network functional connectivity in the anterior and posterior default mode network (ADMN and PDMN), left and right frontoparietal network (LFPN and RFPN), visual network and self-referential network. Post-hoc test showed that decreased within-network functional connectivity in ADMN, PDMN, LFPN, RFPN, SRN and central network one week after chemotherapy and increased six months after chemotherapy (all P < 0.05). As for the between-network functional connectivity, the PDMN- sensorimotor network connectivity showed the same tendency. Most of these within- and between-network functional connectivity changes were negatively associated with blood biochemical indexes and cognitive assessment scores (all P < 0.05). Conclusions These results indicated that chemotherapy may induce widespread abnormalities in resting state networks, which may serve as a potential biomarker of chemotherapy related cognitive impairment, providing insights for further functional recovery treatment.
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Affiliation(s)
- Yun Feng
- Department of Medical Imaging, Jinling Clinical Hospital, Nanjing Medical University, 305 Zhongshan East Road, Xuanwu District, Nanjing, 210002, Jiangsu, China.,Department of Medical Imaging, Medical Imaging Center, The Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University, Huai'an, 223300, Jiangsu, China
| | - Yun Fei Wang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, 210002, Jiangsu, China
| | - Li Juan Zheng
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, 210002, Jiangsu, China
| | - Zhao Shi
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, 210002, Jiangsu, China
| | - Wei Huang
- Department of Medical Imaging, Medical Imaging Center, The Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University, Huai'an, 223300, Jiangsu, China
| | - Long Jiang Zhang
- Department of Medical Imaging, Jinling Clinical Hospital, Nanjing Medical University, 305 Zhongshan East Road, Xuanwu District, Nanjing, 210002, Jiangsu, China. .,Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, 210002, Jiangsu, China. .,Department of Medical Imaging, Jinling Clinical Hospital, Southern Medical University, 305 Zhongshan East Road, Xuanwu District, Nanjing, 210002, Jiangsu, China.
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Sousa H, Almeida S, Bessa J, Pereira MG. The Developmental Trajectory of Cancer-Related Cognitive Impairment in Breast Cancer Patients: A Systematic Review of Longitudinal Neuroimaging Studies. Neuropsychol Rev 2020; 30:287-309. [PMID: 32607817 DOI: 10.1007/s11065-020-09441-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 05/12/2020] [Indexed: 01/21/2023]
Abstract
This systematic review explored the neurobiological mechanisms underlying the clinical time course of cancer-related cognitive impairment (CRCI) in breast cancer patients through the review of longitudinal neuroimaging studies. Before chemotherapy, results reported no evidence for neuropsychological, structural (gray matter) and brain perfusion changes. However, functional brain alterations were evident and revealed a frontoparietal hyperactivation during working memory tasks. Fatigue and number of days since surgery were the two suggested confounding factors. Acutely after chemotherapy, this review found no evidence for neuropsychological changes while suggesting a pattern of frontal structural, perfusion and functional brain abnormalities. These findings seemed to be dependent on age, menopausal status at baseline, and fMRI task performed. Years after chemotherapy, results revealed evidence of partial neuropsychological, structural, and functional brain recovery. Regarding brain abnormality, this review suggested that it may begin quite early in the disease course, be more prominent shortly after chemotherapy and partially recover over time. Several hypotheses underlying these changes were discussed. The present review also provided important information for developing a time-specific treatment and prevention strategies and for the consideration of functional neuroimaging as a relevant tool for CRCI diagnosis, clinical monitoring, and intervention studies. The findings also suggested the need to implement studies with longitudinal designs, including a pre-treatment assessment, since cross-sectional studies were not able to detect this pattern of recovery over time, supporting only the theory of brain abnormalities, in breast cancer survivors.
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Affiliation(s)
- Helena Sousa
- Family Health & Illness Research Group, School of Psychology, University of Minho, Campus de Gualtar, 4710-057, Braga, Portugal
- Research Center in Psychology (CIPsi), School of Psychology, University of Minho, Campus de Gualtar, 4710-057, Braga, Portugal
| | - Susana Almeida
- Research Center in Psychology (CIPsi), School of Psychology, University of Minho, Campus de Gualtar, 4710-057, Braga, Portugal
- Psycho-Oncology Service, Portuguese Institute of Oncology, Porto, Portugal; Cuf Hospital, Porto; Faculty of Medicine, University of Porto, Braga, Portugal
| | - João Bessa
- Research Center in Psychology (CIPsi), School of Psychology, University of Minho, Campus de Gualtar, 4710-057, Braga, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's - PT Government Associate Laboratory, Guimarães, Braga, Portugal
| | - M Graça Pereira
- Family Health & Illness Research Group, School of Psychology, University of Minho, Campus de Gualtar, 4710-057, Braga, Portugal.
