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Bhatt NS, Brazauskas R, Torres AP, Phelan R, Shaw BE. Relationship between work performance and quality of life in long-term survivors of pediatric and adolescent hematopoietic cell transplant. J Cancer Surviv 2024; 18:772-780. [PMID: 36585573 PMCID: PMC9803401 DOI: 10.1007/s11764-022-01308-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/27/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE To assess work status, missed time at work (absenteeism), work performance (presenteeism), and their relationship with quality of life (QOL) among long-term survivors of childhood hematopoietic cell transplant (HCT). METHODS A single-center cross-sectional survey study of adult survivors of childhood allogeneic HCT (performed between 1985 and 2010). Work and QOL data were captured using the World Health Organization Health and Work Performance Questionnaire and the National Institutes of Health Patient Reported Outcomes Measurement Information System (PROMIS), respectively. Higher absenteeism and presenteeism scores meant higher missed time at work and productivity, respectively. PROMIS domains were scored on a T-score metric with a mean score of reference population at 50 and standard deviation of 10. Univariate linear regression was performed to study factors associated with increase in PROMIS scores. RESULTS Forty-four survivors completed the survey. Median ages at HCT and survey were 11 years (interquartile range [IQR] 7-13) and 30 years (IQR 26-34), respectively. Seventy-three percent were working, 23% were unemployed, and 4% were students. Employed survivors reported less pain and sleep disturbance. Higher absolute presenteeism was associated with less pain interference and more satisfaction with social roles and activities and physical function. Higher relative presenteeism was associated with less cognitive concerns. CONCLUSIONS AND IMPLICATIONS FOR CANCER SURVIVORS We found significant associations between survivors' work status, performance, and QOL. Our findings provide an important insight on the implications of work outcomes on HCT survivors' physical, mental, and social health and emphasize the importance of longitudinal assessment of work status, performance, and QOL.
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Affiliation(s)
- Neel S Bhatt
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA.
| | - Ruta Brazauskas
- Division of Biostatistics, Institute of Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Akasha Palou Torres
- Division of Pediatric Hematology/Oncology/ BMT, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rachel Phelan
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Division of Pediatric Hematology/Oncology/ BMT, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Bronwen E Shaw
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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de Almeida ACP, de Azevedo VD, Alves TRDM, Santos VEP, Silva GWDS, de Azevedo IC. Common mental disorders in hematopoietic stem cell transplant patients: a scoping review. Rev Bras Enferm 2023; 77:e20220581. [PMID: 38088687 PMCID: PMC10704667 DOI: 10.1590/0034-7167-2022-0581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 09/22/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE to map common recurrent mental disorders in patients undergoing hematopoietic stem cell transplantation. METHODS this is a scoping review carried out in January 2022 in electronic databases and repositories of dissertations and thesis. Studies that answered the research question, met the objective of the study and were available in full electronically, in any language, were included. RESULTS the sample consisted of 28 studies, 14 of which were published in the United States of America. The common mental disorders found were depressive, anxiety, post-traumatic stress and mood disorders. Twenty symptoms were mentioned, among the most prevalent are fatigue and sleep disorders/insomnia. CONCLUSIONS the difficulty and importance of carrying out the differential diagnosis of these disorders were highlighted, since their symptoms can be confused with other health problems and have a strong potential to interfere with patients' evolution.
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Filgueira L, Steinberg A, Mendonca R, Lim SH. Returning to employment following allogeneic hematopoietic stem cell transplant: A major problem among survivors. EJHAEM 2023; 4:1132-1142. [PMID: 38024592 PMCID: PMC10660407 DOI: 10.1002/jha2.788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/21/2023] [Accepted: 08/29/2023] [Indexed: 12/01/2023]
Abstract
Quality of life (QoL) is an important aspect of cancer survivorship. One of the most acute problems that impact survivors in many aspects of activities of daily living and compromise their QoL is the inability to return to employment following successful cancer therapy. This is most prominent among survivors after allogeneic hematopoietic stem cell transplant (allo-HSCT). More than 50% of the survivors following allo-HSCT remain unemployed one year after the procedure. This problem extends beyond the initial few years; unemployment rates among those who underwent allo-HSCT during their childhoods or adolescence have remained high. The inability to return to employment imposes a financial burden. Survivors following allo-HSCT also experience a multitude of chronic psychosocial complications that may be both contributing and consequential to the inability to return to employment. However, many transplant programs and cancer centers do not have return-to-employment programs. In this review paper, we discuss the prevalence of unemployment following allo-HSCT. We examine the psychosocial symptoms experienced by survivors and how they may affect survivors' ability to return to employment. Finally, we propose a multi-disciplinary multi-pronged occupation-focused approach to address the complex and inter-related psychosocial symptoms to help alleviate the problem.
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Affiliation(s)
- Luis Filgueira
- Programs in Occupational TherapyColumbia University Irving Medical CenterNew York CityNew YorkUSA
| | - Amir Steinberg
- Department of MedicineDivision of Hematology and OncologyNew York Medical CollegeValhallaNew YorkUSA
| | - Rochelle Mendonca
- Programs in Occupational TherapyColumbia University Irving Medical CenterNew York CityNew YorkUSA
| | - Seah H. Lim
- Department of MedicineDivision of Hematology and OncologyState University of New York Upstate Medical UniversitySyracuseNew YorkUSA
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Cusatis R, Balza J, Uttke Z, Kode V, Suelzer E, Shaw BE, Flynn KE. Patient-reported cognitive function among hematopoietic stem cell transplant and cellular therapy patients: a scoping review. Qual Life Res 2023; 32:939-964. [PMID: 36203005 PMCID: PMC10259487 DOI: 10.1007/s11136-022-03258-0] [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: 09/12/2022] [Indexed: 10/10/2022]
Abstract
PURPOSE Cognitive dysfunction is a known complication following cellular therapies (CT), which can be assessed through performance based and patient-reported measures. We performed a systematic scoping review to assess self-reported cognitive function measures used among adult CT patients and describe long-term results, including associations with clinical outcomes. METHODS Library databases were searched from inception to February 2020 according to PRISMA guidelines. Additional studies were identified through reference lists and trial protocols. Two members of the research team screened titles and abstracts and resolved discrepancies. Articles that met eligibility criteria continued to full-text review, with 25% double screening. Articles were removed if they (1) were not original research, peer-reviewed articles; (2) were the wrong disease, age, or treatment-specific patient population; (3) did not use patient-reported outcomes; (4) did not separately report cognitive function outcomes. RESULTS Of the1952 articles, 56 were included. Twenty-one patient-reported measures of cognitive function were used; most frequently the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30), which includes a two-item cognitive function subscale (57%; n = 32). Thirteen studies collected performance-based and self-reported measures and of those (n = 6) who assessed associations found moderate correlations (range r = .13-.58). Longitudinal patterns showed declines in cognitive function soon after treatment (< 1 month) returning to baseline at 1 year. Cognitive function was often associated with other quality of life measures, chiefly depression (n = 5). CONCLUSIONS EORTC-QLQ-C30 is the most commonly used to measure, though there remain numerous measures used, including several measures with little previous validation and investigator developed items.
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Affiliation(s)
- Rachel Cusatis
- Center for International Blood and Marrow Transplant Research (CIBMTR), Medical College of Wisconsin, Milwaukee, WI, USA.
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Joanna Balza
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Zachary Uttke
- National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - Vishwajit Kode
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Bronwen E Shaw
- Center for International Blood and Marrow Transplant Research (CIBMTR), Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kathryn E Flynn
- Center for International Blood and Marrow Transplant Research (CIBMTR), Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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Prevalence and Determinants of Return to Work as a Patient-Centered Outcome in Survivors of Hematopoietic Cell Transplantation. Curr Hematol Malig Rep 2022; 17:228-242. [PMID: 36194316 DOI: 10.1007/s11899-022-00678-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW Employment is an important indicator of health and functional recovery for hematopoietic cell transplantation (HCT) survivors and has significant social and economic impacts. Cancer survivors treated with conventional non-HCT therapy are known to be at a higher risk of unemployment or not returning to work after completion of therapy compared with the control population. However, the literature on return-to-work challenges among HCT survivors remains limited. RECENT FINDINGS Here we summarize the evidence on prevalence and determinants of return-to-work challenges among HCT survivors using previously published literature. Findings from previously published research show that return to work or unemployment is a major concern among HCT survivors, especially for allogeneic HCT recipients, and prior studies have identified several modifiable risk factors associated with it. Survivors' post-HCT employment status is significantly associated with quality of life, impacting physical, emotional, social, and financial aspects of their lives. We also highlight the gaps in current knowledge such as limited information on employment outcomes of childhood, adolescent, and young adult HCT survivors; work-related challenges among employed HCT survivors; consequences of work-related challenges; and interventions to improve return to work among HCT survivors. Findings highlighted in this review make a strong case of a multidisciplinary return-to-work support for HCT survivors to properly address their needs.
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Patterns of Concerns Among Hematological Cancer Survivors. Cancer Nurs 2022; 45:447-456. [PMID: 35120022 DOI: 10.1097/ncc.0000000000001060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Advances in treatment for hematological cancers warrant greater attention on survivorship concerns. OBJECTIVE The aims of this study were to describe survivorship concerns among hematological cancer survivors, identify subgroups of survivors with distinct classes of concerns, and examine sociodemographic and clinical differences across subgroups. METHODS We conducted a cross-sectional analysis of data from 1160 hematological cancer survivors, who rated their degree of concern regarding 20 physical, emotional, and practical changes. Clusters of concerns were identified using latent class analysis. Associations between respondent characteristics and cluster membership were calculated using multinomial logistic regression. RESULTS Survivors had a mean of 7.5 concerns (SD, 4.6; range, 0-19), the most frequent being fatigue/tiredness (85.4%); anxiety, stress, and worry about cancer returning (70.2%); and changes to concentration/memory (55.4%). Three distinct classes of concerns were identified: class 1 (low, 47.0%), characterized by low endorsement of most concerns, apart from fatigue; class 2 (moderate, 32.3%), characterized by high endorsement of a combination of concerns across domains; and class 3 (high, 20.7%), characterized by the highest number of concerns out of the 3 identified classes, including greater endorsement of concerns relating to sexual well-being. Class membership was differentiated by survivor age, sex, marital status, and diagnosis. CONCLUSIONS Three distinct patterns of concerns were detected in a large sample of hematological cancer survivors. Patterns of concerns could be differentiated by survivor characteristics. IMPLICATIONS FOR PRACTICE Our study highlights the concerns experienced by hematological cancer survivors and provides support for a tailored biopsychosocial approach to survivorship care in this context.
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Change in Patients' Perceived Cognition Following Chimeric Antigen Receptor T-Cell Therapy for Lymphoma. Transplant Cell Ther 2022; 28:401.e1-401.e7. [PMID: 35580732 PMCID: PMC9339228 DOI: 10.1016/j.jtct.2022.05.015] [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: 01/29/2022] [Revised: 04/13/2022] [Accepted: 05/10/2022] [Indexed: 12/17/2022]
Abstract
Chimeric antigen receptor (CAR) T-cell therapy can lead to durable responses in patients with relapsed/refractory hematologic malignancies. Immune effector cell-associated neurotoxicity syndrome (ICANS) and cytokine release syndrome (CRS) are common and may place patients at risk for longer-term cognitive impairment. This study examined changes in cognition in the first year after CD19-directed CAR T-cell therapy for lymphoma, as well as CAR T-cell therapy-specific risk-factors (e.g., ICANS, CRS) and nonspecific risk factors (e.g., baseline quality of life, frailty) for worsening cognition. Patients' perceived cognition was assessed at baseline and at days 90 and 360. Clinical variables were abstracted from medical records. Piecewise mixed models were used to examine acute change (i.e., within 90 days) and longer-term change (i.e., from 90 days to 360 days) in cognition, as well as to explore risk factors for worsening cognition. Among 118 participants (mean age 61, 59% male), mean levels of perceived cognition did not change from baseline to day 90 (P> .05) but worsened from day 90 to day 360 in global cognition and in the domains of memory, language, organization, and divided attention (P< .05). Although statistically significant, changes were small (d values 0.15-0.28). Greater baseline fatigue, anxiety, and depression were associated with worse global cognition at day 90 (P< .01). Patients with more severe ICANS post-CART reported worse global cognition at day 360 (P< .05), although there were no differences in perceived cognition by severity of CRS (P> .05). Other putative risk factors were not associated with acute or longer-term changes in perceived cognition (P> .05). CAR T-cell therapy recipients reported delayed deterioration in several cognitive domains, although changes were small. These findings may be useful when educating future patients on what to expect when receiving CAR T-cell therapy.
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Long-term patient-reported neurocognitive outcomes in adult survivors of hematopoietic cell transplant. Blood Adv 2022; 6:4347-4356. [PMID: 35584396 PMCID: PMC9327540 DOI: 10.1182/bloodadvances.2021006672] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 05/11/2022] [Indexed: 11/20/2022] Open
Abstract
Long-term adult HCT survivors reported average cognitive quality of life compared with the general population. Survivors with hearing issues and sleep impairments were more likely to report lower quality of life and impaired neurocognitive function.
