Cognitive function in cancer survivors: analysis of the 1999-2002 National Health and Nutrition Examination Survey

Anxiety, depression, and concentration in cancer survivors: National Health and Nutrition Examination Survey results

PURPOSE

We report on prevalence of anxiety, depression, and concentration difficulties and their associations in survivors of cancer in a nationally representative sample up to 25 years after diagnosis.

METHODS

Using the National Health and Nutrition Examination Survey (NHANES) data from 2015 to 2018, participants between the ages of 18 and 79 self-reported on cancer history, symptoms of anxiety, depression, and difficulties with concentration.

RESULTS

Of 10,337 participants, 691 (6.7%) reported a previous diagnosis of cancer; the median time since diagnosis was 8 years. Prevalence was similar between those with and without cancer for anxiety (45.8% versus 46.9%) and depression (19.7% versus 20.0%). Concentration difficulties were more common (11.3% versus 9.0%) for those with a history of cancer compared to those without (adjusted OR = 1.38, 95% CI: 1.00-1.90). Prevalence of mental health symptoms was not related to time since diagnosis. Anxiety and depression were highly correlated (r = 0.81, 95% CI: 0.74-0.86) and moderately correlated with difficulty with concentration (r = 0.52, 95%CI: 0.40-0.64 and r = 0.64, 95% CI: 0.53-0.74 respectively).

CONCLUSIONS

Difficulty with concentration was more commonly reported by participants with than without a cancer history. Report of anxiety and depression was no different between participants with and without a history of cancer. Anxiety, depression, and difficulties with concentration were strongly related. Further research is needed to explore if there is a causal association, and if so, the direction of these correlations, so that interventions may be appropriately targeted.

A Systematic Review on the Potential Acceleration of Neurocognitive Aging in Older Cancer Survivors

As survival rates increase, more emphasis has gone to possible cognitive sequelae in older cancer patients, which could be explained by accelerated brain aging. In this review, we provide a complete overview of studies investigating neuroimaging, neurocognitive, and neurodegenerative disorders in older cancer survivors (>65 years), based on three databases (Pubmed, Web of Science and Medline). Ninety-six studies were included. Evidence was found for functional and structural brain changes (frontal regions, basal ganglia, gray and white matter), compared to healthy controls. Cognitive decline was mainly found in memory functioning. Anti-hormonal treatments were repeatedly associated with cognitive decline (tamoxifen) and sometimes with an increased risk of Alzheimer's disease (androgen deprivation therapy). Chemotherapy was inconsistently associated with later development of cognitive changes or dementia. Radiotherapy was not associated with cognition in patients with non-central nervous system cancer but can play a role in patients with central nervous system cancer, while neurosurgery seemed to improve their cognition in the short-term. Individual risk factors included cancer subtypes (e.g., brain cancer, hormone-related cancers), treatment (e.g., anti-hormonal therapy, chemotherapy, cranial radiation), genetic predisposition (e.g., APOE, COMT, BDNF), age, comorbidities (e.g., frailty, cognitive reserve), and psychological (e.g., depression, (post-traumatic) distress, sleep, fatigue) and social factors (e.g., loneliness, limited caregiver support, low SES). More research on accelerated aging is required to guide intervention studies.

Association between Handgrip Strength and Cognitive Function in Older Adults: Korean Longitudinal Study of Aging (2006-2018)

Accumulating research indicates that handgrip strength is associated with cognitive function. Studies have also shown the difference in cognitive decline between males and females. We investigated the association between baseline handgrip strength and later cognitive function in older adults according to sex using the dataset from Korean Longitudinal Study of Aging (2006–2018). Overall, 9707 observations of 1750 participants (989 males and 761 females) over 65 years of age were sampled from the first wave, followed by six consecutive waves. The Korean version of the Mini-Mental State Examination and baseline handgrip strength scores were assessed. Sociodemographic and health-related variables were also included as covariates in the multivariable linear mixed models. Males in the lowest quartile of the baseline handgrip strength decreased in cognitive function (β = −0.54, standard error (SE) = 0.16, p < 0.001), compared to males in the highest quartile. For females, those in the second lowest quartile (β = −0.65, SE = 0.19, p < 0.001) and the lowest quartile (β = −0.53, SE = 0.19, p< 0.01) decreased in cognitive function. Handgrip strength may be positively associated with later cognitive function, but the association may be non-linear and differ between sexes. Sex-specific preventive assessment of handgrip strength may help identify older adults at risk for cognitive impairment.