- Research Center in Psychology (CIPsi), School of Psychology, University of Minho, Campus de Gualtar, 4710-057, Braga, Portugal.
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Cognitive Impairment in Patients with Breast Cancer before Surgery: Results from a CANTO Cohort Subgroup. Cancer Epidemiol Biomarkers Prev 2020; 29:1759-1766. [DOI: 10.1158/1055-9965.epi-20-0346] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/27/2020] [Accepted: 06/24/2020] [Indexed: 11/16/2022] Open
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Chemotherapy-induced brain changes in breast cancer survivors: evaluation with multimodality magnetic resonance imaging. Brain Imaging Behav 2020; 13:1799-1814. [PMID: 30937827 DOI: 10.1007/s11682-019-00074-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Chemotherapy related cognitive impairments are common in breast cancer patients undergoing chemotherapy. These cognitive dysfunctions are mainly attributable to chemotherapy related brain structural and functional alterations. Multimodality magnetic resonance imaging (MRI) can reveal brain gray matter volume loss, white matter microstructural disruption, reduced gray matter density, impaired cerebral blood flow and brain structural and functional connection networks at both local and global levels. This review outlines the potential applications of multimodality MR imaging techniques in chemotherapy induced cognitive deficit in breast cancer survivors and provides future research perspective in this field.
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Aberrant static and dynamic functional connectivity of the executive control network in lung cancer patients after chemotherapy: a longitudinal fMRI study. Brain Imaging Behav 2020; 14:927-940. [PMID: 32304022 PMCID: PMC7275001 DOI: 10.1007/s11682-020-00287-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The purpose of the current study was to investigate chemotherapy-related variations in the intrinsic static and dynamic functional connectivity (sFC and dFC, respectively) of the executive control network (ECN) in lung cancer patients. MATERIALS AND METHODS In this study, we evaluated 18 lung cancer patients scanned before and after adjuvant chemotherapy treatment and compared the patients with 21 healthy controls (HCs). All subjects underwent resting-state functional MRI (rs-fMRI). We constructed the sFC and dFC of the bilateral dorsolateral prefrontal cortex (DLPFC) using a sliding-window approach, and the correlations between the changed sFC or dFC and cognitive performance were analyzed. RESULTS Whole-brain sFC analysis showed that the lung cancer patients showed significant FC pattern changes in the bilateral DLPFC, mainly in the bilateral superior frontal gyrus (SFG), bilateral middle frontal gyrus, left superior temporal gyrus, left inferior parietal lobe and the right insula. Furthermore, after chemotherapy, the lung cancer patients showed significantly reduced dFC variability between the right DLPFC and right precuneus compared with HCs. In addition, the decreased dFC between the right DLPFC and left SFG in the lung cancer patients after chemotherapy in state 1 and between the right DLPFC and left insula in the lung cancer patients before chemotherapy in state 2 were negatively correlated with MoCA scores ((r = -0.520, p = 0.039; r = -0.548, p = 0.028, respectively). CONCLUSIONS Our results reveal that dynamic connectivity analysis is more effective and sensitive than methods that assume static brain states for linking brain FC patterns and chemotherapy.