Survivors of hematopoietic cell transplant (HCT) are at risk for neurocognitive impairments, which can negatively affect quality of life. Given limited studies, we aimed to describe the neurocognitive outcomes in a cohort of long-term adult HCT survivors. Eligible survivors (age ≥21 years at HCT and alive ≥2 years following HCT) completed a 60-question survey of neurocognitive function and quality of life, which included the Neuro-Quality of Life Cognitive Function Short Form (Neuro-QoL) and the Childhood Cancer Survivor Study Neurocognitive Questionnaire (NCQ). Analyses of risk factors included univariate comparisons and multivariable logistic regression. Survivors (n = 1861, 47.7% female, 65.6% allogeneic HCT) were surveyed at a median age of 64.2 years (interquartile range [IQR], 56.8-70.5) and a median 12.0 years (IQR, 6.0-21.0) from HCT. Survivors reported average Neuro-QoL scores (50.0 allogeneic; 49.2 autologous survivors) compared with an expected mean of 50 in the general population. On the NCQ, 17.4% to 31.2% of survivors reported impairments (Z-score >1.28) in task efficiency, memory, emotional regulation, or organization, compared with an expected 10% in the general population (all P < .01). In multivariable regression analyses, impaired Neuro-QoL (T-score <40) was independently associated with hearing issues (odds ratio [OR], 2.13; 95% confidence interval [CI], 1.46-3.10) and sleep impairment (OR, 4.41; 95% CI, 2.80-6.94) among allogeneic survivors, with comparable associations in autologous survivors. Overall, long-term adult HCT survivors reported average cognitive quality of life compared with the general population. Subsets of survivors with hearing issues and sleep impairments were more likely to report lower quality of life and impaired neurocognitive function, which may facilitate targeted monitoring or interventions following HCT.
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Bury-Kamińska M, Szudy-Szczyrek A, Nowaczyńska A, Jankowska-Łęcka O, Hus M, Kot K. Chemotherapy-Related Differences in Cognitive Functioning and Their Biological Predictors in Patients with Multiple Myeloma. Brain Sci 2021; 11:1166. [PMID: 34573187 PMCID: PMC8466339 DOI: 10.3390/brainsci11091166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/10/2021] [Accepted: 08/29/2021] [Indexed: 11/21/2022] Open
Abstract
The paper presents a study on the changes in cognitive functioning in patients undergoing chemotherapy with diagnosed multiple myeloma (MM). The aim of the study was to answer the following two main research questions: Does the treatment stage differentiate the functioning of cognitive processes in patients with diagnosed MM and to what extent? Is it possible to treat biological factors (TNF-α, IL-6, IL-10, and BDNF) as predictors of patients' cognitive functioning? The patients were examined twice, before the treatment and after 4-6 cycles of chemotherapy. Selected neuropsychological research methods as well as experimental and clinical trials were employed to diagnose the patients' general cognitive state, attention, memory, and executive functions. The level of biological factors was assessed with the ELISA test. The results show that the patients' cognitive functioning was worse before the treatment than during the cytostatic therapy. It was also possible to predict the cognitive state of patients suffering from multiple myeloma based on a selected biological parameter (neurotrophin BDNF).
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Affiliation(s)
- Magdalena Bury-Kamińska
- Department of Clinical Psychology and Neuropsychology, Institute of Psychology, Maria Curie-Skłodowska University in Lublin, 45 Głęboka, 20-612 Lublin, Poland
| | - Aneta Szudy-Szczyrek
- Department of Hemato-Oncology and Bone Marrow Transplantation, Medical University of Lublin, 2 Karmelicka, 20-400 Lublin, Poland; (A.S.-S.); (A.N.); (O.J.-Ł.); (M.H.); (K.K.)
| | - Aleksandra Nowaczyńska
- Department of Hemato-Oncology and Bone Marrow Transplantation, Medical University of Lublin, 2 Karmelicka, 20-400 Lublin, Poland; (A.S.-S.); (A.N.); (O.J.-Ł.); (M.H.); (K.K.)
| | - Olga Jankowska-Łęcka
- Department of Hemato-Oncology and Bone Marrow Transplantation, Medical University of Lublin, 2 Karmelicka, 20-400 Lublin, Poland; (A.S.-S.); (A.N.); (O.J.-Ł.); (M.H.); (K.K.)
| | - Marek Hus
- Department of Hemato-Oncology and Bone Marrow Transplantation, Medical University of Lublin, 2 Karmelicka, 20-400 Lublin, Poland; (A.S.-S.); (A.N.); (O.J.-Ł.); (M.H.); (K.K.)
| | - Klaudia Kot
- Department of Hemato-Oncology and Bone Marrow Transplantation, Medical University of Lublin, 2 Karmelicka, 20-400 Lublin, Poland; (A.S.-S.); (A.N.); (O.J.-Ł.); (M.H.); (K.K.)
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Janicsák H, Ungvari GS, Gazdag G. Psychosocial aspects of hematopoietic stem cell transplantation. World J Transplant 2021; 11:263-276. [PMID: 34316451 PMCID: PMC8290998 DOI: 10.5500/wjt.v11.i7.263] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/18/2021] [Accepted: 06/18/2021] [Indexed: 02/06/2023] Open
Abstract
Hematopoietic stem cell transplantation (HSCT) has become a conventional and potentially curative treatment for various hematological diseases. As more sophisticated procedures have been developed and mortality rates have decreased, attention has shifted to the psychosocial challenges associated with transplantation. The psychosocial difficulties accompanying transplantation are addressed in the context of both quality of life (QOL) and psychopathological research. Among the psychiatric comorbidities of HSCT, anxiety, depression, sleep and sexual disorders, delirium and post-traumatic stress disorder are the most studied conditions. Recently, more attention has been focused on the psychosocial burden of caregivers. Devising recommendations for the management of psychiatric symptoms and psychosocial interventions in HSCT sufferers and close relatives is a major concern to consultation–liaison psychiatrists and transplant teams. This review synthesizes and critically evaluates the current literature on the psychosocial aspects of HSCT and appraises the clinical significance of these outcomes. Issues of QOL assessment; psychosocial functioning and QOL in the course of HSCT; impact of graft-versus-host disease and other predictors of QOL and psychosocial functioning; comorbid psychiatric disorders; and interventions to maintain or improve QOL and reduce psychopathology and psychosocial burden on family members are presented.
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Affiliation(s)
- Henrietta Janicsák
- Department of Psychiatry and Psychiatric Rehabilitation, Jahn Ferenc South Pest Hospital, Budapest 1204, Hungary
| | - Gabor S Ungvari
- Division of Psychiatry, University of Notre Dame, Fremantle 6009, Australia
- Division of Psychiatry, School of Medicine, University of Western Australia, Perth 6009, Australia
| | - Gábor Gazdag
- Department of Psychiatry and Psychiatric Rehabilitation, Jahn Ferenc South Pest Hospital, Budapest 1204, Hungary
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Semmelweis University, Budapest 1083, Hungary
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Kelly DL, Syrjala K, Taylor M, Rentscher KE, Hashmi S, Wood WA, Jim H, Barata A, Flynn KE, Burns LJ, Shaw BE, Petersdorf E, Yero AC, Emmrich AD, Morris KE, Costanzo ES, Knight JM. Biobehavioral Research and Hematopoietic Stem Cell Transplantation: Expert Review from the Biobehavioral Research Special Interest Group of the American Society for Transplantation and Cellular Therapy. Transplant Cell Ther 2021; 27:747-757. [PMID: 34139388 DOI: 10.1016/j.jtct.2021.06.007] [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: 02/25/2021] [Revised: 06/04/2021] [Accepted: 06/07/2021] [Indexed: 01/12/2023]
Abstract
Hematopoietic stem cell transplantation (HCT) is a potentially curative treatment for many hematologic conditions. Despite advances in conditioning and supportive measures, however, there remain significant comorbidities that threaten survivorship. Adverse effects of stress-related biobehavioral processes-defined here as the interactions of behavioral, psychological, and socioenvironmental factors with biology-impact immune recovery and function and are particularly salient in the HCT context, given the importance of immune reconstitution for improved survivorship. However, biobehavioral processes have been underinvestigated in this vulnerable group compared with other cancer populations. Here the Biobehavioral Research Special Interest Group (SIG) of the American Society for Transplantation and Cellular Therapy provides an expert review to inform research directions explicating the biological correlates of behavioral symptoms and evaluate the impact of these on HCT outcomes. The goal of this expert review is to provide a foundation for advancing science that effectively integrates behavioral and biological processes to optimize quality of life and improve clinical outcomes for HCT recipients.
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Affiliation(s)
- Debra Lynch Kelly
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida and University of Florida Health Cancer Center, Gainesville, Florida
| | - Karen Syrjala
- Biobehavioral Sciences Department, Fred Hutchinson Cancer Research Center and University of Washington School of Medicine, Seattle, Washington
| | - Mallory Taylor
- Division of Hematology-Oncology, Department of Pediatrics, University of Washington, Seattle, Washington
| | - Kelly E Rentscher
- Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, California
| | - Shahrukh Hashmi
- Department of Hematology and Onclolgy; Sheikh Shakhbout Medical City/Mayo Clinic, Abu Dhabi, United Arab Emirates
| | - William A Wood
- Division of Hematology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Heather Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Anna Barata
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Kathryn E Flynn
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Linda J Burns
- Center for International Blood and Marrow Transplant Research, Milwaukee, Wisconsin
| | - Bronwen E Shaw
- Center for International Blood and Marrow Transplantation Research, Froedtert and the Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Effie Petersdorf
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Anela Carrazana Yero
- Department of Biobehavioral Nursing Science, University of Florida, Gainesville, Florida
| | - Amanda D Emmrich
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Keayra E Morris
- Department of Psychiatry, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Erin S Costanzo
- Department of Psychiatry and Carbone Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin
| | - Jennifer M Knight
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Microbiology and Immunology, Medical College of Wisconsin, Milwaukee, Wisconsin.
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12
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Wu NL, Krull KR, Cushing-Haugen KL, Ullrich NJ, Kadan-Lottick NS, Lee SJ, Chow EJ. Long-term neurocognitive and quality of life outcomes in survivors of pediatric hematopoietic cell transplant. J Cancer Surviv 2021; 16:696-704. [PMID: 34086185 DOI: 10.1007/s11764-021-01063-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 05/24/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Pediatric patients who undergo hematopoietic cell transplant (HCT) are at risk for neurocognitive impairments, which can impact quality of life. Given limited long-term studies, we aimed to characterize the late neurocognitive outcomes in a cohort of pediatric HCT survivors. METHODS Eligible survivors (HCT at age < 21 year and ≥ 1 year post-HCT) completed a 60-question survey of neurocognitive function and quality of life, which included the Childhood Cancer Survivor Study Neurocognitive Questionnaire (CCSS-NCQ) and the Neuro-Quality of Life Cognitive Function Short Form (Neuro-QoL). Analyses of risk factors included univariate comparisons and multivariable logistic regression. RESULTS Participants (n = 199, 50.3% female, 53.3% acute leukemia, 87.9% allogeneic transplants) were surveyed at median age of 37.8 years (interquartile range [IQR] 28.5-48.8) at survey and median 27.6 years (IQR 17.0-34.0) from transplant. On the CCSS-NCQ, 18.9-32.5% of survivors reported impairments (Z score > 1.28) in task efficiency, memory, emotional regulation, or organization, compared with expected 10% in the general population (all p < 0.01). In contrast, survivors reported average Neuro-QoL (T score 49.6±0.7) compared with population normative value of 50 (p = 0.52). In multivariable regression, impaired Neuro-QoL (T score < 40) was independently associated with hearing issues (OR 4.97, 95% CI 1.96-12.6), history of stroke or seizure (OR 4.46, 95% CI 1.44-13.8), and sleep disturbances (OR 6.95, 95% CI 2.53-19.1). CONCLUSIONS Although long-term survivors of pediatric HCT reported higher rates of impairment in specific neurocognitive domains, cognitive quality of life was perceived as similar to the general population. Subsets of survivors with certain co-morbidities had substantially worse neurocognitive outcomes. IMPLICATIONS FOR CANCER SURVIVORS While the long-term impact of pediatric HCT can include neurocognitive deficits, survivors report average cognitive quality of life.
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Affiliation(s)
- Natalie L Wu
- Department of Pediatrics, Division of Hematology/Oncology, University of Washington, Seattle Children's Hospital, 4600 Sand Point Way NE, Seattle, WA, 98105, USA.
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., P.O. Box 19024, Seattle, WA, 98109, USA.
| | - Kevin R Krull
- Department of Epidemiology and Cancer Control, Department of Psychology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Kara L Cushing-Haugen
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., P.O. Box 19024, Seattle, WA, 98109, USA
| | - Nicole J Ullrich
- Department of Neurology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Nina S Kadan-Lottick
- Department of Pediatrics, Yale University School of Medicine, Yale Cancer Center, PO Box 208028, New Haven, CT, 06520, USA
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., P.O. Box 19024, Seattle, WA, 98109, USA
| | - Eric J Chow
- Department of Pediatrics, Division of Hematology/Oncology, University of Washington, Seattle Children's Hospital, 4600 Sand Point Way NE, Seattle, WA, 98105, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., P.O. Box 19024, Seattle, WA, 98109, USA
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13
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Lacy M, Fong M, Bolton C, Maranzano M, Bishop M, Artz A. Cognitive functioning of older adults prior to hematopoietic stem cell transplantation. Bone Marrow Transplant 2021; 56:2575-2581. [PMID: 34031555 DOI: 10.1038/s41409-021-01331-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 10/26/2020] [Accepted: 04/26/2021] [Indexed: 11/09/2022]
Abstract
Hematopoietic cell transplantation is increasingly used in older adults with hematological malignancies. Younger adult patients who undergo HCT have shown to commonly present with cognitive impairment and depression prior to transplant; however, little research has been done to understand the cognitive and emotional functioning of older adults undergoing HCT. This study aimed to investigate the rate of cognitive impairment in a retrospective sample of older adult HCT candidates prior to transplant using a comprehensive battery. Ninety-three patients over the age of 60 completed a neuropsychology test battery that assessed standard domains of cognitive and emotional functioning. Impairment was defined as z-scores = < -1.5 on at least two tests or a z score = < -2.0 on at least one test. Results indicated that over 68% of patients were impaired with nearly a third of the sample showing impairment in verbal learning and memory and approximately one fifth showing impairments in aspects of executive function, processing speed, and visual learning. Ten percent of the patients endorsed symptoms indicative of a clinical level of depression. Medical comorbidities nor depression predicted cognitive impairment. These findings suggest that older adults candidates for HCT are at risk for cognitive impairment prior to transplant and thus cognition should be a consideration when developing treatment plans.