Assessment and Management of Cognitive Function in Patients with Prostate Cancer Treated with Second-Generation Androgen Receptor Pathway Inhibitors

Preservation of cognitive function is an important outcome in oncology. Optimal patient management requires an understanding of cognitive effects of the disease and its treatment and an efficacious approach to assessment and management of cognitive dysfunction, including selection of treatments to minimize the risk of cognitive impairment. Awareness is increasing of the potentially detrimental effects of cancer-related cognitive dysfunction on functional independence and quality of life. Prostate cancer occurs most often in older men, who are more likely to develop cognitive dysfunction than younger individuals; this population may be particularly vulnerable to treatment-related cognitive disorders. Prompt identification of treatment-induced cognitive dysfunction is a crucial aspect of effective cancer management. We review the potential etiologies of cognitive decline in patients with prostate cancer, including the potential role of androgen receptor pathway inhibitors; commonly used tools for assessing cognitive function validated in metastatic castration-resistant prostate cancer and adopted in non-metastatic castration-resistant prostate cancer trials; and strategies for management of cognitive symptoms. Many methods are currently used to assess cognitive function. The prevalence and severity of cognitive dysfunction vary according to the instruments and criteria applied. Consensus on the definition of cognitive dysfunction and on the most appropriate approaches to quantify its extent and progression in patients treated for prostate cancer is lacking. Evidence-based guidance on the appropriate tools and time to assess cognitive function in patients with prostate cancer is required.

Validity of self-reported cancer: Comparison between self-report versus cancer registry records in the Geelong Osteoporosis Study

BACKGROUND

Determining the validity of self-reported data is important. The aim of this study was to assess the validity of self-reported cancer and investigate factors associated with accurate reporting in men and women.

METHODS

Study participants (n = 1727) from the Geelong Osteoporosis Study, located in south-eastern Australia, were utilised. Self-reported cancer data were compared to Victorian Cancer Registry records. Age, socioeconomic status (SES), education and time between cancer diagnosis and study appointment were investigated as factors associated with accuracy of self-report.

RESULTS

There were 142 participants who self-reported a cancer and 135 with a VCR record. Comparing self-report to any registry record, sensitivity was 63.7 %, specificity 96.5 %, PPV 60.6 %, NPV 96.9 %, and overall agreement ĸ0.588. Comparing exact-match records, sensitivity was 58.8 %, specificity 95.5 %, PPV 49.3 %, NPV 96.9 % and overall agreement ĸ0.499. In logistic regression models, post-secondary education was independently associated with accuracy of any (OR 1.72, 95 % CI 1.10-2.70) and exact-match (OR 1.59, 95 % CI 1.05-2.42) self-report, compared to cancer registry record. For any cancer, being aged >70 years was inversely associated with accuracy (OR 0.24, 95 % CI 0.15-0.38). Likewise, for matched cancer reporting, those aged 60-70 years (OR 0.51, 95 %CI 0.30-0.88) and >70 years (OR 0.23, 95 % CI 0.15-0.35) were less accurate. No other significant associations were detected.

CONCLUSION

Results suggest moderate agreement between self-report and registry data for any cancer among men and women. However, when comparing self-report to registry data for exact-match cancer type, level of overall agreement deteriorated. Self-report cancer data may be acceptable for determining a history of cancer, although, is less accurate in identifying history of specific cancer types documented in registry-based data.

