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Ng DQ, Hudson C, Nguyen T, Gupta SK, Koh YQ, Acharya MM, Chan A. Dynamin-1 is a potential mediator in Cancer-Related Cognitive Impairment. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.06.04.597349. [PMID: 38895481 PMCID: PMC11185648 DOI: 10.1101/2024.06.04.597349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
Dynamin-1 (DNM1) consolidates memory through synaptic transmission and modulation and has been explored as a therapeutic target in Alzheimer's disease. Through a two-prong approach, this study examined its role in cancer-related cognitive impairment (CRCI) pathogenesis using human and animal models. The human study recruited newly diagnosed, chemotherapy-naïve adolescent and young adult cancer and non-cancer controls to complete a cognitive instrument (FACT-Cog) and blood draws for up to three time points. Concurrently, a syngeneic young-adult WT (C57BL/6 female) mouse model of breast cancer was developed to study DNM1 expression in the brain. Samples from eighty-six participants with 30 adolescent and young adult (AYA) cancer and 56 non-cancer participants were analyzed. DNM1 levels were significantly lower among cancer participants compared to non-cancer prior to treatment. While receiving cancer treatment, cognitively impaired patients were found with a significant downregulation of DNM1, but not among those without impairment. In murine breast cancer-bearing mice receiving chemotherapy, we consistently found a significant decline in DNM1 immunoreactivity in the hippocampal CA1 and CA3 subregions. Observed in both human and animal studies, the downregulation of DNM1 is linked with the onset of CRCI. Future research should explore the potential of DNM1 in CRCI pathogenesis and therapeutics development.
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Wang L, Ding Y, Zhang Y, Chen Y, Xue M, Wang X. The association between neuropsychological impairment, self-perceived cognitive deficit, symptoms, and health related quality of life in newly diagnosed ovarian cancer patients. Asia Pac J Oncol Nurs 2024; 11:100447. [PMID: 38798881 PMCID: PMC11127092 DOI: 10.1016/j.apjon.2024.100447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 03/18/2024] [Indexed: 05/29/2024] Open
Abstract
Objective To assess cognitive function in patients newly diagnosed with ovarian cancer (OC) before treatment and explore the relationship between neuropsychological impairment, self-perceived cognitive deficit, symptoms, and health-related quality of life in them. Methods From May 2021 to February 2022, 105 women newly diagnosed with OC were enrolled in the Cancer Center of Fudan University, Shanghai, China. Objective and subjective cognitive functions were assessed using the Montreal Cognitive Assessment (MoCA) scale and Perceptual Deficits Questionnaire (PDQ). Symptoms and quality of life were evaluated using the Memorial Symptom Assessment Scale (MSAS) and Functional Assessment of Cancer Therapy-Ovarian Cancer (FACT-O), respectively. Results This study included 105 newly diagnosed OC patients, with an average age of 49.73 (±8.48) years. Of these, 72.38% had impaired neuropsychological test scores, especially in delayed recall, abstraction, and visuospatial/executive function. Retrospective, and prospective memory were the most serious perceived deficits. The results of the MoCA test were not associated with PDQ (Rs = -0.180, P = 0.067) and significantly correlated with the distress index, physiological and total scores of the MSAS, and emotional well- being of the FACT-O. The PDQ positively correlated with all MSAS dimensions but not with the FACT-O. Conclusion The incidence of neuropsychological impairment in patients newly diagnosed with OC was high, with no association with self-perceived cognitive deficits. It is recommended that healthcare providers include cognitive impairment in symptom management in this population, who may benefit from early assessment, prevention, and intervention.
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Affiliation(s)
- Liying Wang
- School of Nursing, Fudan University, Shanghai, China
- Department of Nursing, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yan Ding
- School of Nursing, Fudan University, Shanghai, China
- Department of Nursing, Obstetrics & Gynecology Hospital of Fudan University, Shanghai, China
| | - Yi Zhang
- Department of Nursing, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yaqiong Chen
- Department of Nursing, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Mei Xue
- Department of Nursing, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xia Wang
- Department of Nursing, Obstetrics & Gynecology Hospital of Fudan University, Shanghai, China
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Mulholland MM, Stuifbergen A, De La Torre Schutz A, Franco Rocha OY, Blayney DW, Kesler SR. Evidence of compensatory neural hyperactivity in a subgroup of chemotherapy-treated breast cancer survivors and its association with brain aging. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.22.24306190. [PMID: 38712178 PMCID: PMC11071584 DOI: 10.1101/2024.04.22.24306190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Chemotherapy-related cognitive impairment (CRCI) remains poorly understood in terms of the mechanisms of cognitive decline. Neural hyperactivity has been reported on average in cancer survivors, but it is unclear which patients demonstrate this neurophenotype, limiting precision medicine in this population. We evaluated a retrospective sample of 80 breast cancer survivors and 80 non-cancer controls, age 35-73, for which we had previously identified and validated three data-driven, biological subgroups (biotypes) of CRCI. We measured neural activity using the z-normalized percent amplitude of fluctuation from resting state functional magnetic resonance imaging (MRI). We tested established, quantitative criteria to determine if hyperactivity can accurately be considered compensatory. We also calculated brain age gap by applying a previously validated algorithm to anatomic MRI. We found that neural activity differed across the three CRCI biotypes and controls (F = 13.5, p < 0.001), with Biotype 2 demonstrating significant hyperactivity compared to the other groups (p < 0.004, corrected), primarily in prefrontal regions. Alternatively, Biotypes 1 and 3 demonstrated significant hypoactivity (p < 0.02, corrected). Hyperactivity in Biotype 2 met several of the criteria to be considered compensatory. However, we also found a positive relationship between neural activity and brain age gap in these patients (r = 0.45, p = 0.042). Our results indicated that neural hyperactivity is specific to a subgroup of breast cancer survivors and, while it seems to support preserved cognitive function, it could also increase the risk of accelerated brain aging. These findings could inform future neuromodulatory interventions with respect to the risks and benefits of up or downregulation of neural activity.
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Affiliation(s)
- Michele M Mulholland
- Department of Comparative Medicine, The University of Texas MD Anderson Cancer Center, Bastrop, TX, USA
| | - Alexa Stuifbergen
- Division of Adult Health, School of Nursing, University of Texas at Austin, Austin, TX, USA
| | | | - Oscar Y Franco Rocha
- Division of Adult Health, School of Nursing, University of Texas at Austin, Austin, TX, USA
| | - Douglas W Blayney
- Department of Medical Oncology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Shelli R Kesler
- Division of Adult Health, School of Nursing, University of Texas at Austin, Austin, TX, USA
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Fowler ME, Murdaugh D, Harmon C, Al-Obaidi M, Sharafeldin N, Bhatia S, Giri S, Williams GR. Longitudinal changes in patient-reported cognitive complaints among older adults with gastrointestinal malignancies - results from the Cancer and Aging Resilience Evaluation (CARE) Registry. J Cancer Surviv 2024; 18:521-530. [PMID: 36114326 PMCID: PMC10020125 DOI: 10.1007/s11764-022-01254-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/31/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE Longitudinal change in patient-reported cognitive complaints (CC) in older adults with cancer is poorly understood. The purpose of this study was to evaluate early longitudinal CC and predictors among older adults with cancer. METHODS We examined early CC change on the PROMIS® Short Form4a Cognitive Function among adults ≥ 60 years with GI cancer enrolled in the Cancer and Aging Resilience Evaluation (CARE) undergoing geriatric assessment (GA) at baseline and one 3-6-month follow-up. Multivariable linear regression examined associations of demographics, socioeconomics, GA domains, baseline cognitive score, and treatment toxicities on follow-up cognitive score. Bayesian analysis of covariance (ANCOVA) determined best fitting model. RESULTS A total of 218 participants were included. The median follow-up was 3.7 months, the mean age was 69.2 ± 7.1, and 57.3% were male. The most common cancer was colorectal (30.7%) with most stage III/IV (73.7%). About half (51.8%) had stable cognition baseline to follow-up (follow-up t-score ± 5 points of baseline), 20.6% improved (≥ 5 increase), and 27.5% declined (≥ 5 decrease). After adjustment, there were no significant baseline predictors of follow-up cognitive t-score. Baseline t-score was the best-fitting predictor of follow-up t-score. CONCLUSIONS In this first study, examining early change in CC among older adults with cancer, ~ 28% exhibited cognitive decline. Baseline cognition is the most important early predictor of follow-up cognition. Longer follow-up is needed to identify long-term predictors of CC change in cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS Cognitive decline, even early, may occur in many older adults with cancer. Baseline and regular follow-up assessments of cognitive symptoms are an important component of survivorship care.
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Affiliation(s)
- Mackenzie E Fowler
- Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Donna Murdaugh
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Christian Harmon
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mustafa Al-Obaidi
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Noha Sharafeldin
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Pediatrics, Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Smith Giri
- Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Grant R Williams
- Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
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Chan YN, Betancur S, Conklin JL, Hirschey R, Piepmeier A, Foster M, Anderson RA, Bender CM, Bryant AL. Cognitive Function in Adults With Acute Myeloid Leukemia Treated With Chemotherapy: A Systematic Review. Cancer Nurs 2024; 47:121-131. [PMID: 36066343 PMCID: PMC10232672 DOI: 10.1097/ncc.0000000000001164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Chemotherapy is essential for treating acute myeloid leukemia (AML). Previous studies concluded that survivors of cancer who were treated with chemotherapy experience cognitive impairment. Therefore, it is important to understand cognitive function in survivors of AML. OBJECTIVE The aim of this study was to explore distributions and correlates of cognitive function, and prediction of cognitive function on other outcomes in adults with AML who were treated with chemotherapy. METHODS A health science librarian systematically searched PubMed, CINAHL, PsycINFO, and EMBASE databases. Two reviewers independently conducted the title, abstract, and full-text screening. Data were extracted and synthesized based on the aims of the review. RESULTS A total of 10 articles were included. Findings indicate that up to 62.2% of adults with AML experienced impaired cognitive function after starting chemotherapy. Three studies found cognitive function remained stable over time. Education and cytokines were potential correlates of cognitive function. Worse cognitive function may predict lower physical performance and higher mortality, although the results were inconsistent across studies. CONCLUSION Impaired cognitive function was observed in adults with AML who were treated with chemotherapy. However, no study used a validated subjective cognitive-function-specific patient-reported questionnaire, and previous studies focusing on cognitive function included relatively young samples. Hence, further research on cognitive function in older adults with AML is needed. IMPLICATIONS FOR PRACTICE Because of the high prevalence of cognitive impairment identified, it is important to screen cognitive function in adults with AML who are planning to receive chemotherapy to intervene and provide support earlier.
