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Chen D, Mackenzie L, Hossain SZ, Wang JX, Jiang PL, Wang Y, Qin L, Zhen J, Jia J. Cognitive impairment experienced by Chinese breast cancer survivors. Sci Rep 2023; 13:22245. [PMID: 38097726 PMCID: PMC10721869 DOI: 10.1038/s41598-023-49524-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 12/08/2023] [Indexed: 12/17/2023] Open
Abstract
To identify cognitive function in Chinese breast cancer survivors. Research questions were: is cognitive function was associated with breast cancer and/or chemotherapy treatment and/or psychological functioning:? and did women with breast cancer experience more cognitive and psychological issues than age-matched women without cancer? Breast cancer survivors with chemotherapy (n = 106, mean age = 50.2 ± 9.5), breast cancer survivors without chemotherapy (n = 100, mean age = 50.5 ± 10.0) and matched healthy controls (n = 96, mean age = 47.9 ± 9.1) completed a battery of cognitive and psychosocial functioning. Demographic characteristics were also collected. The Perceived Cognitive Impairment score for cancer groups was significantly higher than for the healthy group (p = 0.04), but not between the cancer groups. Processing speed was significantly slower in the cancer groups than in the healthy group (both p < 0.001), but not between the cancer groups. Age, living status and education were significantly associated with the FACT-Cog (all p < 0.05). The correlations between the FACT-Cog score and BSI score were strong (r = 0.60 p < 0.01), and between the HADS anxiety and depression scales were strong (r = 0.53 and 0.50, p < 0.01) but correlations were weaker between performance based cognitive tests and measures of psychological functioning. Breast cancer groups indicated more cognitive impairment and reduced psychological functioning compared to the healthy group. However, there was no differences between the breast cancer groups. Chinese breast cancer survivors experienced excess cognitive impairment not associated with usual ageing. Assessment and intervention to address cognitive impairment should be made available to breast cancer survivors.
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Affiliation(s)
- Dan Chen
- Department of Rehabilitation Medicine, Jing'an District Central Hospital of Shanghai, Shanghai, China
- Department of Rehabilitation Medicine, Huashan Hospital Fudan University, Shanghai, China
| | - Lynette Mackenzie
- Discipline of Occupational Therapy, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia.
| | - Syeda Zakia Hossain
- Discipline of Behavioural Sciences, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia
| | - Jing-Xin Wang
- Department of Rehabilitation Medicine, Zhengzhou Central Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Ping-Lan Jiang
- Department of Breast Surgery, Xiangya Hospital of Central South University, Changsha, China
| | - Yuanxiao Wang
- Department of Breast Surgery, Yunnan Cancer Hospital, Yunnan, China
| | - Lanhui Qin
- Department of Rehabilitation, the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Jun Zhen
- Department of Rehabilitation, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong, China
| | - Jie Jia
- Department of Rehabilitation Medicine, Jing'an District Central Hospital of Shanghai, Shanghai, China
- Department of Rehabilitation Medicine, Huashan Hospital Fudan University, Shanghai, China
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Dias-Carvalho A, Ferreira M, Ferreira R, Bastos MDL, Sá SI, Capela JP, Carvalho F, Costa VM. Four decades of chemotherapy-induced cognitive dysfunction: comprehensive review of clinical, animal and in vitro studies, and insights of key initiating events. Arch Toxicol 2021; 96:11-78. [PMID: 34725718 DOI: 10.1007/s00204-021-03171-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 09/23/2021] [Indexed: 01/22/2023]
Abstract
Cognitive dysfunction has been one of the most reported and studied adverse effects of cancer treatment, but, for many years, it was overlooked by the medical community. Nevertheless, the medical and scientific communities have now recognized that the cognitive deficits caused by chemotherapy have a strong impact on the morbidity of cancer treated patients. In fact, chemotherapy-induced cognitive dysfunction or 'chemobrain' (also named also chemofog) is at present a well-recognized effect of chemotherapy that could affect up to 78% of treated patients. Nonetheless, its underlying neurotoxic mechanism is still not fully elucidated. Therefore, this work aimed to provide a comprehensive review using PubMed as a database to assess the studies published on the field and, therefore, highlight the clinical manifestations of chemobrain and the putative neurotoxicity mechanisms.In the last two decades, a great number of papers was published on the topic, mainly with clinical observations. Chemotherapy-treated patients showed that the cognitive domains most often impaired were verbal memory, psychomotor function, visual memory, visuospatial and verbal learning, memory function and attention. Chemotherapy alters the brain's metabolism, white and grey matter and functional connectivity of brain areas. Several mechanisms have been proposed to cause chemobrain but increase of proinflammatory cytokines with oxidative stress seem more relevant, not excluding the action on neurotransmission and cellular death or impaired hippocampal neurogenesis. The interplay between these mechanisms and susceptible factors makes the clinical management of chemobrain even more difficult. New studies, mainly referring to the underlying mechanisms of chemobrain and protective measures, are important in the future, as it is expected that chemobrain will have more clinical impact in the coming years, since the number of cancer survivors is steadily increasing.