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Affiliation(s)
- Maureen Lacy
- University of Chicago Medical Center, Chicago, USA.
| | - Mandy Fong
- Washington University in St. Louis, St. Louis, MO, USA
| | | | | | | | - Andrew Artz
- City of Hope National Medicine Center, Duarte, CA, USA
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14
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Hutchinson AD, Thompson E, Loft N, Lewis I, Wilson C, Yong ASM. Cognitive late effects following allogeneic stem cell transplantation in haematological cancer patients. Eur J Cancer Care (Engl) 2021; 30:e13448. [PMID: 33774876 DOI: 10.1111/ecc.13448] [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] [Revised: 01/18/2021] [Accepted: 02/25/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The objective of this exploratory study was to determine the presence and correlates of self-reported cognition in a sample of haematological cancer patients who had undergone allogeneic stem cell transplantation (SCT). METHODS Haematological cancer patients (n = 30) who had undergone allogeneic SCT between one and five years previously and age-matched control participants (n = 30) completed questionnaires assessing cognition, affect, sleep quality and fatigue and an assessment of premorbid IQ. RESULTS Patients reported significantly poorer perceived cognitive ability (d = 1.12) and greater perceived cognitive impairment (d = 0.96) than controls. Lower fatigue was significantly associated with greater perceived cognitive ability (r = 0.75 patients and controls) and less perceived cognitive impairment (r = 0.80 patients; r = 0.57 controls). Interestingly, depression was significantly correlated with perceived cognitive ability in the control group only (r = 0.80). Hierarchical multiple regressions showed that fatigue was a significant predictor of perceived cognitive ability in patients, accounting for 56% of the variance. CONCLUSIONS This study established that self-reported cognitive ability and cognitive impairment was significantly poorer in haematological cancer patients than controls. Furthermore, fatigue was significantly associated with perceived cognitive ability in patients. Future research should focus on identifying interventions that target fatigue in allogeneic SCT recipients in order to improve quality of life throughout survivorship.
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Affiliation(s)
| | - Elise Thompson
- Justice & Society, University of South Australia, Adelaide, SA, Australia
| | - Nicole Loft
- Department of Haematology, Royal Adelaide Hospital/SA Pathology, Adelaide, SA, Australia
| | - Ian Lewis
- Adelaide Oncology & Haematology, North Adelaide, SA, Australia
| | - Carlene Wilson
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.,Olivia Newton John Cancer Wellness & Research Centre, Heidelberg, Vic., Australia.,School of Psychology and Public Health, La Trobe University, Melbourne, Vic., Australia
| | - Agnes S M Yong
- Department of Haematology, Royal Adelaide Hospital/SA Pathology, Adelaide, SA, Australia.,Precision Medicine Theme, SAHMRI, Adelaide, SA, Australia.,School of Medicine, University of Adelaide, Adelaide, SA, Australia.,Department of Haematology, Royal Perth Hospital, Perth, WA, Australia.,Medical School, University of Western Australia, Perth, WA, USA
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15
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Mayo SJ, Rourke SB, Atenafu EG, Vitorino R, Chen C, Kuruvilla J. Computerized cognitive training in post-treatment hematological cancer survivors: a feasibility study. Pilot Feasibility Stud 2021; 7:36. [PMID: 33514444 PMCID: PMC7847007 DOI: 10.1186/s40814-021-00778-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 01/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Computerized cognitive training (CCT) programs have shown some effectiveness in alleviating cognitive symptoms in long-term cancer survivors. For patients presenting with cognitive symptoms in the early post-treatment phase, the benefit of CCT is unclear. To assess the possibility of testing the effectiveness of CCT in the early post-treatment period, our aim was to investigate the feasibility of an 8-week home-based, online CCT intervention among patients who have recently completed treatment for hematological malignancy. METHODS This study was a single-arm, non-blinded, feasibility study. All participants were provided with the CCT intervention for an 8-week period. Feasibility was evaluated based on participant adherence and patient perceptions of the intervention, assessed through responses to an acceptability questionnaire and semi-structured interviews at the end of the intervention period. RESULTS The feasibility study included 19 patients who had completed treatment for hematological malignancy at a Canadian tertiary cancer center. Adherence to the CCT intervention was limited, with only one participant meeting the criteria for intervention adherence. At the end of the intervention period, participants characterized the program as easy to follow (92%) and felt well-prepared for how to complete the exercises (100%). In semi-structured interviews, participants highlighted post-treatment barriers to intervention adherence that included symptom burden and competing time demands. Participants also suggested improvements to the intervention that could help maintain adherence despite these barriers, such as fostering a sense of accountability, providing personalized feedback and coaching, and enabling opportunities for peer support. CONCLUSIONS Participation in CCT can be challenging in the post-treatment period for hematological cancers. Further research on the effectiveness of CCT in this setting may require the implementation of strategies that support participants' engagement with the intervention in the context of symptoms and competing demands, such as establishing a minimum dose requirement and integrating approaches to help promote and sustain motivation.
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Affiliation(s)
- Samantha J Mayo
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College St., Suite 130, Toronto, ON, M5T 1P8, Canada. .,Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
| | - Sean B Rourke
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Eshetu G Atenafu
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Rita Vitorino
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Christine Chen
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - John Kuruvilla
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
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16
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Gabriel M, Hoeben BAW, Uhlving HH, Zajac-Spychala O, Lawitschka A, Bresters D, Ifversen M. A Review of Acute and Long-Term Neurological Complications Following Haematopoietic Stem Cell Transplant for Paediatric Acute Lymphoblastic Leukaemia. Front Pediatr 2021; 9:774853. [PMID: 35004543 PMCID: PMC8734594 DOI: 10.3389/fped.2021.774853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 12/02/2021] [Indexed: 12/02/2022] Open
Abstract
Despite advances in haematopoietic stem cell transplant (HSCT) techniques, the risk of serious side effects and complications still exists. Neurological complications, both acute and long term, are common following HSCT and contribute to significant morbidity and mortality. The aetiology of neurotoxicity includes infections and a wide variety of non-infectious causes such as drug toxicities, metabolic abnormalities, irradiation, vascular and immunologic events and the leukaemia itself. The majority of the literature on this subject is focussed on adults. The impact of the combination of neurotoxic drugs given before and during HSCT, radiotherapy and neurological complications on the developing and vulnerable paediatric and adolescent brain remains unclear. Moreover, the age-related sensitivity of the nervous system to toxic insults is still being investigated. In this article, we review current evidence regarding neurotoxicity following HSCT for acute lymphoblastic leukaemia in childhood. We focus on acute and long-term impacts. Understanding the aetiology and long-term sequelae of neurological complications in children is particularly important in the current era of immunotherapy for acute lymphoblastic leukaemia (such as chimeric antigen receptor T cells and bi-specific T-cell engager antibodies), which have well-known and common neurological side effects and may represent a future treatment modality for at least a fraction of HSCT-recipients.
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Affiliation(s)
- Melissa Gabriel
- Cancer Centre for Children, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Bianca A W Hoeben
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Hilde Hylland Uhlving
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Olga Zajac-Spychala
- Department of Pediatric Oncology, Hematology and Transplantology, Poznan University of Medical Sciences, Poznań, Poland
| | - Anita Lawitschka
- Haematopoietic Stem Cell Transplant Unit, St. Anna Children's Hospital, Medical University Vienna, Vienna, Austria
| | - Dorine Bresters
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Marianne Ifversen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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17
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Bairey O, Shargian-Alon L, Siegal T. Consolidation Treatment for Primary Central Nervous System Lymphoma: Which Modality for Whom? Acta Haematol 2020; 144:389-402. [PMID: 33242855 DOI: 10.1159/000511208] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 08/30/2020] [Indexed: 01/04/2023]
Abstract
Primary central nervous system lymphoma is a rare aggressive disease that largely affects elderly patients and is associated with poor prognosis. The optimal treatment approach is not yet defined and it consists of induction and consolidation phases. The combination of high-dose (HD) methotrexate-based chemotherapy followed by whole-brain radiotherapy (WBRT) prolongs the median progression-free survival (PFS) and overall survival 2- to 3-fold as compared to WBRT alone but is associated with significant delayed neurotoxicity. Alternative strategies are being investigated in order to improve disease outcomes and spare patients the neurocognitive side effects. These include reduced-dose WBRT, non-myeloablative HD chemotherapy, or HD chemotherapy with autologous stem cell transplantation (HDC/ASCT). There are no randomized studies that compare all these consolidation regimens head to head but recently HDC/ASCT has been evaluated versus WBRT in prospective randomized studies. These studies proved that WBRT and HDC/ASCT yield similar 2-year PFS with preserved or improved cognitive function after HDC/ASCT. Yet, the proportion of patients treated with such intensive consolidation is low, both in real life and in specialized centers, leaving many unsettled issues. This review is appraising current dilemmas related to the choice of consolidating therapeutic modalities, their associated acute and delayed toxicity, and future prospects for alternative approaches in the elderly.
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Affiliation(s)
- Osnat Bairey
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petach Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,
| | - Liat Shargian-Alon
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petach Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tali Siegal
- Neuro-Oncology, Davidoff Cancer Center, Rabin Medical Center, Petah Tiqva, Israel
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18
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Gates P, Gough K, Dhillon H, Wilson C, Hawkes E, Dore V, Perchyonok Y, Rowe CC, Walker AK, Vardy JL, de Ruiter M, Krishnasamy M. Longitudinal exploration of cancer-related cognitive impairment in patients with newly diagnosed aggressive lymphoma: protocol for a feasibility study. BMJ Open 2020; 10:e038312. [PMID: 32994248 PMCID: PMC7526311 DOI: 10.1136/bmjopen-2020-038312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/11/2020] [Accepted: 08/06/2020] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Cancer-related cognitive impairment (CRCI) is a distressing and disabling side-effect of cancer treatments affecting up to 75% of patients. For some patients, their cognitive impairment may be transient, but for a subgroup, these symptoms can be long-standing and have a major impact on the quality of life. This paper describes the protocol for a study: (1) to assess the feasibility of collecting longitudinal data on cognition via self-report, neuropsychological testing, peripheral markers of inflammation and neuroimaging and (2) to explore and describe patterns of cancer-related cognitive impairment over the course of treatment and recovery in patients with newly diagnosed, aggressive lymphoma undergoing standard therapy with curative intent. METHODS AND ANALYSIS This is a prospective, longitudinal, feasibility study in which 30 newly diagnosed, treatment-naive patients with aggressive lymphoma will be recruited over a 12-month period. Patients will complete comprehensive assessments at three time points: baseline (time 1, pre-treatment) and two post-baseline follow-up assessments (time 2, mid-treatment and time 3, 6-8 weeks post-treatment completion). All patients will be assessed for self-reported cognitive difficulties and objective cognitive function using Stroop Colour and Word, Trail Making Test Part A and B, Hopkins Verbal Learning Test-Revised, Controlled Oral Word Association and Digit Span. Blood cell-based inflammatory markers and neuroimaging including a positron emission tomography (PET) with 18F-labelled fluoro-2-deoxyglucose (18F-FDG) and CT (18F-FDG-PET/CT) and a MRI will explore potential inflammatory and neuroanatomical or functional mechanisms and biomarkers related to CRCI. The primary intent of analysis will be to assess the feasibility of collecting longitudinal data on cognition using subjective reports and objective tasks from patients during treatment and recovery for lymphoma. These data will inform the design of a larger-scale investigation into the patterns of cognitive change over the course of treatment and recovery, adding to an underexplored area of cancer survivorship research. ETHICS AND DISSEMINATION Ethical approval has been granted by Austin Health Human Rights Ethics Committee (HREC) in Victoria Australia. Peer reviewed publications and conference presentations will report the findings of this novel study. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ACTRN12619001649101).
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Affiliation(s)
- Priscilla Gates
- Department of Clinical Haematology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Melbourne, Victoria, Australia
- Department of Nursing, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Karla Gough
- Department of Nursing, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Cancer Experiences, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Haryana Dhillon
- Centre for Medical Psychology & Evidence-based Decision-making, School of Psychology, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
| | - Carlene Wilson
- Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Melbourne, Victoria, Australia
- School of Psychology and Public Health, LaTrobe University, Melbourne, Victoria, Australia
| | - Eliza Hawkes
- Department of Clinical Haematology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Melbourne, Victoria, Australia
- Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Vincent Dore
- Biomedical Imaging, Health & Biosecurity Flagship, The Australian e-Health Research Centre, CSIRO Health & Biosecurity, Melbourne, Victoria, Australia
- Department of Molecular Imaging and Therapy, Austin Health, Melbourne, Victoria, Australia
| | - Yuliya Perchyonok
- Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Radiology, Austin Health, Melbourne, Victoria, Australia
| | - Christopher C Rowe
- Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Molecular Imaging and Therapy, Austin Health, Melbourne, Victoria, Australia
| | - Adam K Walker
- Laboratory of ImmunoPsychiatry, Neuroscience Research Australia, Sydney, New South Wales, Australia
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Janette L Vardy
- Concord Cancer Centre, Concord Repatriation and General Hospital, Concord, New South Wales, Australia
- Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Michiel de Ruiter
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Meinir Krishnasamy
- Cancer Nursing Research Group, Department of Nursing/Centre for Cancer Research, School of Health Sciences/University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Academic Nursing Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Research and Education Nursing, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia
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19
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Baumann E, Kuba K, Götze H, Mehnert-Theuerkauf A, Esser P. Initial validation of the German version of the Attentional Function Index in a sample of haematological cancer survivors. Eur J Cancer Care (Engl) 2020; 29:e13226. [PMID: 31958365 DOI: 10.1111/ecc.13226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 12/19/2019] [Accepted: 12/19/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To date, no German instrument exists to assess subjective levels of cancer-related cognitive impairments (CRCI) in cancer survivors. We translated the validated Attentional Function Index (AFI) into German and explored its psychometric properties. METHODS The validation sample consisted of 1,111 haematological cancer survivors mainly recruited from two cancer registries. Factorial structure was explored using principal component analysis, internal consistency via Cronbach's α, construct validity through correlational analyses (Pearson's r) and associations of patient characteristics with the AFI score via regression analyses. RESULTS In line with the original version, we revealed three factors, that is "effective action" (seven items), "attentional lapses" (three items) and "interpersonal effectiveness" (three items). The overall reliability α was .91. Verifying construct validity, the AFI score correlated positively with cognitive functioning (r = .64, p ≤ .01) and global QoL (r = .44, p ≤ .01), but negatively with fatigue (r = -.60, p ≤ .01) and depressive symptomatology (r = -.6, p ≤ .01). Older age (β = .12, p < .001), higher comorbidity (β = -.07, p = .02) and being male patient (β = .07, p = .01) were significantly associated with the AFI scores, but effect sizes were small. CONCLUSION The German translation of the AFI shows good psychometric properties and thus may be reasonably applied to measure the subjective level of CRCI in German-speaking oncological populations.