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Affiliation(s)
- Ya-Ning Chan
- Author Affiliations: School of Nursing (Dr Chan, Ms Betancur, and Drs Hirschey, Anderson, and Bryant), Health Sciences Library (Ms Conklin), and Lineberger Comprehensive Cancer Center (Drs Hirschey, Foster, and Bryant), University of North Carolina at Chapel Hill; Department of Exercise Science, Elon University (Dr Piepmeier), North Carolina; and School of Nursing, University of Pittsburgh (Dr Bender), Pennsylvania
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Serra-Blasco M, Souto-Sampera A, Medina JC, Flix-Valle A, Ciria-Suarez L, Arizu-Onassis A, Ruiz-Romeo M, Jansen F, Rodríguez A, Pernas S, Ochoa-Arnedo C. Cognitive-enhanced eHealth psychosocial stepped intervention for managing breast cancer-related cognitive impairment: Protocol for a randomized controlled trial. Digit Health 2024; 10:20552076241257082. [PMID: 39070895 PMCID: PMC11273701 DOI: 10.1177/20552076241257082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 05/08/2024] [Indexed: 07/30/2024] Open
Abstract
Introduction Breast cancer often leads to cancer-related cognitive impairment (CRCI), which includes both objective and subjective cognitive deficits. While psychosocial interventions benefit quality of life and distress reduction, their impact on cognitive deficits is uncertain. This study evaluates the integration of a cognitive module into a digital psychosocial intervention for breast cancer patients. Methods In this randomized controlled trial (RCT), 88 recently diagnosed breast cancer (BC) patients will receive the ICOnnecta't program (control group) - a digital stepped intervention addressing a variety of psychosocial needs. The experimental group (n = 88) will receive ICOnnecta't plus a cognitive module. Assessments at baseline, 3, 6, and 12 months will measure the interventions' impact on cognition, emotional distress, medication adherence, quality of life, post-traumatic stress, work functioning and healthcare experience. Feasibility and cost-utility analyses will also be conducted. Results The cognitive module includes three levels. The first level contains a cognitive screening using FACT-Cog Perceived Cognitive Impairment (PCI). Patients with PCI <54 progress to a cognitive psychoeducational campus (Level 2) with content on cognitive education, behavioural strategies and mindfulness. Patients with persistent or worsened PCI (≥6) after 3 months move to Level 3, an online cognitive training through CogniFit software delivered twice a week over 12 weeks. Conclusions This study assesses whether integrating a cognitive module into a digital psychosocial intervention improves objective and subjective cognition in breast cancer patients. Secondary outcomes explore cognitive improvement's impact on psychosocial variables. The research will contribute to testing efficacious approaches for detecting and addressing cognitive dysfunction in breast cancer patients. Trial registration ClinicalTrials.gov, NCT06103318. Registered 26 October 2023, https://classic.clinicaltrials.gov/ct2/show/NCT06103318?term=serra-blasco&draw=2&rank=4.
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Affiliation(s)
- Maria Serra-Blasco
- ICOnnecta’t Digital Health Program, Catalan Institute of Oncology, Hospitalet del Llobregat, Spain
- The Bellvitge Biomedical Research Institute IDIBELL, Psychooncology and Digital Health Group, Hospitalet del Llobregat, Spain
- Mental Health Networking Biomedical Research Centre (CIBERSAM), Carlos III Health Institute, Barcelona, Spain
| | - Arnau Souto-Sampera
- ICOnnecta’t Digital Health Program, Catalan Institute of Oncology, Hospitalet del Llobregat, Spain
- The Bellvitge Biomedical Research Institute IDIBELL, Psychooncology and Digital Health Group, Hospitalet del Llobregat, Spain
- Department of Clinical Psychology and Psychobiology, Universitat de Barcelona, Barcelona, Spain
| | - Joan C. Medina
- The Bellvitge Biomedical Research Institute IDIBELL, Psychooncology and Digital Health Group, Hospitalet del Llobregat, Spain
- Department of Psychology and Education Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Aida Flix-Valle
- ICOnnecta’t Digital Health Program, Catalan Institute of Oncology, Hospitalet del Llobregat, Spain
- The Bellvitge Biomedical Research Institute IDIBELL, Psychooncology and Digital Health Group, Hospitalet del Llobregat, Spain
- Department of Clinical Psychology and Psychobiology, Universitat de Barcelona, Barcelona, Spain
| | - Laura Ciria-Suarez
- ICOnnecta’t Digital Health Program, Catalan Institute of Oncology, Hospitalet del Llobregat, Spain
- The Bellvitge Biomedical Research Institute IDIBELL, Psychooncology and Digital Health Group, Hospitalet del Llobregat, Spain
| | - Alejandra Arizu-Onassis
- The Bellvitge Biomedical Research Institute IDIBELL, Psychooncology and Digital Health Group, Hospitalet del Llobregat, Spain
- Department of Clinical Psychology and Psychobiology, Universitat de Barcelona, Barcelona, Spain
| | - Marina Ruiz-Romeo
- The Bellvitge Biomedical Research Institute IDIBELL, Psychooncology and Digital Health Group, Hospitalet del Llobregat, Spain
- Department of Clinical Psychology and Psychobiology, Universitat de Barcelona, Barcelona, Spain
| | - Femke Jansen
- Department of Otolaryngology-Head and Neck Surgery, Amsterdam UMC, VUmc Cancer Center Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, The Netherlands
| | - Ana Rodríguez
- Breast Cancer Functional Unit, Catalan Institute of Oncology, Hospitalet del Llobregat, Spain
| | - Sonia Pernas
- Breast Cancer Functional Unit, Catalan Institute of Oncology, Hospitalet del Llobregat, Spain
| | - Cristian Ochoa-Arnedo
- ICOnnecta’t Digital Health Program, Catalan Institute of Oncology, Hospitalet del Llobregat, Spain
- The Bellvitge Biomedical Research Institute IDIBELL, Psychooncology and Digital Health Group, Hospitalet del Llobregat, Spain
- Department of Clinical Psychology and Psychobiology, Universitat de Barcelona, Barcelona, Spain
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Moon C, Wilson RL, Gonzalo-Encabo P, Kang DW, Mithani S, Dieli-Conwright CM, Patel DI. Measurement of Cognitive Function in Exercise Oncology Studies in Patients Treated With Chemotherapy: A Scoping Review. Integr Cancer Ther 2024; 23:15347354241265349. [PMID: 39045709 PMCID: PMC11271141 DOI: 10.1177/15347354241265349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 06/07/2024] [Accepted: 06/14/2024] [Indexed: 07/25/2024] Open
Abstract
Cancer-associated cognitive deficits following chemotherapy have received increased attention in clinical research. Exercise has been shown to preserve cognitive function in cancer patients, though the overall effect is mixed. Here we present a scoping review of the published literature summarizing methods used to assess cognitive function in exercise oncology trials. Methods: PubMed, PsycINFO and CINAHL databases were searched using keywords "cognition," "cancer" OR "neoplasm" OR "tumor," "chemotherapy" and "exercise" OR "physical activity." Studies eligible for inclusion include prospective studies that were published in English in peer-reviewed journals that include a method of assessing cognitive function in adult cancer patients, in which an exercise modality or method of quantifying exercise habits was evident. Studies were excluded if they included a pediatric population, patients that were not diagnosed with cancer, or were systematic/narrative/scoping reviews, protocol papers or dissertation/theses. Results: A total of 29 studies met the inclusion criteria. In total, 29 unique assessments were used to evaluate cognitive function, including patient-reported outcomes (PROs; n = 8) and objective (n = 21) methods. More than half (n = 17) of included studies relied on PROs while 12 studies utilized objective measures of cognitive function Cognitive domains of the PROs were limited in scope, focusing on memory and attention/concentration while the objective measures were broader and inclusive of multiple domains. Conclusion: The results of this review indicate that mixed approaches to evaluating cognitive function in cancer patients pose a major limitation to understanding the role of exercise as an integrative approach. The evidence demonstrates a need for more uniform assessment of cognitive function in exercise oncology trials.