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Affiliation(s)
- Ana Dias-Carvalho
- Associate Laboratory i4HB-Institute for Health and Bioeconomy, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313, Porto, Portugal. .,UCIBIO-Applied Molecular Biosciences Unit, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313, Porto, Portugal.
| | - Mariana Ferreira
- Associate Laboratory i4HB-Institute for Health and Bioeconomy, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313, Porto, Portugal.,UCIBIO-Applied Molecular Biosciences Unit, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313, Porto, Portugal.,LAQV/REQUIMTE, Department of Chemistry, University of Aveiro, Aveiro, Portugal
| | - Rita Ferreira
- LAQV/REQUIMTE, Department of Chemistry, University of Aveiro, Aveiro, Portugal
| | - Maria de Lourdes Bastos
- Associate Laboratory i4HB-Institute for Health and Bioeconomy, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313, Porto, Portugal.,UCIBIO-Applied Molecular Biosciences Unit, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313, Porto, Portugal
| | - Susana Isabel Sá
- Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal.,Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - João Paulo Capela
- Associate Laboratory i4HB-Institute for Health and Bioeconomy, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313, Porto, Portugal.,UCIBIO-Applied Molecular Biosciences Unit, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313, Porto, Portugal.,Faculdade de Ciências da Saúde, Universidade Fernando Pessoa, Porto, Portugal
| | - Félix Carvalho
- Associate Laboratory i4HB-Institute for Health and Bioeconomy, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313, Porto, Portugal.,UCIBIO-Applied Molecular Biosciences Unit, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313, Porto, Portugal
| | - Vera Marisa Costa
- Associate Laboratory i4HB-Institute for Health and Bioeconomy, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313, Porto, Portugal. .,UCIBIO-Applied Molecular Biosciences Unit, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313, Porto, Portugal.
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Zhang H, Li P, Liu T, Wang X, Feng W, Chen R, Wei H, Li G, Ning L, Zhang M, Zhang Y. Focal white matter microstructural alteration after anthracycline-based systemic treatment in long-term breast cancer survivors: a structural magnetic resonance imaging study. Brain Imaging Behav 2021; 16:843-854. [PMID: 34608574 DOI: 10.1007/s11682-021-00551-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2021] [Indexed: 11/29/2022]
Abstract
Understanding the neural correlates of cognitive problems in patients with breast cancer (BC) after systemic treatment have been a topic of increasing investigation. The heterogeneity of the systemic treatment regimens may undermine our ability to identify brain microstructural alterations resulting from any given regimen. We investigated the detrimental effects of the anthracycline-based systemic treatment (AST) regimen (epirubicin and cyclophosphamide + docetaxel + tamoxifen) on brain gray matter (GM) and white matter (WM) microstructural alteration in long-term BC survivors. We performed a battery of neuropsychological tests and structural magnetic resonance imaging (MRI) to 31 long-term BC survivors who had received the AST regimen (AST group) and 43 healthy controls (HC group). Voxel-based morphometry evaluated the whole-brain voxel-wise GM volume, while diffusion tensor imaging technique with tract-based spatial statistics analysis evaluated whole-brain WM microstructural alteration. Partial least squares regression (PLSR) was used to evaluate the relationship between cognitive impairment and brain microstructural alteration in BC survivors. Compared with the HC group, the AST group exhibited a significantly poorer performance in attention, as well as a marginal significantly poorer performance in verbal working memory and executive function. Significantly lower fractional anisotropy (FA), higher radial diffusivity (RD), and lower axial diffusivity (AD) in multiple brain WM regions were showed in AST group compared with the HC group. Overlap of lower FA and higher RD was found in the body of corpus callosum (CC) and bilateral superior corona radiata (SCR), whereas overlap of lower FA and AD was found in the body of CC and right SCR. The PLSR results showed that the WM regions with overlap of lower FA and AD were significantly associated with executive and verbal working memory decline. No significant difference was observed in the GM volume between groups. Our results suggest that microstructural abnormalities of certain vulnerable WM regions in the AST regimen-exposed brain may provide neuroimaging evidence for the identification of brain injury and cognitive impairment induced by specific chemotherapy regimens.