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Affiliation(s)
- Esther Baumann
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Katharina Kuba
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Heide Götze
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Anja Mehnert-Theuerkauf
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Peter Esser
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
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20
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Root JC, Campbell C, Rocha-Cadman X, Kasven-Gonzalez N, Maloy M, Flynn J, Devlin SM, Jakubowski AA. Pretransplantation Cognitive Dysfunction in Advanced-Age Hematologic Cancers: Predictors and Associated Outcomes. Biol Blood Marrow Transplant 2020; 26:1497-1504. [PMID: 32447045 DOI: 10.1016/j.bbmt.2020.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/11/2020] [Accepted: 05/13/2020] [Indexed: 11/28/2022]
Abstract
Patients presenting for treatment of hematologic cancers may be at increased risk for cognitive dysfunction before allogeneic hematopoietic stem cell transplantation (HSCT) due to advanced age, previous chemotherapy treatment, deconditioning, and fatigue. Cognitive dysfunction may affect treatment decision making, ability to recall or follow post-HSCT treatment recommendations and overall survival (OS). A total of 448 patients admitted for HSCT between 2011 and 2014 were administered the Montreal Cognitive Assessment (MoCA) by occupational therapists during admission before transplantation, and 260 were reassessed following transplantation and before discharge. We examined select predictor variables, including age, Karnofsky Performance Status, sex, disease type, psychotropic medications, and select outcome variables, including OS, and nonrelapse mortality (NRM). Before transplantation, 36.4% of patients met criteria for cognitive dysfunction. Age was found to be a significant predictor, along with disease type (myelodysplastic syndrome [MDS], myeloproliferative disorder [MPD]). No significant association was found between cognitive dysfunction and OS or NRM. Longitudinal analysis from pretransplantation to post-transplantation indicated significant decline following HSCT. Notably, one-third of the study cohort showed cognitive dysfunction at hospital discharge. A significant proportion of HSCT candidates present with cognitive dysfunction, with older patients and those diagnosed with MDS and MPD at greatest risk in this cohort. Attention to cognitive dysfunction before transplantation may alert the treatment team to high-risk cases that require increased oversight, inclusion by caregivers, and referral to occupational therapy at discharge. Longitudinal follow-up studies are needed to clarify the specific effect of HSCT on cognitive dysfunction and the impact of cognitive dysfunction on transplantation outcomes.
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Affiliation(s)
- James C Root
- Department of Psychiatry and Behavioral Sciences, Weill Cornell Medical College, New York, New York.
| | - Claudine Campbell
- Department of Neurology, Weill Cornell Medical College, New York, New York
| | | | | | - Molly Maloy
- Health Informatics, Weill Cornell Medical College, New York, New York
| | - Jessica Flynn
- Department of Epidemiology and Biostatistics, Weill Cornell Medical College, New York, New York
| | - Sean M Devlin
- Department of Epidemiology and Biostatistics, Weill Cornell Medical College, New York, New York
| | - Ann A Jakubowski
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, New York, New York
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21
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Cognitive complaints by hematopoietic cell transplantation recipients and change in neuropsychological performance over time. Support Care Cancer 2020; 29:247-254. [PMID: 32346799 DOI: 10.1007/s00520-020-05458-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 04/04/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE Hematopoietic stem cell transplant (HSCT) recipients are at risk for cognitive decline. Cross-sectional studies show patients' complaints of cognitive decline do not correlate well with concurrently measured objective neuropsychological performance, but rather with emotional variables and health-related quality of life. This longitudinal study investigated whether patient self-report of cognitive status would be concordant with objectively measured neuropsychological performance after accounting for change from their own pre-transplant objective baseline. METHODS Pre-HSCT and at 30 and 100 days post-HSCT, 46 patients underwent computerized neuropsychological testing (CogState) and completed surveys assessing patient-reported cognitive complaints, emotional symptoms (depression, anxiety), sleep quality, daytime sleepiness, and physical and functional well-being. Correlations were calculated between cognitive complaints and neuropsychological performance (at each time-point and across time-points), as well as all other patient-reported variables. RESULTS Patient-reported cognitive complaints were largely independent of concurrently assessed objective neuropsychological performance. Uniquely, our longitudinal data demonstrated significant medium to large effect size associations between subjective cognitive complaints post-HSCT with objectively measured change from pre-HSCT in attention, visual learning, and working memory (p < .05-.01). Subjective cognitive complaints post-HSCT were also associated with depression, anxiety, daytime sleepiness and physical well-being (p < .05-.001). CONCLUSIONS Patients appear better able to assess their cognitive functioning relative to their own baseline and changes across time rather than relative to community norms. Thus, patient complaints of cognitive compromise justify further in-depth neuropsychological, emotional, and functional assessment. Future research into relationships between cognitive complaints and neuropsychological performance should account for changes in performance over time.
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22
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A mixed methods analysis of perceived cognitive impairment in hematopoietic stem cell transplant survivors. Palliat Support Care 2020; 17:396-402. [PMID: 30238868 DOI: 10.1017/s1478951518000664] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Hematopoietic stem cell transplant (HSCT) survivors may show evidence of objective cognitive impairment; however, perceived cognitive problems and their impact on quality of life are less well-understood. The purpose of this study was to explore HSCT survivors' perceptions of cognitive impairment and its effect on daily life functioning. METHOD Sixty-nine autologous and allogeneic HSCT survivors nine months to three years posttransplant experiencing mild survivorship problems completed a brief structured interview regarding perceived cognitive impairment since transplant. Data were coded and content analyzed. The frequency of participants reporting cognitive problems by domain and associations between reports of cognitive problems and age, depressed mood, anxiety, and health-related quality of life were examined. RESULT Overall, 49 of the 69 participants (71%) reported cognitive impairments after transplant: 38 in memory (55%), 29 in attention and concentration (42%), and smaller numbers in other domains. There were no significant differences in problems reported by transplant type. Of the 50 participants who worked before transplant, 19 (38%) did not return to work following transplant, with 12 citing cognitive and health problems as being the reason. There were significant associations between reports of cognitive impairment and younger age (p = 0.02), depressed mood (p = 0.02), anxiety (p = 0.002), and health-related quality of life (p = 0.008). SIGNIFICANCE OF RESULTS A large proportion of survivors reported cognitive impairment following HSCT that impaired daily life functioning. Perceived cognitive impairment was associated with younger age, greater distress and reduced health-related quality of life.
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23
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Brain glucose metabolism in patients with newly diagnosed multiple myeloma significantly decreases after high-dose chemotherapy followed by autologous stem cell transplantation. Nucl Med Commun 2020; 41:288-293. [DOI: 10.1097/mnm.0000000000001144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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24
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Sharafeldin N, Richman J, Bosworth A, Chen Y, Singh P, Patel SK, Wang X, Francisco L, Forman SJ, Wong FL, Bhatia S. Clinical and Genetic Risk Prediction of Cognitive Impairment After Blood or Marrow Transplantation for Hematologic Malignancy. J Clin Oncol 2020; 38:1312-1321. [PMID: 32083992 DOI: 10.1200/jco.19.01085] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Using a candidate gene approach, we tested the hypothesis that individual single nucleotide polymorphisms (SNPs) and gene-level variants are associated with cognitive impairment in patients with hematologic malignancies treated with blood or marrow transplantation (BMT) and that inclusion of these SNPs improves risk prediction beyond that offered by clinical and demographic characteristics. PATIENTS AND METHODS In the discovery cohort, BMT recipients underwent a standardized battery of neuropsychological tests pre-BMT and at 6 months, 1 year, 2 years, and 3 years post-BMT. Associations between 68 candidate genes and cognitive impairment were assessed using generalized estimating equation models. Elastic-Net regression was used to build Base (sociodemographic), Clinical, and Combined (Base plus Clinical plus genetic) risk prediction models of post-BMT impairment. An independent nonoverlapping cohort from the BMT Survivor Study with self-report of learning/memory problems (as identified by their health care provider) was used for model replication. RESULTS The discovery cohort included 277 participants (58.5% males; 68.6% non-Hispanic whites; and 46.6% allogeneic BMT recipients). Adjusting for BMT type, age at BMT, sex, race/ethnicity, and cognitive reserve, SNPs in the blood-brain barrier, telomere homeostasis, and DNA repair genes were significantly associated with cognitive impairment. Compared with the Clinical Model, the Combined Model had higher predictive power in both the discovery cohort (mean area under the receiver operating characteristic curve [AUC], 0.89; 95% CI, 0.85 to 0.93 v 0.77; 95% CI, 0.71 to 0.83; P = 1.24 × 10-9) and the replication cohort (AUC, 0.71; 95% CI, 0.66 to 0.76 v 0.63; 95% CI, 0.57 to 0.68; P = .004). CONCLUSION Inclusion of candidate genetic variants enhanced the prediction of risk of post-BMT cognitive impairment beyond that offered by demographic/clinical characteristics and represents a step toward a personalized approach to managing patients at high risk for cognitive impairment after BMT.
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Affiliation(s)
- Noha Sharafeldin
- Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Joshua Richman
- Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | | | - Yanjun Chen
- Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Purnima Singh
- Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | | | - Xuexia Wang
- Department of Mathematics, University of North Texas, Denton, TX
| | - Liton Francisco
- Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Stephen J Forman
- Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA
| | | | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, Birmingham, AL
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25
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Wlodarek L, Cao F, Alibhai FJ, Fekete A, Noyan N, Tobin SW, Marvasti TB, Wu J, Li SH, Weisel RD, Wang LY, Jia Z, Li RK. Rectification of radiotherapy-induced cognitive impairments in aged mice by reconstituted Sca-1 + stem cells from young donors. J Neuroinflammation 2020; 17:51. [PMID: 32028989 PMCID: PMC7006105 DOI: 10.1186/s12974-019-1681-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 12/17/2019] [Indexed: 01/03/2023] Open
Abstract
Background Radiotherapy is widely used and effective for treating brain tumours, but inevitably impairs cognition as it arrests cellular processes important for learning and memory. This is particularly evident in the aged brain with limited regenerative capacity, where radiation produces irreparable neuronal damage and activation of neighbouring microglia. The latter is responsible for increased neuronal death and contributes to cognitive decline after treatment. To date, there are few effective means to prevent cognitive deficits after radiotherapy. Methods Here we implanted hematopoietic stem cells (HSCs) from young or old (2- or 18-month-old, respectively) donor mice expressing green fluorescent protein (GFP) into old recipients and assessed cognitive abilities 3 months post-reconstitution. Results Regardless of donor age, GFP+ cells homed to the brain of old recipients and expressed the macrophage/microglial marker, Iba1. However, only young cells attenuated deficits in novel object recognition and spatial memory and learning in old mice post-irradiation. Mechanistically, old recipients that received young HSCs, but not old, displayed significantly greater dendritic spine density and long-term potentiation (LTP) in CA1 neurons of the hippocampus. Lastly, we found that GFP+/Iba1+ cells from young and old donors were differentially polarized to an anti- and pro-inflammatory phenotype and produced neuroprotective factors and reactive nitrogen species in vivo, respectively. Conclusion Our results suggest aged peripherally derived microglia-like cells may exacerbate cognitive impairments after radiotherapy, whereas young microglia-like cells are polarized to a reparative phenotype in the irradiated brain, particularly in neural circuits associated with rewards, learning, and memory. These findings present a proof-of-principle for effectively reinstating central cognitive function of irradiated brains with peripheral stem cells from young donor bone marrow. Electronic supplementary material The online version of this article (10.1186/s12974-019-1681-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lukasz Wlodarek
- Toronto General Hospital Research Institute, University Health Network, Toronto Medical Discovery Tower, Room 3-702, 101 College Street, Toronto, Ontario, M5G 1L7, Canada.,Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Feng Cao
- Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Program in Neurosciences & Mental Health, SickKids Research Institute, Floor 5, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada
| | - Faisal J Alibhai
- Toronto General Hospital Research Institute, University Health Network, Toronto Medical Discovery Tower, Room 3-702, 101 College Street, Toronto, Ontario, M5G 1L7, Canada
| | - Adam Fekete
- Program in Neurosciences & Mental Health, SickKids Research Institute, Floor 5, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada
| | - Nima Noyan
- Toronto General Hospital Research Institute, University Health Network, Toronto Medical Discovery Tower, Room 3-702, 101 College Street, Toronto, Ontario, M5G 1L7, Canada
| | - Stephanie W Tobin
- Toronto General Hospital Research Institute, University Health Network, Toronto Medical Discovery Tower, Room 3-702, 101 College Street, Toronto, Ontario, M5G 1L7, Canada
| | - Tina B Marvasti
- Toronto General Hospital Research Institute, University Health Network, Toronto Medical Discovery Tower, Room 3-702, 101 College Street, Toronto, Ontario, M5G 1L7, Canada.,Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Jun Wu
- Toronto General Hospital Research Institute, University Health Network, Toronto Medical Discovery Tower, Room 3-702, 101 College Street, Toronto, Ontario, M5G 1L7, Canada
| | - Shu-Hong Li
- Toronto General Hospital Research Institute, University Health Network, Toronto Medical Discovery Tower, Room 3-702, 101 College Street, Toronto, Ontario, M5G 1L7, Canada
| | - Richard D Weisel
- Toronto General Hospital Research Institute, University Health Network, Toronto Medical Discovery Tower, Room 3-702, 101 College Street, Toronto, Ontario, M5G 1L7, Canada.,Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Department of Surgery, Division of Cardiac Surgery, University of Toronto, Toronto, ON, Canada
| | - Lu-Yang Wang
- Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada. .,Program in Neurosciences & Mental Health, SickKids Research Institute, Floor 5, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada.
| | - Zhengping Jia
- Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada. .,Program in Neurosciences & Mental Health, SickKids Research Institute, Floor 5, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada.
| | - Ren-Ke Li
- Toronto General Hospital Research Institute, University Health Network, Toronto Medical Discovery Tower, Room 3-702, 101 College Street, Toronto, Ontario, M5G 1L7, Canada. .,Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada. .,Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, ON, Canada. .,Department of Surgery, Division of Cardiac Surgery, University of Toronto, Toronto, ON, Canada.