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Henneghan A, Rao V, Harrison RA, Karuturi M, Blayney DW, Palesh O, Kesler SR. Cortical Brain Age from Pre-treatment to Post-chemotherapy in Patients with Breast Cancer. Neurotox Res 2020; 37:788-799. [PMID: 31900898 DOI: 10.1007/s12640-019-00158-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/18/2019] [Accepted: 12/22/2019] [Indexed: 12/12/2022]
Abstract
Chemotherapy-related cognitive impairment and associated brain changes may reflect accelerated brain aging; however, empirical evidence for this theory is limited. The purpose of this study was to measure brain aging in newly diagnosed patients with breast cancer treated with chemotherapy (n = 43) and compare its longitudinal change to that of controls (n = 50). Brain age indices, derived from cortical measures, were compared between women with breast cancer and matched healthy controls across 3 timepoints (time 1: pre-surgery, time 2: 1 month following chemotherapy completion, and time 3: 1-year post-chemotherapy). The breast cancer group showed a significant decrease in cortical thickness across the 3 timepoints (p < .001) and a trend towards significant increase in predicted brain age especially from pre-treatment (time 1) to post-chemotherapy (time 2) compared to controls (p = 0.08). Greater increase in predicted brain age was related to several clinical factors (HER-2 status, surgery type, and history of neoadjuvant chemotherapy) and greater decrease in cortical thickness was associated with greater decrease in performance on a verbal learning task from time 1 to time 3 (r = - 0.48, p < .01). This study demonstrated evidence of increased cortical brain aging in middle-aged patients with breast cancer following chemotherapy treatment that was associated with decreased verbal memory performance.
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Affiliation(s)
- Ashley Henneghan
- University of Texas at Austin School of Nursing, 1710 Red River St, Austin, TX, 78701, USA. .,Department of Oncology, Dell Medical School, University of Texas at Austin, 1601 Trinity St, Austin, TX, USA.
| | - Vikram Rao
- University of Texas at Austin School of Nursing, 1710 Red River St, Austin, TX, 78701, USA
| | - Rebecca A Harrison
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 431, Houston, TX, 77030, USA
| | - Meghan Karuturi
- Department of Breast Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Unit 1354, 1155 Pressler St., Houston, TX, 77030, USA
| | - Douglas W Blayney
- Division of Medical Oncology, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Oxana Palesh
- Department of Psychiatry and Behavioral Sciences, Stanford University Cancer Institute, Stanford University, 401 Quarry Road, Office 2318, Stanford, CA, 94305, USA
| | - Shelli R Kesler
- University of Texas at Austin School of Nursing, 1710 Red River St, Austin, TX, 78701, USA.,Department of Oncology, Dell Medical School, University of Texas at Austin, 1601 Trinity St, Austin, TX, USA
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Henneghan AM, Gibbons C, Harrison RA, Edwards ML, Rao V, Blayney DW, Palesh O, Kesler SR. Predicting Patient Reported Outcomes of Cognitive Function Using Connectome-Based Predictive Modeling in Breast Cancer. Brain Topogr 2020; 33:135-142. [PMID: 31745689 PMCID: PMC8006573 DOI: 10.1007/s10548-019-00746-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 11/07/2019] [Indexed: 11/29/2022]
Abstract
Being able to predict who will likely experience cancer related cognitive impairment (CRCI) could enhance patient care and potentially reduce economic and human costs associated with this adverse event. We aimed to determine if post-treatment patient reported CRCI could also be predicted from baseline resting state fMRI in patients with breast cancer. 76 newly diagnosed patients (n = 42 planned for chemotherapy; n = 34 not planned for chemotherapy) and 50 healthy female controls were assessed at 3 times points [T1 (prior to treatment); T2 (1 month post chemotherapy); T3 (1 year after T2)], and at yoked intervals for controls. Data collection included self-reported executive dysfunction, memory function, and psychological distress and resting state fMRI data converted to connectome matrices for each participant. Statistical analyses included linear mixed modeling, independent t tests, and connectome-based predictive modeling (CPM). Executive dysfunction increased over time in the chemotherapy group and was stable in the other two groups (p < 0.001). Memory function decreased over time in both patient groups compared to controls (p < 0.001). CPM models successfully predicted executive dysfunction and memory function scores (r > 0.31, p < 0.002). Support vector regression with a radial basis function (SVR RBF) showed the highest performance for executive dysfunction and memory function (r = 0.68; r = 0.44, p's < 0.001). Baseline neuroimaging may be useful for predicting patient reported cognitive outcomes which could assist in identifying patients in need of surveillance and/or early intervention for treatment-related cognitive effects.