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Affiliation(s)
- Crisann Moon
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Rebekah L. Wilson
- Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Paola Gonzalo-Encabo
- Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Dong-Woo Kang
- Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Sara Mithani
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | | | - Darpan I. Patel
- University of Texas Medical Branch at Galveston, Galveston, TX, USA
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Chan FHF, Goh ZZS, Zhu X, Tudor Car L, Newman S, Khan BA, Griva K. Subjective cognitive complaints in end-stage renal disease: a systematic review and meta-analysis. Health Psychol Rev 2023; 17:614-640. [PMID: 36200562 DOI: 10.1080/17437199.2022.2132980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 09/30/2022] [Indexed: 11/04/2022]
Abstract
Cognitive impairment is common in patients with end-stage renal disease (ESRD) and is associated with compromised quality of life and functional capacity, as well as worse clinical outcomes. Most previous research and reviews in this area were focused on objective cognitive impairment, whereas patients' subjective cognitive complaints (SCCs) have been less well-understood. This systematic review aimed to provide a broad overview of what is known about SCCs in adult ESRD patients. Electronic databases were searched from inception to January 2022, which identified 221 relevant studies. SCCs appear to be highly prevalent in dialysis patients and less so in those who received kidney transplantation. A random-effects meta-analysis also shows that haemodialysis patients reported significantly more SCCs than peritoneal dialysis patients (standardised mean difference -0.20, 95% confidence interval -0.38 to -0.03). Synthesis of longitudinal studies suggests that SCCs remain stable on maintenance dialysis treatment but may reduce upon receipt of kidney transplant. Furthermore, SCCs in ESRD patients have been consistently associated with hospitalisation, depression, anxiety, fatigue, and poorer quality of life. There is limited data supporting a strong relation between objective and subjective cognition but preliminary evidence suggests that this association may be domain-specific. Methodological limitations and future research directions are discussed.
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Affiliation(s)
- Frederick H F Chan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Zack Z S Goh
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Xiaoli Zhu
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Nursing Services, National Healthcare Group Polyclinics, Singapore
| | - Lorainne Tudor Car
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Department of Primary Care and Public Health, Imperial College London School of Public Health, London, UK
| | - Stanton Newman
- School of Health Sciences, Division of Health Services Research and Management, City University of London, London, UK
| | - Behram A Khan
- National Kidney Foundation, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Konstadina Griva
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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Vargo MM. Outcome Measures and Patient-Reported Metrics in Cancer Rehabilitation. Curr Oncol Rep 2023; 25:869-882. [PMID: 37148415 DOI: 10.1007/s11912-023-01412-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 05/08/2023]
Abstract
PURPOSE OF REVIEW The current panorama of measurement tools for use in cancer rehabilitation is reviewed. For rehabilitation purposes, evaluating function is of the highest priority. RECENT FINDINGS From a patient-reported outcome (PRO) standpoint, SF-36 and EORTC-QLQ-C30 are in most common use in cancer rehabilitation research; these are quality of life measures that contain functional subdomains. Newer tools which are based on item response theory and have options for both computer assisted or short form (SF) administration, including the Patient-Reported Outcomes Measurement Information System (PROMIS) and Activity Measure for Post-acute Care (AMPAC) instruments, show increasing use, especially PROMIS Physical Function SF, and, recently, PROMIS Cancer Function Brief 3D, which has been validated in the cancer population, with domains of physical function, fatigue, and social participation, to track clinical rehabilitation outcomes. Evaluating objective measures of function in cancer patients is also crucial. Utilization of clinically feasible tools for cancer rehabilitation, to employ for both screening purposes and for monitoring of rehabilitation treatment efficacy, is an evolving area, much needed to promote further research and improved, consistent clinical care for cancer patients and survivors.
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Affiliation(s)
- Mary M Vargo
- Physical Medicine and Rehabilitation, MetroHealth Medical Center, Case Western Reserve University, 4229 Pearl Road, Cleveland, OH, 44109, USA.
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10
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Ng DQ, Chan D, Acharya MM, Grill JD, Chan A. Research Attitude and Interest among Cancer Survivors with or without Cognitive Impairment. Cancers (Basel) 2023; 15:3409. [PMID: 37444519 PMCID: PMC10340755 DOI: 10.3390/cancers15133409] [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: 05/08/2023] [Revised: 06/15/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND We examined the research attitudes and willingness to participate in clinical research among cancer survivors with varying degrees of cognitive function. METHODS This is a secondary analysis of data collected through the University of California Irvine Consent-to-Contact registry. Cancer survivors completed the Cognitive Function Instrument (CFI), the Research Attitudes Questionnaire (RAQ), and willingness to participate (WTP) in certain research procedures. Perceived cognitive impairment (CI) was defined as the worst 20% CFI scores. RESULTS Here, 265 CI and 909 cognitively non-impaired (CNI) participants' data were analyzed. Mean age and sex distribution were similar, with fewer non-Hispanic Whites and education years among CI participants. More CI participants self-reported past diagnoses of Alzheimer's disease, mild cognitive impairment, stroke, depression, post-traumatic stress disorder, and alcohol abuse (all p < 0.05). CI participants were significantly more interested in studies investigating approved medications (92% vs. 87%, p = 0.030), lumbar puncture (47% vs. 38%, p = 0.027), and autopsy (78% vs. 69%, p = 0.022). After removing survivors with co-existing neuropsychiatric conditions, interest in autopsy studies remained statistically higher among CI (79% vs. 69%, p = 0.022). CONCLUSIONS Participants with cancer and CI are open to research procedures and interventions that are traditionally less utilized, which may facilitate the discovery of the pathogenesis and interventions for cancer-related cognitive impairment (CRCI).
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Affiliation(s)
- Ding Quan Ng
- School of Pharmacy and Pharmaceutical Sciences, University of California Irvine, Irvine, CA 92697, USA
| | - Daniella Chan
- School of Pharmacy and Pharmaceutical Sciences, University of California Irvine, Irvine, CA 92697, USA
| | - Munjal M. Acharya
- School of Medicine, University of California Irvine, Irvine, CA 92697, USA
| | - Joshua D. Grill
- School of Medicine, University of California Irvine, Irvine, CA 92697, USA
- School of Biological Sciences, University of California Irvine, Irvine, CA 92697, USA
| | - Alexandre Chan
- School of Pharmacy and Pharmaceutical Sciences, University of California Irvine, Irvine, CA 92697, USA
- School of Medicine, University of California Irvine, Irvine, CA 92697, USA
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Liu H, Li Y, Li Y, Wang J, Su N, Cui N, Xu K, Sun Y, Cao F. Psychometric properties of the Chinese version of the Cognitive Reserve Assessment Scale in Health in patients with cancer. BMC Psychiatry 2023; 23:5. [PMID: 36597052 PMCID: PMC9811687 DOI: 10.1186/s12888-022-04506-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 12/28/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Cognitive reserve is a modifiable factor that could prevent cognitive decline in patients with cancer. The Cognitive Reserve Assessment Scale in Health (CRASH) is an instrument used to assess cognitive reserve. This study aims to develop and examine the psychometric properties of the Chinese version of the CRASH for patients with cancer. METHODS A cross-sectional survey was conducted with 167 cancer patients from four wards of two hospitals in China. Thirty-one patients were re-assessed to examine the test-retest reliability. Four translators and three reviewers developed the Chinese version of the scale. We assessed its structural validity, concurrent validity, internal consistency, test-retest reliability, measurement error, and floor/ceiling effects. RESULTS Confirmatory factor analysis showed a good model fit with the four-factor structure of the original CRASH. The CRASH scores were statistically significantly associated with neuropsychological test scores, indicating sufficient concurrent validity. The internal consistency was acceptable, except for leisure activities, with standardized Cronbach's alphas (0.64-0.94) and standardized Omega (0.66-0.95). There was excellent test-retest reliability, with a high intraclass correlation coefficient (0.914-0.993) of total scores and scores for each domain. The measurement error was acceptable, and no floor or ceiling effects were observed. CONCLUSIONS The Chinese version of the CRASH is a valid and reliable instrument to assess cognitive reserve in patients with cancer. Moreover, cognitive reserve measured by the CRASH was associated with low cognitive performance in cancer patients.
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Affiliation(s)
- Hong Liu
- grid.27255.370000 0004 1761 1174Department of Nursing Psychology, School of Nursing and Rehabilitation, Shandong University, No.44 Wenhuaxi Road, Jinan city, 250012 Shandong Province China
| | - Yanyan Li
- grid.11135.370000 0001 2256 9319School of Nursing, Peking University, Beijing, China
| | - Yang Li
- grid.89336.370000 0004 1936 9924School of Nursing, The University of Texas at Austin, Austin, USA
| | - Jianwen Wang
- grid.27255.370000 0004 1761 1174Department of Nursing Psychology, School of Nursing and Rehabilitation, Shandong University, No.44 Wenhuaxi Road, Jinan city, 250012 Shandong Province China
| | - Na Su
- grid.440144.10000 0004 1803 8437Imaging Department, Shandong Cancer Hospital and Institute, Jinan, China
| | - Naixue Cui
- grid.27255.370000 0004 1761 1174Department of Nursing Psychology, School of Nursing and Rehabilitation, Shandong University, No.44 Wenhuaxi Road, Jinan city, 250012 Shandong Province China
| | - Kun Xu
- grid.440144.10000 0004 1803 8437Department of Gastrointestinal Surgery, Shandong Cancer Hospital and Institute, Jinan, China
| | - Yaoyao Sun
- grid.27255.370000 0004 1761 1174Department of Nursing Psychology, School of Nursing and Rehabilitation, Shandong University, No.44 Wenhuaxi Road, Jinan city, 250012 Shandong Province China
| | - Fenglin Cao
- Department of Nursing Psychology, School of Nursing and Rehabilitation, Shandong University, No.44 Wenhuaxi Road, Jinan city, 250012, Shandong Province, China.
