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Zeng Q, Li C, Yu T, Zhang H. Comparative Effects of Exercise Interventions and Mindfulness-Based Interventions for Cognitive Impairment and Quality of Life in Breast Cancer Survivors During or After Cancer Treatment: A Systematic Review and Bayesian Network Meta-analysis. Am J Phys Med Rehabil 2024; 103:777-788. [PMID: 38684135 DOI: 10.1097/phm.0000000000002531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
OBJECTIVE The aim of this network meta-analysis was to compare the improvement effects of various exercise interventions and mindfulness-based interventions to determine the best interventions for the improvement of cognitive impairment. DESIGN Seven databases were searched to screen randomized controlled trials of exercise interventions and mindfulness-based interventions to improve cognitive impairment. The network meta-analysis was performed using Revman 5.3, R 4.2.1 and ADDIS 1.16.8 software. RESULTS Thirty-four randomized controlled trials involving 14 interventions were included in the study. In terms of cognitive function, except for mindfulness-based stress reduction, all interventions showed significantly greater improvement in cognitive function compared with conventional therapy. Physical activity and Qigong showed better effect in improving executive function. In terms of improving verbal memory, compensatory cognitive training, neurofeedback training, Qigong, and sham Qigong were more effective than other interventions. On performing surface under the cumulative ranking curve analysis, acceptance and commitment therapy, neurofeedback training, Qigong, and mediation had the best effects on cognitive function, quality of life, executive function, and processing speed, respectively. CONCLUSIONS Mindfulness-based interventions were found to be more effective than exercise interventions for alleviating cognitive impairment. More robust randomized controlled trials focusing on acceptance and commitment therapy for cognitive impairment are required to support the current evidence.
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Affiliation(s)
- Qing Zeng
- From the School of Nursing, Lanzhou University, Lanzhou, Gansu, People's Republic of China
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2
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Pembroke L, Sherman KA, Dhillon HM, Francis H, Gillatt D, Gurney H. Online Group Cognitive Rehabilitation Program for Prostate Cancer Survivors: Development Using Codesign and the Theoretical Domains Framework. Semin Oncol Nurs 2024:151695. [PMID: 39054190 DOI: 10.1016/j.soncn.2024.151695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 06/19/2024] [Accepted: 06/21/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVES This study aimed to describe the adaptation of a group cognitive rehabilitation program for prostate cancer survivors (PCS) via telehealth delivery using a codesign approach with PCS experiencing cancer-related cognitive impairment. The Theoretical Domains Framework (TDF) also informed the intervention development. METHODS Intervention development consisted of three steps: 1) Adapting an existing cancer-related cognitive rehabilitation program for PCS; 2) Conducting a codesign focus group workshop to gather feedback that was analyzed using a template approach; and 3) Incorporation of consumer feedback to refine the program for future piloting in PCS. Components of the finalized intervention were mapped onto the TDF domains. RESULTS Six PCS were involved in the codesign focus group workshop, providing feedback on program structure, the topics and its order, and rehabilitation activities. A manualized four-week online group cognitive rehabilitation program titled "Promoting Cognitive Wellbeing in Prostate Cancer Survivors (ProCog)" was developed. Four sessions of 2-hours' duration were designed exploring: cognitive/brain functions; the impact of cancer treatments and ageing; the relationship between thoughts, feelings and behaviors; values-based goal-setting; and skills/strategies to manage fatigue and improve attention, memory, aspects of executive functioning, and emotional functioning. CONCLUSIONS Consumer input and guidance from the TDF ensures a robust development process for the online ProCog intervention, designed for and with PCS experiencing cognitive difficulties. As an important initial step before piloting, this adaptation and development process ensures that ProCog addresses consumer needs and preferences and targets factors increasing behavior change. IMPLICATIONS FOR NURSING PRACTICE This research raises awareness of possible cancer-related cognitive impairments in prostate cancer survivors and strategies for rehabilitation. ProCog is an accessible online intervention that nurses can use to refer patients needing cognitive rehabilitation.
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Affiliation(s)
- Lorna Pembroke
- Lifespan Health and Wellbeing Research Centre, Macquarie University, New South Wales, Australia; School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University & Macquarie University Hospital, New South Wales, Australia.
| | - Kerry A Sherman
- Lifespan Health and Wellbeing Research Centre, Macquarie University, New South Wales, Australia; School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University & Macquarie University Hospital, New South Wales, Australia
| | - Haryana M Dhillon
- Centre for Medical Psychology and Evidence-based Decision-making, School of Psychology, Faculty of Science, University of Sydney, New South Wales, Australia; Psycho-Oncology Cooperative Research Group, School of Psychology, Faculty of Science, University of Sydney, New South Wales, Australia
| | - Heather Francis
- School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University & Macquarie University Hospital, New South Wales, Australia
| | - David Gillatt
- Macquarie University Urology Clinic, Faculty of Medicine and Health Sciences, Macquarie, University & Macquarie University Hospital, New South Wales, Australia
| | - Howard Gurney
- Macquarie University Clinical Trials Unit (CTU), Faculty of Medicine and Health Sciences, Macquarie University & Macquarie University Hospital, New South Wales, Australia
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Nakamura ZM, Ali NT, Crouch A, Dhillon H, Federico A, Gates P, Grech L, Kesler SR, Ledbetter L, Mantovani E, Mayo S, Ng DQ, Pembroke L, Pike KE, Tamburin S, Tan CJ, Toh YL, Yang Y, Von Ah D, Allen DH. Impact of Cognitive Rehabilitation on Cognitive and Functional Outcomes in Adult Cancer Survivors: A Systematic Review. Semin Oncol Nurs 2024:151696. [PMID: 39048409 DOI: 10.1016/j.soncn.2024.151696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 06/20/2024] [Accepted: 06/21/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVES This systematic review (PROSPERO CRD42021275421) synthesized evidence on the efficacy of cognitive rehabilitation on cognitive and functional outcomes in adult cancer survivors. METHODS Articles were identified though PubMed/MEDLINE, EMBASE, PsycINFO, and Web of Science from inception through June 30, 2023. Studies included participants ≥18 years old, diagnosed with cancer. Primary outcomes were validated measures of subjective and objective cognition. Articles were dual reviewed for eligibility and data extraction. Risk of bias was assessed with the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields. RESULTS The search yielded 3,811 articles; 65 full-text articles were reviewed; 53 articles (15 cognitive training, 14 strategy-based, 21 combinations, three inpatient rehabilitation), representing 52 unique studies, were included. Positive effects were observed in at least one objective cognitive measure in 93% of strategy training, 81% of cognitive training, 79% of combination rehabilitation interventions. Positive effects were observed in subjective cognition in 100% of strategy training, 55% of cognitive training, and 92% of combination interventions. Among studies with comparator groups, processing speed improved in 60% of cognitive training studies, while strategy training did not improve processing speed; otherwise, cognitive domain effects were similar between intervention types. Impact on functional outcomes was inconclusive. CONCLUSIONS Cognitive rehabilitation appear beneficial for cancer-related cognitive impairment (CRCI). Differential effects on specific cognitive domains (eg, processing speed) and subjective cognition may exist between intervention types. IMPLICATIONS FOR NURSING PRACTICE Nurses should increase patient and provider awareness of the benefits of cognitive rehabilitation for CRCI.
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Affiliation(s)
- Zev M Nakamura
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | | | - Adele Crouch
- Indiana University School of Nursing, Indianapolis, Indiana
| | - Haryana Dhillon
- Psycho-Oncology Cooperative Research Group, Faculty of Science, The University of Sydney, New South Wales, Australia
| | - Angela Federico
- Department of Neurosciences, Biomedicine and Movement Sciences, GB Rossi Hospital, University of Verona, Verona, Italy
| | - Priscilla Gates
- Peter Mac Callum Cancer Center, Deakin University, Burwood, Victoria, Australia
| | - Lisa Grech
- School of Psychology, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | | | - Leila Ledbetter
- Duke University Medical Center Library, DUMC 3702, Durham, North Carolina
| | - Elisa Mantovani
- Department of Neurosciences, Biomedicine and Movement Sciences, GB Rossi Hospital, University of Verona, Verona, Italy
| | | | - Ding Quan Ng
- University of California Irvine, School of Pharmacy & Pharmaceutical Sciences, Irvine, CA, USA
| | - Lorna Pembroke
- School of Psychological Sciences Level 3, Australian Hearing Hub, Health and Human Sciences, Macquarie University, New South Wales, Australia
| | - Kerryn E Pike
- School of Applied Psychology, Griffith University, Gold Coast, Queensland, Australia
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, GB Rossi Hospital, University of Verona, Verona, Italy
| | - Chia Jie Tan
- College of Pharmacy, University of Utah, Salt Lake City, Utah
| | - Yi Long Toh
- Department of Pharmacy, National University of Singapore, Singapore
| | - Yesol Yang
- The Ohio State University Comprehensive Cancer Center, Colombus, Ohio
| | - Diane Von Ah
- The Ohio State University, College of Nursing, Colombus, Ohio
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Lazarou I, Krooupa AM, Nikolopoulos S, Apostolidis L, Sarris N, Papadopoulos S, Kompatsiaris I. Cancer Patients' Perspectives and Requirements of Digital Health Technologies: A Scoping Literature Review. Cancers (Basel) 2024; 16:2293. [PMID: 39001356 PMCID: PMC11240750 DOI: 10.3390/cancers16132293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 06/14/2024] [Accepted: 06/19/2024] [Indexed: 07/16/2024] Open
Abstract
Digital health technologies have the potential to alleviate the increasing cancer burden. Incorporating patients' perspectives on digital health tools has been identified as a critical determinant for their successful uptake in cancer care. The main objective of this scoping review was to provide an overview of the existing evidence on cancer patients' perspectives and requirements for patient-facing digital health technologies. Three databases (CINAHL, MEDLINE, Science Direct) were searched and 128 studies were identified as eligible for inclusion. Web-based software/platforms, mobile or smartphone devices/applications, and remote sensing/wearable technologies employed for the delivery of interventions and patient monitoring were the most frequently employed technologies in cancer care. The abilities of digital tools to enable care management, user-friendliness, and facilitate patient-clinician interactions were the technological requirements predominantly considered as important by cancer patients. The findings from this review provide evidence that could inform future research on technology-associated parameters influencing cancer patients' decisions regarding the uptake and adoption of patient-facing digital health technologies.
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Affiliation(s)
- Ioulietta Lazarou
- Information Technologies Institute (ITI), Centre for Research and Technology Hellas (CERTH), 6th km Charilaou-Thermi Road, P.O. Box 6036, 57001 Thessaloniki, Greece
| | - Anna-Maria Krooupa
- Information Technologies Institute (ITI), Centre for Research and Technology Hellas (CERTH), 6th km Charilaou-Thermi Road, P.O. Box 6036, 57001 Thessaloniki, Greece
| | - Spiros Nikolopoulos
- Information Technologies Institute (ITI), Centre for Research and Technology Hellas (CERTH), 6th km Charilaou-Thermi Road, P.O. Box 6036, 57001 Thessaloniki, Greece
| | - Lazaros Apostolidis
- Information Technologies Institute (ITI), Centre for Research and Technology Hellas (CERTH), 6th km Charilaou-Thermi Road, P.O. Box 6036, 57001 Thessaloniki, Greece
| | - Nikos Sarris
- Information Technologies Institute (ITI), Centre for Research and Technology Hellas (CERTH), 6th km Charilaou-Thermi Road, P.O. Box 6036, 57001 Thessaloniki, Greece
| | - Symeon Papadopoulos
- Information Technologies Institute (ITI), Centre for Research and Technology Hellas (CERTH), 6th km Charilaou-Thermi Road, P.O. Box 6036, 57001 Thessaloniki, Greece
| | - Ioannis Kompatsiaris
- Information Technologies Institute (ITI), Centre for Research and Technology Hellas (CERTH), 6th km Charilaou-Thermi Road, P.O. Box 6036, 57001 Thessaloniki, Greece
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Brick R, Padgett L, Jones J, Wood KC, Pergolotti M, Marshall TF, Campbell G, Eilers R, Keshavarzi S, Flores AM, Silver JK, Virani A, Livinski AA, Ahmed MF, Kendig T, Khalid B, Barnett J, Borhani A, Bernard G, Lyons KD. The influence of telehealth-based cancer rehabilitation interventions on disability: a systematic review. J Cancer Surviv 2023; 17:1725-1750. [PMID: 35218521 PMCID: PMC8881759 DOI: 10.1007/s11764-022-01181-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 02/02/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To characterize delivery features and explore effectiveness of telehealth-based cancer rehabilitation interventions that address disability in adult cancer survivors. METHODS A systematic review of electronic databases (CINAHL Plus, Cochrane Library: Database of Systematic Reviews, Embase, National Health Service's Health Technology Assessment, PubMed, Scopus, Web of Science) was conducted in December 2019 and updated in April 2021. RESULTS Searches identified 3,499 unique studies. Sixty-eight studies met inclusion criteria. There were 81 unique interventions across included studies. Interventions were primarily delivered post-treatment and lasted an average of 16.5 weeks (SD = 13.1). They were most frequently delivered using telephone calls (59%), administered delivered by nursing professionals (35%), and delivered in a one-on-one format (88%). Risk of bias of included studies was primarily moderate to high. Included studies captured 55 measures of disability. Only 54% of reported outcomes had data that allowed calculation of effect sizes ranging -3.58 to 15.66. CONCLUSIONS The analyses suggest small effects of telehealth-based cancer interventions on disability, though the heterogeneity seen in the measurement of disability makes it hard to draw firm conclusions. Further research using more diverse samples, common measures of disability, and pragmatic study designs is needed to advance telehealth in cancer rehabilitation. IMPLICATIONS FOR CANCER SURVIVORS Telehealth-based cancer rehabilitation interventions have the potential to increase access to care designed to reduce disability across the cancer care continuum.