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Affiliation(s)
- Ashley M Henneghan
- School of Nursing, University of Texas at Austin, 1710 Red River St., Austin, TX, 78712, USA.
| | - Chris Gibbons
- PROVE Center, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, 02115, USA
| | - Rebecca A Harrison
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 431, Houston, TX, 77030, USA
| | - Melissa L Edwards
- Department of Family Medicine & Institute for Translational Research, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
| | - Vikram Rao
- School of Nursing, University of Texas at Austin, 1710 Red River St., Austin, TX, 78712, USA
| | - Douglas W Blayney
- Associate Division Chief of Medical Oncology, Stanford University School of Medicine, 875 Blake Wilbur Drive, CC-2219, Stanford, CA, 94305-5827, USA
| | - Oxana Palesh
- Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford University, 401 Quarry Road, Office 2318, Stanford, CA, 94305, USA
| | - Shelli R Kesler
- School of Nursing, University of Texas at Austin, 1710 Red River St., Austin, TX, 78712, USA
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Kesler SR, Harrison RA, Petersen ML, Rao V, Dyson H, Alfaro-Munoz K, Weathers SP, de Groot J. Pre-surgical connectome features predict IDH status in diffuse gliomas. Oncotarget 2019; 10:6484-6493. [PMID: 31741712 PMCID: PMC6849657 DOI: 10.18632/oncotarget.27301] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 10/21/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Gliomas are the most common type of malignant brain tumor. Clinical outcomes depend on many factors including tumor molecular characteristics. Mutation of the isocitrate dehydrogenase (IDH) gene confers significant benefits in terms of survival and quality of life. Preoperative determination of IDH genotype can facilitate surgical planning, allow for novel clinical trial designs, and assist clinical counseling surrounding the individual patient's disease. METHODS In this study, we aimed to evaluate a novel approach for non-invasively predicting IDH status from conventional MRI via connectomics, a whole-brain network-based technique. We retrospectively extracted 93 connectome features from the preoperative, T1-weighted MRI data of 234 adult patients (148 IDH mutated) and evaluated the performance of four common machine learning models to predict IDH genotype. RESULTS Area under the curve (AUC) of the receiver operator characteristic were 0.76 to 0.94 with random forest (RF) showing significantly higher performance (p < 0.01) than other algorithms. Feature selection schemes and the addition of age and tumor location did not change RF performance. CONCLUSIONS Our findings suggest that connectomics is a feasible approach for preoperatively predicting IDH genotype in patients with gliomas. Our results support prior evidence that RF is an ideal machine learning method for this area of research. Additionally, connectomics provides unique insights regarding potential mechanisms of tumor genotype on large-scale brain network organization.
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Affiliation(s)
- Shelli R. Kesler
- Cancer Neuroscience Laboratory, School of Nursing, The University of Texas at Austin, Austin, Texas, USA
- Department of Diagnostic Medicine, Dell School of Medicine, The University of Texas at Austin, Austin, Texas, USA
- These authors contributed equally to this work
| | - Rebecca A. Harrison
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- These authors contributed equally to this work
| | - Melissa L. Petersen
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Vikram Rao
- Cancer Neuroscience Laboratory, School of Nursing, The University of Texas at Austin, Austin, Texas, USA
- Department of Diagnostic Medicine, Dell School of Medicine, The University of Texas at Austin, Austin, Texas, USA
| | - Hannah Dyson
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kristin Alfaro-Munoz
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Shiao-Pei Weathers
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - John de Groot
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Amidi A, Wu LM. Structural brain alterations following adult non-CNS cancers: a systematic review of the neuroimaging literature. Acta Oncol 2019; 58:522-536. [PMID: 30732518 DOI: 10.1080/0284186x.2018.1563716] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background: Cancer and cancer treatments may impact the brain through several pathways leading to cognitive impairment. Neuroimaging evidence has begun to elucidate the neurobiological underpinnings of cancer-related cognitive impairment. The aim of this paper was to systematically review available literature on structural brain alterations following adult non-central nervous system (CNS) cancers and associated treatments. Methods: This review followed PRISMA guidelines and was registered in PROSPERO (ID#107387). Comprehensive searches were conducted in June 2018 using PubMed and Web of Science. Inclusion criteria were English peer-reviewed journal articles of formal, controlled studies that examined structural neuroimaging outcomes in adult non-CNS cancer patients and survivors. Selected articles were assessed for quality and risk of bias using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Results: Thirty-six publications of prospective and cross-sectional studies met inclusion criteria and were included. Structural brain alterations following cancer and its treatment were reported in a majority of the publications as evidenced by reduced global and local gray matter volumes, impaired white matter microstructural integrity, and brain network alterations. Structural alterations were most often evident when cancer-treated groups were compared with healthy controls, and more subtle when compared with cancer controls. Regarding the existence of pretreatment impairments, the evidence was equivocal. There was significant between-study heterogeneity in imaging analytical approaches and use of statistical adjustments. Over half reported associations with cognitive outcomes, though regions and associated cognitive domains were heterogeneous. Conclusions: Structural brain alterations following cancer and cancer treatments were reported in a majority of the reviewed studies. However, the extent of observed alterations depended on the choice of comparison groups. Methodological issues exist that will need to be addressed systematically to ensure the validity of findings. Large-scale prospective studies with extended assessment points are warranted to replicate and build upon initial findings.