Cognitive function in long-term lymphoma survivors: relationship between subjective reports and objective assessments and with quality of life

Cognitive functioning plays a fundamental role in people's life and quality of life (QoL), and anti-cancer chemotherapy may provoke long-lasting cognitive problems. This study investigated the subjective perception of cognitive functioning in long-term lynfoma survivors and its associations with objectively assessed cognitive functioning and QoL. 198 long-term lynfoma survivors were administered the Cognitive Functioning Self-Assessment Scale (CFSS), the Esame Neuropsicologico Breve 2 (ENB2) and the Short Form 36 Health Survey Questionnaire (SF-36). Subjectively reported cognitive functioning was worse than the norm for the general population (p<0.001). Difficulty in recalling recent information (22%), using of periphrases or generic terms (16.7%) and tip-of-the-tongue phenomena (14.7%) were the cognitive difficulties most frequently reported. CFSS overall score correlated positively with the number of impaired performances (p<0.001) and borderline performances (p=0.014) on the ENB2. Both subjectively and objectively assessed cognitive measures correlated negatively with most assessed QoL domains, indicating that QoL is worse when cognitive functioning is poor. Subjective concerns about one's own cognitive functioning are a reality for long-term lynphoma survivors, who experience these worries more than the general population does. Since improving QoL is a priority in oncology, this study supports the use of interventions to improve cognitive functioning in cancer survivors.

Lipophilic Antioxidants and Cognitive Function in the Elderly

Objective:

To determine the relationship between blood serum lipophilic antioxidant levels and cognitive function (CF) in older adults aged 60 and above guided by the oxidative stress theory of aging.

Methods:

Cross-sectional data from the National Health and Nutrition Examination Survey (n = 291) for older adults aged 60 and above were examined using Pearson correlation coefficient and multiple linear regression to determine whether blood serum antioxidant status predicted CF while controlling for age, sex, race, hypertension, smoking status, and body mass index.

Results:

Alpha-tocopherol, retinyl palmitate, trans-lycopene, and retinyl stearate were all significantly correlated with CF. After controlling for covariates, α-tocopherol and retinyl palmitate were associated with CF. Age, sex, and current smoking status were significant predictors of CF.

Conclusions:

The benefits of antioxidants in CF may be a part of nutritional recommendations which include α-tocopherol and retinyl palmitate for delay of CI, and subsequently a better quality of life.

The confused oncologic patient: a rational clinical approach

PURPOSE OF REVIEW

The purpose of this review is to provide a practical clinical approach to confusion in the patient with cancer. Confusion in the cancer population has a broader differential diagnosis than in the general medical population. The clinician must consider the usual differential diagnoses as well as causes unique to the cancer patient including direct complications from the cancer and indirect complications related to cancer treatment.

RECENT FINDINGS

In the recent age of precision medicine, the oncologist now utilizes the genomic profile of both the patient and the tumor to provide advanced biologic therapies including targeted anticancer drugs, antiangiogenic agents, and immunotherapy. Such advances carry with them an emerging pattern of neurotoxicity which, although less well described in the literature, is now an important consideration to the clinical approach to confusion in cancer patients.

SUMMARY

Confusion is the most common neurologic complication in cancer and is associated with significant morbidity, mortality, and prolonged hospital stays resulting in increased healthcare costs. Early recognition and treatment of delirium is essential to improve clinical outcomes.

Self-reported cognitive scales in a US National Survey: reliability, validity, and preliminary evidence for associations with alcohol and drug use

AIMS

To evaluate relationships between measures of cognitive functioning and alcohol or drug use among adults (≥ 18 years) in the US general population.

DESIGN

Two cognitive scales were created based on dimensionality and reliability of self-reported Executive Function Index items. Relationships between the two scales and validators were evaluated. Associations between the cognitive scales and past-year frequency of alcohol or drug use were estimated with adjusted odds ratios (aOR).