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26
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Elwadhi D, Khandelwal SK, Kumar L, Sharma A. Short-Term Impact of Hematopoietic Stem Cell Transplantation on Psychiatric Morbidity and Quality of Life in Hematological Malignancies in Adults. Indian J Psychol Med 2020; 42:61-68. [PMID: 31997867 PMCID: PMC6970306 DOI: 10.4103/ijpsym.ijpsym_70_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/13/2019] [Accepted: 10/24/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Hematopoietic stem cell transplantation (HSCT) is an established treatment for a number of malignancies. Quality of life (QOL) is an important marker for assessing arduous treatment modalities. Diagnosis of cancer, HSCT, and the physical and psychosocial sequelae of the intensive treatment lead to a deficit in the QOL of the recipient. This study aimed to assess the impact of HSCT on psychiatric morbidity and QOL in patients with hematological malignancies. METHODS A longitudinal pre-post study was conducted at a cancer research center. Thirty patients with hematological malignancies were assessed at three different time points for psychiatric symptoms and QOL. Sociodemographic and clinical variables were collected using a semi-structured questionnaire. Comprehensive psychopathological rating scale was used to assess the psychiatric symptoms. WHO QOL Bref and cancer-specific European Organisation for Research and Treatment of Cancer Quality of life Questionnaire (EORTC-QLQ) were used to measure the quality of life. RESULTS The mean (SD) age of the sample was 42.3 (12.8) years, with 24 males and 6 females. Most patients reported anxiety and depressive symptoms, reaching a peak at 3 week post-HSCT. The maximum deficit in QOL scores was seen at 3 weeks, with further improvement at 3-month post-transplant. CONCLUSIONS HSCT leads to an increase in symptoms and a decrease in QOL during the acute phase. In the long run, it leads to improvement in physical and psychological wellbeing, with improvement in QOL. The recent surge in the long-term survivors of the procedure calls for further research in this direction so as to aid in their full recovery.
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Affiliation(s)
- Deeksha Elwadhi
- Department of Health Research, Holy Family Hospital, New Delhi, India
| | - S K Khandelwal
- Department of Psychiatry, Holy Family Hospital, New Delhi, India
| | - Lalit Kumar
- Department of Medical Oncology, AIIMS, New Delhi, India
| | - Atul Sharma
- Department of Medical Oncology, AIIMS, New Delhi, India
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Koll TT, Sheese AN, Semin J, Ernst W, High R, Wildes TM, Fisher A, Murman DL. Screening for cognitive impairment in older adults with hematological malignancies using the Montreal Cognitive Assessment and neuropsychological testing. J Geriatr Oncol 2019; 11:297-303. [PMID: 31831362 DOI: 10.1016/j.jgo.2019.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 11/21/2019] [Accepted: 11/25/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The primary objective of the current study is to describe the prevalence and profile of cognitive domains affected in older adults with hematological malignancies evaluated for hematopoietic cell transplantation (HCT) using the Montreal Cognitive Assessment (MoCA) and neuropsychological tests. The secondary objective is to determine if a specific MoCA cut-off score would correlate with the identification of cognitive impairment detected by neuropsychological tests. This would facilitate interpretation of cognitive screening and referral of patients who would likely need further neuropsychological testing. MATERIALS AND METHODS Fifty-one patients 60 years and older who were evaluated for HCT were assessed using a battery of standardized neuropsychological tests and MoCA. We analyzed Receiver Operating Characteristics (ROC) comparing MoCA scores and four different neuropsychological test criteria for cognitive impairment. RESULTS The prevalence of cognitive impairment detected by neuropsychological tests was 53 to 70.6% using the criteria for patients with cancer by the International Cancer Cognition Task Force (ICCTF). The following cognitive domains were most affected: language, learning and memory, visuospatial skills, and executive function. MoCA is an appropriate screening test for cognitive impairment. Using the ICCTF criteria, 86 to 100% of patients are correctly classified as having significant cognitive impairment on neuropsychological tests using a cut-off score of 20 or less. CONCLUSION There is a high prevalence of cognitive impairment identified by neuropsychological tests in older patients with hematological malignancies evaluated for HCT. Identification of an appropriate MoCA cut-off score in this population is important to identify patients who would benefit from further assessment.
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Affiliation(s)
- Thuy T Koll
- Division of Geriatrics, Gerontology, and Palliative Medicine, Department of Internal Medicine, University of Nebraska Medical Center, 986155 Nebraska Medical Center, Omaha, NE 68198-6155, USA.
| | - Amelia Nelson Sheese
- Division of Neuropsychology, Department of Neurological Sciences, 988425 Nebraska Medical Center, University of Nebraska Medical Center, Omaha, NE 68198-8425, USA
| | - Jessica Semin
- Division of Geriatrics, Gerontology, and Palliative Medicine, Department of Internal Medicine, University of Nebraska Medical Center, 986155 Nebraska Medical Center, Omaha, NE 68198-6155, USA
| | - Weston Ernst
- Division of Geriatrics, Gerontology, and Palliative Medicine, Department of Internal Medicine, University of Nebraska Medical Center, 986155 Nebraska Medical Center, Omaha, NE 68198-6155, USA
| | - Robin High
- Department of Biostatistics, University of Nebraska Medical Center, 984375 Nebraska Medical Center, Omaha, NE 68198-4375, USA
| | - Tanya M Wildes
- Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, 660 South Euclid Ave., Campus Box 8056, St. Louis, MO 63110, USA
| | - Alfred Fisher
- Division of Geriatrics, Gerontology, and Palliative Medicine, Department of Internal Medicine, University of Nebraska Medical Center, 986155 Nebraska Medical Center, Omaha, NE 68198-6155, USA
| | - Daniel L Murman
- Department of Neurological Sciences, University of Nebraska Medical Center, 988440 Nebraska Medical Center, Omaha, NE 68198-8440, USA
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28
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Jayani R, Rosko A, Olin R, Artz A. Use of geriatric assessment in hematopoietic cell transplant. J Geriatr Oncol 2019; 11:225-236. [PMID: 31761694 DOI: 10.1016/j.jgo.2019.09.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 09/26/2019] [Accepted: 09/30/2019] [Indexed: 12/21/2022]
Abstract
Hematopoietic cell transplant (HCT) is an important aspect of treatment for many hematologic malignancies. As cancer is a disease associated with aging, and hematologic malignancies are no exception, rates of autologous and allogeneic HCT utilization in older adults are on the rise. The most common indications for autologous HCT are multiple myeloma and lymphoma, and for allogenic HCT are acute myeloid leukemia and myelodysplastic syndrome. Older adults into their eighth decade of life can have favorable outcomes after autologous and allogeneic HCT, at least among select patients. Evaluation of older adults prior to HCT can be aided by utilizing a geriatric assessment (GA). GA can identify areas of vulnerability in older adults prior to HCT not captured by more traditional measures. In the future, GA may be utilized to guide interventions prior to HCT to improve outcomes of older adults. Further studies are needed to expand the paucity of data in utilizing GA to identify three groups of patients: those who clearly benefit from HCT, those who would clearly be harmed, and those who might benefit but would require additional support during and after HCT.
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Affiliation(s)
- Reena Jayani
- Moffitt Cancer Center, Blood and Marrow Transplant and Cellular Immunotherapy Program, 12902 USF Magnolia Dr, Tampa, FL 33612, United States of America; Vanderbilt University Medical Center, Division of Hematology and Oncology, 2220 Pierce Ave, 777 Preston Research Building, Nashville, TN 37232-6307, United States of America.
| | - Ashley Rosko
- The Ohio State University, Department of Internal Medicine, Division of Hematology, 460 W 10th Ave, Columbus, OH 43210, United States of America.
| | - Rebecca Olin
- University of California San Francisco, Department of Medicine, Division of Hematology/Oncology, 400 Parnassus Ave., Fourth Floor, San Francisco, CA 94143, United States of America.
| | - Andrew Artz
- City of Hope, Department of Hematology and Hematopoietic Cell Transplantation, 1500 E. Duarte Road, Duarte, CA 91010, United States of America.
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29
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Mayo SJ, Messner HA, Rourke SB, Howell D, Victor JC, Lipton JH, Kuruvilla J, Gutpa V, Kim DDH, Michelis FV, Metcalfe K. Predictors of the trajectory of cognitive functioning in the first 6 months after allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 2019; 55:918-928. [PMID: 31745248 DOI: 10.1038/s41409-019-0746-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 10/31/2019] [Accepted: 11/04/2019] [Indexed: 11/09/2022]
Abstract
Certain subgroups of patients may be particularly vulnerable to cognitive decline after treatment with allogeneic hematopoietic stem cell transplant (HCT). The objective of this study was to identify predictors of cognitive functioning changes within the first 6 months after HCT. Fifty-eight adults treated with allogeneic HCT (53% male, mean 48 years of age) completed neuropsychological tests of learning/memory, psychomotor efficiency/processing speed, and executive functioning/working memory at three time points: pre-HCT and day 100 and 6 months post transplant. On average, there was significant improvement in learning/memory (p = 0.002), psychomotor efficiency/processing speed (p < 0.0001), and executive functioning/working memory (p < 0.0001), at 6 months. Multilevel modeling identified predictors of divergence from this trajectory; Karnofsky performance status <80 was associated with worsening learning/memory over time; peak severity of acute graft-versus-host disease >=Grade 2 was associated with worsening psychomotor efficiency/processing speed; and greater years of education predicted a faster improvement in psychomotor efficiency/processing speed. Other factors were associated with cognitive functioning over time: higher intelligence quotient (IQ) was associated with better cognitive functioning, and older age, being male, and greater pretransplant comorbidities were associated with worse cognitive functioning. Overall, cognitive performance appears to improve over the first 6 months after transplant. However, pretransplant and posttransplant factors may influence this trajectory.
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Affiliation(s)
- Samantha J Mayo
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada. .,Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
| | - Hans A Messner
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Sean B Rourke
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Doris Howell
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.,Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - J Charles Victor
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Jeffrey H Lipton
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - J Kuruvilla
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Vikas Gutpa
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Dennis Dong Hwan Kim
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Fotios V Michelis
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kelly Metcalfe
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.,Women's College Research Institute, Toronto, ON, Canada
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30
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Stratton J, Sylvia A, Hoodin F, Choi SW, Pawarode A, Giordani B, Votruba K. The utility of cognitive changes in identifying those with acute graft vs. host disease following allogeneic hematopoietic cell transplant. Clin Neuropsychol 2019; 34:969-980. [PMID: 31619131 DOI: 10.1080/13854046.2019.1672791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: Acute graft versus host disease (aGVHD) is a common complication of allogeneic hematopoietic cell transplant (HCT) and is associated with morbidity and mortality. Identifying those at risk for developing aGVHD is crucial for early intervention. The current study assessed whether scores on a brief cognitive screening measure could identify those that develop aGVHD by 100 days post-HCT.Methods: Participants were 37 patients undergoing allogeneic HCT, assessed prior to transplant, and at 30- and 100-days post-HCT. Of those completing all evaluations, patients were divided into those who did (n = 14) and did not (n = 16) develop aGVHD by day 100 post-HCT. At 100 days post-transplant, groups did not differ on relevant demographic factors, disease, conditioning regimen, relatedness of donor, stem cell source, steroid use, total body irradiation use, human leukocyte antigens (HLA) match, or frequency of infection.Results: At 100 days post-HCT, those with aGVHD performed significantly worse on a working memory measure than those without aGvHD. The presence of aGVHD at day 100 increased significantly with every one standard deviation decrease in working memory from baseline to 30 days post-HCT (odds ratio = 3.08; 95% CI: 1.00-9.36). These findings were observed despite a small sample size and statistically controlling for multiple analyses.Conclusions: While this study is exploratory in nature, and has a small sample size, findings suggest that early detection of working memory declines could coincide with, or signal the development of, aGVHD. Potential etiologies are discussed. Implementing early cognitive screening within the first 30 days post-HCT may be useful in identifying patients at risk for aGVHD.