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Affiliation(s)
- Ali Amidi
- Department of Psychology & Behavioural Sciences, Unit for Psycho-Oncology & Health Psychology, Aarhus University, Aarhus, Denmark
| | - Lisa M. Wu
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Zeng Y, Cheng ASK, Song T, Sheng X, Cheng H, Qiu Y, Xie J, Chan CCH. Changes in functional brain networks and neurocognitive function in Chinese gynecological cancer patients after chemotherapy: a prospective longitudinal study. BMC Cancer 2019; 19:386. [PMID: 31023249 PMCID: PMC6485110 DOI: 10.1186/s12885-019-5576-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 04/03/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Previous neurocognitive assessments in non-central nervous system cancers highlight the high incidence of neurocognitive dysfunction in this study population. However, there have been few studies exploring neurocognitive dysfunction induced by chemotherapy in gynecological cancer patients. This prospective longitudinal study was conducted to assess neurocognitive functioning and functional brain networks in Chinese gynecological cancer patients pre- and post-chemotherapy, while additionally including age-matched healthy subjects as the control group. METHODS All research participants were evaluated using a resting-state functional magnetic resonance imaging and neurocognition assessment. Behavioral data were conducted using SPSS for descriptive statistics, correlation and comparison analyses. Preprocessing of MRI (Magnetic Resonance Imaging) data and network analyses were performed using GRETNA (Graph Theoretical Network Analysis). RESULTS A total of 40 subjects joined this study, with 20 subjects in each group. With the exception of the mean of psychomotor speed, there was no significant difference pre-chemotherapy between patients and healthy controls in neurocognitive test mean scores (Ps > 0.05). During the post-chemotherapy assessment, there were significant differences in the mean scores of neurocognitive tests (including Digit Span tests, verbal memory, immediate recall, delayed recall, and information processing speed tests) (all Ps < 0 .05). Longitudinal graph analysis revealed statistically significant differences in the patient group, with significant decreases in both local efficiency (P < 0.01) and global efficiency (P = 0.04). Lower raw TMT-A scores were significantly associated with lower local efficiency (r = 0.37, P = 0.03). Lower verbal memory scores were statistically significant and associated with lower global efficiency (r = 0.54, P = 0.02) in the patient group, but not in the healthy control group. CONCLUSIONS This study found that the risk of brain function and neurocognitive changes following chemotherapy could potentially guide patients in making appropriate treatment decisions, and this study may identify a cohort that could be suited for study of an intervention.