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Affiliation(s)
- Rachelle Brick
- Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, 20850, USA.
| | - Lynne Padgett
- VA Central Office, Health Services Research and Development, 1100 1st St NE, Suite 6, Washington, DC, 20002, USA
| | - Jennifer Jones
- Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre, University Health Network, 200 Elizabeth Sr. PMB-B-045, Toronto, ON, M5G 2C4, Canada
| | - Kelley Covington Wood
- ReVital Cancer Rehabilitation, Select Medical, 4714 Gettysburg Road, Mechanicsburg, PA, 17055, USA
| | - Mackenzi Pergolotti
- ReVital Cancer Rehabilitation, Select Medical, 4714 Gettysburg Road, Mechanicsburg, PA, 17055, USA
| | - Timothy F Marshall
- Ivy Rehab Network, 1311 Mamaroneck Ave, Suite 140, White Plains, NY, 10605, USA
| | - Grace Campbell
- Duquesne University School of Nursing, 600 Forbes Avenue, Pittsburgh, PA, 15282, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences and UPMC Hillman Cancer Center at UPMC Magee, School of Medicine, University of Pittsburgh, 300 Halket Street, Pittsburgh, PA, 15213, USA
| | - Rachel Eilers
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Bridgeside Point I, 100 Technology Drive, Pittsburgh, PA, 15219, USA
| | - Sareh Keshavarzi
- Department of Biostatistics, Princess Margaret Cancer Center, 610 University Ave, Toronto, ON, Canada
- Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, Canada
| | - Ann Marie Flores
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, 60611, USA
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, 645 North Michigan Avenue, 11th Floor, Chicago, IL, 60611, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 645 North Michigan Avenue, 11th Floor, Chicago, IL, 60611, USA
| | - Julie K Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, USA
- Brigham and Women's Hospital, 55 Fruit Street, Boston, MA, USA
- Spaulding Rehabilitation Hospital, 55 Fruit Street, Boston, MA, USA
| | - Aneesha Virani
- Department of Rehabilitation Services, Northside Hospital, 1000 Johnson Ferry Road, Atlanta, GA, 30342, USA
| | - Alicia A Livinski
- National Institutes of Health Library, Office of Research Services, OD, NIH, MSC 1150, 10 Center Drive, Bethesda, MD, 20892, USA
| | - Mohammed Faizan Ahmed
- Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre, University Health Network, 200 Elizabeth Sr. PMB-B-045, Toronto, ON, M5G 2C4, Canada
| | - Tiffany Kendig
- ReVital Cancer Rehabilitation, Select Medical, 4714 Gettysburg Road, Mechanicsburg, PA, 17055, USA
| | - Bismah Khalid
- Department of Occupational Science & Occupational Therapy, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1VT, Canada
| | - Jeremy Barnett
- George Washington University School of Medicine and Health Sciences, 2300 I St. NW, Washington, DC, 20052, USA
| | - Anita Borhani
- Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre, University Health Network, 200 Elizabeth Sr. PMB-B-045, Toronto, ON, M5G 2C4, Canada
| | - Graysen Bernard
- Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre, University Health Network, 200 Elizabeth Sr. PMB-B-045, Toronto, ON, M5G 2C4, Canada
| | - Kathleen Doyle Lyons
- Department of Occupational Therapy, MGH Institute of Health Professions, Charlestown Navy Yard, Building 79/96, 79 13th Street, Boston, MA, 02129, USA
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Duivon M, Lange M, Binarelli G, Lefel J, Hardy-Léger I, Kiasuwa-Mbengi R, Méric JB, Charles C, Joly F. Improve the management of cancer-related cognitive impairment in clinical settings: a European Delphi study. J Cancer Surviv 2023:10.1007/s11764-023-01436-8. [PMID: 37934312 DOI: 10.1007/s11764-023-01436-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 07/21/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE Cancer-related cognitive impairment (CRCI) is under-addressed by healthcare professionals owing to a lack of clinical management guidelines. This European Delphi study proposes recommendations to healthcare professionals for the management of CRCI in patients with non-central nervous system (non-CNS) cancers. METHODS Twenty-two recommendations were developed based on a literature review and authors' clinical experience, split into three categories: screening, cognitive assessment, intervention. The survey included European professionals, experts in CRCI. The Delphi method was used: experts rated the clinical relevancy of recommendations on a 9-point Likert scale in three rounds. A recommendation was accepted if all votes were between 7 and 9. Recommendations not accepted in round 1 and round 2 were deleted, or modified and rated in round 3. RESULTS Eighteen professionals (psychologists, physicians, researchers) voted and accepted 15 recommendations. Experts recommended the systematic screening of CRCI, followed by a short objective cognitive assessment, if complaints screened. A comprehensive evaluation is recommended if CRCI persists 6 months post-treatment. Cognitive rehabilitation, physical activity, meditative-movement therapy, and multimodal intervention should be offered. Recommendations about frequency and duration of interventions, the professional to administer cognitive rehabilitation and the use of meditation and cognitive training without psychoeducation were not accepted. CONCLUSIONS This survey provides 15 recommendations to assist healthcare professionals in detecting, assessing and offering interventions for CRCI. IMPLICATIONS FOR CANCER SURVIVORS These recommendations should be included in supportive care to help healthcare professionals to detect CRCI and propose the best available intervention for patients with cognitive complaints. Developing CRCI management in clinical settings would improve patients' quality of life.
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Affiliation(s)
- Mylène Duivon
- Normandie Univ, UNICAEN, INSERM, ANTICIPE, 14000, Caen, France
| | - Marie Lange
- Normandie Univ, UNICAEN, INSERM, ANTICIPE, 14000, Caen, France
- Clinical Research Department, Centre François Baclesse, 14000, Caen, France
- Cancer & Cognition Platform, Ligue Contre le Cancer, 14000, Caen, France
| | - Giulia Binarelli
- Normandie Univ, UNICAEN, INSERM, ANTICIPE, 14000, Caen, France
- Clinical Research Department, Centre François Baclesse, 14000, Caen, France
| | - Johan Lefel
- Care Support Department, Centre Henri Becquerel, 76000, Rouen, France
| | | | - Régine Kiasuwa-Mbengi
- Department of Public Health and Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium
| | - Jean-Baptiste Méric
- Public Health Division, National Cancer Institute, 52 Avenue André Morizet, 92100, Boulogne-Billancourt, France
| | - Cécile Charles
- Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, France
| | - Florence Joly
- Normandie Univ, UNICAEN, INSERM, ANTICIPE, 14000, Caen, France.
- Clinical Research Department, Centre François Baclesse, 14000, Caen, France.
- Cancer & Cognition Platform, Ligue Contre le Cancer, 14000, Caen, France.
- Medical Oncology Department, CHU de Caen, 14000, Caen, France.
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Ferguson RJ, Terhorst L, Gibbons B, Posluszny DM, Chang H, Bovbjerg DH, McDonald BC. Using Single-Case Experimental Design and Patient-Reported Outcome Measures to Evaluate the Treatment of Cancer-Related Cognitive Impairment in Clinical Practice. Cancers (Basel) 2023; 15:4643. [PMID: 37760621 PMCID: PMC10526413 DOI: 10.3390/cancers15184643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/13/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
Cancer-related cognitive impairment (CRCI) affects a large proportion of cancer survivors and has significant negative effects on survivor function and quality of life (QOL). Treatments for CRCI are being developed and evaluated. Memory and attention adaptation training (MAAT) is a cognitive-behavioral therapy (CBT) demonstrated to improve CRCI symptoms and QOL in previous research. The aim of this article is to describe a single-case experimental design (SCED) approach to evaluate interventions for CRCI in clinical practice with patient-reported outcome measures (PROs). We illustrate the use of contemporary SCED methods as a means of evaluating MAAT, or any CRCI treatment, once clinically deployed. With the anticipated growth of cancer survivorship and concurrent growth in the number of survivors with CRCI, the treatment implementation and evaluation methods described here can be one way to assess and continually improve CRCI rehabilitative services.
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Affiliation(s)
- Robert J. Ferguson
- Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15232, USA; (D.M.P.); (H.C.)
| | - Lauren Terhorst
- Department of Occupational Therapy, School of Health Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA 15260, USA;
| | - Benjamin Gibbons
- Department of Family Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA;
| | - Donna M. Posluszny
- Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15232, USA; (D.M.P.); (H.C.)
| | - Hsuan Chang
- Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15232, USA; (D.M.P.); (H.C.)
| | - Dana H. Bovbjerg
- UPMC Hillman Cancer Center, Department of Psychiatry, Biobehavioral Cancer Control Program, University of Pittsburgh, Pittsburgh, PA 15232, USA;
| | - Brenna C. McDonald
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
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Liu Y, Liu JE, Chen S, Zhao F, Chen L, Li R. Effectiveness of Nonpharmacologic Interventions for Chemotherapy-Related Cognitive Impairment in Breast Cancer Patients: A Systematic Review and Network Meta-analysis. Cancer Nurs 2023; 46:E305-E319. [PMID: 37607381 DOI: 10.1097/ncc.0000000000001152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Neurotoxicity is a major adverse effect of chemotherapy in breast cancer (BC) patients. A number of nonpharmacologic interventions are used to alleviate chemotherapy-related cognitive impairment (CRCI), but no studies have compared their effectiveness. OBJECTIVES The aim of this study was to identify and compare the effectiveness of different nonpharmacologic interventions for CRCI in BC patients. METHODS A systematic review and network meta-analysis was conducted following the Cochrane guidelines. All randomized controlled trials were searched in the Cochrane Library, PubMed, MEDLINE (via OVID), Web of Science, EMBASE, and CINAHL databases from inception to September 2021. Studies using nonpharmacologic interventions to manage CRCI symptoms were included. A network meta-analysis and a comparative effects ranking were completed by STATA v14.0. RESULTS Twelve studies with 8 nonpharmacologic interventions were included. For subjective outcomes on CRCI, there was no significant difference between nonpharmacologic interventions. For objective outcomes, qigong and exercise were more effective than the psychotherapy. Qigong and exercise were also more effective than music therapy. The top 3 interventions were psychotherapy (83.4%), music therapy (60.8%), and electroacupuncture (52.5%) for subjective outcomes and qigong (87.7%), exercise (82.1%), and electroacupuncture (70.3%) for objective outcomes. CONCLUSION In the subjective evaluation, it was difficult to judge which interventions are best, but psychotherapy had the greatest probability. For objective evaluation, qigong and exercise may be the best nonpharmacologic interventions. IMPLICATIONS FOR PRACTICE This study provides evidence for the effectiveness of nonpharmacologic interventions for CRCI in BC patients and facilitates support for future clinical trials and work.
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Affiliation(s)
- Yu Liu
- Author Affiliation: School of Nursing, Capital Medical University, People's Republic of China
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Wang XY, Wang J, Zhang S. Analysis of load status and management strategies of main caregivers of patients with malignant tumors of digestive tract. World J Gastrointest Oncol 2023; 15:973-978. [PMID: 37389114 PMCID: PMC10302986 DOI: 10.4251/wjgo.v15.i6.973] [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: 03/17/2023] [Revised: 04/12/2023] [Accepted: 04/23/2023] [Indexed: 06/14/2023] Open
Abstract
Caregiver load refers to the subjective and objective negative impact of caregivers in the care of patients, and excessive load will have a serious impact on patients and caregivers themselves and can reduce their quality of life. For the main caregivers, it not only needs to care for the patients in life and daily life, but also needs to pay the cost of treatment for the patients, coupled with the need to carry out their own original work, life, etc. excessive life pressure, economic pressure, work pressure, emotional pressure, etc. lead to heavy load of the main caregivers, which can easily cause caregivers to have different degrees of psychological problems, which will cause serious adverse effects on the caregivers themselves and cancer patients, not conducive to the construction of a harmonious family and society. This article analyzes the current situation of primary caregiver burden in patients with gastrointestinal malignant tumors, analyzes its influencing factors, and specifies specific treatment strategies. It is hoped to provide scientific guidance for later related research and application.
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Affiliation(s)
- Xiao-Yan Wang
- Emergency Department, West China Hospital of Sichuan University, Chengdu 610000, Sichuan Province, China
| | - Jing Wang
- ENT (Ear-Nose-Throat) Department, Chengdu Hospital of Combination of Chinese Traditional and Western Medicine, Chengdu 610000, Sichuan Province, China
| | - Shu Zhang
- Emergency Department, West China Hospital of Sichuan University, Chengdu 610000, Sichuan Province, China
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Tao TJ, Lim TK, Yeung ETF, Liu H, Shris PB, Ma LKY, Lee TMC, Hou WK. Internet-based and mobile-based cognitive behavioral therapy for chronic diseases: a systematic review and meta-analysis. NPJ Digit Med 2023; 6:80. [PMID: 37117458 PMCID: PMC10141870 DOI: 10.1038/s41746-023-00809-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 03/30/2023] [Indexed: 04/30/2023] Open
Abstract
Positive adjustment to chronic diseases reduces psychiatric comorbidity and enhances quality of life. Very little is known about the benefit of internet-based and mobile-based Cognitive Behavioral Therapy (IM-CBT) on physical outcomes and its reciprocal interactions with psychiatric outcomes, the active therapeutic elements, and effect moderators among people with major chronic medical conditions. In this systematic review and meta-analysis (PROSPERO: CRD42022265738), CINAHL of Systematic Reviews, MEDLINE, PsycINFO, PubMed, Web of Science are systematically searched up to 1 June 2022, for randomized controlled trials (RCTs) comparing IM-CBT against non-CBT control condition(s) among people with chronic disease(s). Primary outcomes include improvements in psychiatric symptoms (depressive, anxiety, PTSD symptoms, general psychological distress) from baseline to post-intervention and follow-ups. Secondary outcomes include improvements in physical distress (physical symptoms, functional impairment, self-rated ill health, objective physiological dysfunction). Among 44 RCTs (5077 patients with seven different chronic diseases), IM-CBT improves depressive symptoms, anxiety symptoms, and general psychological distress at post-intervention and across follow-ups, and improves physical distress and functional impairment at post-intervention. Preliminary evidence suggests that behavioral modification and problem-solving could be necessary components to reduce psychiatric symptoms in IM-CBT, whereas cognitive restructuring, psychoeducation, and mindfulness elements relate to reduced physical distress. IM-CBT shows stronger benefits in chronic pain, cancer, arthritis, and cardiovascular disease, relative to other conditions. Changes in psychiatric symptoms and physical distress prospectively predict each other over time. IM-CBT is an effective intervention for comprehensive symptom management among people with chronic diseases.
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Affiliation(s)
- Tiffany Junchen Tao
- Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong SAR, China
| | - Teck Kuan Lim
- Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong SAR, China
| | - Ernest Tsun Fung Yeung
- Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong SAR, China
| | - Huinan Liu
- Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong SAR, China
- Department of Special Education and Counselling, The Education University of Hong Kong, Hong Kong SAR, China
| | - Phoenix Bibha Shris
- Department of Psychology, The Education University of Hong Kong, Hong Kong SAR, China
| | - Lawrence Ka Yin Ma
- Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong SAR, China
- Department of Psychology, The Education University of Hong Kong, Hong Kong SAR, China
| | - Tatia Mei Chun Lee
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Neuropsychology & Human Neuroscience, The University of Hong Kong, Hong Kong SAR, China
| | - Wai Kai Hou
- Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong SAR, China.
- Department of Psychology, The Education University of Hong Kong, Hong Kong SAR, China.
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11
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Park JH, Jung SJ, Lee LJ, Rhu J, Bae SH. Impact of non-pharmacological interventions on cognitive impairment in women with breast cancer: A systematic review and meta-analysis. Asia Pac J Oncol Nurs 2023; 10:100212. [PMID: 37095894 PMCID: PMC10121786 DOI: 10.1016/j.apjon.2023.100212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 02/16/2023] [Indexed: 03/06/2023] Open
Abstract
Objective This study aimed to examine the characteristics of research conducted on nonpharmacological interventions for cognitive impairment in patients with breast cancer and identify the primary effects of nonpharmacological interventions through a systematic review and meta-analysis. Methods Five electronic databases were searched to identify all randomized controlled trial studies until September 30, 2022, using the key terms "breast cancer," "cognitive disorders," and their possible variations. The Cochrane Risk of Bias tool was used to assess risk of bias. The effect sizes were calculated in Hedges' g. Potential moderators influencing the intervention effects were explored. Results Twenty-three studies were included in the systematic review, and 17 studies were included in the meta-analysis. Among the nonpharmacological interventions for patients with breast cancer, cognitive rehabilitation and physical activity were the most common, followed by cognitive behavioral therapy. The meta-analysis indicated that nonpharmacological interventions had a significant effect on attention (g = 0.83; 95% CI: 0.14 to 1.52; I 2 = 76%), immediate recall (g = 0.33; 95% CI: 0.18 to 0.49; I 2 = 0%), executive function (g = 0.25; 95% CI: 0.13 to 0.37; I 2 = 0%), and processing speed (g = 0.44; 95% CI: 0.14 to 0.73; I 2 = 51%) among objective cognitive functions, as well as subjective cognitive function (g = 0.68; 95% CI: 0.40 to 0.96; I 2 = 78%). Intervention type and mode of delivery were potential moderators for the effects of nonpharmacological interventions on cognitive functions. Conclusions Nonpharmacological interventions can improve subjective and objective cognitive functioning among patients with breast cancer undergoing cancer treatment. Therefore, it is necessary to provide nonpharmacological interventions by screening patients at high risk of cancer-related cognitive impairment. Systematic review registration CRD42021251709.