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Affiliation(s)
- John Stratton
- Department of Psychiatry, Michigan Medicine, Ann Arbor, MI, USA
| | - Allison Sylvia
- Department of Psychiatry, Michigan Medicine, Ann Arbor, MI, USA
| | - Flora Hoodin
- Department of Psychiatry, Michigan Medicine, Ann Arbor, MI, USA.,Department of Psychology, Eastern Michigan University, Ann Arbor, MI, USA
| | - Sung Won Choi
- Department of Pediatrics, Michigan Medicine, Ann Arbor, MI, USA
| | - Attaphol Pawarode
- Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - Bruno Giordani
- Department of Psychiatry, Michigan Medicine, Ann Arbor, MI, USA
| | - Kristen Votruba
- Department of Psychiatry, Michigan Medicine, Ann Arbor, MI, USA
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31
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Mohammed J, Smith SR, Burns L, Basak G, Aljurf M, Savani BN, Schoemans H, Peric Z, Chaudhri NA, Chigbo N, Alfred A, Bakhsh H, Salooja N, Chris Chim A, Hashmi SK. Role of Physical Therapy before and after Hematopoietic Stem Cell Transplantation: White Paper Report. Biol Blood Marrow Transplant 2019; 25:e191-e198. [DOI: 10.1016/j.bbmt.2019.01.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 01/09/2019] [Indexed: 11/26/2022]
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32
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Costa DSJ, Fardell JE. Why Are Objective and Perceived Cognitive Function Weakly Correlated in Patients With Cancer? J Clin Oncol 2019; 37:1154-1158. [PMID: 30920881 DOI: 10.1200/jco.18.02363] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Daniel S J Costa
- 1 Royal North Shore Hospital, St Leonards, NSW, Australia.,2 University of Sydney, Sydney, NSW, Australia
| | - Joanna E Fardell
- 3 University of New South Wales, Sydney, NSW, Australia.,4 Sydney Children's Hospital, Sydney, NSW, Australia
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33
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Psychological Considerations in Hematopoietic Stem Cell Transplantation. PSYCHOSOMATICS 2019; 60:331-342. [PMID: 31072626 DOI: 10.1016/j.psym.2019.02.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 02/07/2019] [Accepted: 02/08/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND In recent decades, advances in transplantation medicine, and improved posttransplant care have reduced morbidity and mortality from hematopoietic stem cell transplantations (HSCTs). However, patients undergoing HSCT report a high prevalence of psychological distress, which can negatively impact recovery, function, and health outcomes, including mortality and higher risk of graft vs. host disease. Appropriate assessment and management of these psychological symptoms lead to better engagement with treatment and a variety of superior health outcomes. OBJECTIVE We provide a narrative review of the psychological challenges that accompany HSCT and suggest management approaches to equip psychiatric consultants involved in the care of this patient population. METHODS We reviewed published work in PubMed, PsycInfo, and Scopus electronic databases on the common psychological challenges in HSCT, their vulnerability factors, as well as practical interventions for managing these challenges. RESULTS We outline the phases of the HSCT hospitalization and discuss common psychological challenges, such as depression, delirium, and post-traumatic stress reactions that accompany HSCT. We suggest an approach to psychiatric consults during the HSCT hospitalization and discuss practical interventions for managing psychological challenges in this population. CONCLUSIONS Though pharmacological and behavioral interventions have been successfully used to treat psychosocial challenges in HSCT, further research is needed to understand the optimal psychiatric assessment tools, treatment strategies, and the long-term psychiatric care needed to address psychiatric comorbidities in this growing patient population.
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Zangrandi A, Gasparini F, Imovilli A, Napoli M, Marti A, Angelini D, Barletta-Rodolfi C, Ghidoni E. Atypical non-progressive semantic impairment following allogeneic bone marrow transplantation in a patient with Waldenström’s macroglobulinemia: A case report. Clin Neuropsychol 2018; 33:798-810. [DOI: 10.1080/13854046.2018.1499966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Andrea Zangrandi
- Clinical Neuropsychology, Cognitive Disorders and Dyslexia Unit, Department of Neurology, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Federico Gasparini
- Clinical Neuropsychology, Cognitive Disorders and Dyslexia Unit, Department of Neurology, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Annalisa Imovilli
- Department of Haematology, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Manuela Napoli
- Neuroradiology Unit, Department of Diagnostic Imaging, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Alessandro Marti
- Clinical Neuropsychology, Cognitive Disorders and Dyslexia Unit, Department of Neurology, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Damiano Angelini
- Clinical Neuropsychology, Cognitive Disorders and Dyslexia Unit, Department of Neurology, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Caterina Barletta-Rodolfi
- Clinical Neuropsychology, Cognitive Disorders and Dyslexia Unit, Department of Neurology, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Enrico Ghidoni
- Clinical Neuropsychology, Cognitive Disorders and Dyslexia Unit, Department of Neurology, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
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35
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Bhatt NS, Brazauskas R, Tecca HR, Carreras J, Burns LJ, Phelan R, Salit RB, Syrjala KL, Talano JAM, Shaw BE. Post-transplantation employment status of adult survivors of childhood allogeneic hematopoietic cell transplant: A report from the Center for International Blood and Marrow Transplant Research (CIBMTR). Cancer 2018; 125:144-152. [PMID: 30368771 DOI: 10.1002/cncr.31781] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 08/28/2018] [Accepted: 09/04/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND Data are scarce regarding employment outcomes of survivors of childhood allogeneic hematopoietic cell transplantation (alloHCT) and the factors that affect their employment status. METHODS By using the Center for International Blood and Marrow Transplant Research database, the authors studied employment outcomes of ≥1-year survivors of childhood alloHCT who were age ≥18 years at their most recent assessment (year of transplantation, 1985-2010). Employment status was assessed at their attained ages (ages 18-22, 23-27, and 28-32 years) and according to transplantation center (TC) location (United States or International). A multivariable analysis assessing the factors that affected employed status (full-time/part-time work or student) was performed. RESULTS Unemployment rates among 2844 survivors were persistently high at all attained ages (United States TCs: ages 18-22 [14%], 23-27 [15%], and 28-32 [13%] years; International TCs: ages 18-22 [56%], 23-27 [53%], and 28-32 [68%] years). The factors associated a with higher likelihood of employment included: older age at alloHCT (ages 5-9-years: hazard ratio [HR], 2.07; 95% confidence interval [CI], 1.65-2.6; ages 10-14 years: HR, 4.43; 95% CI, 3.58-5.47; ages 15-18-years: HR, 7.13; 95% CI, 5.72-8.88), myeloablative conditioning without total body irradiation (TBI) (HR, 1.56; 95% CI, 1.38-1.77), reduced-intensity conditioning with TBI (HR, 1.47; 95% CI, 1.19-1.8) or without TBI (HR, 2.51; 95% CI, 2.15-2.92), and US-based TC (HR, 1.84; 95% CI, 1.62-2.08). CONCLUSIONS Young adult survivors of childhood alloHCT have high unemployment rates at all studied attained ages after HCT. Future efforts should be directed toward understanding the causes of unemployment their and relation to quality of life using patient-reported outcome measures.
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Affiliation(s)
- Neel S Bhatt
- Department of Pediatric Hematology/Oncology/Bone Marrow Transplantation, Medical College of Wisconsin, Milwaukee, Wisconsin.,Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ruta Brazauskas
- Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.,Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Heather R Tecca
- Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jeanette Carreras
- Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Linda J Burns
- National Marrow Donor Program/Be The Match and CIBMTR, Minneapolis, Minnesota
| | - Rachel Phelan
- Department of Pediatric Hematology/Oncology/Bone Marrow Transplantation, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Rachel B Salit
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Department of Medicine, University of Washington, Seattle, Washington
| | - Karen L Syrjala
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
| | - Julie-An M Talano
- Department of Pediatric Hematology/Oncology/Bone Marrow Transplantation, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Bronwen E Shaw
- Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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Burns LJ, Abbetti B, Arnold SD, Bender J, Doughtie S, El-Jawahiri A, Gee G, Hahn T, Horowitz MM, Johnson S, Juckett M, Krishnamurit L, Kullberg S, LeMaistre CF, Loren A, Majhail NS, Murphy EA, Rizzo D, Roche-Green A, Saber W, Schatz BA, Schmit-Pokorny K, Shaw BE, Syrjala KL, Tierney DK, Ullrich C, Vanness DJ, Wood WA, Denzen EM. Engaging Patients in Setting a Patient-Centered Outcomes Research Agenda in Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2018; 24:1111-1118. [DOI: 10.1016/j.bbmt.2018.01.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 01/28/2018] [Indexed: 10/18/2022]
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Sharafeldin N, Bosworth A, Patel SK, Chen Y, Morse E, Mather M, Sun C, Francisco L, Forman SJ, Wong FL, Bhatia S. Cognitive Functioning After Hematopoietic Cell Transplantation for Hematologic Malignancy: Results From a Prospective Longitudinal Study. J Clin Oncol 2018; 36:463-475. [DOI: 10.1200/jco.2017.74.2270] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Cognitive impairment is well-recognized after myeloablative allogeneic hematopoietic cell transplantation (HCT). However, cognitive functioning after reduced-intensity allogeneic or autologous HCT remains unclear. Methods A total of 477 HCT recipients (236 autologous, 128 reduced-intensity allogeneic, 113 myeloablative allogeneic) underwent standardized neuropsychologic testing before HCT and at 6 months and 1, 2, and 3 years after HCT. Ninety-nine frequency-matched healthy controls underwent testing at commensurate time points. Primary outcomes of the study were practice effect–adjusted domain-specific T scores and global deficit scores. Piecewise generalized estimating equation models were used to compare groups and to identify associated variables and post-HCT trends of cognitive impairment. Results Median age was 52 years (range, 18 to 74 years) for HCT recipients and 55 years (range, 19 to 73 years) for controls. Post-HCT scores were comparable between controls and autologous and reduced-intensity HCT recipients. Myeloablative HCT recipients had significantly lower ( P < .001) post-HCT scores than controls for executive function, verbal speed, processing speed, auditory memory, and fine motor dexterity. Pre-HCT to 6 months post-HCT scores did not change after reduced-intensity HCT but declined significantly for fine motor dexterity ( P < .001) after myeloablative HCT. However, pre-HCT to 3 years post-HCT scores declined significantly ( P < .003) in reduced-intensity HCT recipients for executive function, verbal fluency, and working memory. Older age, male sex, and lower education, income, and cognitive reserve were associated with post-HCT cognitive impairment. At 3 years post-HCT, global cognitive impairment was present in 18.7% of autologous and 35.7% of allogeneic HCT recipients. Conclusion Myeloablative allogeneic HCT recipients showed significant cognitive decline compared with healthy controls. Reduced-intensity allogeneic HCT recipients showed evidence of delayed decline. Cognitive functioning in autologous HCT recipients generally was spared. The study identified vulnerable subpopulations that could benefit from targeted interventions.
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Affiliation(s)
- Noha Sharafeldin
- Noha Sharafeldin, Liton Francisco, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL; and Alysia Bosworth, Sunita K. Patel, Yanjun Chen, Emily Morse, Molly Mather, Canlan Sun, Stephen J. Forman, and F. Lennie Wong, City of Hope, Duarte, CA
| | - Alysia Bosworth
- Noha Sharafeldin, Liton Francisco, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL; and Alysia Bosworth, Sunita K. Patel, Yanjun Chen, Emily Morse, Molly Mather, Canlan Sun, Stephen J. Forman, and F. Lennie Wong, City of Hope, Duarte, CA
| | - Sunita K. Patel
- Noha Sharafeldin, Liton Francisco, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL; and Alysia Bosworth, Sunita K. Patel, Yanjun Chen, Emily Morse, Molly Mather, Canlan Sun, Stephen J. Forman, and F. Lennie Wong, City of Hope, Duarte, CA
| | - Yanjun Chen
- Noha Sharafeldin, Liton Francisco, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL; and Alysia Bosworth, Sunita K. Patel, Yanjun Chen, Emily Morse, Molly Mather, Canlan Sun, Stephen J. Forman, and F. Lennie Wong, City of Hope, Duarte, CA
| | - Emily Morse
- Noha Sharafeldin, Liton Francisco, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL; and Alysia Bosworth, Sunita K. Patel, Yanjun Chen, Emily Morse, Molly Mather, Canlan Sun, Stephen J. Forman, and F. Lennie Wong, City of Hope, Duarte, CA
| | - Molly Mather
- Noha Sharafeldin, Liton Francisco, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL; and Alysia Bosworth, Sunita K. Patel, Yanjun Chen, Emily Morse, Molly Mather, Canlan Sun, Stephen J. Forman, and F. Lennie Wong, City of Hope, Duarte, CA
| | - Canlan Sun
- Noha Sharafeldin, Liton Francisco, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL; and Alysia Bosworth, Sunita K. Patel, Yanjun Chen, Emily Morse, Molly Mather, Canlan Sun, Stephen J. Forman, and F. Lennie Wong, City of Hope, Duarte, CA
| | - Liton Francisco
- Noha Sharafeldin, Liton Francisco, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL; and Alysia Bosworth, Sunita K. Patel, Yanjun Chen, Emily Morse, Molly Mather, Canlan Sun, Stephen J. Forman, and F. Lennie Wong, City of Hope, Duarte, CA
| | - Stephen J. Forman
- Noha Sharafeldin, Liton Francisco, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL; and Alysia Bosworth, Sunita K. Patel, Yanjun Chen, Emily Morse, Molly Mather, Canlan Sun, Stephen J. Forman, and F. Lennie Wong, City of Hope, Duarte, CA
| | - F. Lennie Wong
- Noha Sharafeldin, Liton Francisco, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL; and Alysia Bosworth, Sunita K. Patel, Yanjun Chen, Emily Morse, Molly Mather, Canlan Sun, Stephen J. Forman, and F. Lennie Wong, City of Hope, Duarte, CA
| | - Smita Bhatia
- Noha Sharafeldin, Liton Francisco, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL; and Alysia Bosworth, Sunita K. Patel, Yanjun Chen, Emily Morse, Molly Mather, Canlan Sun, Stephen J. Forman, and F. Lennie Wong, City of Hope, Duarte, CA
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Mayo SJ, Kuruvilla J, Laister RC, Ayala AP, Alm M, Byker W, Kelly DL, Saligan L. Blood-based biomarkers of cancer-related cognitive impairment in non-central nervous system cancer: protocol for a scoping review. BMJ Open 2018; 8:e017578. [PMID: 29374660 PMCID: PMC5829658 DOI: 10.1136/bmjopen-2017-017578] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Cancer-related cognitive impairment (CRCI) can have detrimental effects on quality of life, even among patients with non-central nervous system (CNS) cancers. Several studies have been conducted to explore different markers associated with CRCI to understand its pathobiology. It is proposed that the underlying mechanisms of CRCI are related to a cascade of physiological adaptive events in response to cancer and/or treatment. Hence, peripheral blood would be a logical source to observe and identify these physiological events. This paper outlines the protocol for a scoping review being conducted to summarise the extant literature regarding blood-based biomarkers of CRCI among patients with non-CNS cancer. METHODS/ANALYSIS Methods will be informed by the updated guidelines of Arksey and O'Malley. The systematic search for literature will include electronic databases, handsearching of key journals and reference lists, forward citation tracking and consultation with content experts. Study selection will be confirmed by duplicate review and calculation of inter-rater reliability. Data to be charted will include study design, sample size, cancer and treatment characteristics, demographic characteristics, cognitive variable/s and biomarkers assessed, associations between cognitive functioning and biomarkers (including statistics used), and rigour in biomarker sample collection and processing. Results will be presented through: (1) a descriptive numerical summary of studies, including a flow diagram based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement, (2) a list of blood-based biomarkers associated with CRCI and (3) a narrative overview developed through collaboration among the research team and consultation with content experts. DISSEMINATION The findings of this review will highlight current directions and gaps in the current body of evidence that may lead to improved rigour in future CRCI investigations. The dissemination of this work will be facilitated through the involvement of clinicians and researchers on the research team, an external consultation process and the presentation of the results through scholarly publication and presentation.