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Affiliation(s)
- Huawen Zhang
- Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Republic of China.,Department of Medical Imaging, No.215 Hospital of Shaanxi Nuclear Geology, Xianyang, China
| | - Peng Li
- Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Republic of China.,Department of Medical Imaging, No.215 Hospital of Shaanxi Nuclear Geology, Xianyang, China
| | - Tonghui Liu
- Department of Medical Imaging, No.215 Hospital of Shaanxi Nuclear Geology, Xianyang, China
| | - Xueyuan Wang
- Department of Medical Imaging, No.215 Hospital of Shaanxi Nuclear Geology, Xianyang, China
| | - Wei Feng
- Department of Medical Imaging, No.215 Hospital of Shaanxi Nuclear Geology, Xianyang, China
| | - Rui Chen
- Department of Medical Imaging, No.215 Hospital of Shaanxi Nuclear Geology, Xianyang, China
| | - Hengyang Wei
- Department of Medical Imaging, No.215 Hospital of Shaanxi Nuclear Geology, Xianyang, China
| | - Guoqiang Li
- Department of Medical Imaging, No.215 Hospital of Shaanxi Nuclear Geology, Xianyang, China
| | - Long Ning
- Department of Medical Imaging, No.215 Hospital of Shaanxi Nuclear Geology, Xianyang, China
| | - Ming Zhang
- Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Republic of China.
| | - Yuchen Zhang
- Department of Oncology, The First Affiliated Hospital, Xi'an Jiaotong University, No. 277, West Yanta Road, Xi'an, Shaanxi, 710061, Republic of China.
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4
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Zhao C, Tang C, Li C, Ning W, Hu Z, Xin L, Zhou HB, Huang J. Novel hybrid conjugates with dual estrogen receptor α degradation and histone deacetylase inhibitory activities for breast cancer therapy. Bioorg Med Chem 2021; 40:116185. [PMID: 33965842 DOI: 10.1016/j.bmc.2021.116185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/17/2021] [Accepted: 04/26/2021] [Indexed: 02/07/2023]
Abstract
Hormone therapy targeting estrogen receptors is widely used clinically for the treatment of breast cancer, such as tamoxifen, but most of them are partial agonists, which can cause serious side effects after long-term use. The use of selective estrogen receptor down-regulators (SERDs) may be an effective alternative to breast cancer therapy by directly degrading ERα protein to shut down ERα signaling. However, the solely clinically used SERD fulvestrant, is low orally bioavailable and requires intravenous injection, which severely limits its clinical application. On the other hand, double- or multi-target conjugates, which are able to synergize antitumor activity by different pathways, thus may enhance therapeutic effect in comparison with single targeted therapy. In this study, we designed and synthesized a series of novel dual-functional conjugates targeting both ERα degradation and histone deacetylase inhibiton by combining a privileged SERD skeleton 7-oxabicyclo[2.2.1]heptane sulfonamide (OBHSA) with a histone deacetylase inhibitor side chain. We found that substituents on both the sulfonamide nitrogen and phenyl group of OBHSA unit had significant effect on biological activities. Among them, conjugate 16i with N-methyl and naphthyl groups exhibited potent antiproliferative activity against MCF-7 cells, and excellent ERα degradation activity and HDACs inhibitory ability. A further molecular docking study indicated the interaction patterns of these conjugates with ERα, which may provide guidance to design novel SERDs or PROTAC-like SERDs for breast cancer therapy.