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12
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Tanay MAL, Armes J, Moss-Morris R, Rafferty AM, Robert G. A systematic review of behavioural and exercise interventions for the prevention and management of chemotherapy-induced peripheral neuropathy symptoms. J Cancer Surviv 2023; 17:254-277. [PMID: 33710510 PMCID: PMC9971149 DOI: 10.1007/s11764-021-00997-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 01/19/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Chemotherapy-induced peripheral neuropathy (CIPN) can result in functional difficulties. Pharmacological interventions used to prevent CIPN either show low efficacy or lack evidence to support their use and to date, duloxetine remains the only recommended treatment for painful CIPN. Non-pharmacological interventions such as exercise and behavioural interventions for CIPN exist. PURPOSE The aims were to (1) identify and appraise evidence on existing behavioural and exercise interventions focussed on preventing or managing CIPN symptoms, (2) describe psychological mechanisms of action by which interventions influenced CIPN symptoms, (3) determine the underpinning conceptual models that describe how an intervention may create behaviour change, (4) identify treatment components of each intervention and contextual factors, (5) determine the nature and extent of patient and clinician involvement in developing existing interventions and (6) summarise the relative efficacy or effectiveness of interventions to lessen CIPN symptoms and to improve quality of life, balance and muscle strength. METHODS A systematic search of Ovid Medline, Cochrane Library, EMBASE, PsycINFO, Health Management Information Consortium, Global Health and CINAHL was performed to identify articles published between January 2000 to May 2020, followed by OpenGrey search and hand-searching of relevant journals. Studies that explored behavioural and/or exercise interventions designed to prevent or improve symptoms of CIPN in adults who had received or were receiving neurotoxic chemotherapy for any type of cancer, irrespective of when delivered within the cancer pathway were included. RESULTS Nineteen randomised controlled trials and quasi-experimental studies which explored behavioural (n=6) and exercise (n=13) interventions were included. Four studies were rated as methodologically strong, ten were moderate and five were weak. Ten exercise and two behavioural interventions, including those that improved CIPN knowledge and self-management resources and facilitated symptom self-reporting, led to reduced CIPN symptoms during and/or after chemotherapy treatment. CONCLUSIONS The extent of potential benefits from the interventions was difficult to judge, due to study limitations. Future interventions should incorporate a clear theoretical framework and involve patients and clinicians in the development process. IMPLICATIONS FOR CANCER SURVIVORS Our findings show exercise interventions have beneficial effects on CIPN symptoms although higher quality research is warranted. Behavioural interventions that increase patient's CIPN knowledge, improve self-management capacity and enable timely access to symptom management led to reduced CIPN symptoms.
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Affiliation(s)
- Mary Anne Lagmay Tanay
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK.
| | - Jo Armes
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Rona Moss-Morris
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Anne Marie Rafferty
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Glenn Robert
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
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13
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Oldacres L, Hegarty J, O'Regan P, Murphy-Coakley NM, Saab MM. Interventions promoting cognitive function in patients experiencing cancer related cognitive impairment: A systematic review. Psychooncology 2023; 32:214-228. [PMID: 36443527 PMCID: PMC10107470 DOI: 10.1002/pon.6073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 11/17/2022] [Accepted: 11/22/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVE To examine the effect of interventions used to enhance cognitive function in patients experiencing cancer-related cognitive impairment. METHODS Studies including adults with a non-metastatic cancer who have received chemotherapy as part of their treatment and who have undergone interventions targeting cancer-related cognitive impairment were included. Studies involving patients with metastatic cancer and pre-existing cognitive deficits were excluded. Academic Search Complete, CINAHL Plus with full text, MEDLINE, Education Full Text, PsycARTICLES, PsycINFO, and ERIC were searched for studies published between January 2011 and September 2022. Data extraction and quality appraisal were conducted by two authors and cross-checked by the review team. Quality appraisal was conducted using 12 items from the Mixed Methods Appraisal Tool. Findings were presented narratively without meta-analysis. RESULTS Thirty-one studies were included. Interventions were categorised as integrative/complementary, cognitive behavioural therapy and compensatory strategies, exercise, psychoeducational/psychosocial, brain-training, and pharmacological. Over 100 instruments were identified, including the Functional Assessment of Cancer Therapy-Cognitive, Trail Making Tests-A and B, and instruments measuring secondary outcomes, including depression. Instruments often measured attention and concentration, language, memory, executive function, and/or patient-reported outcomes. Improvements were reported, with most studies measuring some or various aspects of cognitive functioning and very few studies measuring all domains of cognitive functioning, making it difficult to draw definitive conclusions about effectiveness. CONCLUSIONS Various interventions are available to treat cancer-related cognitive impairment. Outcome measurement was inconsistent and future research should prioritise using standardised measures. Current evidence, whilst not being definitive, suggests that certain interventions show greater promise than others, including cognitive behavioural therapy and brain training.
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Affiliation(s)
- Laura Oldacres
- School of Nursing & Midwifery, University College Cork, Cork, Ireland.,Bon Secours Hospital, Cork, Ireland
| | - Josephine Hegarty
- School of Nursing & Midwifery, University College Cork, Cork, Ireland
| | - Patricia O'Regan
- School of Nursing & Midwifery, University College Cork, Cork, Ireland
| | | | - Mohamad M Saab
- School of Nursing & Midwifery, University College Cork, Cork, Ireland
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Jassim GA, Doherty S, Whitford DL, Khashan AS. Psychological interventions for women with non-metastatic breast cancer. Cochrane Database Syst Rev 2023; 1:CD008729. [PMID: 36628983 PMCID: PMC9832339 DOI: 10.1002/14651858.cd008729.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Breast cancer is the most common cancer affecting women worldwide. It is a distressing diagnosis and, as a result, considerable research has examined the psychological sequelae of being diagnosed and treated for breast cancer. Breast cancer is associated with increased rates of depression and anxiety and reduced quality of life. As a consequence, multiple studies have explored the impact of psychological interventions on the psychological distress experienced after a diagnosis of breast cancer. This review is an update of a Cochrane Review first published in 2015. OBJECTIVES To assess the effect of psychological interventions on psychological morbidities and quality of life among women with non-metastatic breast cancer. SEARCH METHODS: We searched the Cochrane Breast Cancer Group Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov up to 16 March 2021. We also scanned the reference lists of relevant articles. SELECTION CRITERIA Randomised controlled trials that assessed the effectiveness of psychological interventions for women with non-metastatic breast cancer. DATA COLLECTION AND ANALYSIS Two review authors independently appraised, extracted data from eligible trials, and assessed risk of bias and certainty of the evidence using the GRADE approach. Any disagreement was resolved by discussion. Extracted data included information about participants, methods, the intervention and outcomes. MAIN RESULTS We included 60 randomised controlled trials comprising 7998 participants. The most frequent reasons for exclusion were non-randomised trials and the inclusion of women with metastatic disease. The updated review included 7998 randomised women; the original review included 3940 women. A wide range of interventions was evaluated. Most interventions were cognitive- or mindfulness-based, supportive-expressive, and educational. The interventions were mainly delivered face-to-face (56 studies) and in groups (50 studies) rather than individually (10 studies). Most intervention sessions were delivered on a weekly basis with an average duration of 14 hours. Follow-up time ranged from two weeks to 24 months. Pooled standardised mean differences (SMD) from baseline indicated that the intervention may reduce depression (SMD -0.27, 95% confidence interval (CI) -0.52 to -0.02; P = 0.04; 27 studies, 3321 participants, I2 = 91%, low-certainty evidence); anxiety (SMD -0.43, 95% CI -0.68 to -0.17; P = 0.0009; 22 studies, 2702 participants, I2 = 89%, low-certainty evidence); mood disturbance in the intervention group (SMD -0.18, 95% CI -0.31 to -0.04; P = 0.009; 13 studies, 2276 participants, I2 = 56%, low-certainty evidence); and stress (SMD -0.34, 95% (CI) -0.55 to -0.12; P = 0.002; 8 studies, 564 participants, I2 = 31%, low-certainty evidence). The intervention is likely to improve quality of life in the intervention group (SMD 0.78, 95% (CI) 0.32 to 1.24; P = 0.0008; 20 studies, 1747 participants, I2 = 95%, low-certainty evidence). Adverse events were not reported in any of the included studies. AUTHORS' CONCLUSIONS Based on the available evidence, psychological intervention may have produced favourable effects on psychological outcomes, in particular depression, anxiety, mood disturbance and stress. There was also an improvement in quality of life in the psychological intervention group compared to control group. Overall, there was substantial variation across the studies in the range of psychological interventions used, control conditions, measures of the same outcome and timing of follow-up.
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Affiliation(s)
- Ghufran A Jassim
- Department of Family & Community Medicine, Royal College of Surgeons in Ireland-Medical University of Bahrain (RCSI Bahrain), Busaiteen, Bahrain
| | - Sally Doherty
- Psychiatry, Royal College of Surgeons in Ireland- Medical University of Bahrain (RCSI Bahrain), Busaiteen, Bahrain
| | | | - Ali S Khashan
- School of Public Health, University College Cork, Cork, Ireland
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15
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Kukafka R, Kim S, Kim SH, Yoo SH, Sung JH, Oh EG, Kim N, Lee J. Digital Health Interventions for Adult Patients With Cancer Evaluated in Randomized Controlled Trials: Scoping Review. J Med Internet Res 2023; 25:e38333. [PMID: 36607712 PMCID: PMC9862347 DOI: 10.2196/38333] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 09/15/2022] [Accepted: 10/25/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Digital care has become an essential component of health care. Interventions for patients with cancer need to be effective and safe, and digital health interventions must adhere to the same requirements. OBJECTIVE The purpose of this study was to identify currently available digital health interventions developed and evaluated in randomized controlled trials (RCTs) targeting adult patients with cancer. METHODS A scoping review using the JBI methodology was conducted. The participants were adult patients with cancer, and the concept was digital health interventions. The context was open, and sources were limited to RCT effectiveness studies. The PubMed, CINAHL, Embase, Cochrane Library, Research Information Sharing Service, and KoreaMed databases were searched. Data were extracted and analyzed to achieve summarized results about the participants, types, functions, and outcomes of digital health interventions. RESULTS A total of 231 studies were reviewed. Digital health interventions were used mostly at home (187/231, 81%), and the web-based intervention was the most frequently used intervention modality (116/231, 50.2%). Interventions consisting of multiple functional components were most frequently identified (69/231, 29.9%), followed by those with the self-manage function (67/231, 29%). Web-based interventions targeting symptoms with the self-manage and multiple functions and web-based interventions to treat cognitive function and fear of cancer recurrence consistently achieved positive outcomes. More studies supported the positive effects of web-based interventions to inform decision-making and knowledge. The effectiveness of digital health interventions targeting anxiety, depression, distress, fatigue, health-related quality of life or quality of life, pain, physical activity, and sleep was subject to their type and function. A relatively small number of digital health interventions specifically targeted older adults (6/231, 2.6%) or patients with advanced or metastatic cancer (22/231, 9.5%). CONCLUSIONS This scoping review summarized digital health interventions developed and evaluated in RCTs involving adult patients with cancer. Systematic reviews of the identified digital interventions are strongly recommended to integrate digital health interventions into clinical practice. The identified gaps in digital health interventions for cancer care need to be reflected in future digital health research.
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Affiliation(s)
| | - Sanghee Kim
- College of Nursing and Mo-im Kim Nursing Research Institute, Yonsei Evidence Based Nursing Center of Korea: Affiliation of the Joanna Briggs Institution, Yonsei University, Seoul, Republic of Korea
| | - Soo Hyun Kim
- Department of Nursing, Inha University, Inchon, Republic of Korea
| | - Sung-Hee Yoo
- College of Nursing, Chonnam National University, Gwangju, Republic of Korea
| | - Ji Hyun Sung
- College of Nursing, Kosin University, Busan, Republic of Korea
| | - Eui Geum Oh
- College of Nursing and Mo-im Kim Nursing Research Institute, Yonsei Evidence Based Nursing Center of Korea: Affiliation of the Joanna Briggs Institution, Yonsei University, Seoul, Republic of Korea
| | - Nawon Kim
- Yonsei Medical Library, Yonsei University, Seoul, Republic of Korea
| | - Jiyeon Lee
- College of Nursing and Mo-im Kim Nursing Research Institute, Yonsei Evidence Based Nursing Center of Korea: Affiliation of the Joanna Briggs Institution, Yonsei University, Seoul, Republic of Korea
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16
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Lozano-Lozano M, Galiano-Castillo N, Gonzalez-Santos A, Ortiz-Comino L, Sampedro-Pilegaard M, Martín-Martín L, Arroyo-Morales M. Effect of mHealth plus occupational therapy on cognitive function, mood and physical function in people after cancer: Secondary analysis of a randomized controlled trial. Ann Phys Rehabil Med 2022; 66:101681. [PMID: 35671976 DOI: 10.1016/j.rehab.2022.101681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 04/29/2022] [Accepted: 05/07/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Medical and surgical treatments for breast cancer have various adverse effects. Both mobile health and supervised intervention strategies have been implemented to overcome these effects, but some gaps remain to be addressed. Scientific evidence for the effectiveness of occupational therapy in cancer is limited. OBJECTIVE To compare the clinical effectiveness of the BENECA mHealth app used alone or combined with an integral supervised rehabilitation strategy that focused on cognitive performance, mood state, functional capacity, and cancer-related pain and fatigue in overweight women after breast cancer. METHODS In this secondary analysis of an assessor-blinded randomized controlled clinical trial, 80 overweight women after breast cancer (stage I-IIIA) were randomly allocated to an integral approach group (IA; n=40) or a control group (CG; n=40). All participants participated in an 8-week intervention. Assessments were performed at baseline, 8 weeks, and 6 months and included cognitive performance (Trial Making Test and Wechsler Adult Intelligence Scale), psychological state (Hospital Anxiety and Depression Scale), pain (Brief Pain Inventory), fatigue (Piper Fatigue Scale), and physical function (6 min walk test). An intention-to-treat analysis was conducted with analysis of covariance. RESULTS Selective attention (TMT) was significantly higher in the IA group, with a moderate to large effect size for TMT A (T2: d=1.1; T 3: d=1.2), working memory and processing speed (WAIS), anxiety and general HADS score (d=1.6), and functional capacity at 8 weeks and 6 months (d=1.5). Fatigue perception (mean difference, -0.6; 95% CI -1.4 to 0.04; p=0.009) and pain (intensity level p<0.001; interference level p=0.002) were also significantly more improved in the IA group. CONCLUSIONS An integral strategy involving the BENECA mHealth app with a supervised, multimodal intervention improved cognitive, psychological, and functional performance in women after breast cancer more than mHealth alone. Occupational therapy has a role to play in breast cancer rehabilitation.
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Affiliation(s)
- Mario Lozano-Lozano
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Spain; Sport and Health Joint University Institute (iMUDS), Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; "Cuídate" Support Unit for Oncology Patients, Granada, Spain; Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain
| | - Noelia Galiano-Castillo
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Spain; Sport and Health Joint University Institute (iMUDS), Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; "Cuídate" Support Unit for Oncology Patients, Granada, Spain; Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain
| | - Angela Gonzalez-Santos
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Spain; Sport and Health Joint University Institute (iMUDS), Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; "Cuídate" Support Unit for Oncology Patients, Granada, Spain; Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain
| | - Lucía Ortiz-Comino
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Spain; Sport and Health Joint University Institute (iMUDS), Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; "Cuídate" Support Unit for Oncology Patients, Granada, Spain
| | - Marc Sampedro-Pilegaard
- The Research Initiative of Activity Studies and Occupational Therapy, Department of Public Health, University of Southern Denmark, Denmark; REHPA, the Danish Knowledge Centre for Rehabilitation and Palliative care, Odense University Hospital, Denmark
| | - Lydia Martín-Martín
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Spain; Sport and Health Joint University Institute (iMUDS), Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; "Cuídate" Support Unit for Oncology Patients, Granada, Spain; Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain.
| | - Manuel Arroyo-Morales
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Spain; Sport and Health Joint University Institute (iMUDS), Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; "Cuídate" Support Unit for Oncology Patients, Granada, Spain; Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain
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Ferguson RJ, Manculich J, Chang H, Sareen NJ, Snitz BE, Terhorst L, Bovbjerg DH, Duensing AU. Self-reported cognitive impairments and quality of life in patients with gastrointestinal stromal tumor: Results of a multinational survey. Cancer 2022; 128:4017-4026. [PMID: 36125989 PMCID: PMC9633548 DOI: 10.1002/cncr.34469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 08/02/2022] [Accepted: 08/03/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Cancer-related cognitive impairment (CRCI) has long-term effects on survivor quality of life, but CRCI research on patients with gastrointestinal stromal tumor (GIST) is lacking. The aims of this study were to investigate CRCI and concomitant quality of life among patients with GIST. METHODS An online survey was used to assess CRCI in adult patients with GIST using the validated Functional Assessment of Cancer Therapy-Cognitive-v.3. Age, education, demographically indexed IQ, general health, and quality of life factors (e.g., fatigue, emotional distress) were also assessed. The online survey was administered through five international GIST and sarcoma support organizations. RESULTS Over the 3-month recruitment period, the survey was completed by 485 participants: mean age, 57.80 (SD, 11.51), median 5 years after diagnosis. A majority (63.91%) reported experiencing cognitive symptoms with a significant negative quality of life impact. Controlling for age, patients with GIST ≥5 years after diagnosis reported worse cognitive function than those <5 years after diagnosis (p < .05) but did not differ in educational level or IQ. Whereas longer term survivors were more likely to have been treated with tyrosine kinase inhibitor (TKI) therapies, there was no observed association of TKI therapy with self-reported cognitive impairments. CONCLUSIONS A majority of GIST patients report cognitive symptoms that have a negative impact on quality of life, with longer term survivors (≥5 years) tending to report more cognitive impairments. Given the success of TKI therapy to substantially increase overall survival of patients with GIST, addressing CRCI in clinical practice may improve long-term GIST survivor function and quality of life.