SETTING

United States, using the 2012-13 National Epidemiologic Survey on Alcohol and Related Conditions-III, a nationally representative adult sample selected by multi-stage probability sampling.

PARTICIPANTS

36 085 respondents.

MEASUREMENTS

Past-year substance use outcome variables categorized binge drinking, marijuana, cocaine, opioid, sedative/tranquilizer and stimulant use as frequent (at least weekly to daily), infrequent (any to two to three times/month) or no use, assessed by the Alcohol Use Disorder and Associated Disabilities Interview Schedule-5. Key predictors were the two cognitive scales. Construct validators included education and functional impairment. Covariates included age, gender, income and race/ethnicity.

FINDINGS

Nine cognitive items fitted a two-factor model (comparative fit index = 0.973): attention (five items) and executive functioning (four items). Both scales were associated positively with higher education (Ps < 0.001) and negatively with functional impairment (Ps < 0.001), demonstrating construct validity. Poorer attention was associated with frequent and infrequent binge drinking and use of drugs [aOR range = 1.07 (binge drinking) to 1.72 (stimulants), Ps ≤ 0.01]. Poorer executive functioning was associated with frequent binge drinking and use of drugs [aOR range = 1.22 (binge drinking) to 2.03 (cocaine), Ps < 0.001] and infrequent use of all drugs [aOR range = 1.19 (marijuana) to 1.63 (cocaine), Ps < 0.001].

CONCLUSIONS

Impairments in attention and executive functioning are positively associated with substance use in the US general population.

Cancer and Cognitive Function: The PATH Through Life Project

Background

A limited number of studies have shown that cancer diagnosis plays a protective role in Alzheimer's disease. However, the effect of the cancer diagnosis on general cognitive function/cognitive decline has not been previously examined. The aim of this study was to investigate the relationship between cancer diagnosis and cognitive function and mild cognitive impairment/disorders (MCI/MCD), adjusting for cancer treatments.

Methods

These data were drawn from the Personality and Total Health (PATH) Through Life Study, a population-based Australian cohort study. A total of 2,547 participants (age range 60-66 years; 48.4% women) who answered cancer-related questions were included in analyses. Random effects linear and logistic models were used to analyze 8-year follow-up data.

Results

Participants who were diagnosed with cancer at or prior to baseline (n = 166) had higher levels of physical conditions and depression compared with those who received cancer diagnoses during follow-ups (n = 346) and those who reported no cancer history (n = 2,035). A main effect suggested an improvement in processing speed (p < .01), working memory (p < .05), and simple reaction time (p < .05) for those who received the cancer diagnosis after baseline when compared with those without a cancer diagnosis. However, these group differences were no longer significant when adjusted for cancer treatments. Those with a cancer diagnosis at or prior to baseline reported poorer processing speed when compared with those without a cancer diagnosis, even after adjusting for the treatments.

Conclusions

A cancer diagnosis alone did not play a protective role for cognitive function and cognitive impairment in this population of older community-living individuals.

What is known and unknown about chemotherapy-related cognitive impairment in patients with haematological malignancies and areas of needed research

Cancer-related cognitive impairment (CRCI) is an important clinical problem for cancer patients and survivors. In this review, we summarize studies investigating the occurrence of impaired cognition in patients with haematological malignancies. Most published studies focus on survivors of childhood acute lymphoblastic leukaemia and primary central nervous system lymphoma. We also discuss studies conducted in acute myeloid leukaemia, myelodysplastic syndromes, chronic myeloid leukaemia, Hodgkin lymphoma (HL), non-HL and chronic lymphocytic leukaemia. Although research in this area is still emerging, it appears that a subset of chemotherapy-treated haematological malignancy survivors experience CRCI. Future research should focus on expanding the literature reviewed here with larger studies appropriately powered to assess cognition via objective and subjective measures in a longitudinal fashion to tease apart the impact of disease and the various forms of cancer treatment.