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Affiliation(s)
- Yingchun Zeng
- Research Institute of Gynecology and Obstetrics, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China
| | - Andy S. K. Cheng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China
| | - Ting Song
- Department of Radiology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiujie Sheng
- Research Institute of Gynecology and Obstetrics, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Huaidong Cheng
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, Hefel, China
| | - Yingwei Qiu
- Department of Radiology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jianfei Xie
- Department of Surgery, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Chetwyn C. H. Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China
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45
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Gullett JM, Cohen RA, Yang GS, Menzies VS, Fieo RA, Kelly DL, Starkweather AR, Jackson-Cook CK, Lyon DE. Relationship of fatigue with cognitive performance in women with early-stage breast cancer over 2 years. Psychooncology 2019; 28:997-1003. [PMID: 30761683 DOI: 10.1002/pon.5028] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 02/06/2019] [Accepted: 02/12/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Fatigue and cognitive dysfunction are major concerns for women with early-stage breast cancer during treatment and into survivorship. However, interrelationships of these phenomena and their temporal patterns over time are not well documented, thus limiting the strategies for symptom management interventions. In this study, changes in fatigue across treatment phases and the relationship among fatigue severity and its functional impact with objective cognitive performance were examined. METHODS Participants (N = 75) were assessed at five time points beginning prior to chemotherapy to 24 months after initial chemotherapy. Fatigue severity and impact were measured on the Brief Fatigue Inventory. Central nervous system (CNS) Vital Signs was used to measure performance based cognitive testing. Temporal changes in fatigue were examined, as well as the relationship between fatigue and cognitive performance, at each time point using linear mixed effect models. RESULTS Severity of fatigue varied as a function of phase of treatment. Fatigue severity and its functional impact were moderate at baseline, increased significantly during chemotherapy, and returned to near baseline levels by 2 years. At each time point, fatigue severity and impact were significantly associated with diminished processing speed and complex attention performance. CONCLUSIONS A strong association between fatigue and objective cognitive performance suggests that they are likely functionally related. That cognitive deficits were evident at baseline, whereas fatigue was more chemotherapy dependent, implicates that two symptoms share some common bases but may differ in underlying mechanisms and severity over time. This knowledge provides a basis for introducing strategies for tailored symptom management that vary over time.
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Affiliation(s)
- Joseph M Gullett
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, Florida.,Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida
| | - Ronald A Cohen
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, Florida.,Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida
| | - Gee Su Yang
- College of Nursing, University of Florida, Gainesville, Florida
| | | | - Robert A Fieo
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, Florida.,Department of Aging and Geriatric Research, University of Florida, Gainesville, Florida
| | - Debra L Kelly
- College of Nursing, University of Florida, Gainesville, Florida
| | | | - Colleen K Jackson-Cook
- Department of Pathology, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Debra E Lyon
- College of Nursing, University of Florida, Gainesville, Florida
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van der Willik KD, Schagen SB, Ikram MA. Cancer and dementia: Two sides of the same coin? Eur J Clin Invest 2018; 48:e13019. [PMID: 30112764 PMCID: PMC6220770 DOI: 10.1111/eci.13019] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 08/13/2018] [Indexed: 12/12/2022]
Abstract
Noncentral nervous system cancer and the brain share an interesting and complex relation, with an emerging body of evidence showing that cancer patients are at an increased risk of developing cognitive problems. In contrast, population-based studies consistently find an inverse link between cancer and dementia, that is patients with dementia having a lower risk of subsequently developing cancer, and cancer patients being less often diagnosed with dementia. Different biological processes such as inversely activated cell proliferation and survival pathways have been suggested to have an important role underlying this inverse association. However, the effect of methodological biases including surveillance or survival bias has not been completely ruled out, calling into question the inverse direction of the association between cancer and dementia. In fact, emerging evidence now suggests that cancer and dementia might share a positive association. This narrative review summarises the current literature on cancer, cognitive problems and dementia. Moreover, different strategies will be discussed to reduce the impact of potential methodological biases on the association between cancer and dementia, trying to reveal the true direction of this link.