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Affiliation(s)
- Samantha J Mayo
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - John Kuruvilla
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Rob C Laister
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Ana Patricia Ayala
- Gerstein Science Information Centre, University of Toronto, Toronto, Ontario, Canada
| | - Mark Alm
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Will Byker
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Debra Lynch Kelly
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida, USA
| | - Leorey Saligan
- Symptoms Biology Unit, Division of Intramural Research, National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland, USA
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Buchbinder D, Kelly DL, Duarte RF, Auletta JJ, Bhatt N, Byrne M, DeFilipp Z, Gabriel M, Mahindra A, Norkin M, Schoemans H, Shah AJ, Ahmed I, Atsuta Y, Basak GW, Beattie S, Bhella S, Bredeson C, Bunin N, Dalal J, Daly A, Gajewski J, Gale RP, Galvin J, Hamadani M, Hayashi RJ, Adekola K, Law J, Lee CJ, Liesveld J, Malone AK, Nagler A, Naik S, Nishihori T, Parsons SK, Scherwath A, Schofield HL, Soiffer R, Szer J, Twist I, Warwick AB, Wirk BM, Yi J, Battiwalla M, Flowers MDE, Savani B, Shaw BE. Neurocognitive dysfunction in hematopoietic cell transplant recipients: expert review from the late effects and Quality of Life Working Committee of the CIBMTR and complications and Quality of Life Working Party of the EBMT. Bone Marrow Transplant 2018; 53:535-555. [PMID: 29343837 DOI: 10.1038/s41409-017-0055-7] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/19/2017] [Accepted: 11/19/2017] [Indexed: 12/13/2022]
Abstract
Hematopoietic cell transplantation (HCT) is a potentially curative treatment for children and adults with malignant and non-malignant diseases. Despite increasing survival rates, long-term morbidity following HCT is substantial. Neurocognitive dysfunction is a serious cause of morbidity, yet little is known about neurocognitive dysfunction following HCT. To address this gap, collaborative efforts of the Center for International Blood and Marrow Transplant Research and the European Society for Blood and Marrow Transplantation undertook an expert review of neurocognitive dysfunction following HCT. In this review, we define what constitutes neurocognitive dysfunction, characterize its risk factors and sequelae, describe tools and methods to assess neurocognitive function in HCT recipients, and discuss possible interventions for HCT patients with this condition. This review aims to help clinicians understand the scope of this health-related problem, highlight its impact on well-being of survivors, and to help determine factors that may improve identification of patients at risk for declines in cognitive functioning after HCT. In particular, we review strategies for preventing and treating neurocognitive dysfunction in HCT patients. Lastly, we highlight the need for well-designed studies to develop and test interventions aimed at preventing and improving neurocognitive dysfunction and its sequelae following HCT.
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Affiliation(s)
- David Buchbinder
- Division of Pediatrics Hematology, Children's Hospital of Orange County, Orange, CA, USA.
| | | | | | - Jeffery J Auletta
- Blood and Marrow Transplant Program and Host Defense Program, Divisions of Hematology/Oncology/Bone Marrow Transplant and Infectious Diseases, Nationwide Children's Hospital, Columbus, OH, USA
| | - Neel Bhatt
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Michael Byrne
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Zachariah DeFilipp
- Blood and Marrow Transplant Program, Massachusetts General Hospital, Boston, MA, USA
| | - Melissa Gabriel
- The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Anuj Mahindra
- Scripps Blood & Marrow Transplant Program, La Jolla, CA, USA
| | - Maxim Norkin
- Division of Pediatrics Hematology, Children's Hospital of Orange County, Orange, CA, USA
| | | | - Ami J Shah
- Division of Stem Cell Transplantation and Regenerative Medicine, Lucille Packard Children's Hospital, Stanford School of Medicine, Palo Alto, CA, USA
| | - Ibrahim Ahmed
- Rainbow Babies and Children's Hospital, Cleveland, OH, USA.,Division of Pediatric Hem/Onc/BMT, Children's Mercy Kansas City, Kansas City, Missouri; UMKC School of Medicine, Kansas City, MO, USA
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan.,Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | - Sara Beattie
- Department of Psychosocial Oncology and Rehabilitation, Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Sita Bhella
- Department of Medicine, School of Medicine, Queen's University, Kingston, ON, K7L 3N6, Canada
| | - Christopher Bredeson
- The Ottawa Hospital Blood and Marrow Transplant Program and the Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Nancy Bunin
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jignesh Dalal
- Division of Pediatric Hem/Onc/BMT, Children's Mercy Kansas City, Kansas City, Missouri; UMKC School of Medicine, Kansas City, MO, USA.,Case Western Reserve School of Medicine, Cleveland, OH, USA
| | - Andrew Daly
- Tom Baker Cancer Centre, Calgary, AB, Canada
| | | | - Robert Peter Gale
- Hematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, UK
| | - John Galvin
- Division of Hematology/Oncology, Department of Medicine and Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Mehdi Hamadani
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Robert J Hayashi
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Kehinde Adekola
- Division of Hematology/Oncology, Department of Medicine and Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jason Law
- Tufts University Medical Center, Boston, MA, USA
| | - Catherine J Lee
- Utah Blood and Marrow Transplant Program Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Jane Liesveld
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Adriana K Malone
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Arnon Nagler
- Hematology Division and BMT, Chaim Sheba Medical Center, Tel Hashomer, Israel.,Tel Aviv University, Tel Aviv, Israel
| | - Seema Naik
- Texas Transplant Institute, San Antonino, TX, USA
| | - Taiga Nishihori
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | - Angela Scherwath
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Jeff Szer
- Department Clinical Haematology and Bone Marrow Transplantation, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Ida Twist
- The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Anne B Warwick
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, USA
| | - Baldeep M Wirk
- Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Jean Yi
- Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Minoo Battiwalla
- Hematology Branch, National Heart, Lung and Blood Institute, Bethesda, MD, USA
| | - Mary D E Flowers
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Bipin Savani
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bronwen E Shaw
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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40
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Late Complications of Hematologic Diseases and Their Therapies. Hematology 2018. [DOI: 10.1016/b978-0-323-35762-3.00093-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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41
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Kelly DL, Buchbinder D, Duarte RF, Auletta JJ, Bhatt N, Byrne M, DeFilipp Z, Gabriel M, Mahindra A, Norkin M, Schoemans H, Shah AJ, Ahmed I, Atsuta Y, Basak GW, Beattie S, Bhella S, Bredeson C, Bunin N, Dalal J, Daly A, Gajewski J, Gale RP, Galvin J, Hamadani M, Hayashi RJ, Adekola K, Law J, Lee CJ, Liesveld J, Malone AK, Nagler A, Naik S, Nishihori T, Parsons SK, Scherwath A, Schofield HL, Soiffer R, Szer J, Twist I, Warwick A, Wirk BM, Yi J, Battiwalla M, Flowers ME, Savani B, Shaw BE. Neurocognitive Dysfunction in Hematopoietic Cell Transplant Recipients: Expert Review from the Late Effects and Quality of Life Working Committee of the Center for International Blood and Marrow Transplant Research and Complications and Quality of Life Working Party of the European Society for Blood and Marrow Transplantation. Biol Blood Marrow Transplant 2017; 24:228-241. [PMID: 28939455 DOI: 10.1016/j.bbmt.2017.09.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 09/04/2017] [Indexed: 12/25/2022]
Abstract
Hematopoietic cell transplantation (HCT) is a potentially curative treatment for children and adults with malignant and nonmalignant diseases. Despite increasing survival rates, long-term morbidity after HCT is substantial. Neurocognitive dysfunction is a serious cause of morbidity, yet little is known about neurocognitive dysfunction after HCT. To address this gap, collaborative efforts of the Center for International Blood and Marrow Transplant Research and the European Society for Blood and Marrow Transplantation undertook an expert review of neurocognitive dysfunction after HCT. In this review we define what constitutes neurocognitive dysfunction, characterize its risk factors and sequelae, describe tools and methods to assess neurocognitive function in HCT recipients, and discuss possible interventions for HCT patients with this condition. This review aims to help clinicians understand the scope of this health-related problem, highlight its impact on well-being of survivors, and help determine factors that may improve identification of patients at risk for declines in cognitive functioning after HCT. In particular, we review strategies for preventing and treating neurocognitive dysfunction in HCT patients. Finally, we highlight the need for well-designed studies to develop and test interventions aimed at preventing and improving neurocognitive dysfunction and its sequelae after HCT.
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Affiliation(s)
| | - David Buchbinder
- Divsison of Pediatrics Hematology, Children's Hospital of Orange County, Orange, California
| | | | - Jeffrey J Auletta
- Blood and Marrow Transplant Program and Host Defense Program, Division of Hematology, Nationwide Children's Hospital, Columbus, Ohio; Blood and Marrow Transplant Program and Host Defense Program, Division of Oncology, Nationwide Children's Hospital, Columbus, Ohio; Blood and Marrow Transplant Program and Host Defense Program, Division of Bone Marrow Transplant and Infectious Diseases, Nationwide Children's Hospital, Columbus, Ohio
| | - Neel Bhatt
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Michael Byrne
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Zachariah DeFilipp
- Blood and Marrow Transplant Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Melissa Gabriel
- The Children's Hospital at Westmead, New South Wales, Australia
| | - Anuj Mahindra
- Scripps Blood & Marrow Transplant Program, La Jolla, California
| | - Maxim Norkin
- Shands HealthCare and University of Florida, Gainesville, Florida
| | | | - Ami J Shah
- Division of Stem Cell Transplantation and Regenerative Medicine, Lucille Packard Children's Hospital, Stanford School of Medicine, Palo Alto, California
| | - Ibrahim Ahmed
- Division of Pediatric Hem/Onc/BMT, Children's Mercy Kansas City, Kansas City, Missouri; UMKC School of Medicine, Kansas City, Missouri
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan; Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | - Sara Beattie
- Department of Psychosocial Oncology and Rehabilitation, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Sita Bhella
- Department of Psychosocial Oncology and Rehabilitation, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Christopher Bredeson
- Ottawa Hospital Blood and Marrow Transplant Program and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Nancy Bunin
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jignesh Dalal
- Case Western Reserve School of Medicine, Cleveland, Ohio; Rainbow Babies and Children's Hospital, Cleveland, Ohio
| | - Andrew Daly
- Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | | | - Robert Peter Gale
- Division of Experimental Medicine, Department of Medicine, Imperial College London, Hematology Research Centre, London, United Kingdom
| | - John Galvin
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Mehdi Hamadani
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Robert J Hayashi
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Kehinde Adekola
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Jason Law
- Tufts University Medical Center, Boston, Massachusetts
| | - Catherine J Lee
- Utah Blood and Marrow Transplant Program Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Jane Liesveld
- Department of Medicine, University of Rochester Medical Center, Rochester, New York
| | - Adriana K Malone
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Arnon Nagler
- Hematology Division and BMT, Chaim Sheba Medical Center, Tel Hashomer, Israel; Tel Aviv University, Tel Aviv, Israel
| | - Seema Naik
- Texas Transplant Institute, San Antonino, Texas
| | - Taiga Nishihori
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | | | - Angela Scherwath
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Jeff Szer
- Department Clinical Haematology and Bone Marrow Transplantation, Royal Melbourne Hospital, Victoria, Australia
| | - Ida Twist
- The Children's Hospital at Westmead, New South Wales, Australia
| | - Anne Warwick
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Baldeep M Wirk
- Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, Washington
| | - Jean Yi
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Minoo Battiwalla
- Hematopoietic Transplantation Section, Hematology Branch, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Mary E Flowers
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Bipin Savani
- Blood and Marrow Transplant Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Bronwen E Shaw
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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Abstract
BACKGROUND Fatigue is highly prevalent after hematopoietic stem cell transplantation (HCT). It has been described as intense and may last for years following treatment. OBJECTIVE The aim of this study is to compare fatigue, physical activity, sleep, emotional distress, cognitive function, and biological measures in HCT survivors with persistent fatigue (n = 25) with age- and gender-matched healthy controls with occasional tiredness (n = 25). METHODS Data were collected using (a) objective, real-time assessments of physical activity and sleep over 7 days; (b) patient-reported fatigue assessments; (c) computerized objective testing of cognitive functioning; and (d) biological measures. Differences between groups were examined using multivariate analysis of variance. RESULTS Survivors of HCT reported increased physical (P < .001), mental (P < .001), and overall (P < .001) fatigue as well as increased anxiety (P < .05) and depression (P < .01) compared with healthy controls. Red blood cell (RBC) levels were significantly lower in HCT survivors (P < .001). Levels of RBC for both groups, however, were in the normal range. Tumor necrosis factor-α (P < .001) and interleukin-6 (P < .05) levels were significantly higher in HCT survivors. CONCLUSIONS Persistent fatigue in HCT survivors compared with healthy controls with occasional tiredness is accompanied by increased anxiety and depression along with decreased RBC counts. Elevated tumor necrosis factor-α and interleukin-6 levels may be important biomarkers. IMPLICATIONS FOR PRACTICE This study provides preliminary support for the conceptualization of fatigue as existing on a continuum, with tiredness anchoring one end and exhaustion the other. Persistent fatigue experienced by HCT survivors is more severe than the occasional tiredness of everyday life.