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Affiliation(s)
- Robert J. Ferguson
- Biobehavioral Cancer Control ProgramUPMC Hillman Cancer CenterPittsburghPennsylvaniaUSA,Department of MedicineUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Jessica Manculich
- Biobehavioral Cancer Control ProgramUPMC Hillman Cancer CenterPittsburghPennsylvaniaUSA
| | - Hsuan Chang
- Biobehavioral Cancer Control ProgramUPMC Hillman Cancer CenterPittsburghPennsylvaniaUSA,Present address:
Hsuan Chang does not currently have an academic or corporate affiliation
| | - Nikita J. Sareen
- Biobehavioral Cancer Control ProgramUPMC Hillman Cancer CenterPittsburghPennsylvaniaUSA,Cancer Therapeutics ProgramUPMC Hillman Cancer CenterPittsburghPennsylvaniaUSA,Present address:
University of Florida, College of MedicineGainesvilleFloridaUSA
| | - Beth E. Snitz
- Department of NeurologyUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Lauren Terhorst
- School of Health and Rehabilitation Sciences Data CenterUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Dana H. Bovbjerg
- Biobehavioral Cancer Control ProgramUPMC Hillman Cancer CenterPittsburghPennsylvaniaUSA,Department of PsychiatryUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Anette U. Duensing
- Cancer Therapeutics ProgramUPMC Hillman Cancer CenterPittsburghPennsylvaniaUSA,Department of PathologyUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
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18
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Liu T, Xu J, Cheng H, Zhang Y, Wang S, Lin L, Tian L. Effects of internet-based cognitive behavioral therapy on anxiety and depression symptoms in cancer patients: A meta-analysis. Gen Hosp Psychiatry 2022; 79:135-145. [PMID: 36375342 DOI: 10.1016/j.genhosppsych.2022.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/17/2022] [Accepted: 09/19/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE This meta-analysis was to critically evaluate the effects of Internet-based cognitive behavioral therapy (ICBT) on the symptoms of anxiety and depression in cancer patients. METHODS Eight Chinese and English databases (CNKI, Wanfang, VIP, CBM, Cochrane Library, PubMed, Embase, and PsycINFO) were systematically searched from the inception of databases to May 2022 for relevant randomized controlled trials (RCTs). According to the Cochrane Collaboration criteria, two reviewers independently assessed the risk of bias and extract data from included studies. All analyses were performed with Review Manager 5.4. RESULTS Thirteen qualified studies were included in the meta-analysis, twelve of which reported the effect of ICBT on anxiety in 2079 cancer patients; thirteen of the studies reported the effect of ICBT on depression in 2179 patients. The meta-analysis indicated that ICBT was effective in improving anxiety [SMD = -0.37, 95%CI (-0.62, -0.12), P < 0.01, I2 = 86%] and depression [SMD = -0.27, 95%CI (-0.44, -0.09), P < 0.01, I2 = 72%] symptoms in cancer patients, especially those undergoing anti-cancer treatment. Therapist-guided ICBT was more effective than self-directed ICBT. ICBT lasting for ≤12 weeks could relieve anxiety and depressive symptoms of cancer patients. ICBT with number of modules ≥5 had a small effect on anxiety and depression relief while ICBT with number of modules <5 was found to be ineffective. CONCLUSIONS ICBT lasting for ≤12 weeks, especially therapist-directed, helps relieve the anxiety and depressive symptoms of cancer patients. The ideal number of modules for ICBT and its long-term efficacy need to be validated by more studies of higher-quality.
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Affiliation(s)
- Tingting Liu
- The First Affiliated Hospital of Soochow University, Suzhou 215006, People's Republic of China; School of Nursing, Medical College of Soochow University, Suzhou 215006, People's Republic of China
| | - Juan Xu
- The First Affiliated Hospital of Soochow University, Suzhou 215006, People's Republic of China
| | - Hui Cheng
- School of Nursing, Medical College of Soochow University, Suzhou 215006, People's Republic of China
| | - Yueyue Zhang
- School of Nursing, Medical College of Soochow University, Suzhou 215006, People's Republic of China
| | - Shaotong Wang
- School of Nursing, Medical College of Soochow University, Suzhou 215006, People's Republic of China
| | - Lu Lin
- The First Affiliated Hospital of Soochow University, Suzhou 215006, People's Republic of China; School of Nursing, Medical College of Soochow University, Suzhou 215006, People's Republic of China.
| | - Li Tian
- The First Affiliated Hospital of Soochow University, Suzhou 215006, People's Republic of China; School of Nursing, Medical College of Soochow University, Suzhou 215006, People's Republic of China.
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Addison S, Shirima D, Aboagye-Mensah EB, Dunovan SG, Pascal EY, Lustberg MB, Arthur EK, Nolan TS. Effects of tandem cognitive behavioral therapy and healthy lifestyle interventions on health-related outcomes in cancer survivors: a systematic review. J Cancer Surviv 2022; 16:1023-1046. [PMID: 34357555 PMCID: PMC8342979 DOI: 10.1007/s11764-021-01094-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/23/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE Healthy lifestyle (HL) behaviors and cognitive behavioral therapy (CBT) have been individually shown to improve adverse effects of cancer treatment. Little is known about how such programs in tandem affect health-related outcomes. This review evaluates extant literature on tandem CBT/HL interventions on health-related outcomes in cancer survivors. METHODS A comprehensive search of PubMed, PsychINFO, CINAHL, and Embase databases revealed numerous studies involving CBT and HL tandem interventions in cancer survivors in the last 20 years. Studies meeting the inclusion criteria were examined and assessed by the authors. RESULTS The 36 studies included 5199 participants. Interventions involved the use of CBT in combination with a HL condition (stress reduction, increasing physical activity, etc.). These tandem conditions were compared against no intervention, usual care, and/or CBT alone or HL alone. Interventions were delivered by a variety of interventionists, and over different durations. The most common HL target outcomes were stress, and insomnia. Most studies (31 of 36) reported a reduction in adverse treatment and/or cancer-related effects. CONCLUSION Findings were biased with the overrepresentation of breast cancer survivors, and underrepresentation of minority groups, and those with advanced cancer. Thus, this review highlights the need for further research to test tandem interventions against CBT alone and HL alone, and toward identifying the most efficacious interventions for dissemination and implementation across diverse groups of cancer survivors. Implications for cancer survivors Tandem CBT/HL interventions can improve health-related outcomes for cancer survivors when compared to usual care, but there is a paucity of knowledge to suggest differential outcomes when compared to CBT or HL alone.
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Affiliation(s)
- Sarah Addison
- The Ohio State College of Medicine, 370 West 9th Avenue, Columbus, OH 43210 USA
| | - Damalie Shirima
- The Ohio State University Comprehensive Cancer, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, 460 W 10th Ave, Columbus, OH 43210 USA
| | | | - Shanon G. Dunovan
- College of Nursing, University of Nebraska Medical Center, 4111 Dewey Ave, Omaha, NE 68198 USA
| | - Esther Y. Pascal
- Department of Microbiology, College of Arts and Sciences, The Ohio State University, 281 W Lane Ave, Columbus, OH 43210 USA
| | - Maryam B. Lustberg
- The Ohio State University Comprehensive Cancer, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, 460 W 10th Ave, Columbus, OH 43210 USA
- Department of Internal Medicine, Division of Medical Oncology, College of Medicine, The Ohio State University, 370 West 9th Avenue, Columbus, OH 43210 USA
| | - Elizabeth K. Arthur
- The Ohio State University Comprehensive Cancer, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, 460 W 10th Ave, Columbus, OH 43210 USA
- The Ohio State College of Nursing, 1585 Neil Avenue, Columbus, OH 43210 USA
| | - Timiya S. Nolan
- The Ohio State University Comprehensive Cancer, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, 460 W 10th Ave, Columbus, OH 43210 USA
- The Ohio State College of Nursing, 1585 Neil Avenue, Columbus, OH 43210 USA
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20
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Sleight A, Gerber LH, Marshall TF, Livinski A, Alfano CM, Harrington S, Flores AM, Virani A, Hu X, Mitchell SA, Varedi M, Eden M, Hayek S, Reigle B, Kerkman A, Neves R, Jablonoski K, Hacker ED, Sun V, Newman R, McDonnell KK, L'Hotta A, Schoenhals A, Dpt NLS. Systematic Review of Functional Outcomes in Cancer Rehabilitation. Arch Phys Med Rehabil 2022; 103:1807-1826. [PMID: 35104445 PMCID: PMC9339032 DOI: 10.1016/j.apmr.2022.01.142] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To systematically review the evidence regarding rehabilitation interventions targeting optimal physical or cognitive function in adults with a history of cancer and describe the breadth of evidence as well as strengths and limitations across a range of functional domains. DATA SOURCES PubMed, Cumulative Index to Nursing and Allied Health Plus, Scopus, Web of Science, and Embase. The time scope was January 2008 to April 2019. STUDY SELECTION Prospective, controlled trials including single- and multiarm cohorts investigating rehabilitative interventions for cancer survivors at any point in the continuum of care were included, if studies included a primary functional outcome measure. Secondary data analyses and pilot/feasibility studies were excluded. Full-text review identified 362 studies for inclusion. DATA EXTRACTION Extraction was performed by coauthor teams and quality and bias assessed using the American Academy of Neurology (AAN) Classification of Evidence Scheme (class I-IV). DATA SYNTHESIS Studies for which the functional primary endpoint achieved significance were categorized into 9 functional areas foundational to cancer rehabilitation: (1) quality of life (109 studies), (2) activities of daily living (61 studies), (3) fatigue (59 studies), (4) functional mobility (55 studies), (5) exercise behavior (37 studies), (6) cognition (20 studies), (7) communication (10 studies), (8) sexual function (6 studies), and (9) return to work (5 studies). Most studies were categorized as class III in quality/bias. Averaging results found within each of the functional domains, 71% of studies reported statistically significant results after cancer rehabilitation intervention(s) for at least 1 functional outcome. CONCLUSIONS These findings provide evidence supporting the efficacy of rehabilitative interventions for individuals with a cancer history. The findings should be balanced with the understanding that many studies had moderate risk of bias and/or limitations in study quality by AAN criteria. These results may provide a foundation for future work to establish clinical practice guidelines for rehabilitative interventions across cancer disease types.
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Affiliation(s)
- Alix Sleight
- Department of Physical Medicine and Rehabilitation, Cedars-Sinai Medical Center, Los Angeles, California, United States; Center for Integrated Research in Cancer and Lifestyle (CIRCL), Cedars-Sinai Medical Center, Los Angeles, California, United States; Cedars Sinai Cancer, Los Angeles, California, United States; Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, United States.
| | - Lynn H Gerber
- College of Health and Human Services, George Mason University, Fairfax County, Virginia, United States; Inova Health System, Inova Medicine Services, Falls Church, Virginia, United States
| | | | - Alicia Livinski
- National Institutes of Health Library, Office of Research Services, National Institutes of Health, Bethesda, Maryland, United States
| | - Catherine M Alfano
- Northwell Health Cancer Institute, New Hyde Park, New York, United States; Center for Personalized Health, Feinstein Institutes for Medical Research, Manhasset, New York, United States; Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, United States
| | - Shana Harrington
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States
| | - Ann Marie Flores
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States; Robert H. Lurie Comprehensive Cancer Center, Cancer Survivorship Institute, Chicago, Illinois, United States
| | - Aneesha Virani
- Rehabilitation Department, Northside Hospital, Atlanta, Georgia, United States
| | - Xiaorong Hu
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Boston, Massachusetts, United States; Rehabilitation Medicine School, Nanjing Medical University, Nanjing, China
| | - Sandra A Mitchell
- Outcomes Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, United States
| | - Mitra Varedi
- Epidemiology and Cancer Control Department, St Jude Children's Research Hospital, Memphis, Tennessee, United States
| | - Melissa Eden
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Scottsdale, Arizona, United States
| | - Samah Hayek
- Clalit Health Services, Clalit Research Institute, Ramat-Gan, Israel
| | - Beverly Reigle
- College of Nursing, University of Cincinnati, Cincinnati, Ohio, United States
| | - Anya Kerkman
- Lincoln Cancer Rehabilitation, Lincoln, Nebraska, United States; CHI Health St Elizabeth, Lincoln, Nebraska, United States
| | - Raquel Neves
- Czech Rehabilitation Hospital, Al Ain, United Arab Emirates
| | - Kathleen Jablonoski
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, United States; Department of Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | - Eileen Danaher Hacker
- Department of Science of Nursing Care, Indiana University School of Nursing, Indianapolis, Indiana, United States
| | - Virginia Sun
- Department of Population Sciences, City of Hope, Duarte, California, United States; Department of Surgery, City of Hope, Duarte, California, United States
| | - Robin Newman
- Department of Occupational Therapy, Boston University College of Health and Rehabilitation Sciences: Sargent College, Boston, Massachusetts, United States
| | - Karen Kane McDonnell
- College of Nursing, University of South Carolina, Columbia, South Carolina, United States
| | - Allison L'Hotta
- Department of Occupational Therapy, Washington University in St Louis, St Louis, Missouri, United States
| | - Alana Schoenhals
- Mrs T.H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, United States
| | - Nicole L Stout Dpt
- West Virginia University Cancer Institute, West Virginia University School of Public Health, Morgantown, West Virginia, United States; Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, United States
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21
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Yilmaz S, Janelsins MC, Flannery M, Culakova E, Wells M, Lin PJ, Loh KP, Epstein R, Kamen C, Kleckner AS, Norton SA, Plumb S, Alberti S, Doyle K, Porto M, Weber M, Dukelow N, Magnuson A, Kehoe LA, Nightingale G, Jensen-Battaglia M, Mustian KM, Mohile SG. Protocol paper: Multi-site, cluster-randomized clinical trial for optimizing functional outcomes of older cancer survivors after chemotherapy. J Geriatr Oncol 2022; 13:892-903. [PMID: 35292232 PMCID: PMC9283231 DOI: 10.1016/j.jgo.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/01/2022] [Accepted: 03/04/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Cancer survivors over the age of 65 have unique needs due to the higher prevalence of functional and cognitive impairment, comorbidities, geriatric syndromes, and greater need for social support after chemotherapy. In this study, we will evaluate whether a Geriatric Evaluation and Management-Survivorship (GEMS) intervention improves functional outcomes important to older cancer survivors following chemotherapy. METHODS A cluster-randomized trial will be conducted in approximately 30 community oncology practices affiliated with the University of Rochester Cancer Center (URCC) National Cancer Institute Community Oncology Research Program (NCORP) Research Base. Participating sites will be randomized to the GEMS intervention, which includes Advanced Practice Practitioner (APP)-directed geriatric evaluation and management (GEM), and Survivorship Health Education (SHE) that is combined with Exercise for Cancer Patients (EXCAP©®), or usual care. Cancer survivors will be recruited from community oncology practices (of participating oncology physicians and APPs) after the enrolled clinicians have consented and completed a baseline survey. We will enroll 780 cancer survivors aged 65 years and older who have completed curative-intent chemotherapy for a solid tumor malignancy within four weeks of study enrollment. Cancer survivors will be asked to choose one caregiver to also participate for a total up to 780 caregivers. The primary aim is to compare the effectiveness of GEMS for improving patient-reported physical function at six months. The secondary aim is to compare effectiveness of GEMS for improving patient-reported cognitive function at six months. Tertiary aims include comparing the effectiveness of GEMS for improving: 1) Patient-reported physical function at twelve months; 2) objectively assessed physical function at six and twelve months; and 3) patient-reported cognitive function at twelve months and objectively assessed cognitive function at six and twelve months. Exploratory health care aims include: 1) Survivor satisfaction with care, 2) APP communication with primary care physicians (PCPs), 3) completion of referral appointments, and 4) hospitalizations at six and twelve months. Exploratory caregiver aims include: 1) Caregiver distress; 2) caregiver quality of life; 3) caregiver burden; and 4) satisfaction with patient care at six and twelve months. DISCUSSION If successful, GEMS would be an option for a standardized APP-led survivorship care intervention. TRIAL REGISTRATION ClinicalTrials.govNCT05006482, registered on August 9, 2021.