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Affiliation(s)
- Chenxi Zhao
- Hubei Key Laboratory of Cell Homeostasis, College of Life Sciences, Wuhan University, Wuhan 430072, China
| | - Chu Tang
- Hubei Provincial Key Laboratory of Developmentally Originated Disease, Frontier Science Center for Immunology and Metabolism, Key Laboratory of Combinatorial Biosynthesis and Drug Discovery (Wuhan University), Ministry of Education, Wuhan University School of Pharmaceutical Sciences, Wuhan 430071, China
| | - Changhao Li
- Hubei Key Laboratory of Cell Homeostasis, College of Life Sciences, Wuhan University, Wuhan 430072, China
| | - Wentao Ning
- Hubei Provincial Key Laboratory of Developmentally Originated Disease, Frontier Science Center for Immunology and Metabolism, Key Laboratory of Combinatorial Biosynthesis and Drug Discovery (Wuhan University), Ministry of Education, Wuhan University School of Pharmaceutical Sciences, Wuhan 430071, China
| | - Zhiye Hu
- Hubei Provincial Key Laboratory of Developmentally Originated Disease, Frontier Science Center for Immunology and Metabolism, Key Laboratory of Combinatorial Biosynthesis and Drug Discovery (Wuhan University), Ministry of Education, Wuhan University School of Pharmaceutical Sciences, Wuhan 430071, China
| | - Lilan Xin
- Hubei Provincial Key Laboratory of Developmentally Originated Disease, Frontier Science Center for Immunology and Metabolism, Key Laboratory of Combinatorial Biosynthesis and Drug Discovery (Wuhan University), Ministry of Education, Wuhan University School of Pharmaceutical Sciences, Wuhan 430071, China
| | - Hai-Bing Zhou
- Hubei Provincial Key Laboratory of Developmentally Originated Disease, Frontier Science Center for Immunology and Metabolism, Key Laboratory of Combinatorial Biosynthesis and Drug Discovery (Wuhan University), Ministry of Education, Wuhan University School of Pharmaceutical Sciences, Wuhan 430071, China.
| | - Jian Huang
- Hubei Key Laboratory of Cell Homeostasis, College of Life Sciences, Wuhan University, Wuhan 430072, China.
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Jebahi F, Sharma S, Bloss JE, Wright HH. Effects of tamoxifen on cognition and language in women with breast cancer: A systematic search and a scoping review. Psychooncology 2021; 30:1262-1277. [PMID: 33866625 DOI: 10.1002/pon.5696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 04/01/2021] [Accepted: 04/02/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Breast cancer treatments bring adverse consequences that interfere with everyday functioning. Importantly, some of these treatments are associated with cognitive and language changes. Tamoxifen is a selective estrogen receptor modulator and is a common endocrine therapy treatment for breast cancer. The current review examines the specific domains of cognition and language affected by the use of tamoxifen in women with breast cancer. METHODS We conducted a systematic search that examined cognitive and/or language functions in chemotherapy-naïve women with breast cancer taking tamoxifen. PubMed, Cochrane CENTRAL, CINAHL Complete, PsycINFO, Scopus, EMBASE, and the Grey Literature Report (greylit.org) were searched. Covidence Systematic Review software (covidence.org) was used to manage the screening process of study titles and abstracts as well as full texts. A total of 17 studies were included in the review. RESULTS A range of cognitive and language domains were reported. These were grouped into seven broad domains: attention, memory, speed, executive functioning, verbal abilities, visual abilities, and language abilities. Results showed that there is compelling evidence that specific domains of memory and speed are negatively affected by the use of tamoxifen. In addition, there was a pattern of change in domains of executive functions and verbal abilities. CONCLUSIONS Tamoxifen affects specific cognitive and language domains. Language domains beyond semantics have not been studied and thus conclusions related to these domains, and language in general, could not be made. Studies exploring the effects of tamoxifen on the different domains of language are recommended.