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Bevans M, El-Jawahri A, Tierney DK, Wiener L, Wood WA, Hoodin F, Kent EE, Jacobsen PB, Lee SJ, Hsieh MM, Denzen EM, Syrjala KL. National Institutes of Health Hematopoietic Cell Transplantation Late Effects Initiative: The Patient-Centered Outcomes Working Group Report. Biol Blood Marrow Transplant 2017; 23:538-551. [PMID: 27660168 PMCID: PMC5346334 DOI: 10.1016/j.bbmt.2016.09.011] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 09/12/2016] [Indexed: 12/20/2022]
Abstract
In 2015, the National Institutes of Health convened six working groups to address the research needs and best practices for late effects of hematopoietic stem cell transplantation survivors. The Patient-Centered Outcomes Working Group, charged with summarizing the HRQOL evidence base, used a scoping review approach to efficiently survey the large body of literature in adult and pediatric HCT survivors over 1 year after transplantation. The goals of this paper are to (1) summarize the current literature describing patient-centered outcomes in survivors, including the various dimensions of health-related quality of life affected by HCT, and describe interventions tested to improve these outcomes; (2) highlight areas with sufficient evidence allowing for integration into standard practice; (3) address methodological issues that restrict progress in this field; (4) identify major gaps to guide future research; and (5) specify priority research recommendations. Patient-centered outcomes were summarized within physical, psychological, social, and environmental domains, as well as for adherence to treatment, and health behaviors. Interventions to improve outcomes were evaluated for evidence of efficacy, although few interventions have been tested in long-term HCT survivors. Methodologic issues defined included lack of consistency in the selection of patient-centered outcome measures, along with the absence of a standard for timing, frequency, and mode of administration. Recommendations for HCT survivorship care included integration of annual screening of patient-centered outcomes, use of evidence-based practice guidelines, and provision of treatment summaries and survivorship care plans after HCT. Three priority research recommendations included the following: (1) design and test risk-targeted interventions with dose-intensity modulation matching the needs of HCT survivors with priority domains, including sexual dysfunction, fatigue, sleep disruption, nonadherence to medications and recommended health care, health behaviors including physical inactivity and healthy eating, and psychological dysfunction, with particular consideration of novel technologies to reach HCT survivors distant from their transplantation centers; (2) design a consensus-based methodologic framework for outcomes evaluation; and (3) evaluate and compare existing practices for integrating patient-centered outcome screening and interventions across HCT survivorship programs.
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Affiliation(s)
- Margaret Bevans
- Nursing Department, National Institutes of Health Clinical Center, Bethesda, Maryland.
| | - Areej El-Jawahri
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - D Kathryn Tierney
- Division of Primary, Preventive and Community Medicine, Stanford University, Stanford, California
| | - Lori Wiener
- Psychosocial Support and Research Program, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - William A Wood
- Division of Hematology and Oncology, University of North Carolina, Durham, North Carolina
| | - Flora Hoodin
- Department of Psychiatry, University of Michigan & Department of Psychology, Eastern Michigan University, Ann Arbor, Michigan
| | - Erin E Kent
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Paul B Jacobsen
- Psychosocial and Palliative Care Program, Moffitt Cancer Center, Tampa, Florida
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Matthew M Hsieh
- Molecular and Clinical Hematology Branch, National Institutes of Health, National Heart Lung and Blood Institute, Bethesda, Maryland
| | - Ellen M Denzen
- National Marrow Donor Program/Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Karen L Syrjala
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
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Cognitive problems following hematopoietic stem cell transplant: relationships with sleep, depression and fatigue. Bone Marrow Transplant 2016; 52:279-284. [PMID: 27941775 PMCID: PMC5288285 DOI: 10.1038/bmt.2016.248] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 06/09/2016] [Accepted: 06/10/2016] [Indexed: 11/09/2022]
Abstract
Cognitive problems are a significant, persistent concern for patients undergoing hematopoietic stem cell transplant (HSCT). Sleep is important for many cognitive tasks; however, the relationship between sleep and cognitive problems for HSCT patients is unknown. This study examined the relationship between sleep and cognitive problems for HSCT patients from pre to post transplant. Patients undergoing HSCT (N=138) completed questionnaires at pre-transplant and during the 12 months following transplant. Questionnaires assessed sleep and cognitive problems as well as commonly co-occurring symptoms: depressive symptoms, fatigue and pain. Post hoc analyses examined the relationship of specific sleep problems with cognitive problems. Sleep problems covaried with cognitive problems even after controlling for depressive symptoms, fatigue and pain. Depressive symptoms and fatigue were also uniquely related to cognitive problems. Post hoc analyses suggest that sleep somnolence, shortness of breath, snoring and perceptions of inadequate sleep may contribute to the association found between sleep and cognitive problems. Findings suggest that sleep problems are associated with and may contribute to cognitive problems for HSCT patients. However, sleep problems are rarely screened for or discussed during clinic visits. Assessing and treating specific sleep problems in addition to depressive symptoms and fatigue may have implications for improving cognitive problems for HSCT patients.
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45
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Process of allogeneic hematopoietic cell transplantation decision making for older adults. Bone Marrow Transplant 2015; 51:623-8. [DOI: 10.1038/bmt.2015.241] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 09/03/2015] [Accepted: 09/07/2015] [Indexed: 01/01/2023]
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Luskin MR, Banerjee R, Del Percio S, Loren AW. A Pound of Cure Requires An Ounce (or More) of Prevention: Survivorship and Complications of Therapy for Hematologic Malignancies. Curr Hematol Malig Rep 2015; 10:225-36. [PMID: 26162948 DOI: 10.1007/s11899-015-0274-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Patients treated for a hematologic malignancy are at risk for treatment-related complications. As the goal of therapy is frequently curative, treatments are especially intensive and long-term toxicity is common. Chemotherapy and radiation are associated with increased risk for cardiac and pulmonary disease, endocrine disorders, infertility, sexual dysfunction, second cancers, and psychosocial distress. The risk for each complication is dictated by patient characteristics including age, co-morbidities, and genetic predispositions, as well as the specifics of therapy. Survivors of pediatric cancers and allogeneic hematopoietic stem cell transplantation have unique risks due to vulnerable age at time of toxic exposure and ongoing immune dysfunction, respectively.
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Affiliation(s)
- Marlise R Luskin
- Division of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA,
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47
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Jim HSL, Evans B, Jeong JM, Gonzalez BD, Johnston L, Nelson AM, Kesler S, Phillips KM, Barata A, Pidala J, Palesh O. Sleep disruption in hematopoietic cell transplantation recipients: prevalence, severity, and clinical management. Biol Blood Marrow Transplant 2014; 20:1465-84. [PMID: 24747335 PMCID: PMC4163090 DOI: 10.1016/j.bbmt.2014.04.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 04/09/2014] [Indexed: 10/25/2022]
Abstract
Sleep disruption is common among hematopoietic cell transplant (HCT) recipients, with over 50% of recipients experiencing sleep disruption pre-transplant, with up to 82% of patients experiencing moderate to severe sleep disruption during hospitalization for transplant and up to 43% after transplant. These rates of sleep disruption are substantially higher than what we see in the general population. Although sleep disruption can be distressing to patients and contribute to diminished quality of life, it is rarely discussed during clinical visits. The goal of the current review is to draw attention to sleep disruption and disorders (ie, insomnia, obstructive sleep apnea, restless legs syndrome) as a clinical problem in HCT in order to facilitate patient education, intervention, and research. We identified 35 observational studies published in the past decade that examined sleep disruption or disorders in HCT. Most studies utilized a single item measure of sleep, had small sample size, and included heterogeneous samples of patients. Six studies of the effects of psychosocial and exercise interventions on sleep in HCT have reported no significant improvements. These results highlight the need for rigorous observational and interventional studies of sleep disruption and disorders in HCT recipients..
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Affiliation(s)
| | - Bryan Evans
- Department of Psychology, University of South Florida, Tampa, Florida
| | - Jiyeon M Jeong
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | | | - Laura Johnston
- Division of Blood and Marrow Transplantation, Stanford University School of Medicine, Stanford, California
| | - Ashley M Nelson
- Department of Psychology, University of South Florida, Tampa, Florida
| | - Shelli Kesler
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | | | - Anna Barata
- Moffitt Cancer Center, Tampa, Florida; Psychiatry and Legal Medicine PhD Program, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joseph Pidala
- Department of Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, Florida
| | - Oxana Palesh
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
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Törnquist AL, Martin L, Winiarski J, Fahnehjelm KT. Ocular manifestations and visual functions in patients with Fanconi anaemia. Acta Ophthalmol 2014; 92:171-8. [PMID: 23648176 DOI: 10.1111/aos.12132] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Fanconi anaemia (FA) is a multisystemic disorder with ocular implications. This study aims to describe visual function, ocular characteristics and visual processing skills in patients with FA after haematopoietic stem cell transplantation. METHODS Ten patients with FA, ages 8-17 years, underwent ophthalmological examinations, corneal, periocular and fundus photography, visual evoked potentials (VEPs), visual fields and ocular motor and visual processing information tests. RESULTS Best-corrected decimal visual acuity was ≥0.65 in all 20 eyes. Microcornea was present in 18 of 18 eyes, short axial lengths in six of six eyes, steep corneal curvatures in four of six eyes, ptosis in 14 of 16 eyes, short palpebral fissures in 15 of 16 eyes and hypotelorism in three of seven patients. Optic disc areas were smaller in patients with FA compared to controls (p = 0.0003 right, p = 0.0003 left eye). Visual fields were abnormal in 4 of 18 eyes, while VEP was abnormal in 1 of 20 eyes. Eight patients had ocular motor dysfunction, while nine of 10 patients showed delay in visual processing skills. CONCLUSION Patients with FA can present with microcornea, microphthalmia, ptosis, steep corneal curvatures, small optic discs, ptosis and delay in visual processing skills. Detailed ophthalmological and visual processing skills assessments and developmental investigations are important to detect impairments and facilitate appropriate support.
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Affiliation(s)
- Alba Lucia Törnquist
- Department of Clinical Neuroscience, Karolinska Institutet and St. Erik Eye Hospital, Stockholm, SwedenDepartment of Clintec, Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, SwedenDepartment of Paediatrics, Karolinska University Hospital, Huddinge, Stockholm, Sweden
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Rueda-Lara M, Lopez-Patton MR. Psychiatric and psychosocial challenges in patients undergoing haematopoietic stem cell transplants. Int Rev Psychiatry 2014; 26:74-86. [PMID: 24716502 DOI: 10.3109/09540261.2013.866075] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Haematological malignancies are often treated with haematopoietic stem cell transplants (HSCT). The disease and its treatment are challenging and life threatening, as they not only affect the recipients, but also their families. This review highlights the available data on the psychological, psychiatric and social impact of these illnesses and their treatment on recipients and families. There are robust data that correlate HSCT with emotional distress, as emotional and physical functioning significantly affect quality of life. Psychiatric co-morbidity including anxiety, depression, adjustment and post-traumatic stress disorder, delirium and cognitive deficits have been reported at different stages in the transplant process. This review will highlight the psychosocial and clinical research findings relevant to HSCT patients and will summarize recommendations for future psychosocial research in this population.
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Affiliation(s)
- Maria Rueda-Lara
- University of Miami/Leonard Miller School of Medicine, Department of Psychiatry and Behavioral Sciences, Sylvester Comprehensive Cancer Center , Miami, Florida , USA
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50
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Jones D, Vichaya EG, Wang XS, Sailors MH, Cleeland CS, Wefel JS. Acute cognitive impairment in patients with multiple myeloma undergoing autologous hematopoietic stem cell transplant. Cancer 2013; 119:4188-95. [PMID: 24105672 DOI: 10.1002/cncr.28323] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 06/21/2013] [Accepted: 07/23/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND Few studies have examined the acute effects of autologous hematopoietic stem cell transplantation (Au-HSCT) on the neuropsychological functioning of patients with multiple myeloma (MM). The prevalence of cognitive deficits after induction chemotherapy (pre-AuHSCT) was examined in patients with MM, clinically significant changes in cognitive function 1 and 3 months post-AuHSCT were determined, and patients who may be vulnerable to cognitive decline during this period were identified. METHODS A total of 53 patients with MM were recruited pre-AuHSCT. Neuropsychological tests measuring multiple cognitive domains (attention, psychomotor speed, learning/memory, language, executive function, motor function) were administered pre-AuHSCT and 1 and 3 months post-AuHSCT. A pretreatment assessment was not available. An Overall Cognitive Function Index was computed to determine cognitive impairment pre-AuHSCT, and a practice-effect-adjusted Reliable Change Index was used to determine cognitive change over time. RESULTS Overall, deficits were more frequent in learning/memory, executive function, motor function, and psychomotor speed. Before AuHSCT, 47% of patients (25/53) exhibited cognitive impairment as determined by the Overall Cognitive Function Index. One month post-AuHSCT, 49% of patients (20/41) demonstrated clinically significant decline on 1 or more measures; 3 months post-AuHSCT, 48% (14 of 29 patients) showed decline on 1 or more measures. Older patients, minorities, and those with advanced disease, more induction cycles, or postinduction deficits showed greater vulnerability to decline. CONCLUSIONS Nearly half of the patients showed vulnerability to impairment in learning/memory or executive function after receiving induction therapy, and the prevalence of impairment remained high post-AuHSCT. Awareness of cognitive impairment and associated risk factors in actively treated patients is important for considering psychosocial or other support for patients with acute cognitive symptoms.
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Affiliation(s)
- Desiree Jones
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
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