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Affiliation(s)
- S Yilmaz
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA; Geriatric Oncology Research, James P Wilmot Cancer Institute, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA.
| | - M C Janelsins
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA
| | - M Flannery
- School of Nursing, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA
| | - E Culakova
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA
| | - M Wells
- Geriatric Oncology Research, James P Wilmot Cancer Institute, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA
| | - P-J Lin
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA
| | - K P Loh
- Division of Hematology/Oncology, Department of Medicine, James P Wilmot Cancer Institute, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA
| | - R Epstein
- Department of Family Medicine Research, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA
| | - C Kamen
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA
| | - A S Kleckner
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, USA
| | - S A Norton
- School of Nursing, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA
| | - S Plumb
- Geriatric Oncology Research, James P Wilmot Cancer Institute, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA
| | - S Alberti
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA
| | - K Doyle
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA
| | - M Porto
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA
| | - M Weber
- Department of Neurology, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA
| | - N Dukelow
- Department of Medicine, Physical Medicine and Rehabilitation, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA
| | - A Magnuson
- Division of Hematology/Oncology, Department of Medicine, James P Wilmot Cancer Institute, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA
| | - L A Kehoe
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA
| | - G Nightingale
- Department of Pharmacy Practice, Jefferson College of Pharmacy, Thomas Jefferson University, Philadelphia, PA, USA
| | - M Jensen-Battaglia
- Geriatric Oncology Research, James P Wilmot Cancer Institute, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA
| | - K M Mustian
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA
| | - S G Mohile
- Geriatric Oncology Research, James P Wilmot Cancer Institute, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA; Division of Hematology/Oncology, Department of Medicine, James P Wilmot Cancer Institute, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA
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22
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Abstract
Background: Some levothyroxine (LT4)-treated hypothyroid patients report a constellation of persistent and distressing cognitive symptoms that has been termed brain fog. This narrative review focuses on attempts to define and measure hypothyroid-associated brain fog, summarize possible etiologies and contributing factors, present treatment options, and propose avenues for future research. Methods: Published literature was reviewed to summarize available information on patient-reported symptoms associated with brain fog in hypothyroidism, as well as objective evidence of impairment based on neurocognitive testing and functional imaging studies. Given the limited information specific for hypothyroid-associated brain fog, relevant data from other medical conditions associated with brain fog were also reviewed and incorporated into recommendations for clinical care and future research areas. Results: Hypothyroid-associated brain fog has not been well defined or quantitated, and the underlying pathophysiology is unclear. Symptoms vary among patients but commonly include fatigue, depressed mood, and cognitive difficulties in the areas of memory and executive function. Symptoms often predate the diagnosis of hypothyroidism, and the magnitude of cognitive impairment can range from mild to severe. Regardless of severity, these symptoms are associated with impaired quality of life and cause dissatisfaction with treatment, so often lead to requests for alternate therapies. Disease-specific and psychological factors impact the experience of brain fog in complex ways, including potential limitations in LT4 monotherapy, self-knowledge of a disease state, and expectations for therapeutic effects. Conclusions: Brain fog is a variable symptom complex in people with hypothyroidism, causing significant distress and diminished quality of life. In the absence of proven therapies, individualized treatment plans are recommended, which incorporate thyroid-specific, general medical, and psychosocial approaches. In particular, cognitive rehabilitation is an underutilized technique that is beneficial in other medical conditions associated with brain fog and could improve symptoms in hypothyroid people. The limitations in our current knowledge and questions presented throughout this review highlight a major need for clinical research in this understudied area. Future research should include attention to standardization of survey instruments to quantitate brain fog in hypothyroid people, as well as rigorously designed intervention studies.
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Affiliation(s)
- Mary H. Samuels
- Division of Endocrinology, Diabetes and Clinical Nutrition, Oregon Health & Science University, Portland, Oregon, USA
| | - Lori J. Bernstein
- Department of Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
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23
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A Telehealth-Based Cognitive-Adaptive Training (e-OTCAT) to Prevent Cancer and Chemotherapy-Related Cognitive Impairment in Women with Breast Cancer: Protocol for a Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127147. [PMID: 35742400 PMCID: PMC9222777 DOI: 10.3390/ijerph19127147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/02/2022] [Accepted: 06/08/2022] [Indexed: 12/24/2022]
Abstract
Background: Many women with breast cancer experience a great number of side effects, such as cognitive impairment, during and after chemotherapy that reduces their quality of life. Currently, research focusing on the use of non-pharmacological, and specifically telehealth interventions to prevent or mitigate them has been insufficient. Methods: This protocol describes a randomized controlled trial aimed at studying the preventive effects of a videoconferenced cognitive-adaptive training (e-OTCAT) program (ClinicalTrials.gov NCT04783402). A number of 98 eligible participants will be randomized to one of the following groups: (a) the experimental group receiving the e-OTCAT program during 12 consecutive weeks since the beginning of chemotherapy; and (b) the control group receiving and educational handbook and usual care. The primary outcome will be the cognitive function. Secondary measures will be psychological distress, fatigue, sleep disturbance, quality of life and occupational performance. The time-points for these measures will be placed at baseline, after 12 weeks and six months of post-randomization. Conclusion: This trial may support the inclusion of multidimensional interventions through a telehealth approach in a worldwide growing population suffering from breast cancer, emphasizing the prevention of cognitive impairment as one of the side effects of cancer and its treatments.
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24
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Hoogland AI, Barata A, Logue J, Kommalapati A, Hyland KA, Nelson AM, Eisel SL, Small BJ, James BW, Christy SM, Bulls HW, Booth-Jones M, Jayani RV, Jain MD, Mokhtari S, Chavez JC, Lazaryan A, Shah BD, Locke FL, Jim HS. Change in Neurocognitive Performance Among Patients with Non-Hodgkin Lymphoma in the First Year after Chimeric Antigen Receptor T Cell Therapy. Transplant Cell Ther 2022; 28:305.e1-305.e9. [PMID: 35378330 PMCID: PMC9197947 DOI: 10.1016/j.jtct.2022.03.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/11/2022] [Accepted: 03/28/2022] [Indexed: 01/31/2023]
Abstract
The success of chimeric antigen receptor (CAR) T cell therapy in treating patients with relapsed/refractory hematologic malignancies is leading to a growing number of survivors treated with this regimen. To our knowledge, no previous studies have examined neurocognitive performance in adult CAR T cell therapy recipients, despite high rates of neurotoxicity and cytokine release syndrome (CRS) in the acute treatment period. This study examined changes in neurocognitive performance in the first year after CAR T cell therapy for non-Hodgkin lymphoma (NHL). Putative risk factors for worsening neurocognitive performance (eg, neurotoxicity, CRS) were explored as well. Neurocognition was assessed before initiation of CAR T cell therapy and at 30, 90, and 360 days post-treatment. Clinical variables were abstracted from medical records. Mixed models were used to examine change in total neurocognitive performance (TNP) and cognitive domains (ie, attention, executive function, verbal ability, immediate and delayed memory, and visuospatial abilities). Among 117 participants (mean age, 61 years; 62% male), TNP and executive function declined slightly on average from baseline to day 90 and then improved from day 90 to day 360 (P < .04). Small but significant linear declines in visuospatial ability on average were also observed over time (P = .03). Patients who had 4 or more lines of previous therapy and those with worse neurotoxicity (but not CRS) demonstrated worse TNP. CAR T cell therapy recipients reported transient or persistent deterioration in several cognitive domains, although changes were slight. These findings may be useful when educating future patients on what to expect when receiving CAR T cell therapy.
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Affiliation(s)
- Aasha I. Hoogland
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL
| | - Anna Barata
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL
| | - Jennifer Logue
- Department of Blood and Marrow Transplantation and Cellular Therapy, Moffitt Cancer Center, Tampa, FL
| | - Anuhya Kommalapati
- Department of Blood and Marrow Transplantation and Cellular Therapy, Moffitt Cancer Center, Tampa, FL
| | - Kelly A. Hyland
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL
| | - Ashley M. Nelson
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL
| | - Sarah L. Eisel
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL
| | - Brent J. Small
- School of Aging Studies, University of South Florida, Tampa, FL
| | - Brian W. James
- Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Shannon M. Christy
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL
| | - Hailey W. Bulls
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL
| | | | - Reena V. Jayani
- Department of Blood and Marrow Transplantation and Cellular Therapy, Moffitt Cancer Center, Tampa, FL
| | - Michael D. Jain
- Department of Blood and Marrow Transplantation and Cellular Therapy, Moffitt Cancer Center, Tampa, FL
| | | | - Julio C. Chavez
- Department of Blood and Marrow Transplantation and Cellular Therapy, Moffitt Cancer Center, Tampa, FL
| | - Aleksandr Lazaryan
- Department of Blood and Marrow Transplantation and Cellular Therapy, Moffitt Cancer Center, Tampa, FL
| | - Bijal D. Shah
- Department of Blood and Marrow Transplantation and Cellular Therapy, Moffitt Cancer Center, Tampa, FL
| | - Frederick L. Locke
- Department of Blood and Marrow Transplantation and Cellular Therapy, Moffitt Cancer Center, Tampa, FL
| | - Heather S.L. Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL
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25
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Mackenzie L, Marshall K. Effective non-pharmacological interventions for cancer related cognitive impairment in adults (excluding central nervous system or head and neck cancer): systematic review and meta-analysis. Eur J Phys Rehabil Med 2022; 58:258-270. [PMID: 34498828 PMCID: PMC9980504 DOI: 10.23736/s1973-9087.21.06898-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Cancer-related cognitive impairment (CRCI) is prevalent in cancer survivors, and impairments affect daily living tasks and overall wellbeing. This review aimed to identify and evaluate published randomized controlled trials (RCTs) of interventions to manage CRCI in adult populations, to analyze their effectiveness and to investigate the quality of the studies. EVIDENCE ACQUISITION Seven databases were searched (Medline, Scopus, CINAHL, AMED, PsychINFO, OTseeker, and the Cochrane Database of Systematic Reviews), including years 2005-2020, for randomized controlled trials (RCTs) investigating interventions to address cognition for adults with cancer. The final search was conducted in February 2021. The quality of studies was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for RCTs. Meta-analysis used comprehensive meta-analysis software. The study protocol was registered with PROSPERO (registration N. CRD42017076868). EVIDENCE SYNTHESIS A total of 45 studies involving 4727 participants examined interventions for CRCI and met selection criteria. Categories of interventions included cognitive training-based intervention (N.=15), cognitive behavior therapy (CBT) (N.=4), physical activity (N.=16) and other supportive therapies (N.=10). Meta-analysis indicated beneficial overall effects for all categories of interventions: cognitive training (standardized mean difference [SMD]=0.41, 95% CI: 0.28-0.53, I2=88.87%); CBT (SMD=0.30, 95% CI: 0.14-0.46, I2=44.86%); physical activity (SMD=0.27, 95% CI: 0.20-0.35, I2=37.67%); and supportive therapies (SMD=0.27, 95% CI: 0.16-0.39, I2=64.94%). Studies used self-report cognitive outcome measures and neurocognitive testing, or a mixture. CONCLUSIONS Findings suggest that effective intervention for CRCI exist, and cognitive training is consistently supported as an effective intervention; however, a high level of heterogeneity was found. CRCI research is currently dominated by breast cancer survivors, and quality research is also needed to address the broader population of cancer survivors who experience CRCI.
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Affiliation(s)
- Lynette Mackenzie
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia -
| | - Kelsey Marshall
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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26
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Cheng ASK, Wang X, Niu N, Liang M, Zeng Y. Neuropsychological Interventions for Cancer-Related Cognitive Impairment: A Network Meta-Analysis of Randomized Controlled Trials. Neuropsychol Rev 2022; 32:893-905. [PMID: 35091967 DOI: 10.1007/s11065-021-09532-1] [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: 05/02/2021] [Accepted: 11/11/2021] [Indexed: 01/17/2023]
Abstract
The aim of this network meta-analysis was to evaluate the comparative effects of neuropsychological interventions for cancer-related cognitive impairment (CRCI), and to rank the best intervention options for adult cancer patients with CRCI. Twenty-seven eligible randomized controlled trials (RCTs) were searched, and a total of six interventions identified: cognitive behavioral therapies (CBT), cognitive rehabilitation (CR), cognitive training (CT), meditation/mindfulness-based interventions, psychoeducation, and supportive care. In terms of effectiveness, the relative effect size of CBT, CR, and CT in managing subjective cognition had statistically significant differences - 0.94 (0.43-1.44), 0.54 (0.03-1.05), and 0.47 (0.13-0.81), respectively. The most effective interventions to manage the objective cognition of attention were meditation or mindfulness-based interventions: intervention effect size was 0.58 (0.24-0.91). The relative effect size of CT had a statistically significant difference in managing verbal memory, and the intervention effect size was 1.16 (0.12-2.20). The relative effect size of psychoeducation in managing executive function compared with control had a statistically significant difference, which was 0.56 (0.26-0.86). For managing information processing speed, the most effective intervention was CT and the effect size was -0.58 (-1.09--0.06). This network meta-analysis found that CT is the most effective intervention for managing the objective cognition of verbal memory and processing speed; meditation/mindfulness-based interventions may be the best option for enhancing attention; psychoeducation is the most effective intervention for managing executive function; CT may be the best option for managing verbal fluency as the intervention ranking probability. For the management of subjective cognition, CBT may be the most effective intervention.
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Affiliation(s)
- Andy S K Cheng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Xiaoming Wang
- Institute of Neurological Diseases, Affiliated Hospital of North Sichuan Medical College, North Sichuan Medical College, Nanchong, China
| | - Niu Niu
- Department of Nursing, China Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Minyu Liang
- Department of Nursing, Home For The Aged Guangzhou, Guangzhou, China
| | - Yingchun Zeng
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, China.
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Országhová Z, Mego M, Chovanec M. Long-Term Cognitive Dysfunction in Cancer Survivors. Front Mol Biosci 2022; 8:770413. [PMID: 34970595 PMCID: PMC8713760 DOI: 10.3389/fmolb.2021.770413] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 11/17/2021] [Indexed: 12/12/2022] Open
Abstract
Cancer-related cognitive impairment (CRCI) is a frequent side effect experienced by an increasing number of cancer survivors with a significant impact on their quality of life. Different definitions and means of evaluation have been used in available literature; hence the exact incidence of CRCI remains unknown. CRCI can be described as cognitive symptoms reported by cancer patients in self-reported questionnaires or as cognitive changes evaluated by formal neuropsychological tests. Nevertheless, association between cognitive symptoms and objectively assessed cognitive changes is relatively weak or absent. Studies have focused especially on breast cancer patients, but CRCI has been reported in multiple types of cancer, including colorectal, lung, ovarian, prostate, testicular cancer and hematological malignancies. While CRCI has been associated with various treatment modalities, including radiotherapy, chemotherapy, hormone therapy and novel systemic therapies, it has been also detected prior to cancer treatment. Therefore, the effects of cancer itself with or without the psychological distress may be involved in the pathogenesis of CRCI as a result of altered coping mechanisms after cancer diagnosis. The development of CRCI is probably multifactorial and the exact mechanisms are currently not completely understood. Possible risk factors include administered treatment, genetic predisposition, age and psychological factors such as anxiety, depression or fatigue. Multiple mechanisms are suggested to be responsible for CRCI, including direct neurotoxic injury of systemic treatment and radiation while other indirect contributing mechanisms are hypothesized. Chronic neuroinflammation mediated by active innate immune system, DNA-damage or endothelial dysfunction is hypothesized to be a central mechanism of CRCI pathogenesis. There is increasing evidence of potential plasma (e.g., damage associated molecular patterns, inflammatory components, circulating microRNAs, exosomes, short-chain fatty acids, and others), cerebrospinal fluid and radiological biomarkers of cognitive dysfunction in cancer patients. Discovery of biomarkers of cognitive impairment is crucial for early identification of cancer patients at increased risk for the development of CRCI or development of treatment strategies to lower the burden of CRCI on long-term quality of life. This review summarizes current literature on CRCI with a focus on long-term effects of different cancer treatments, possible risk factors, mechanisms and promising biomarkers.