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12
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Lv P, Ma G, Chen W, Liu R, Xin X, Lu J, Su S, Li M, Yang S, Ma Y, Rong P, Dong N, Chen Q, Zhang X, Han X, Zhang B. Brain morphological alterations and their correlation to tumor differentiation and duration in patients with lung cancer after platinum chemotherapy. Front Oncol 2022; 12:903249. [PMID: 36016623 PMCID: PMC9396961 DOI: 10.3389/fonc.2022.903249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveChemotherapy-related brain impairments and changes can occur in patients with lung cancer after platinum chemotherapy and have a substantial impact on survivors’ quality of life. Therefore, it is necessary to understand the brain neuropathological alterations and response mechanisms to provide a theoretical basis for rehabilitation strategies. This study aimed to investigate the related brain morphological changes and clarified their correlation with clinical and pathological indicators in patients with lung cancer after platinum chemotherapy.MethodsOverall, 28 patients with chemotherapy, 56 patients without chemotherapy, and 41 healthy controls were categorized in three groups, matched for age, sex, and years of education, and included in the cross-sectional comparison of brain volume and cortical thickness. 14 matched patients before and after chemotherapy were subjected to paired comparison for longitudinal observation of brain morphological changes. Three-dimensional T1-weighted images were acquired from all participants, and quantitative parameters were calculated using the formula of the change from baseline. Correlation analysis was performed to evaluate the relationship between abnormal morphological indices and clinical information of patients.ResultsBrain regions with volume differences among the three groups were mainly distributed in frontal lobe and limbic cortex. Additionally, significant differences in cerebrospinal fluid were observed in most ventricles, and the main brain regions with cortical thickness differences were the gyrus rectus and medial frontal cortex of the frontal lobe, transverse temporal gyrus of the temporal lobe, insular cortex, anterior insula, and posterior insula of the insular cortex. According to the paired comparison, decreased brain volumes in the patients after chemotherapy appeared in some regions of the frontal, parietal, temporal, and occipital lobes; limbic cortex; insular cortex; and lobules VI-X and decreased cortical thickness in the patients after chemotherapy was found in the frontal, temporal, limbic, and insular cortexes. In the correlation analysis, only the differentiation degree of the tumor and duration after chemotherapy were significantly correlated with imaging indices in the abnormal brain regions.ConclusionsOur findings illustrate the platinum-related brain reactivity morphological alterations which provide more insights into the neuropathological mechanisms of patients with lung cancer after platinum chemotherapy and empirical support for the details of brain injury related to cancer and chemotherapy.
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Affiliation(s)
- Pin Lv
- Department of Radiology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Guolin Ma
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Wenqian Chen
- Department of Radiology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Renyuan Liu
- Department of Radiology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Xiaoyan Xin
- Department of Radiology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Jiaming Lu
- Department of Radiology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Shu Su
- The Comprehensive Cancer Centre of Drum Tower Hospital, Medical School of Nanjing University and Clinical Cancer Institute of Nanjing University, Nanjing, China
| | - Ming Li
- Department of Radiology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - ShangWen Yang
- Department of Radiology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Yiming Ma
- Department of Radiology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Ping Rong
- Department of Radiology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Ningyu Dong
- Department of Radiology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Qian Chen
- Department of Radiology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Xin Zhang
- Department of Radiology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Xiaowei Han
- Department of Radiology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
- *Correspondence: Xiaowei Han, ; Bing Zhang,
| | - Bing Zhang
- Department of Radiology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
- Institute of Medical Imaging and Artificial Intelligence, Nanjing University, Nanjing, China
- Jiangsu Key Laboratory of Molecular Medicine, Nanjing, China
- Institute of Brain Science, Nanjing University, Nanjing, China
- *Correspondence: Xiaowei Han, ; Bing Zhang,
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13
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Duval A, Davis CG, Khoo EL, Romanow H, Shergill Y, Rice D, Smith AM, Poulin PA, Collins B. Mindfulness-based stress reduction and cognitive function among breast cancer survivors: A randomized controlled trial. Cancer 2022; 128:2520-2528. [PMID: 35385137 DOI: 10.1002/cncr.34209] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/25/2022] [Accepted: 03/03/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Breast cancer (BC) survivors frequently report changes in cognition after chemotherapy. Mindfulness may benefit survivors by mitigating cancer-related cognitive impairment. As part of a larger study investigating the effects of mindfulness-based stress reduction (MBSR) for BC survivors living with neuropathic pain, the authors assessed whether MBSR would have an effect on cognitive outcomes. METHODS Participants were randomized to an MBSR intervention group (n = 30) or a waitlist control group (n = 30). Cognitive assessments were administered at 3 time points: at baseline, 2 weeks, and 3 months post-MBSR in the intervention group and at equivalent time intervals for the control group. Multilevel models were used to assess whether MBSR significantly improved task performance at each time point. RESULTS MBSR participants showed a significantly greater reduction in prospective and retrospective memory failures at 2 weeks postintervention. No effects of MBSR were noted for objective assessments. CONCLUSIONS These results suggest that MBSR training reduces subjective (but not objective) memory-related impairments in BC survivors who receive treatment with chemotherapy. This study provides insight into a noninvasive intervention to ameliorate memory difficulties in BC survivors.
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Affiliation(s)
- Alicia Duval
- Department of Psychology, Carleton University, Ottawa, Ontario, Canada
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | | | - Eve-Ling Khoo
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Heather Romanow
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Danielle Rice
- Department of Psychology, McGill University, Montreal, Quebec, Canada
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Andra M Smith
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Patricia A Poulin
- Department of Anesthesiology and Pain Medicine, The University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
- Department of Psychology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Barbara Collins
- Department of Psychology, Carleton University, Ottawa, Ontario, Canada
- Department of Psychology, The Ottawa Hospital, Ottawa, Ontario, Canada
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14
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Ko D, Dietrich MS, Gifford KA, Ridner SH. Subjective Cognition Reported by Caregivers Is Correlated With Objective Cognition in Liver Transplant Recipients. Liver Transpl 2022; 28:269-279. [PMID: 34137503 PMCID: PMC8785255 DOI: 10.1002/lt.26213] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 06/09/2021] [Accepted: 06/13/2021] [Indexed: 02/03/2023]
Abstract
Objective cognitive assessments, a gold standard diagnostic tool for cognitive impairment, may not be feasible in busy liver transplantation (LT) practice because they are often time consuming. This study determined whether subjective cognition, patients' self-ratings and/or caregivers' ratings of patients' cognition, reflects objective cognition in LT recipients. A convenience sample of 60 adult LT recipients and their caregivers, recruited at a single transplant center, participated in this cross-sectional descriptive study. Subjective cognition (ie, recipient self-rated and caregiver rated) was measured using the Everyday Cognition (ECog; global and 6 domain scores). Objective global and domain-specific cognition of recipients was measured using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Trail Making Test parts A and B, Digit Span Backward, and Rey-Osterrieth Complex Figure. Agreement between LT recipients' ECog scores and those of their caregivers was fair to moderate (intraclass correlation coefficient = 0.48 for global score, 0.35-0.56 for domain scores). Significant, albeit rather weak, correlations were found between subjective and objective scores. Recipients' ECog visuospatial abilities scores were correlated with Rey-Osterrieth Complex Figure scores (rs = -0.39; P = 0.007), whereas caregivers' ECog global, attention, visuospatial abilities, and organization scores were, respectively, correlated with the scores of RBANS global (rs = -0.33; P = 0.04) and attention (rs = -0.46; P = 0.005), Rey-Osterrieth Complex Figure (Copy; rs = -0.34; P = 0.03), and Trail Making Test part A (rs = 0.31; P = 0.049). The findings suggest that caregivers may estimate LT recipients' cognition better than recipients themselves. Caregivers may provide supplemental information that could be useful for clinicians when considering the cognitive functioning of LT recipients.
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Affiliation(s)
- Dami Ko
- School of Nursing, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
| | - Mary S. Dietrich
- School of Nursing, Vanderbilt University, Nashville, Tennessee,Department of Biostatistics, School of Medicine, Vanderbilt University, Nashville, Tennessee,Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Katherine A. Gifford
- Vanderbilt Memory and Alzheimer’s Center, Vanderbilt University Medical Center, Nashville, Tennessee,Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sheila H. Ridner
- School of Nursing, Vanderbilt University, Nashville, Tennessee,Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
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15
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Boelsbjerg HB, Kurita GP, Sjøgren P, Hansen NV. Combining subjective and objective appraisals of cognitive dysfunction in patients with cancer: a deeper understanding of meaning and impact on suffering? Support Care Cancer 2022; 30:3603-3612. [PMID: 35029771 DOI: 10.1007/s00520-021-06777-7] [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: 08/16/2021] [Accepted: 12/20/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Patients with advanced cancer often experience cognitive dysfunction, which may influence decision making, self-perception, and existential well-being. However, there is little evidence regarding this issue. This study analysed associations between objective neuropsychological measures and patients' self-report of cognitive dysfunction interfering with everyday life, general well-being, and sense of existential value. METHODS A mixed method study assessed 13 adult patients with advanced cancer with validated neuropsychological tests, which assessed sustained attention, psychomotor speed, memory/attention, mental flexibility, and a measure of global cognitive function. These were followed by semi-structured interviews focusing on subjective experiences of cognitive dysfunction. Agreement between subjective and objective measures were analysed by Cohen's Kappa (k). Thematic analysis explored associations with cognitive deficits. RESULTS Poor cognitive performance on the neuropsychological tests was observed regarding sustained attention (n = 8), psychomotor speed (n = 1), memory/attention (n = 2), mental flexibility (n = 9), and global cognitive function (n = 3). Almost all patients (n = 12) had complaints of cognitive dysfunction. However, the agreement between the two assessments was weak (k ≤ 0.264). Cognitive dysfunction challenged the patients with regard to practice everyday life including their existential values related to meaning of life and well-being. Adjustment of the sense of living according to one's existential values and changes of self-perception were also related positively and negatively to existential well-being. CONCLUSION Despite the weak agreement between objective and subjective measures of cognitive function, many of the patients reported experiences of cognitive dysfunction that had an impact on their daily life and existential well-being, adding to the suffering experienced.