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Affiliation(s)
- Fatima Jebahi
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, North Carolina, USA.,Fulbright Association, Washington, District of Columbia, USA
| | - Saryu Sharma
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, North Carolina, USA
| | - Jamie E Bloss
- Laupus Library Liaison, East Carolina University, Greenville, North Carolina, USA
| | - Heather H Wright
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, North Carolina, USA
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Bai L, Yu E. A narrative review of risk factors and interventions for cancer-related cognitive impairment. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:72. [PMID: 33553365 PMCID: PMC7859819 DOI: 10.21037/atm-20-6443] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Cancer-related cognitive impairment (CRCI) refers to a series of cognitive impairment symptoms associated with alternations in brain structure and function, caused by a non-central nervous system malignant tumor and its related treatment. CRCI may present as memory loss, impaired concentration, difficulty in multitasking and word retrieval, and reduced comprehension speed. CRCI has become one of the prevalent factors that compromise the quality of life for cancer survivors. Different treatments, including surgery, chemotherapy, radiotherapy, endocrine therapy, and targeted drugs, may contribute to CRCI. Meanwhile, patients’ factors, including emotional challenges and genetic makeup, also contribute to the development of CRCI. The condition can be treated with using stimulants methylphenidate and modafinil, metabolites of nicotine: cotinine, antidepressants of fluoxetine and fluvoxamine, dementia drug of donepezil, and antioxidants ZnSO4, n-acetyl cysteine, propofol, and Chinese herbal of silver leaf medicine. Psychotherapies, including meditation and relaxation, cognitive rehabilitation training, along with physical therapies, including aerobic exercise, resistance training, balance training, yoga, qigong, tai chi electroencephalogram biofeedback, and acupuncture, are also beneficial in alleviating cancer-related cognitive impairment symptoms. In recent years, researchers have focused on factors related to the condition and on the available interventions. However, most research was conducted independently, and no review has yet summarized the latest findings. This review details and discusses the status of related factors and potential treatments for CRCI. We also supply specific recommendations to facilitate future research and integration in this field.
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Affiliation(s)
- Lu Bai
- Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China.,Institute of Cancer and Basic Medicine, Chinese Academy of Sciences, Beijing, China
| | - Enyan Yu
- Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China.,Institute of Cancer and Basic Medicine, Chinese Academy of Sciences, Beijing, China
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Perrier J, Viard A, Levy C, Morel N, Allouache D, Noal S, Joly F, Eustache F, Giffard B. Longitudinal investigation of cognitive deficits in breast cancer patients and their gray matter correlates: impact of education level. Brain Imaging Behav 2020; 14:226-241. [PMID: 30406352 DOI: 10.1007/s11682-018-9991-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Cognitive deficits are a major complaint in breast cancer patients, even before chemotherapy. Comprehension of the cerebral mechanisms related to cognitive impairment in breast cancer patients remains difficult due to the scarcity of studies investigating both cognitive and anatomical imaging changes. Furthermore, only some of the patients experienced cognitive decline following chemotherapy, yet few studies have identified risk factors for cognitive deficits in these patients. It has been shown that education level could impact cognitive abilities during the recovery phase following chemotherapy. Our main aim was to longitudinally evaluate cognitive and anatomical changes associated with cancer and chemotherapy in breast cancer patients. Our secondary aim was to assess the impact of education level on cognitive performances and gray matter (GM) atrophy in these patients. Twenty patients were included before chemotherapy (T1), 1 month (T2) and 1 year (T3) after chemotherapy. Twenty-seven controls without a history of cancer were assessed at T1 and T3 only. Cluster groups based on education level were defined for both groups and were further compared. Comparison between patients and controls revealed deficits in patients on verbal episodic memory retrieval at T1 and T3 and on executive functions at T3. After chemotherapy, breast cancer patients had GM atrophy that persisted or recovered 1 year after chemotherapy depending on the cortical areas. Increase in GM volumes from T1 to T3 were also found in both groups. At T2, patients with a higher level of education compared to lower level exhibited higher episodic memory retrieval and state anxiety scores, both correlating with cerebellar volume. This higher level of education group exhibited hippocampal atrophy. Our results suggest that, before chemotherapy, cancer-related processes impact cognitive functioning and that this impact seems exacerbated by the effect of chemotherapy on certain brain regions. Increase in GM volumes after chemotherapy were unexpected and warrant further investigations. Higher education level was associated, 1 month after the end of chemotherapy, with greater anxiety and hippocampal atrophy despite a lack of cognitive deficits. These results suggest, for the first time, the occurrence of compensation mechanisms that may be linked to cognitive reserve in relationship to state anxiety. This identification of factors, which may compensate cognitive impairment following chemotherapy, is critical for patient care and quality of life.