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Affiliation(s)
- Zuzana Országhová
- 2nd Department of Oncology, Faculty of Medicine, Comenius University and National Cancer Institute, Bratislava, Slovakia
| | - Michal Mego
- 2nd Department of Oncology, Faculty of Medicine, Comenius University and National Cancer Institute, Bratislava, Slovakia
| | - Michal Chovanec
- 2nd Department of Oncology, Faculty of Medicine, Comenius University and National Cancer Institute, Bratislava, Slovakia
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Turner K, Bobonis Babilonia M, Naso C, Nguyen O, Gonzalez BD, Oswald LB, Robinson E, Elston Lafata J, Ferguson RJ, Alishahi Tabriz A, Patel K, Hallanger-Johnson J, Aldawoodi N, Hong YR, Jim HSL, Speiss PE. Healthcare providers and professionals' experiences with telehealth oncology implementation during the COVID-19 pandemic: A qualitative study. J Med Internet Res 2021; 24:e29635. [PMID: 34907900 PMCID: PMC8772877 DOI: 10.2196/29635] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/07/2021] [Accepted: 12/15/2021] [Indexed: 01/12/2023] Open
Abstract
Background Rapid implementation of telehealth for cancer care during COVID-19 required innovative and adaptive solutions among oncology health care providers and professionals (HPPs). Objective The aim of this qualitative study was to explore oncology HPPs’ experiences with telehealth implementation during the COVID-19 pandemic. Methods This study was conducted at Moffitt Cancer Center (Moffitt), an NCI (National Cancer Institute)-Designated Comprehensive Cancer Center. Prior to COVID-19, Moffitt piloted telehealth visits on a limited basis. After COVID-19, Moffitt rapidly expanded telehealth visits. Telehealth visits included real-time videoconferencing between HPPs and patients and virtual check-ins (ie, brief communication with an HPP by telephone only). We conducted semistructured interviews with 40 oncology HPPs who implemented telehealth during COVID-19. The interviews were recorded, transcribed verbatim, and analyzed for themes using Dedoose software (version 4.12). Results Approximately half of the 40 participants were physicians (n=22, 55%), and one-quarter of the participants were advanced practice providers (n=10, 25%). Other participants included social workers (n=3, 8%), psychologists (n=2, 5%), dieticians (n=2, 5%), and a pharmacist (n=1, 3%). Five key themes were identified: (1) establishing and maintaining patient-HPP relationships, (2) coordinating care with other HPPs and informal caregivers, (3) adapting in-person assessments for telehealth, (4) developing workflows and allocating resources, and (5) future recommendations. Participants described innovative strategies for implementing telehealth, such as coordinating interdisciplinary visits with multiple HPPs and inviting informal caregivers (eg, spouse) to participate in telehealth visits. Health care workers discussed key challenges, such as workflow integration, lack of physical exam and biometric data, and overcoming the digital divide (eg, telehealth accessibility among patients with communication-related disabilities). Participants recommended policy advocacy to support telehealth (eg, medical licensure policies) and monitoring how telehealth affects patient outcomes and health care delivery. Conclusions To support telehealth growth, implementation strategies are needed to ensure that HPPs and patients have the tools necessary to effectively engage in telehealth. At the same time, cancer care organizations will need to engage in advocacy to ensure that policies are supportive of oncology telehealth and develop systems to monitor the impact of telehealth on patient outcomes, health care quality, costs, and equity.
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Affiliation(s)
- Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, MRC-CANCONT, Tampa, US
| | | | - Cristina Naso
- Virtual Health Program, Moffitt Cancer Center, Tampa, US
| | - Oliver Nguyen
- Department of Health Outcomes & Biomedical Information, University of Florida, Gainesville, US
| | - Brian D Gonzalez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, MRC-CANCONT, Tampa, US
| | - Laura B Oswald
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, MRC-CANCONT, Tampa, US
| | | | - Jennifer Elston Lafata
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill, Chapel Hill, US
| | | | - Amir Alishahi Tabriz
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, MRC-CANCONT, Tampa, US
| | - Krupal Patel
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, Tampa, US
| | | | | | - Young-Rock Hong
- Department of Health Services Research, Management and Policy, University of Florida, Tampa, US
| | - Heather S L Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, MRC-CANCONT, Tampa, US
| | - Philippe E Speiss
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, US
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Matsumoto K, Hamatani S, Shimizu E. Effectiveness of Videoconference-Delivered Cognitive Behavioral Therapy for Adults With Psychiatric Disorders: Systematic and Meta-Analytic Review. J Med Internet Res 2021; 23:e31293. [PMID: 34898445 PMCID: PMC8713091 DOI: 10.2196/31293] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/14/2021] [Accepted: 10/29/2021] [Indexed: 12/23/2022] Open
Abstract
Background Cognitive behavioral therapy (CBT) is the gold standard of psychotherapy for psychiatric disorders. However, the format of delivering CBT in person limits access to the intervention. The advancements in information and communication technology, especially the internet, present an opportunity for cognitive behavioral therapists to service patients or clients in remote areas through videoconferencing. Although many randomized controlled trials of videoconference-delivered cognitive behavioral therapy (VCBT) have already been conducted, the overall estimated effect size of VCBT for psychiatric disorders has not been examined by systematic reviews and meta-analyses. Objective This study attempts to evaluate the effectiveness of VCBT for psychiatric disorders through a systematic and meta-analytic review. Methods A systematic review and meta-analysis of studies in which VCBT was directly compared to control groups (such as treatment as usual, attention control, wait-list control, and other minimal supports) was carried out. To identify previous studies that meet our study objective, 2 independent reviewers undertook a systematic search through seven databases: MEDLINE (via PubMed), Web of Science, Science Direct, PsycINFO, CINAHL, LILACS, and SciELO. Other databases (ClinicalTrials.gov and Cochrane Central Resister of Controlled Trials) were also checked. All studies included in the review were assessed using the quality criteria of the Cochrane Collaboration. Statistical analysis was performed by using Cochrane Review Manager (RevMan, version 5.4.0). Standardized mean difference was used in major meta-analyses where a P value of .05 or less was the threshold for statistical significance. A heterogeneity test and the chi-square test were performed to assess the presence and extent of statistical heterogeneity with significance set at P<.10. Funnel plots were visually inspected to assess the risk of bias. Subgroup analyses were conducted for each disorder to estimate intervention effects. Results The systematic search resulted in 16 studies (total N=1745) that met the criteria for this study and were included in the review. There were 10 studies on depressive symptoms, 3 on chronic pain, 1 on generalized anxiety disorder, 1 on obsessive-compulsive disorder, and 1 on hypochondriasis. The quality and risk of bias was also assessed. Results showed a pooled effect size (Hedge g) post treatment of −0.49 (95% CI –0.68 to –0.29), indicating that VCBT is effective for clients with psychiatric disorders. Study quality did not affect outcomes. Conclusions While the overall results indicate the effectiveness of VCBT, there are still only a limited number of studies on specific psychiatric and somatic conditions. Therefore, more randomized controlled trials are needed to establish the effectiveness of VCBT for different disorders. Trial Registration International Prospective Register of Systematic Reviews (PROSPERO) CRD42021224832; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=224832
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Affiliation(s)
- Kazuki Matsumoto
- Research Center for Child Mental Development, Chiba University, Chiba, Japan.,Laboratory of Neuropsychology, Institute of Liberal Arts and Science, Kanazawa University, Kanazawa, Japan
| | - Sayo Hamatani
- Research Center for Child Mental Development, Chiba University, Chiba, Japan.,Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.,Research Center for Child Mental Development, University of Fukui, Fukui, Japan
| | - Eiji Shimizu
- Research Center for Child Mental Development, Chiba University, Chiba, Japan.,Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, Chiba, Japan.,Cognitive Behavioral Therapy Center, Chiba University Hospital, Chiba, Japan
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30
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Ziadni MS, Gonzalez-Castro L, Anderson S, Krishnamurthy P, Darnall BD. Efficacy of a Single-Session "Empowered Relief" Zoom-Delivered Group Intervention for Chronic Pain: Randomized Controlled Trial Conducted During the COVID-19 Pandemic. J Med Internet Res 2021; 23:e29672. [PMID: 34505832 PMCID: PMC8463950 DOI: 10.2196/29672] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/08/2021] [Accepted: 08/01/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Cognitive behavioral therapy-pain is an evidence-based treatment for chronic pain that can have significant patient burden, including health care cost, travel, multiple sessions, and lack of access in remote areas. OBJECTIVE The study aims to pilot test the efficacy of a single-session videoconference-delivered empowered relief (ER) intervention compared to waitlist control (WLC) conditions among individuals with chronic pain. We hypothesized that ER would be superior to WLC in reducing pain catastrophizing, pain intensity, and other pain-related outcomes at 1-3 months posttreatment. METHODS We conducted a randomized controlled trial involving a web-based sample of adults (N=104) aged 18-80 years with self-reported chronic pain. Participants were randomized (1:1) to 1 of 2 unblinded study groups: ER (50/104, 48.1%) and WLC (54/104, 51.9%). Participants allocated to ER completed a Zoom-delivered class, and all participants completed follow-up surveys at 2 weeks and 1, 2, and 3 months posttreatment. All the study procedures were performed remotely and electronically. The primary outcome was pain catastrophizing 1-month posttreatment, with pain intensity, pain bothersomeness, and sleep disruption as secondary outcomes. We also report a more rigorous test of the durability of treatment effects at 3 months posttreatment. Data were collected from September 2020 to February 2021 and analyzed using intention-to-treat analysis. The analytic data set included participants (18/101, 17.8% clinic patients; 83/101, 82.1% community) who completed at least one study survey: ER (50/101, 49.5%) and WLC (51/104, 49%). RESULTS Participants (N=101) were 69.3% (70/101) female, with a mean age of 49.76 years (SD 13.90; range 24-78); 32.7% (33/101) had an undergraduate degree and self-reported chronic pain for 3 months. Participants reported high engagement (47/50, 94%), high satisfaction with ER (mean 8.26, SD 1.57; range 0-10), and high satisfaction with the Zoom platform (46/50, 92%). For the between-groups factor, ER was superior to WLC for all primary and secondary outcomes at 3 months posttreatment (highest P<.001), and between-groups Cohen d effect sizes ranged from 0.45 to 0.79, indicating that the superiority was of moderate to substantial clinical importance. At 3 months, clinically meaningful pain catastrophizing scale (PCS) reductions were found for ER but not for WLC (ER: PCS -8.72, 42.25% reduction; WLC: PCS -2.25, 11.13% reduction). ER resulted in significant improvements in pain intensity, sleep disturbance, and clinical improvements in pain bothersomeness. CONCLUSIONS Zoom-delivered ER had high participant satisfaction and very high engagement. Among adults with chronic pain, this single-session, Zoom-delivered, skills-based pain class resulted in clinically significant improvement across a range of pain-related outcomes that was sustained at 3 months. Web-based delivery of ER could allow greater accessibility of home-based pain treatment and could address the inconveniences and barriers faced by patients when attempting to receive in-person care. TRIAL REGISTRATION ClinicalTrials.gov NCT04546685; https://clinicaltrials.gov/ct2/show/NCT04546685.
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Affiliation(s)
- Maisa S Ziadni
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Lluvia Gonzalez-Castro
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Steven Anderson
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | | | - Beth D Darnall
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
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31
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Cancer-Related Cognitive Impairment or “Chemobrain:” Emerging Assessments, Treatments, and Targets for Intervention. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2021. [DOI: 10.1007/s40141-021-00319-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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32
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Magnuson A, Ahles T, Chen BT, Mandelblatt J, Janelsins MC. Cognitive Function in Older Adults With Cancer: Assessment, Management, and Research Opportunities. J Clin Oncol 2021; 39:2138-2149. [PMID: 34043437 PMCID: PMC8260910 DOI: 10.1200/jco.21.00239] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/11/2021] [Accepted: 03/25/2021] [Indexed: 12/12/2022] Open
Affiliation(s)
- Allison Magnuson
- Department of Medicine, University of Rochester Medical Center, Wilmot Cancer Institute, Rochester, NY
| | - Tim Ahles
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Bihong T. Chen
- Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, CA
| | - Jeanne Mandelblatt
- Georgetown-Lombardi Comprehensive Cancer Center, Cancer Control Program, Georgetown University Medical Center, Washington, DC
| | - Michelle C. Janelsins
- Department of Surgery, Cancer Control, University of Rochester Medical Center, Wilmot Cancer Institute, Rochester, NY
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33
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Kumar NB. The Promise of Nutrient-Derived Bioactive Compounds and Dietary Components to Ameliorate Symptoms of Chemotherapy-Related Cognitive Impairment in Breast Cancer Survivors. Curr Treat Options Oncol 2021; 22:67. [PMID: 34110516 DOI: 10.1007/s11864-021-00865-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2021] [Indexed: 11/30/2022]
Abstract
OPINION STATEMENT One of the most burdensome symptoms reported by breast cancer patients is chemotherapy-related neurocognitive impairment. It is estimated that of the 11 million cancer survivors in the USA, 22% of them are breast cancer patients. The National Cancer Institute classified chemotherapy-related cognitive impairment (CRCI) as one of the most debilitating sequelae of cancer therapy, limiting this patient population from recommencing their lives prior to the diagnosis of breast cancer. Currently, there are no strategies that are established to prevent, mitigate, or treat CRCI. In addition to surviving cancer, quality of life is critical to cancer survivors. Based on the multiple and complex biological and psychosocial etiology, the varying manifestation and extent of cognitive decline documented in breast cancer survivors, possibly attributed to varying combinations of chemotherapy and dose and duration of therapy, multimodal interventions combining promising nutrient-derived bioactive compounds with antioxidant and anti-inflammatory properties, in addition to structured cognitive training and exercise regimens, can work synergistically to reduce inflammation and oxidative stress with significant improvement in cognitive function resulting in improvements in quality of life of breast cancer survivors.
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Affiliation(s)
- Nagi B Kumar
- Cancer Epidemiology Program, Breast & Genitourinary Oncology Departments, H. Lee Moffitt Cancer Center & Research Institute, Inc., 12902 Magnolia Drive, MRC/CANCONT, Tampa, FL, 336129497, USA. .,Oncologic Sciences, University of South Florida College of Medicine, 12902 Magnolia Drive, Tampa, FL, 33612, USA.
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34
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Shari NI, Zainal NZ, Ng CG. Effects of brief acceptance and commitment therapy (ACT) on subjective cognitive impairment in breast cancer patients undergoing chemotherapy. J Psychosoc Oncol 2020; 39:695-714. [PMID: 33287685 DOI: 10.1080/07347332.2020.1856283] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE This study examined the efficacy of a brief acceptance and commitment therapy (ACT) on subjective cognitive impairment in breast cancer patients undergoing chemotherapy. METHODS Data collection was carried out in 3-time points: baseline (T1), screening (T2), and post-treatment (T3). Respondents who had significant subjective cognitive impairment were randomly divided into two groups: intervention (n = 30) and waitlist (n = 30). Respondents in the intervention group received 4 sessions of 1 hour of ACT therapy. FINDINGS Respondents in the intervention group showed significant improvement in subjective cognitive impairment, depression, anxiety, and psychological inflexibility after the ACT intervention (p < 0.05). After controlling the covariates, group differences in all variables were significant except for fatigue and psychological inflexibility has the highest effect size (d = 4.69). CONCLUSION ACT could be considered as an effective intervention to ameliorate subjective cognitive impairment, anxiety, depression, and psychological inflexibility in breast cancer patients undergoing chemotherapy. IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS This study highlights the importance of screening for subjective cognitive impairment in breast cancer patients undergoing chemotherapy and heightens their opportunity to receive proper management as earlier as possible.