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Affiliation(s)
- Hanne Bess Boelsbjerg
- Interacting Minds Centre, Clinical Institute, University of Aarhus, Aarhus, Denmark.,Interdisciplinary Research Unit, Elective Surgery Center, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Geana Paula Kurita
- Palliative Research Group, Department of Oncology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark. .,Multidisciplinary Pain Centre, Department of Anaesthesia, Pain and Respiratory Support, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark. .,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Per Sjøgren
- Palliative Research Group, Department of Oncology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Niels Viggo Hansen
- Danish Center for Mindfulness, Institute for Clinical Medicine, University of Aarhus, Aarhus, Denmark
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16
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Zarrella GV, Perez A, Dietrich J, Parsons MW. Reliability and validity of a novel cognitive self-assessment tool for patients with cancer. Neurooncol Pract 2021; 8:691-698. [PMID: 34777838 DOI: 10.1093/nop/npab045] [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] [Indexed: 12/14/2022] Open
Abstract
Background Subjective cognitive function is an important outcome measure in oncology. The Functional Assessment of Cancer Therapy-Brain (FACT-Br) is a quality of life (QoL) measure that includes indices of physical, emotional, social, and neurologic aspects of disease but does not measure cognitive function. This study seeks to validate a novel index of cognition derived from the FACT-Br. Methods Patients with heterogeneous cancer diagnoses (N = 214) completed neuropsychological evaluation and self-report measures. Nine FACT-Br items regarding cognition were combined to form the FACT-Br-cognitive index (CI). Reliability was evaluated by exploratory factor analysis and internal consistency. Concurrent validity was assessed by correlating FACT-Br-CI with the Patient-Reported Outcomes Measurement Information System (PROMIS) Cognitive-8 scales. Discriminant validity was assessed by correlating FACT-Br-CI with other FACT-Br indices and the Beck Depression and Anxiety Inventories (BDI, BAI). Exploratory analyses evaluated the impact of cognitive performance and disease variables on FACT-Br-CI. Results The FACT-Br-CI consisted of a single factor that demonstrated high internal consistency (α = 0.867) and strong concurrent validity, correlating strongly with PROMIS Cognitive-8 scales (r = 0.675-0.782). The relationship between the FACT-Br-CI and other FACT subscales ranged from moderate to strong (r = 0.372-0.601), as did correlations with measures of depression (BDI, r = -0.621) and anxiety (BAI, r = -0.450). Modest correlations were observed with neuropsychological measures (rs = 0.249-0.300). Conclusions The FACT-Br-CI is a reliable and valid measure of self-reported cognition. Studies that included the FACT-Br could be retrospectively analyzed to assess subjective cognitive outcomes, enriching the information from prior research. Integration of the FACT-Br-CI in routine clinical care may be an efficient method of monitoring cognition.
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Affiliation(s)
- Giuliana V Zarrella
- Department of Psychiatry, Psychology Assessment Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alice Perez
- Department of Psychiatry, Psychology Assessment Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,UConn Health, UConn School of Medicine, Farmington, Connecticut, USA
| | - Jorg Dietrich
- Stephen and Catherine Pappas Center for Neuro-Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael W Parsons
- Department of Psychiatry, Psychology Assessment Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Stephen and Catherine Pappas Center for Neuro-Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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17
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Kesler SR, Henneghan AM, Thurman W, Rao V. Identifying themes for assessing cancer-related cognitive impairment identified by topic modeling and qualitative content analysis of public online comments (Preprint). JMIR Cancer 2021; 8:e34828. [PMID: 35612878 PMCID: PMC9178450 DOI: 10.2196/34828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 04/28/2022] [Accepted: 05/01/2022] [Indexed: 11/28/2022] Open
Abstract
Background Cancer-related cognitive impairment (CRCI) is a common and significant adverse effect of cancer and its therapies. However, its definition and assessment remain difficult due to limitations of currently available measurement tools. Objective This study aims to evaluate qualitative themes related to the cognitive effects of cancer to help guide development of assessments that are more specific than what is currently available. Methods We applied topic modeling and inductive qualitative content analysis to 145 public online comments related to cognitive effects of cancer. Results Topic modeling revealed 2 latent topics that we interpreted as representing internal and external factors related to cognitive effects. These findings lead us to hypothesize regarding the potential contribution of locus of control to CRCI. Content analysis suggested several major themes including symptoms, emotional/psychological impacts, coping, “chemobrain” is real, change over time, and function. There was some conceptual overlap between the 2 methods regarding internal and external factors related to patient experiences of cognitive effects. Conclusions Our findings indicate that coping mechanisms and locus of control may be important themes to include in assessments of CRCI. Future directions in this field include prospective acquisition of free-text responses to guide development of assessments that are more sensitive and specific to cognitive function in patients with cancer.
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Affiliation(s)
- Shelli R Kesler
- School of Nursing, University of Texas at Austin, Austin, TX, United States
| | - Ashley M Henneghan
- School of Nursing, University of Texas at Austin, Austin, TX, United States
| | - Whitney Thurman
- School of Nursing, University of Texas at Austin, Austin, TX, United States
| | - Vikram Rao
- School of Nursing, University of Texas at Austin, Austin, TX, United States
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18
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Shaw C, Baldwin A, Anderson C. Cognitive effects of chemotherapy: An integrative review. Eur J Oncol Nurs 2021; 54:102042. [PMID: 34607177 DOI: 10.1016/j.ejon.2021.102042] [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] [Received: 06/29/2021] [Revised: 09/21/2021] [Accepted: 09/26/2021] [Indexed: 01/12/2023]
Abstract
PURPOSE An estimated 18.1 million new cancer cases (excluding nonmelanoma skin cancers) were diagnosed worldwide in 2020. Despite a rising incidence of cancers worldwide, in developed countries with strong healthcare systems, survival rates are improving as a result of early detection, improved treatments and survivorship care (World Health Organisation (WHO), 2021). Whilst living longer, cancer survivors are often living with side effects of treatment, including chemotherapy related cognitive impairment, often termed "chemobrain". METHOD An integrative review of contemporary literature answering the research question how does chemotherapy affect cognitive function? was undertaken utilising three computerised databases CINAHL, Medline and PUBMED, between 2015 and 2021. Data was thematically analysed to identify themes within published literature. RESULTS Thematic analysis identified four broad themes within the literature regarding chemotherapy induced cognitive impairment. Identified themes included; cognition as part of a complex scenario, proof of existence and searching for the cause, learning to play the game and timing of cognitive impairment. CONCLUSIONS Aggressive treatment with chemotherapy in the adjuvant setting has drastically improved the survival of cancer patients. Subsequent to aggressive treatments, side effects such as cognitive impairment have presented, which may persist in the long term. Despite the exact aetiology of chemotherapy induced cognitive impairment being largely unknown, the consequences of the condition are impacting cancer survivors and their quality of life.
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Affiliation(s)
- Carli Shaw
- Central Queensland University 538 Flinders Street, Townsville, Queensland, Australia, 4810.
| | - Adele Baldwin
- Central Queensland University 538 Flinders Street, Townsville, Queensland, Australia, 4810
| | - Carina Anderson
- Central Queensland University 538 Flinders Street, Townsville, Queensland, Australia, 4810; University of Southern Queensland, Ipswich Campus, 11 Salisbury Rd, Ipswich, Queensland, 4305, Australia
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19
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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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20
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Henneghan AM, Van Dyk K, Kaufmann T, Harrison R, Gibbons C, Heijnen C, Kesler SR. Measuring Self-Reported Cancer-Related Cognitive Impairment: Recommendations From the Cancer Neuroscience Initiative Working Group. J Natl Cancer Inst 2021; 113:1625-1633. [PMID: 33638633 PMCID: PMC8849125 DOI: 10.1093/jnci/djab027] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/07/2021] [Accepted: 02/22/2021] [Indexed: 12/15/2022] Open
Abstract
Cancer and its treatments are associated with increased risk for cancer-related cognitive impairment (CRCI). Methods and measures used to study and assess self-reported CRCI (sr-CRCI), however, remain diverse, resulting in heterogeneity across studies. The Patient-Reported Outcomes Working Group has been formed to promote homogeneity in the methods used to study sr-CRCI. In this report, using a psychometric taxonomy, we inventory and appraise instruments used in research to measure sr-CRCI, and we consider advances in patient-reported outcome methodology. Given its psychometric properties, we recommend the Patient-Reported Outcome Measurement Information System Cognitive Function Short Form 8a for measurement of sr-CRCI in cancer patients and survivors, at a minimum, to increase scientific rigor and progress in addressing CRCI.
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Affiliation(s)
- Ashley M Henneghan
- School of Nursing, University of Texas at Austin, Austin, TX, USA,Department of Oncology, Dell Medical School, University of Texas at Austin, Austin, TX, USA,Correspondence to: Ashley M. Henneghan, PhD, RN, FAAN, School of Nursing, University of Texas at Austin, 1710 Red River St, Austin TX, 78712, USA (e-mail: )
| | - Kathleen Van Dyk
- Semel Institute, Department of Psychiatry and Biobehavioral Sciences David Geffen School of Medicine, Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, CA, USA
| | - Tara Kaufmann
- Department of Oncology , Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Rebecca Harrison
- Department of Neuro Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Christopher Gibbons
- Department of Symptom Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Cobi Heijnen
- Department of Symptom Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shelli R Kesler
- School of Nursing, Department of Diagnostic Medicine, Dell Medical School, University of Texas at Austin, Austin, TX, USA
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21
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Dijkshoorn ABC, van Stralen HE, Sloots M, Schagen SB, Visser-Meily JMA, Schepers VPM. Prevalence of cognitive impairment and change in patients with breast cancer: A systematic review of longitudinal studies. Psychooncology 2021; 30:635-648. [PMID: 33533166 PMCID: PMC8248098 DOI: 10.1002/pon.5623] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 12/23/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Patients with breast cancer face cognitive impairment that affects their quality of life; partially attributable to treatment. Our aim was to detail the prevalence and change of cognitive impairment during the course of treatment. We also investigated the effect of therapy (chemotherapy [CT]) vs. radiotherapy and/or endocrine therapy vs. healthy controls). METHODS This article reviews longitudinal cohort studies published to date in Medline and Embase that (i) assess cognition before and after therapy, (ii) report prevalence cognitive impairment or change, and (iii) use standardized and valid neuropsychological tests. We used the original authors' criteria for cognitive impairment. RESULTS The title and abstract of 891 articles were screened, resulting in the identification of 90 potentially relevant articles while applying the eligibility criteria. After full-text examination, 17 studies were included. Prevalence of cognitive impairment range from 25% before therapy, through 24% after therapy to 21% at maximal 1-year follow-up (FU). Compared to their pretreatment cognitive functioning, 24% of patients decline after treatment and 24% at 1-year FU. Some studies also reported cognitive improvement showing that 15% and 31% of patients improve, respectively. In general, patients undergoing CT have a higher chance of cognitive impairment and decline than no-CT patients and healthy controls. CONCLUSIONS This study shows that one out of four breast cancer patients shows cognitive impairment prior to treatment administration CT and a significant number of patients decline during the course of disease, suggesting that cognitive impairment is not exclusively related to CT and/or no-CT therapies. This study shows that assessment of cognitive functioning, ideally over time, is crucial and may help the implementation of personalized rehabilitation pathways.