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Affiliation(s)
- Kimberly D. van der Willik
- Department of Psychosocial Research and EpidemiologyNetherlands Cancer InstituteAmsterdamThe Netherlands
- Department of EpidemiologyErasmus Medical CenterRotterdamThe Netherlands
| | - Sanne B. Schagen
- Department of Psychosocial Research and EpidemiologyNetherlands Cancer InstituteAmsterdamThe Netherlands
- Brain and CognitionDepartment of PsychologyUniversity of AmsterdamAmsterdamThe Netherlands
| | - M. Arfan Ikram
- Department of EpidemiologyErasmus Medical CenterRotterdamThe Netherlands
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47
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Kesler SR, Ogg R, Reddick WE, Phillips N, Scoggins M, Glass JO, Cheung YT, Pui CH, Robison LL, Hudson MM, Krull KR. Brain Network Connectivity and Executive Function in Long-Term Survivors of Childhood Acute Lymphoblastic Leukemia. Brain Connect 2018; 8:333-342. [PMID: 29936880 PMCID: PMC6103246 DOI: 10.1089/brain.2017.0574] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Chemotherapeutic agents used to treat acute lymphoblastic leukemia (ALL), the most common cancer affecting young children, have been associated with long-term cognitive impairments that reduce quality of life. Executive dysfunction is one of the most consistently observed deficits and can have substantial and pervasive effects on academic success, occupational achievement, psychosocial function, and psychiatric status. We examined the neural mechanisms of executive dysfunction by measuring structural and functional connectomes in 161 long-term survivors of pediatric ALL, age 8-21 years, who were treated on a single contemporary chemotherapy-only protocol for standard/high- or low-risk disease. Lower global efficiency, a measure of information exchange and network integration, of both structural and functional connectomes was found in survivors with executive dysfunction compared with those without dysfunction (p < 0.046). Patients with standard/high- versus low-risk disease and those who received greater number of intrathecal treatments containing methotrexate had the lowest network efficiencies. Patients with executive dysfunction also showed hyperconnectivity in sensorimotor, visual, and auditory-processing regions (p = 0.037) and poor separation between sensorimotor, executive/attention, salience, and default mode networks (p < 0.0001). Connectome disruption was consistent with a pattern of delayed neurodevelopment that may be associated with reduced resilience, adaptability, and flexibility of the brain network. These findings highlight the need for interventions that will prevent or manage cognitive impairment in survivors of pediatric acute lymphoblastic leukemia.
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Affiliation(s)
- Shelli R. Kesler
- Department of Neuro-oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Robert Ogg
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Wilburn E. Reddick
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Nicholas Phillips
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Matthew Scoggins
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - John O. Glass
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Yin Ting Cheung
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Ching-Hon Pui
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Leslie L. Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Melissa M. Hudson
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Kevin R. Krull
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
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48
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Lange M, Joly F. How to Identify and Manage Cognitive Dysfunction After Breast Cancer Treatment. J Oncol Pract 2018; 13:784-790. [PMID: 29232539 DOI: 10.1200/jop.2017.026286] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Attention and memory dysfunction is a common complaint among patients with breast cancer that can be reported during and up to several years after treatment. It can negatively affect patients' quality of life and their ability to work. This phenomenon has mainly been studied in patients with breast cancer who are treated with adjuvant chemotherapy. Women describe concentration problems and difficulties with word finding, multitasking, or remembering new information, as well as more effort and time needed to accomplish these tasks. Such cognitive dysfunction is subtle or moderate and occurs in 15% to 25% of patients. Older patients seem more likely to experience cognitive decline with chemotherapy than do young women with breast cancer. Patients who report that cognitive dysfunction has affected their daily lives for 6 to 12 months after the end of chemotherapy or during hormone therapy may need referral to a neuropsychologist. During the cognitive assessment, the etiology of their cognitive complaints is sought and neuropsychological tests are administered to assess objective cognitive functioning. Psychological factors-fatigue and pain-should be assessed systematically with cognitive complaints to identify precisely the cause of the problems. A nonpharmacologic approach-mainly cognitive rehabilitation-seems to be the most promising for the management of these difficulties, but these preliminary results require confirmation. In the future, early detection of cognitive impairment and cognitive rehabilitation should be included in the portfolio of oncology supportive care to facilitate the return to work of young women and to avoid potential repercussions on adherence to oral treatments and on autonomy in older patients.