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Affiliation(s)
- Nurul Izzah Shari
- Faculty of Medicine, Department of Psychological Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Nor Zuraida Zainal
- Faculty of Medicine, Department of Psychological Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Chong Guan Ng
- Faculty of Medicine, Department of Psychological Medicine, University Malaya, Kuala Lumpur, Malaysia
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35
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Mayo SJ, Lustberg M, M Dhillon H, Nakamura ZM, Allen DH, Von Ah D, C Janelsins M, Chan A, Olson K, Tan CJ, Toh YL, Oh J, Grech L, Cheung YT, Subbiah IM, Petranovic D, D'Olimpio J, Gobbo M, Koeppen S, Loprinzi CL, Pang L, Shinde S, Ntukidem O, Peters KB. Cancer-related cognitive impairment in patients with non-central nervous system malignancies: an overview for oncology providers from the MASCC Neurological Complications Study Group. Support Care Cancer 2020; 29:2821-2840. [PMID: 33231809 DOI: 10.1007/s00520-020-05860-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/26/2020] [Indexed: 02/07/2023]
Abstract
Cancer-related cognitive impairment (CRCI) is commonly experienced by individuals with non-central nervous system cancers throughout the disease and treatment trajectory. CRCI can have a substantial impact on the functional ability and quality of life of patients and their families. To mitigate the impact, oncology providers must know how to identify, assess, and educate patients and caregivers. The objective of this review is to provide oncology clinicians with an overview of CRCI in the context of adults with non-central nervous system cancers, with a particular focus on current approaches in its identification, assessment, and management.
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Affiliation(s)
- Samantha J Mayo
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada. .,Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.
| | - Maryam Lustberg
- The Ohio State Comprehensive Cancer Center, Columbus, OH, USA
| | | | - Zev M Nakamura
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Diane Von Ah
- Indiana University School of Nursing, Indianapolis, IN, USA
| | - Michelle C Janelsins
- Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.,Department of Neuroscience, University of Rochester Medical Center, Rochester, NY, USA.,Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | | | - Karin Olson
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Chia Jie Tan
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yi Long Toh
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeong Oh
- Peter MacCallum Cancer Centre, Parkville, Australia
| | - Lisa Grech
- National University of Singapore, Singapore, Singapore.,Swinburne University, Hawthorn, Australia.,University of Melbourne, Parkville, Australia.,Monash University, Clayton, Australia
| | - Yin Ting Cheung
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | | | - Duska Petranovic
- Clinical Hospital Center Rijeka, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - James D'Olimpio
- Monter Cancer Center, Northwell Cancer Institute, Lake Success, NY, USA
| | - Margherita Gobbo
- Division of Oral Medicine and Pathology, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.,Unit of Oral and Maxillofacial Surgery, Ca Foncello Hospital, Treviso, Italy
| | - Susanne Koeppen
- LVR-Klinikum Essen, University of Duisburg-Essen, Essen, Germany
| | | | | | | | | | - Katherine B Peters
- The Preston Robert Tisch Brain Tumor Center, Duke University, Durham, NC, USA
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36
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Jia M, Zhang X, Wei L, Gao J. Measurement, outcomes and interventions of cognitive function after breast cancer treatment: A narrative review. Asia Pac J Clin Oncol 2020; 17:321-329. [PMID: 33079484 DOI: 10.1111/ajco.13484] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 09/19/2020] [Indexed: 11/29/2022]
Abstract
Cancer-related cognitive impairment (CRCI) is a common complaint in breast cancer patients, especially related to chemotherapy. It is characterized as cognitive disorders in areas of memory, attention and executive function, which can negatively affect patients' quality of life and their ability to work. While various assessment methods of CRCI cause highly diverse results in CRCI-related studies. Currently, it is not clear how cerebral structure and function change in breast cancer patients and underlying mechanisms of developing CRCI are still undefined. Intervention research is limited. This article reviews the results of CRCI-related studies and research progress and discusses the advantages and limits of various methods. Besides, the mechanisms and intervention strategies are reviewed.
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Affiliation(s)
- Miaomiao Jia
- Department of Breast Surgery, Shanxi Bethune Hospital, Taiyuan, Shanxi, China
| | - Xiaojun Zhang
- Department of Breast Surgery, Shanxi Bethune Hospital, Taiyuan, Shanxi, China
| | - Liyuan Wei
- Department of Breast Surgery, Shanxi Bethune Hospital, Taiyuan, Shanxi, China
| | - Jinnan Gao
- Department of Breast Surgery, Shanxi Bethune Hospital, Taiyuan, Shanxi, China
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37
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Bellens A, Roelant E, Sabbe B, Peeters M, van Dam PA. A video-game based cognitive training for breast cancer survivors with cognitive impairment: A prospective randomized pilot trial. Breast 2020; 53:23-32. [PMID: 32554133 PMCID: PMC7375646 DOI: 10.1016/j.breast.2020.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/29/2020] [Accepted: 06/05/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION We investigated whether a web-based cognitive training video game is an effective approach to improve cognitive decline in combination with our standard of care for rehabilitation of breast cancer (BC) patients. MATERIALS AND METHODS Self-selected BC patients between 18 and 71 years old complaining of disturbing cognitive impairment were studied. The patients received access to a web-based internet video game and online cognitive assessments (Aquasnap, Cambridge, MyCQ™). The early intervention group (n = 23) had a training program of 6 months of at least three times a week for a minimum of 60 min of game playing per week at home in addition to standard of care rehabilitation. The delayed intervention (n = 23) received standard of care for three months, followed by three months of similar MyCQ training. Outcome measures were the MyCQ (sub)scores and Activity of Daily Life (ADL), mood, subjective cognition and functional cognitive status measured by classic neuropsychological tests. RESULTS At baseline the means for CFQ (a measure of self-reported cognitive failure), anxiety, PSQI and self-reflectiveness were beyond normal range in both groups. CFQ improved significantly better in the intervention group (p = 0.029). Combining the evolution over time in the entire population a significant improvement was seen for overall MyCQ score, level of fear, physical and emotional role limitation, and health change (all p < 0.05), but self-reflectivess deteriorated (p < 0.05)). Significant differences in the various MyCQ subtests over time were: improved speed in choice reaction time, visual memory recognition, N back 1 and 2, coding, trail making test B, improved accuracy of N back 1 and 2 (all p < 0.05). CONCLUSION A program of cognitive training improves cognitive functioning over time. "Aquasnap" has a beneficial effect on the perception of subjective cognitive functioning (CFQ) but the exact role of video gaming in this process remains uncertain.
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Affiliation(s)
- Anne Bellens
- Multidisciplinary Oncologic Center Antwerp (MOCA), Antwerp University Hospital, Edegem, B2650, Belgium; Centre for Oncological Research (CORE), University of Antwerp, Wilrijk, B2610, Belgium
| | - Ella Roelant
- Clinical Trial Center (CTC), CRC Antwerp, Antwerp University Hospital, University of Antwerp, Edegem, B2650, Belgium; StatUa, Center for Statistics, University of Antwerp, Antwerp, B2000, Belgium
| | - Bernard Sabbe
- Department of Psychiatry, Antwerp University, Wilrijk, Belgium
| | - Marc Peeters
- Multidisciplinary Oncologic Center Antwerp (MOCA), Antwerp University Hospital, Edegem, B2650, Belgium; Centre for Oncological Research (CORE), University of Antwerp, Wilrijk, B2610, Belgium
| | - Peter A van Dam
- Multidisciplinary Oncologic Center Antwerp (MOCA), Antwerp University Hospital, Edegem, B2650, Belgium; Centre for Oncological Research (CORE), University of Antwerp, Wilrijk, B2610, Belgium.
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Floyd R, Dyer AH, Kennelly SP. Non-pharmacological interventions for cognitive impairment in women with breast cancer post-chemotherapy: A systematic review. J Geriatr Oncol 2020; 12:173-181. [PMID: 32536427 DOI: 10.1016/j.jgo.2020.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/29/2020] [Accepted: 05/27/2020] [Indexed: 12/29/2022]
Abstract
PURPOSE Cognitive impairment is a well-reported side-effect of chemotherapy in persons with breast cancer. Whilst non-pharmacological interventions have proven efficacious in the management of cognitive impairment in high-risk groups, their efficacy in cognitive impairment post-chemotherapy in patients with breast cancer remains unclear. METHODS Medline, CINAHL, PsycINFO, Web of Science and Cochrane were searched for randomized controlled trials of non-pharmacological interventions for cognitive impairment post-chemotherapy in women with breast cancer. RESULTS Of 429 results, 83 full-texts were reviewed with ten meeting inclusion criteria. Interventions included cognitive training, exercise and complementary therapies. The non-pharmacological interventions assessed displayed variable benefits in subjective and/or objective cognitive assessments, with no strong evidence for beneficial effects across included studies. No studies assessed the efficacy of multi-domain interventions. CONCLUSIONS There is mixed evidence supporting non-pharmacological interventions for cognitive impairment post-chemotherapy in women with breast cancer. Moving forward, multidomain trials combining non-pharmacological interventions are imperative in this high risk cohort.
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Affiliation(s)
- Ruairí Floyd
- Graduate Entry Medical School, University of Limerick, Ireland.
| | - Adam H Dyer
- Department of Age-related Healthcare, Tallaght University Hospital, Ireland; Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Ireland
| | - Seán P Kennelly
- Department of Age-related Healthcare, Tallaght University Hospital, Ireland; Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Ireland
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Zhang Q, Gao X, Liu S, Yu L, Zhu J, Qiu S. Therapies for cognitive impairment in breast cancer survivors treated with chemotherapy: A protocol for systematic review. Medicine (Baltimore) 2020; 99:e20092. [PMID: 32384481 PMCID: PMC7440308 DOI: 10.1097/md.0000000000020092] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE The aim of this systematic review was to evaluate the effect of therapies for cognitive impairment on patients' perceived cognitive function in breast cancer survivors with chemotherapy-related cognitive impairment. METHOD A literature search of PubMed, Embase, and the Cochrane Library was conducted up to April 2019. Search terms included breast cancer, chemotherapy, and cognitive impairment. RESULT Six randomized controlled trials with a total of 305 patients were included in this review. A total of 6 randomized controlled trials using various treatments (Tibetan sound meditation, donepezil, memory and attention adaptation training, aerobic exercise, acupuncture, Qigong) for chemotherapy-related cognitive impairment met the eligibility criteria and were included. This review showed that meditative interventions (Tibetan sound meditation, Qigong) and cognitive therapy (memory and attention adaptation training) may partially improve some aspects of patients' perceived (self-reported) cognitive functioning, particularly patients' perceived cognitive impairment and ability. CONCLUSION In this systematic review, the results showed that meditative interventions (Tibetan sound meditation, Qigong) and cognitive therapy (memory and attention adaptation training) may be optional therapies. We hope to have more randomized controlled trials to support this result in the future.
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Affiliation(s)
- Qiuhua Zhang
- First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang
| | - Xiufei Gao
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), China
| | - Shan Liu
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), China
| | - Linghong Yu
- First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang
| | - Jiayan Zhu
- First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang
| | - Shengliang Qiu
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), China
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Systematic review of cognitive sequelae of non-central nervous system cancer and cancer therapy. J Cancer Surviv 2020; 14:464-482. [PMID: 32146576 DOI: 10.1007/s11764-020-00870-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 02/22/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The aim of this review is to provide an updated overview of chemotherapy-related cognitive impairment (CRCI) in patients with cancer outside central nervous system (CNS), its incidence and prevalence, the cognitive pattern in neuropsychological studies, neuroimaging findings, and the relationship between chemobrain and aging. Methodological limitations of studies are also discussed. METHODS This review was guided by the PRISMA statement. The MEDLINE and Scopus databases were employed to search articles about CRCI in non-CNS cancer patients published from January 2004 to September 2019. Two types of research were reviewed: prospective studies addressing the effects of chemotherapy on cognition and systematic reviews about factors related with CRCI, also as neuroimaging findings and current available treatments. RESULTS Fifty-nine studies meeting the criteria were analyzed: 47 were longitudinal studies on cancer and cognition and 12 were reviews on risk factors, neuroimaging, and treatment. The majority of studies find cognitive impairment in patients with cancer treated with chemotherapy. The body of the literature on breast cancer is the most abundant, but there are also studies on colorectal, testicular, and lung cancer. Neuroimaging studies show changes in structure and activation in patients undergoing chemotherapy. Non-pharmacological treatment is effective for improving cognition and quality of life. CONCLUSIONS The occurrence of CRCI during the course of treatment in people with different types of cancer is frequent. Some risk factors have been identified, but CRCI is a complex phenomenon, with mediating factors related to cancer and treatment and moderating factors related with lifestyle and health. IMPLICATIONS FOR CANCER SURVIVORS This review highlights the importance of recognizing that this cognitive dysfunction is frequent, mild to moderate in nature but with great impact on quality of life.
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Pergolotti M, Battisti NML, Padgett L, Sleight AG, Abdallah M, Newman R, Van Dyk K, Covington KR, Williams GR, van den Bos F, Pollock Y, Salerno EA, Magnuson A, Gattás-Vernaglia IF, Ahles TA. Embracing the complexity: Older adults with cancer-related cognitive decline-A Young International Society of Geriatric Oncology position paper. J Geriatr Oncol 2020; 11:237-243. [PMID: 31619372 PMCID: PMC7054166 DOI: 10.1016/j.jgo.2019.09.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 08/01/2019] [Accepted: 09/04/2019] [Indexed: 01/16/2023]
Abstract
Cancer-related cognitive decline (CRCD) may have particularly significant consequences for older adults, impacting their functional and physical abilities, level of independence, ability to make decisions, treatment adherence, overall quality of life, and ultimately survival. In honor of Dr. Hurria's work we explore and examine multiple types of screening, assessment and non-pharmacologic treatments for CRCD. We then suggest future research and clinical practice questions to holistically appreciate the complexity of older adults with cancer's experiences and fully integrate the team-based approach to best serve this population.
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Affiliation(s)
- Mackenzi Pergolotti
- ReVital Cancer Rehabilitation, Select Medical, 4174 Gettysburg Rd, Mechanicsburg, PA 17055, USA; Department of Occupational Therapy - College of Health and Human Sciences, Colorado State University, 200 Occupational Therapy Building, Fort Collins, CO 80523-1573, USA.
| | - Nicolò Matteo Luca Battisti
- Department of Medicine - Breast Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton Surrey SM2 5PT, United Kingdom.
| | - Lynne Padgett
- Veterans Affairs Medical Center, Washington, DC, USA
| | - Alix G Sleight
- Outcomes Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, USA.
| | - Maya Abdallah
- Department of Internal Medicine, University of Massachusetts Medical School - Baystate Medical Center, 759 Chestnut St., Springfield, MA, 01199, USA.
| | - Robin Newman
- Department of Occupational Therapy, Boston University Sargent College of Health and Rehabilitation Sciences, 635 Commonwealth Avenue, Boston, MA 02215, USA.
| | - Kathleen Van Dyk
- Jonsson Comprehensive Cancer Center, Cancer Prevention and Control Research, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA 90095, USA.
| | - Kelley R Covington
- ReVital Cancer Rehabilitation, Select Medical, 4174 Gettysburg Rd, Mechanicsburg, PA 17055, USA; Department of Occupational Therapy - College of Health and Human Sciences, Colorado State University, 200 Occupational Therapy Building, Fort Collins, CO 80523-1573, USA.
| | - Grant R Williams
- Divisions of Hematology/Oncology & Gerontology, Geriatrics, and Palliative Care, Institute for Cancer Outcomes and Survivorship, The University of Alabama at Birmingham, 1670 University Blvd, Birmingham, AL 35233, USA.
| | - Frederiek van den Bos
- Departement of Geriatric Medicine, University Medical Centre Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, Netherlands.
| | - YaoYao Pollock
- Geriatric Oncology Fellowship Program, University of California, San Francisco, 1600 Divisadero St, San Francisco, CA 94115, USA.
| | - Elizabeth A Salerno
- Division of Cancer Epidemiology & Genetics, Metabolic Epidemiology Branch, National Cancer Institute, 9609 Medical Center Dr, Rockville, MD 20850, USA.
| | - Allison Magnuson
- Department of Medicine, Hematology/Oncology, University of Rochester Medical Center, 601 Elmwood Ave, Box 704, Rochester, NY 14642, USA.
| | - Isabella F Gattás-Vernaglia
- Division of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, Hospital Sírio-Libanês- Geriatric Oncology Team, Av. Dr. Enéas de Carvalho Aguiar, 155, 8° Andar, Bloco 3, São Paulo, SP CEP 05403-900, Brazil
| | - Tim A Ahles
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, New York, NY 10022, USA.