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Affiliation(s)
- Aicha B C Dijkshoorn
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Haike E van Stralen
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maurits Sloots
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sanne B Schagen
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Johanna M A Visser-Meily
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands.,Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Vera P M Schepers
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands.,Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
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22
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Hardy-Leger I, Charles C, Lange M, Joly F, Roux P, Capel A, Petrucci J, Rigal O, Le Fel J, Vanlemmens L, Everhard S, Martin AL, Vaz Luis I, Coutant C, Cottu P, Levy C, Lerebours F, Andre F, Licaj I, Dauchy S. Differentiation of groups of patients with cognitive complaints at breast cancer diagnosis: Results from a sub-study of the French CANTO cohort. Psychooncology 2020; 30:463-470. [PMID: 33052613 DOI: 10.1002/pon.5572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Cognitive complaints are more frequent in women with breast cancer (BC) than in healthy controls and can be present before any treatment. Findings regarding contributive factors remain inconsistent. This study aimed to identify different groups of patients with cognitive complaints at BC diagnosis and to determine whether these different groups were associated with demographic, medical, or psychological characteristics. METHODS Cognitive complaints were assessed in a subset of 264 women from the French multicenter prospective CANTO cohort, at baseline before any treatment. Clustering analyzes were performed using the six-cognitive dimension Costa's scoring of the FACT-Cog V3. Univariable analyses were used to study how cognitive function (standardized neuropsychological tests, ICCTF), anxiety, depression, fatigue, and quality of life (HADS, FA12, QLQ-C30) were associated with specific cognitive complaints groups. RESULTS Results included 263 women (54±11 years), newly diagnosed with BC (69% stages I-III). Four distinct groups emerged, ranged from "no complaints" (22.8%), "low complaints" (55.1), "mixed complaints" (14.5%), to "consistent complaints" (7.6%). No significant differences were found in terms of demographic and medical factors between the four groups. However, the groups with higher proportions of patients with complaints were found to have more impairment in executive function, higher scores of anxiety, depressive symptoms, and fatigue, and lower quality of life, than the groups with lower proportions of cognitive complaints. CONCLUSION Using complete cognitive assessment prior to BC treatment, we identified four distinct cognitive complaints groups with specific characteristics. This work provides valuable clinical basis to further investigations for a better understanding of cognitive complaints and their associates.
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Affiliation(s)
- Isabelle Hardy-Leger
- Département Interdisciplinaire d'Organisation des Parcours Patients, Gustave Roussy, Université Paris-Saclay, Villejuif, France.,Service de médecine interne et d'immunologie clinique, Unité des maladies neurovirales, CHU de Bicêtre, Le Kremlin-Bicêtre, France
| | - Cécile Charles
- Département Interdisciplinaire d'Organisation des Parcours Patients, Gustave Roussy, Université Paris-Saclay, Villejuif, France.,Laboratoire de Psychopathologie et Processus de Santé (EA 4057), Université Paris Descartes- Sorbonne Paris Cité, Boulogne-Billancourt, France
| | - Marie Lange
- Département de recherche clinique, Centre François Baclesse, Caen, France.,Université de Normandie, UNICAEN, INSERM, ANTICIPE, Caen, France.,Cancer & Cognition Platform, Ligue Contre le Cancer, Caen, France
| | - Florence Joly
- Département de recherche clinique, Centre François Baclesse, Caen, France.,Université de Normandie, UNICAEN, INSERM, ANTICIPE, Caen, France.,Cancer & Cognition Platform, Ligue Contre le Cancer, Caen, France.,Département d'Oncologie Médicale, CHU de Caen, Caen, France
| | - Pauline Roux
- Département Interdisciplinaire d'Organisation des Parcours Patients, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Aurélie Capel
- Département d'Oncologie Médicale, CHU de Caen, Caen, France
| | - Jean Petrucci
- Département Interdisciplinaire d'Organisation des Parcours Patients, Gustave Roussy, Université Paris-Saclay, Villejuif, France.,AP-HP, hôpital Henri-Mondor - Albert Chenevier, Créteil, France.,Fondation FondaMental, fondation de coopération scientifique, Créteil, France
| | | | | | | | | | | | - Ines Vaz Luis
- Gustave Roussy, Université Paris-Saclay, Inserm, Biomarqueurs prédictifs et nouvelles stratégies thérapeutiques en oncologie, Villejuif, France
| | | | - Paul Cottu
- Institut Curie, Paris-Saint Cloud, Paris, France
| | - Christelle Levy
- Institut Normand du Sein, Centre François Baclesse, Caen, France
| | | | - Fabrice Andre
- Gustave Roussy, Université Paris-Saclay, Inserm, Biomarqueurs prédictifs et nouvelles stratégies thérapeutiques en oncologie, Villejuif, France
| | - Idlir Licaj
- Département de recherche clinique, Centre François Baclesse, Caen, France.,Cancer & Cognition Platform, Ligue Contre le Cancer, Caen, France.,Department of Community Medicine, Faculty of Health Sciences, The UiT Arctic University of Norway, Tromsø, Norway
| | - Sarah Dauchy
- Département Interdisciplinaire d'Organisation des Parcours Patients, Gustave Roussy, Université Paris-Saclay, Villejuif, France
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23
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Mir N, MacLennan P, Al-Obaidi M, Murdaugh D, Kenzik KM, McDonald A, Sharafeldin N, Young-Smith C, Paluri R, Gbolahan O, Nandagopal L, Bhatia S, Williams GR. Patient-reported cognitive complaints in older adults with gastrointestinal malignancies at diagnosis- Results from the Cancer & Aging Resilience Evaluation (CARE) study. J Geriatr Oncol 2020; 11:982-988. [PMID: 32173305 PMCID: PMC7332372 DOI: 10.1016/j.jgo.2020.02.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 02/21/2020] [Accepted: 02/23/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Patient-reported cognitive complaint (CI) is poorly described in older adults with cancer. The purpose of this study was to quantify the prevalence and examine the associations of patient-reported CI in older adults with gastrointestinal (GI) malignancies at diagnosis. MATERIALS AND METHODS Using participants ≥60 years with GI malignancies from the Cancer & Aging Resilience Evaluation (CARE) Registry that underwent a Geriatric Assessment (GA), we examined CI using the Patient-Reported Outcomes Measurement Information System (PROMIS®) Short Form 4a Cognitive Function. Cognition scores were dichotomized into normal (scores of 15-20) and impaired (4-14), and bivariate and multivariate analyses were used to examine associations. RESULTS A total of 264 participants with GI malignancy were included, mean age of 70.0 ± 7.1, 55.7% male, pancreatic cancer was the most common cancer (24.2%) and majority were stage III/IV (68.2%). 29.3% of participants endorsed CI. CI was not associated with demographic and clinical domains, but was associated with many GA impairments including instrumental Activities of Daily Living (iADL) impairment (adjusted odds ratio [aOR] 6.0, 95% confidence interval 3.0-11.8), falls (aOR 2.7, 1.4-5.4), anxiety (aOR 10.3, 5.2-20.4), and depression (aOR 10.2, 5.2-20.4). CI was also associated with reduced global mental (aOR 18.7, 8.1-42.2) and physical (aOR 4.7, 2.4-8.9) quality of life, and prior hospitalizations (aOR 2.4, 1.2-4.8). CONCLUSION We found a high prevalence of patient-reported CI in older adults with GI malignancies that was associated with increased GA impairments, reduced health-related quality of life, and increased healthcare utilization.