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Affiliation(s)
- Marie Lange
- Centre François Baclesse; Normandie University, UNICAEN, Institut National de la Santé et de la Recherche Médicale U1086, ANTICIPE; and Centre Hospitalier Universitaire de Caen, Caen, France
| | - Florence Joly
- Centre François Baclesse; Normandie University, UNICAEN, Institut National de la Santé et de la Recherche Médicale U1086, ANTICIPE; and Centre Hospitalier Universitaire de Caen, Caen, France
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49
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Grégoire C, Nicolas H, Bragard I, Delevallez F, Merckaert I, Razavi D, Waltregny D, Faymonville ME, Vanhaudenhuyse A. Efficacy of a hypnosis-based intervention to improve well-being during cancer: a comparison between prostate and breast cancer patients. BMC Cancer 2018; 18:677. [PMID: 29929493 PMCID: PMC6013950 DOI: 10.1186/s12885-018-4607-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 06/18/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Prostate and breast cancer can have a lot of negative consequences such as fatigue, sleep difficulties and emotional distress, which decrease quality of life. Group interventions showed benefits to emotional distress and fatigue, but most of these studies focus on breast cancer patients. However, it is important to test if an effective intervention for breast cancer patients could also have benefits for prostate cancer patients. METHODS Our controlled study aimed to compare the efficacy of a self-hypnosis/self-care group intervention to improve emotional distress, sleep difficulties, fatigue and quality of life of breast and prostate cancer patients. 25 men with prostate cancer and 68 women with breast cancer participated and were evaluated before (T0) and after (T1) the intervention. RESULTS After the intervention, the breast cancer group showed positive effects for anxiety, depression, fatigue, sleep difficulties, and global health status, whereas there was no effect in the prostate cancer group. We showed that women suffered from higher difficulties prior to the intervention and that their oncological treatments were different in comparison to men. CONCLUSION The differences in the efficacy of the intervention could be explained by the baseline differences. As men in our sample reported few distress, fatigue or sleep problems, it is likely that they did not improve on these dimensions. TRIAL REGISTRATION ClinicalTrials.gov ( NCT02569294 and NCT03423927 ). Retrospectively registered in October 2015 and February 2018 respectively.
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Affiliation(s)
- C. Grégoire
- Public Health Department and Sensation and Perception Research Group, GIGA Consciousness, University of Liège, Liège, Belgium
| | - H. Nicolas
- Urology Department, CHR Citadelle, Liège, Belgium
| | - I. Bragard
- Public Health Department and Sensation and Perception Research Group, GIGA Consciousness, University of Liège, Liège, Belgium
| | - F. Delevallez
- Psychology Department, University, Free University of Brussels, Brussels, Belgium
| | - I. Merckaert
- Psychology Department, University, Free University of Brussels, Brussels, Belgium
| | - D. Razavi
- Psychology Department, University, Free University of Brussels, Brussels, Belgium
| | - D. Waltregny
- Urology Department, University Hospital of Liège, University of Liège, Liège, Belgium
| | - M.-E. Faymonville
- Algology-Palliative Care Department, University Hospital of Liège, Sensation and Perception Research Group, GIGA Consciousness, University of Liège, Liège, Belgium
| | - A. Vanhaudenhuyse
- Algology-Palliative Care Department, University Hospital of Liège, Sensation and Perception Research Group, GIGA Consciousness, University of Liège, Liège, Belgium
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50
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Santos JC, Pyter LM. Neuroimmunology of Behavioral Comorbidities Associated With Cancer and Cancer Treatments. Front Immunol 2018; 9:1195. [PMID: 29930550 PMCID: PMC6001368 DOI: 10.3389/fimmu.2018.01195] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 05/14/2018] [Indexed: 12/27/2022] Open
Abstract
Behavioral comorbidities (depression, anxiety, fatigue, cognitive disturbances, and neuropathic pain) are prevalent in cancer patients and survivors. These mental and neurological health issues reduce quality-of-life, which is a significant societal concern given the increasing rates of long-term survival after various cancers. Hypothesized causes of behavioral comorbidities with cancer include tumor biology, stress associated with the cancer experience, and cancer treatments. A relatively recent leading mechanism by which these causes contribute to changes in neurobiology that underlie behavior is inflammation. Indeed, both basic and clinical research indicates that peripheral inflammation leads to central inflammation and behavioral changes in other illness contexts. Given the limitations of assessing neuroimmunology in clinical populations, this review primarily synthesizes evidence of neuroimmune and neuroinflammatory changes due to two components of cancer (tumor biology and cancer treatments) that are associated with altered affective-like or cognitive behaviors in rodents. Specifically, alterations in microglia, neuroinflammation, and immune trafficking to the brain are compiled in models of tumors, chemotherapy, and/or radiation. Evidence-based neuronal mechanisms by which these neuroimmune changes may lead to changes in behavior are proposed. Finally, converging evidence in clinical cancer populations is discussed.
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Affiliation(s)
- Jessica C Santos
- Department of Basic and Applied Immunology, School of Medicine of Ribeirao Preto, University of Sao Paulo, Sao Paulo, Brazil
| | - Leah M Pyter
- Departments of Psychiatry and Behavioral Health and Neuroscience, The Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus, OH, United States
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