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Von Ah D, Crouch A. Cognitive Rehabilitation for Cognitive Dysfunction after Cancer and Cancer Treatment: Implications for Nursing Practice. Semin Oncol Nurs 2020; 36:150977. [PMID: 31959511 DOI: 10.1016/j.soncn.2019.150977] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To provide an overview of cognitive rehabilitation approaches for cognitive dysfunction after cancer and cancer treatment. DATA SOURCES Review and synthesis of empirical articles. CONCLUSION Cognitive rehabilitation approaches, including cognitive behavioral therapy and cognitive training, for cognitive dysfunction appear feasible to deliver, satisfactory to participants, and have shown promising results in cancer survivors. Future research is needed to address optimal dose, delivery method, access, cost, and the vulnerable aging cancer survivor population. IMPLICATIONS FOR NURSING PRACTICE Oncology nurses must understand the available evidence and be able to provide information and options to cancer survivors to address cognitive changes after cancer.
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Affiliation(s)
- Diane Von Ah
- Indiana University School of Nursing, Indianapolis, IN.
| | - Adele Crouch
- Indiana University School of Nursing, Indianapolis, IN
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Zeng Y, Dong J, Huang M, Zhang JE, Zhang X, Xie M, Wefel JS. Nonpharmacological interventions for cancer-related cognitive impairment in adult cancer patients: A network meta-analysis. Int J Nurs Stud 2020; 104:103514. [PMID: 32004776 DOI: 10.1016/j.ijnurstu.2019.103514] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/25/2019] [Accepted: 12/27/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Conventional meta-analyses can only provide direct comparison evidence, and the best options of nonpharmacological interventions for cancer-related cognitive impairment remain largely unknown. OBJECTIVES To evaluate the comparative effects of all known nonpharmacological interventions for cancer-related cognitive impairment, and to rank the best intervention options for adult non- central nervous system cancer patients with cancer-related cognitive impairment. DESIGN Systematic review with a new analytic approach of network meta-analysis. DATA SOURCES Six electronic databases were searched for randomized controlled trials from January 2010 to July 2019. REVIEW METHODS Literature screening, data extraction and quality appraisal was undertaken systematically by two independent reviewers. Quantitative network meta-analysis performed to analyze key study outcomes. The primary outcome was the effectiveness of interventions on subjective cognitive function, and the secondary outcome was the safety of nonpharmacological interventions for cancer-related cognitive impairment. RESULTS There were 29 eligible randomized controlled trials searched, and a total of 10 interventions identified. All 29 randomized controlled trials that were included had no reported significant adverse events, therefore, these 10 nonpharmacological interventions are safe for cancer-related cognitive impairment management. In terms of effectiveness, the pooled overall effects were in favor of these 10 nonpharmacological interventions. The most effective interventions included meditation, cognitive training, cognitive rehabilitation, and exercise interventions, with a mean difference of effective size plus 95% confidence interval 10.26 (1.53, 19.00), 5.02 (1.41, 8.63), 4.88 (0.65, 9.11), and 3.82 (0.52, 7.13), respectively. Other treatment effects did not show statistically significant differences. CONCLUSIONS This network meta-analysis found that meditation interventions, cognitive training, cognitive rehabilitation, and exercise were the most effective interventions for adult non-central nervous system cancer patients to manage cancer-related cognitive impairment. Results of this network meta-analysis contribute evidence-based data to inform medical decision-making.
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Affiliation(s)
- Yingchun Zeng
- Department of Nursing, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Juntao Dong
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Meiling Huang
- Department of Nursing, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
| | - Jun-E Zhang
- School of Nursing, Sun Yat-sen University, Guangzhou, China.
| | - Xiaoming Zhang
- The Affiliated Baoan Hospital of Southern Medical University, The People's Hospital of Baoan Shenzhen, Shenzhen, China
| | - Man Xie
- Jieyang People's Hospital, Jieyang, Guangdong Province, China
| | - Jeffrey S Wefel
- Departments of Neuro-Oncology and Radiation Oncology, The University of Texas MD Anderson Cancer Center, TX, US
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Corbett TK, Groarke A, Devane D, Carr E, Walsh JC, McGuire BE. The effectiveness of psychological interventions for fatigue in cancer survivors: systematic review of randomised controlled trials. Syst Rev 2019; 8:324. [PMID: 31836007 PMCID: PMC6911282 DOI: 10.1186/s13643-019-1230-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 11/12/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Fatigue is a common symptom in cancer patients that can persist beyond the curative treatment phase. This systematic review evaluated the effectiveness of psychological interventions for cancer-related fatigue in post-treatment cancer survivors. METHODS We searched relevant online databases and sources of grey literature. Randomised controlled trials (RCTs) evaluating psychological interventions in adult cancer patients after the completion of treatment, with fatigue as an outcome measure, were included. Two review authors extracted data independently from the selected studies and assessed the methodological quality using the Cochrane Collaboration Risk of Bias Tool. RESULTS Thirty-three psychological interventions were identified. The sample size of the included studies varied between 28 and 409, with 4525 participants overall. Twenty-three of the included studies reported a significant effect of the interventions on reducing fatigue in cancer survivors. Most interventions focused on psychoeducation, mindfulness, cognitive or behaviour therapy-oriented strategies. However, studies differed widely in terms of measurement tools used to assess fatigue, mode, duration and frequency of the intervention delivery. CONCLUSIONS This review showed some tentative support for psychological interventions for fatigue after cancer treatment. However, as the RCTs were heterogeneous in nature and the number of high-quality studies was limited, definitive conclusions are not yet possible. With the growing need for stage-specific research in cancer, this review sought to inform current practice and to summarise the existing evidence base of randomised controlled trials in the area. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number: CRD42014015219.
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Affiliation(s)
- T K Corbett
- NIHR ARC Wessex, School of Health Sciences, University of Southampton, Highfield, Southampton, SO17 1BJ, UK.
| | - A Groarke
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - D Devane
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - E Carr
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - J C Walsh
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - B E McGuire
- School of Psychology, National University of Ireland Galway, Galway, Ireland
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Miladi N, Dossa R, Dogba MJ, Cléophat-Jolicoeur MIF, Gagnon B. Psychostimulants for cancer-related cognitive impairment in adult cancer survivors: a systematic review and meta-analysis. Support Care Cancer 2019; 27:3717-3727. [PMID: 31250183 DOI: 10.1007/s00520-019-04907-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 05/31/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Cognitive impairment is recognized as a common symptom experienced by cancer survivors which impacts on quality of life (QoL) and day-to-day activities. One of the treatment options is the use of psychostimulants but the evidence supporting its use remains unclear. OBJECTIVES To identify the level of evidence of psychostimulants' effect on the management of cognitive impairment in adult cancer survivors. METHODS Electronic databases (MEDLINE, EMBASE, CENTRAL, CINAHL) and reference lists of relevant reviews were searched from inception to December 2017, with no language restrictions applied. Randomized controlled trials (RCTs), evaluating the effect of psychostimulants on cognitive impairment among cancer patients with no primary or secondary brain tumor or brain radiation, were included. The primary outcome was cognitive function changes, whereas secondary outcomes were adverse events (AEs) and QoL. RESULTS Six RCTs were included: three studies investigating methylphenidate and three modafinil, with a total of 244 and 146 patients, respectively. Due to important differences in methodologies between studies, a meta-analysis was assumed inappropriate for the primary outcome. A narrative synthesis was performed. One study using methylphenidate and two using modafinil demonstrated improvements in some cognitive functions as measured by objective cognitive assessment tests. Psychostimulants did not improve QoL and were not associated with more AEs. CONCLUSION To date, limited evidence is available to estimate the usefulness (or lack) of psychostimulants on cognitive function in this population.
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Affiliation(s)
- Nadia Miladi
- Oncology Division, CHU de Québec-Laval University Research Center, Quebec City, QC, Canada
| | - Richi Dossa
- Oncology Division, CHU de Québec-Laval University Research Center, Quebec City, QC, Canada
| | - Maman Joyce Dogba
- Oncology Division, CHU de Québec-Laval University Research Center, Quebec City, QC, Canada
| | | | - Bruno Gagnon
- Oncology Division, CHU de Québec-Laval University Research Center, Quebec City, QC, Canada.
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Riba MB, Donovan KA, Andersen B, Braun II, Breitbart WS, Brewer BW, Buchmann LO, Clark MM, Collins M, Corbett C, Fleishman S, Garcia S, Greenberg DB, Handzo RGF, Hoofring L, Huang CH, Lally R, Martin S, McGuffey L, Mitchell W, Morrison LJ, Pailler M, Palesh O, Parnes F, Pazar JP, Ralston L, Salman J, Shannon-Dudley MM, Valentine AD, McMillian NR, Darlow SD. Distress Management, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2019; 17:1229-1249. [PMID: 31590149 PMCID: PMC6907687 DOI: 10.6004/jnccn.2019.0048] [Citation(s) in RCA: 352] [Impact Index Per Article: 70.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Distress is defined in the NCCN Guidelines for Distress Management as a multifactorial, unpleasant experience of a psychologic (ie, cognitive, behavioral, emotional), social, spiritual, and/or physical nature that may interfere with the ability to cope effectively with cancer, its physical symptoms, and its treatment. Early evaluation and screening for distress leads to early and timely management of psychologic distress, which in turn improves medical management. The panel for the Distress Management Guidelines recently added a new principles section including guidance on implementation of standards of psychosocial care for patients with cancer.
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Affiliation(s)
| | | | - Barbara Andersen
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - IIana Braun
- Dana-Farber/Brigham and Women's Cancer Center
| | | | | | | | | | | | | | | | - Sofia Garcia
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | - Laura Hoofring
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | | | | | | | | | | | | | | | - Janice P Pazar
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | - Laurel Ralston
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
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Fernandes HA, Richard NM, Edelstein K. Cognitive rehabilitation for cancer-related cognitive dysfunction: a systematic review. Support Care Cancer 2019; 27:3253-3279. [PMID: 31147780 DOI: 10.1007/s00520-019-04866-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 04/23/2019] [Accepted: 05/09/2019] [Indexed: 01/03/2023]
Abstract
PURPOSE Individuals with non-central nervous system (CNS) cancers can experience cancer-related cognitive dysfunction (CRCD), negatively impacting daily functioning and quality of life. This systematic review examined cognitive rehabilitation programs aimed at improving cognitive function. METHODS PsychInfo and PubMed were searched in February 2019. Eligible studies evaluated a cognitive rehabilitation program for adults with non-CNS cancers and included at least one objective cognitive measure. Across studies, we assessed methodological quality using relevant criteria based on published intervention-related review guidelines and examined findings from performance-based and self-reported outcome measures. RESULTS 19 studies met inclusion criteria, totalling 1124 participants altogether. These studies included randomized controlled trials (n = 12), partial, quasi or non-randomized controlled trials (n = 3) and single-arm pilot studies (n = 4). All studies found improvements on at least one cognitive measure (performance-based or self-reported). By cognitive domain, objective improvements in memory were most commonly reported, followed by executive functions and processing speed. In terms of methodological quality, studies generally provided clear descriptions of participants and interventions. However, limitations included lack of standardized terminology for interventions, discrepancies in outcome measures, and incomplete statistical reporting. CONCLUSIONS The available evidence supports clinical implementation of cognitive rehabilitation to improve CRCD, with further work in program development, dissemination, and feasibility recommended. We provide specific recommendations to facilitate future research and integration in this field.
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Affiliation(s)
- Holly A Fernandes
- Department of Psychology, Faculty of Health, York University, 4700 Keele St., Toronto, ON, M3J 1P3, Canada.
| | - Nadine M Richard
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Kim Edelstein
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Abstract
Impaired neurocognitive function is an increasingly recognized morbidity in patients who have cancer. Cancer treatments, psychosocial stressors, and the malignancy itself can alter brain function. The mechanisms by which this occurs are under active investigation. Although there is a growing appreciation of its prevalence and causes, there remain limited therapeutic options for the treatment of neurocognitive dysfunction in this population. A persistent scientific and clinical effort to understand its mechanisms and impact is critical to the care of oncology patients.
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Affiliation(s)
- Rebecca A Harrison
- Department of Neuro-Oncology, The University of Texas M.D. Anderson Cancer Center, 1400 Holcombe Boulevard, Unit 0431, Houston, TX 77030, USA.
| | - Jeffrey S Wefel
- Section of Neuropsychology, Department of Neuro-Oncology, The University of Texas M.D. Anderson Cancer Center, 1400 Holcombe Boulevard, Unit 0431, Houston, TX 77030, USA
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Newman R, Lyons KD, Coster WJ, Wong J, Festa K, Ko NY. Feasibility, acceptability and potential effectiveness of an occupation-focused cognitive self-management program for breast cancer survivors. Br J Occup Ther 2019. [DOI: 10.1177/0308022619861893] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Robin Newman
- Department of Occupational Therapy, Sargent College of Health and Rehabilitation Sciences, Boston University, MA, USA
| | - Kathleen Doyle Lyons
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
- Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Wendy J Coster
- Department of Occupational Therapy, Sargent College of Health and Rehabilitation Sciences, Boston University, MA, USA
| | - Jasin Wong
- Department of Occupational Therapy, Sargent College of Health and Rehabilitation Sciences, Boston University, MA, USA
| | - Kate Festa
- Department of Medicine, Section of Hematology Oncology, Boston University Medical School, MA, USA
| | - Naomi Y Ko
- Department of Medicine, Section of Hematology Oncology, Boston University Medical School, MA, USA
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Hoogland AI, Nelson AM, Gonzalez BD, Small BJ, Breen EC, Sutton SK, Syrjala KL, Bower JE, Pidala J, Booth-Jones M, Jacobsen PB, Jim HSL. Worsening cognitive performance is associated with increases in systemic inflammation following hematopoietic cell transplantation. Brain Behav Immun 2019; 80:308-314. [PMID: 30953767 PMCID: PMC6660393 DOI: 10.1016/j.bbi.2019.04.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 03/13/2019] [Accepted: 04/02/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Cognitive decline is a frequently cited concern among patients receiving hematopoietic cell transplantation (HCT), and patients often experience neurocognitive deficits (i.e., stable or worsening neurocognitive performance) throughout the transplant course. Deficits can be most severe during the acute transplant period (i.e., 90 days after transplantation), when patients also typically experience elevated systemic levels of inflammation. Previous studies have identified inflammation as a likely mechanism underlying neurocognitive deficits, primarily in women with breast cancer; however, longitudinal studies have been limited. In this study, our aim was to evaluate the relationship between changes in systemic inflammation and changes in cognition from pre- to post-transplant in patients receiving allogeneic HCT. METHODS Patients scheduled for allogeneic HCT (n = 85) were assessed prior to HCT and 90 days after HCT. Biomarkers of inflammation included IL-6, sTNF-RII, CRP, and IL-1ra, which have been previously associated with neurocognitive deficits in cancer patients. Patients completed neuropsychological testing and self-report questionnaires. RESULTS Mixed models demonstrated that from pre- to post-HCT, increases in IL-6 and sTNF-RII were associated with neurocognitive deficits, and decreases in CRP were associated with better neurocognitive performance. There were no significant associations between changes in inflammation and self-reported cognitive performance. CONCLUSIONS Our findings are the first to our knowledge to report a robust relationship between increasing inflammation and neurocognitive deficits from pre- to post-HCT. Additional studies are needed to confirm these findings in a larger sample.
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Affiliation(s)
| | - Ashley M Nelson
- Moffitt Cancer Center, Tampa, FL, United States; University of South Florida, Tampa, FL, United States
| | | | - Brent J Small
- University of South Florida, Tampa, FL, United States
| | - Elizabeth C Breen
- University of California - Los Angeles, Los Angeles, CA, United States
| | | | - Karen L Syrjala
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Julienne E Bower
- University of California - Los Angeles, Los Angeles, CA, United States
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