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Affiliation(s)
- Nabiel Mir
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Paul MacLennan
- Department of Surgery, Division of Transplantation, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mustafa Al-Obaidi
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Donna Murdaugh
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kelly M Kenzik
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andrew McDonald
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Noha Sharafeldin
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Crystal Young-Smith
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ravi Paluri
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Olumide Gbolahan
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lakshmin Nandagopal
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Smita Bhatia
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Grant R Williams
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
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24
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Myers JS, Cook-Wiens G, Baynes R, Jo MY, Bailey C, Krigel S, Klemp J, Asher A. Emerging From the Haze: A Multicenter, Controlled Pilot Study of a Multidimensional, Psychoeducation-Based Cognitive Rehabilitation Intervention for Breast Cancer Survivors Delivered With Telehealth Conferencing. Arch Phys Med Rehabil 2020; 101:948-959. [DOI: 10.1016/j.apmr.2020.01.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 12/12/2019] [Accepted: 01/23/2020] [Indexed: 12/20/2022]
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25
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The impact of chemotherapy on cognitive function: a multicentre prospective cohort study in testicular cancer. Support Care Cancer 2019; 28:3081-3091. [PMID: 31642990 DOI: 10.1007/s00520-019-05095-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 09/20/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE The causal link between chemotherapy and cognitive impairment is unclear. We studied testicular cancer patients' objective and subjective cognitive function longitudinally, comparing a surgery group with a surgery + chemotherapy group, addressing prior methodological issues using a computerized test to limit assessment issues, and controlling for confounding variables. METHODS Prospectively, of 145 patients from 16 centres with sufficient data, n = 61 receiving surgery + chemotherapy (etoposide and cisplatin ± bleomycin, BEP/EP; or single agent carboplatin) were compared to n = 41 receiving surgery alone. CogHealth assessed six objective cognitive tasks. The Cognitive Failures Questionnaire assessed self-perceived cognitive dysfunction. The Functional Assessment of Chronic Illness Therapy-Fatigue and the Hospital Anxiety and Depression Scale assessed psychological influences. Linear mixed models compared changes from baseline (< 6 months post-surgery/pre-chemotherapy) to follow-up (12-18 months post-baseline), controlling covariates. RESULTS There were no significant interaction effects for five objective cognitive function tasks suggesting that changes over time were not due to group membership. However, psychomotor function (controlling for age) and physical well-being were significantly worse for the chemotherapy versus the surgery group at baseline, with groups converging by follow-up. Groups showed no differences in subjective cognitive dysfunction. The chemotherapy group showed higher anxiety, poorer functional well-being and worse fatigue compared to the surgery-only group at baseline, but not by follow-up. For both groups, emotional well-being, functional well-being and anxiety significantly improved over time. CONCLUSION No substantive differences in objective or subjective cognitive dysfunction in either group persisted 12-18 months post-baseline. Patients undergoing chemotherapy for testicular cancer differ from findings in breast cancer populations. TRIAL REGISTRATION ClinicalTrials.gov Identifier: ACTRN12609000545268.
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26
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Lange M, Licaj I, Clarisse B, Humbert X, Grellard JM, Tron L, Joly F. Cognitive complaints in cancer survivors and expectations for support: Results from a web-based survey. Cancer Med 2019; 8:2654-2663. [PMID: 30884207 PMCID: PMC6536919 DOI: 10.1002/cam4.2069] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 01/29/2019] [Accepted: 02/12/2019] [Indexed: 11/06/2022] Open
Abstract
Background Cognitive complaints are common in cancer survivors. We aimed to assess cognitive complaints in cancer survivors and the associated factors using a large web–based survey. Methods This online survey was proposed to cancer survivors. Participants completed several questions on cognitive complaints experience, expectations for support of cognitive difficulties, preexisting knowledge about chemotherapy–associated cognitive problems and demographic and medical variables. We used multivariable logistic regression models to estimate Odds Ratios and 95% confidence intervals to estimate associations. Results Among 1610 eligible participants (median age 52 [21‐84]), >85% (n = 1393) were breast cancer survivors. Median postcancer treatment time (excluding hormone therapy) was 2.83 years [0.8‐33]. Seventy five percent of the participants (n = 1214) reported cognitive complaints related to cancer treatments. Cognitive difficulties had an impact on work resumption for 76% of the participants (n = 754/982). Most cancer survivors would like to receive support (75%, n = 909) and especially cognitive training (72%, n = 658). Chemotherapy was strongly associated with cognitive complaints (multivariable OR = 3.67, 95% CI: 2.80‐4.82). Self–reported sleep difficulties (ORoften vs. never = 2.84, 95% CI: 1.80‐4.47), preexisting knowledge about chemotherapy–associated cognitive problems (ORNo vs. Yes = 1.69, 95% CI: 1‐29‐2.22) and age (OR21‐64 vs. ≥65 = 0.37, 95% CI: 0.23‐0.58) were also associated with cancer–related cognitive complaints. Conclusions According to this large web–based survey including mainly breast cancer survivors, cognitive complaints were reported by three quarters of participants, which reinforces that cognitive difficulties are a major issue in cancer survivors. Chemotherapy, self–reported sleep difficulties and preexisting knowledge about chemotherapy–associated cognitive problems were strongly associated with cancer–related cognitive complaints. Most cancer survivors wished to receive support and especially cognitive training.
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Affiliation(s)
- Marie Lange
- Clinical Research Department, Centre François Baclesse, Caen, France.,Normandie Univ, UNICAEN, INSERM, ANTICIPE, Caen, France.,Cancer and Cognition Platform, Ligue Nationale Contre le Cancer, Caen, France
| | - Idlir Licaj
- Clinical Research Department, Centre François Baclesse, Caen, France.,Normandie Univ, UNICAEN, INSERM, ANTICIPE, Caen, France.,Cancer and Cognition Platform, Ligue Nationale Contre le Cancer, Caen, France
| | | | - Xavier Humbert
- Department of General Medicine, Medical School, Caen, France.,Department of Pharmacology, University Hospital of Caen, Caen, France.,Normandie Univ, UNICAEN, Caen, France
| | | | - Laure Tron
- Normandie Univ, UNICAEN, INSERM, ANTICIPE, Caen, France.,Cancer and Cognition Platform, Ligue Nationale Contre le Cancer, Caen, France.,University Hospital of Caen, Caen, France
| | - Florence Joly
- Clinical Research Department, Centre François Baclesse, Caen, France.,Normandie Univ, UNICAEN, INSERM, ANTICIPE, Caen, France.,Cancer and Cognition Platform, Ligue Nationale Contre le Cancer, Caen, France.,University Hospital of Caen, Caen, France
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27
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Lacourt TE, Vichaya EG, Escalante C, Manzullo EF, Gunn B, Hess KR, Heijnen CJ, Dantzer R. An effort expenditure perspective on cancer-related fatigue. Psychoneuroendocrinology 2018; 96:109-117. [PMID: 29929087 PMCID: PMC6131045 DOI: 10.1016/j.psyneuen.2018.06.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 04/16/2018] [Accepted: 06/08/2018] [Indexed: 12/20/2022]
Abstract
While fatigue is the most common and debilitating side effect of cancer and cancer treatment it is still poorly understood, partly because it is usually characterized by patient-reported outcomes. As patient-reports are inherently subjective, behavioral correlates of the symptom of fatigue are needed to increase our understanding of the symptom. We focused on motivational effort expenditure as a crucial behavior in cancer-related fatigue, using a validated computerized task contrasting high effort/high reward and low effort/low reward choices under different probabilities of success. Effort expenditure-choices were analyzed in 47 cancer patients differing by their status; current evidence for disease (n = 17) or post-treatment survivors with no evidence for disease (n = 30). In addition, patient-reported fatigue, negative and positive affect, and biomarkers of inflammation were assessed. Patient-reported general and motivational fatigue, negative affect, and plasma concentrations of pro-inflammatory biomarkers were related to higher effort expenditure while positive affect was associated with lower effort expenditure. As all four measures interacted with patient status, exploratory models were computed for patients and survivors separately. These analyses indicated that the effects of fatigue and negative affect were predominantly seen in survivors. In patients still under or shortly post treatment, general fatigue, but not motivational fatigue, was associated with lower effort expenditure but only in the most favorable reward condition. Negative affect did not have an effect. Thus, the effects observed seemed primarily driven by cancer survivors in whom both fatigue and negative affect were associated with higher effort expenditure. These findings are tentatively interpreted to suggest that a tendency to invest more effort despite feelings of fatigue is a vulnerability for developing chronic fatigue. Inflammation and negative affect might contribute to fatigue in some survivors through this effort investment pathway.
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Affiliation(s)
- Tamara E Lacourt
- Neuroimmunology Laboratory, Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Elisabeth G Vichaya
- Neuroimmunology Laboratory, Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Carmen Escalante
- Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ellen F Manzullo
- Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Brandon Gunn
- Radiation Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kenneth R Hess
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Cobi J Heijnen
- Neuroimmunology Laboratory, Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Robert Dantzer
- Neuroimmunology Laboratory, Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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28
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Trachtenberg E, Mashiach T, Ben Hayun R, Tadmor T, Fisher T, Aharon-Peretz J, Dann EJ. Cognitive impairment in hodgkin lymphoma survivors. Br J Haematol 2018; 182:670-678. [PMID: 29974933 DOI: 10.1111/bjh.15448] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 05/17/2018] [Indexed: 12/25/2022]
Abstract
Cancer-related cognitive impairment (CRCI) is commonly reported post-chemotherapy in adults with solid tumours. Hodgkin lymphoma (HL) mostly affects young adults. Data regarding CRCI in HL survivors (HLS) are scarce. The current study aimed to objectively assess CRCI incidence and characteristics in HLS. HLS, who completed first-line (chemotherapy ± radiation) therapy and remained in complete remission for 6 months to 5 years from therapy end, were evaluated. Age- and education-matched healthy individuals served as controls (n = 14). Test results were compared to population norms and healthy controls. Study participants completed self-reported questionnaires evaluating fatigue, depression, anxiety, quality of life and cognitive function. Subjects underwent neurocognitive evaluation, assessing processing speed, memory, attention, executive functions and intelligence domains. The present study included 51 HLS with a median age of 28 years, mean education of 14·5 ± 2·5 years. Complaints related to cognitive deterioration and fatigue were significantly more severe and frequent in HLS compared to healthy controls. Objective neurocognitive evaluation demonstrated that 30% of HLS were impaired in ≥2 cognitive domains. In conclusion, the present study demonstrates that fatigue and cognitive impairment, predominantly in executive functions and memory, constitute frequent and alarming findings in HLS. These adverse effects can persist and exert an impact on all aspects of life.
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Affiliation(s)
| | - Tatiana Mashiach
- Quality Assurance Unit, Rambam Health Care Campus, Haifa, Israel
| | - Rachel Ben Hayun
- Department of Cognitive Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Tamar Tadmor
- Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.,Haematology Unit, Bnai Zion Medical Centre, Haifa, Israel
| | - Tali Fisher
- Department of Cognitive Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Judith Aharon-Peretz
- Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.,Department of Cognitive Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Eldad J Dann
- Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.,Department of Haematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
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29
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Tometich DB, Mosher CE, Hirsh AT, Rand KL, Johns SA, Matthias MS, Outcalt SD, Schneider BP, Mina L, Storniolo AMV, Newton EV, Miller KD. Metastatic breast cancer patients' expectations and priorities for symptom improvement. Support Care Cancer 2018; 26:3781-3788. [PMID: 29736866 DOI: 10.1007/s00520-018-4244-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 04/30/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Little research has examined cancer patients' expectations, goals, and priorities for symptom improvement. Thus, we examined these outcomes in metastatic breast cancer patients to provide patients' perspectives on clinically meaningful symptom improvement and priorities for symptom management. METHODS Eighty women with metastatic breast cancer participated in a survey with measures of comorbidity, functional status, engagement in roles and activities, distress, quality of life, and the modified Patient-Centered Outcomes Questionnaire that focused on 10 common symptoms in cancer patients. RESULTS On average, patients reported low to moderate severity across the 10 symptoms and expected symptom treatment to be successful. Patients indicated that a 49% reduction in fatigue, 48% reduction in thinking problems, and 43% reduction in sleep problems would represent successful symptom treatment. Cluster analysis based on ratings of the importance of symptom improvement yielded three clusters of patients: (1) those who rated thinking problems, sleep problems, and fatigue as highly important, (2) those who rated pain as moderately important, and (3) those who rated all symptoms as highly important. The first patient cluster differed from other subgroups in severity of thinking problems and education. CONCLUSIONS Metastatic breast cancer patients report differing symptom treatment priorities and criteria for treatment success across symptoms. Considering cancer patients' perspectives on clinically meaningful symptom improvement and priorities for symptom management will ensure that treatment is consistent with their values and goals.
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Affiliation(s)
- Danielle B Tometich
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford Street, LD 124, Indianapolis, IN, 46202, USA.
| | - Catherine E Mosher
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford Street, LD 124, Indianapolis, IN, 46202, USA
| | - Adam T Hirsh
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford Street, LD 124, Indianapolis, IN, 46202, USA
| | - Kevin L Rand
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford Street, LD 124, Indianapolis, IN, 46202, USA
| | - Shelley A Johns
- Indiana University School of Medicine, 340 W 10th St #6200, Indianapolis, IN, 46202, USA.,Center for Health Services Research, Regenstrief Institute, 1101 W 10th St, Indianapolis, IN, 46202, USA
| | - Marianne S Matthias
- Indiana University School of Medicine, 340 W 10th St #6200, Indianapolis, IN, 46202, USA.,Center for Health Services Research, Regenstrief Institute, 1101 W 10th St, Indianapolis, IN, 46202, USA.,VA HSR&D Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, 1481 W 10th St, Indianapolis, IN, 46202, USA.,Department of Communication Studies, Indiana University-Purdue University Indianapolis, 425 University Blvd, Indianapolis, IN, 46202, USA
| | - Samantha D Outcalt
- Indiana University School of Medicine, 340 W 10th St #6200, Indianapolis, IN, 46202, USA.,Center for Health Services Research, Regenstrief Institute, 1101 W 10th St, Indianapolis, IN, 46202, USA.,VA HSR&D Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, 1481 W 10th St, Indianapolis, IN, 46202, USA.,Department of Psychiatry, Indiana University School of Medicine, 340 W 10th St #6200, Indianapolis, IN, 46202, USA
| | - Bryan P Schneider
- Indiana University School of Medicine, Indiana University Melvin and Bren Simon Cancer Center, 535 Barnhill Dr, Indianapolis, IN, 46202, USA
| | - Lida Mina
- Banner MD Anderson Cancer Center, 2946 E Banner Gateway Dr, Gilbert, AZ, 85234, USA
| | - Anna Maria V Storniolo
- Indiana University School of Medicine, Indiana University Melvin and Bren Simon Cancer Center, 535 Barnhill Dr, Indianapolis, IN, 46202, USA
| | - Erin V Newton
- Indiana University School of Medicine, Indiana University Melvin and Bren Simon Cancer Center, 535 Barnhill Dr, Indianapolis, IN, 46202, USA
| | - Kathy D Miller
- Indiana University School of Medicine, Indiana University Melvin and Bren Simon Cancer Center, 535 Barnhill Dr, Indianapolis, IN, 46202, USA
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30
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Lenoir D, De Pauw R, Ickmans K, Schumacher C, Timmers I, Kregel J, Coppieters I. Validity and Test-Retest Reliability of the Dutch Modified Perceived Deficits Questionnaire to Examine Cognitive Symptoms in Women with Chronic Whiplash, Chronic Idiopathic Neck Pain, and Fibromyalgia. Pain Pract 2018; 18:850-863. [PMID: 29383819 DOI: 10.1111/papr.12683] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 01/23/2018] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Until now, only reliability and validity of the English version of the modified Perceived Deficits Questionnaire (mPDQ) have been investigated. OBJECTIVE The aim of this study was to translate the mPDQ into Dutch and evaluate its validity and reliability as an assessment tool for self-perceived cognitive problems in patients with chronic whiplash-associated disorders (CWAD), chronic idiopathic neck pain (CINP), and fibromyalgia (FM). METHODS A case-control study was performed with a volunteer sample of 13 women with CWAD, 18 with CINP, and 33 with FM, and 33 women who were healthy and free of pain. The mPDQ was first translated into Dutch, and its test-retest reliability, internal consistency, and discriminative power were examined. RESULTS The intraclass correlation coefficients were higher than 0.74. Cronbach's α values ranged between 0.71 and 0.95. Total mPDQ scores were significantly higher (P < 0.017) in FM and CWAD patients compared to healthy controls. Furthermore, participants performed the Stroop task and the psychomotor vigilance task (PVT), 2 neuropsychological computer-based cognitive performance tests. Correlations between the mPDQ total score and the cognitive performance tests were evaluated. Significant moderate to high correlations were found in all study samples between total mPDQ score and objective cognitive tests (Spearman correlation coefficient = 0.35 to 0.80; P < 0.05). CONCLUSION Therefore, the Dutch version of the mPDQ showed high test-retest reliability and high internal consistency, and was able to distinguish CWAD and FM patients from healthy controls. PERSPECTIVE This article presents the validity and test-retest reliability of the Dutch mPDQ. This measure could help clinicians who seek a reliable and user-friendly way to assess cognitive symptoms in chronic pain patients.
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Affiliation(s)
- D Lenoir
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Pain in Motion International Research Group
| | - R De Pauw
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - K Ickmans
- Pain in Motion International Research Group.,Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussels, Brussels, Belgium
| | - C Schumacher
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - I Timmers
- Department of Cognitive Neuroscience, Maastricht University, Maastricht, The Netherlands.,Department of Rehabilitation Medicine, Maastricht University, Maastricht, The Netherlands
| | - J Kregel
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Pain in Motion International Research Group.,Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussels, Brussels, Belgium
| | - I Coppieters
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Pain in Motion International Research Group
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31
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Ng T, Dorajoo SR, Cheung YT, Lam YC, Yeo HL, Shwe M, Gan YX, Foo KM, Loh WJK, Koo SL, Jain A, Lee GE, Dent R, Yap YS, Ng R, Chan A. Distinct and heterogeneous trajectories of self-perceived cognitive impairment among Asian breast cancer survivors. Psychooncology 2018; 27:1185-1192. [DOI: 10.1002/pon.4635] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 12/20/2017] [Accepted: 12/29/2017] [Indexed: 11/12/2022]
Affiliation(s)
- Terence Ng
- Department of Pharmacy; National University of Singapore; Singapore
- Division of Medical Oncology; National Cancer Centre Singapore; Singapore
| | | | - Yin Ting Cheung
- Department of Pharmacy; National University of Singapore; Singapore
| | - Yick Ching Lam
- Division of Medical Oncology; National Cancer Centre Singapore; Singapore
| | - Hui Ling Yeo
- Department of Pharmacy; National University of Singapore; Singapore
| | - Maung Shwe
- Department of Pharmacy; National University of Singapore; Singapore
| | - Yan Xiang Gan
- Department of Pharmacy; National Cancer Centre Singapore; Singapore
| | - Koon Mian Foo
- Department of Pharmacy; KK Women's and Children's Hospital; Singapore
| | - Wei-Jen Kiley Loh
- Division of Medical Oncology; National Cancer Centre Singapore; Singapore
| | - Si-Lin Koo
- Division of Medical Oncology; National Cancer Centre Singapore; Singapore
| | - Amit Jain
- Division of Medical Oncology; National Cancer Centre Singapore; Singapore
| | - Guek Eng Lee
- Division of Medical Oncology; National Cancer Centre Singapore; Singapore
| | - Rebecca Dent
- Division of Medical Oncology; National Cancer Centre Singapore; Singapore
- Duke-NUS Graduate Medical School Singapore; Singapore
| | - Yoon Sim Yap
- Division of Medical Oncology; National Cancer Centre Singapore; Singapore
| | - Raymond Ng
- Division of Medical Oncology; National Cancer Centre Singapore; Singapore
- Duke-NUS Graduate Medical School Singapore; Singapore
| | - Alexandre Chan
- Department of Pharmacy; National University of Singapore; Singapore
- Department of Pharmacy; National Cancer Centre Singapore; Singapore
- Duke-NUS Graduate Medical School Singapore; Singapore
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