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Affiliation(s)
- Joy Perrier
- Normandie Univ, UNICAEN, PSL University, EPHE, INSERM, U1077, CHU de Caen, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000, Caen, France.
| | - Armelle Viard
- Normandie Univ, UNICAEN, PSL University, EPHE, INSERM, U1077, CHU de Caen, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000, Caen, France
| | - Christelle Levy
- Breast Committee Department, Centre François Baclesse, Caen, France
| | - Nastassja Morel
- Normandie Univ, UNICAEN, PSL University, EPHE, INSERM, U1077, CHU de Caen, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000, Caen, France
| | | | - Sabine Noal
- Breast Committee Department, Centre François Baclesse, Caen, France
| | - Florence Joly
- Clinical Research Department, Caen, France.,Medical Oncology Department, CHU de Caen, Caen, France.,INSERM, U1086, ANTICIPE, Caen, France.,Cancer & Cognition, Platform, Ligue Contre le Cancer, CHU de Caen, Caen, France
| | - Francis Eustache
- Normandie Univ, UNICAEN, PSL University, EPHE, INSERM, U1077, CHU de Caen, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000, Caen, France
| | - Bénédicte Giffard
- Normandie Univ, UNICAEN, PSL University, EPHE, INSERM, U1077, CHU de Caen, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000, Caen, France.,Cancer & Cognition, Platform, Ligue Contre le Cancer, CHU de Caen, Caen, France
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8
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Bellens A, Roelant E, Sabbe B, Peeters M, van Dam PA. A video-game based cognitive training for breast cancer survivors with cognitive impairment: A prospective randomized pilot trial. Breast 2020; 53:23-32. [PMID: 32554133 PMCID: PMC7375646 DOI: 10.1016/j.breast.2020.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/29/2020] [Accepted: 06/05/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION We investigated whether a web-based cognitive training video game is an effective approach to improve cognitive decline in combination with our standard of care for rehabilitation of breast cancer (BC) patients. MATERIALS AND METHODS Self-selected BC patients between 18 and 71 years old complaining of disturbing cognitive impairment were studied. The patients received access to a web-based internet video game and online cognitive assessments (Aquasnap, Cambridge, MyCQ™). The early intervention group (n = 23) had a training program of 6 months of at least three times a week for a minimum of 60 min of game playing per week at home in addition to standard of care rehabilitation. The delayed intervention (n = 23) received standard of care for three months, followed by three months of similar MyCQ training. Outcome measures were the MyCQ (sub)scores and Activity of Daily Life (ADL), mood, subjective cognition and functional cognitive status measured by classic neuropsychological tests. RESULTS At baseline the means for CFQ (a measure of self-reported cognitive failure), anxiety, PSQI and self-reflectiveness were beyond normal range in both groups. CFQ improved significantly better in the intervention group (p = 0.029). Combining the evolution over time in the entire population a significant improvement was seen for overall MyCQ score, level of fear, physical and emotional role limitation, and health change (all p < 0.05), but self-reflectivess deteriorated (p < 0.05)). Significant differences in the various MyCQ subtests over time were: improved speed in choice reaction time, visual memory recognition, N back 1 and 2, coding, trail making test B, improved accuracy of N back 1 and 2 (all p < 0.05). CONCLUSION A program of cognitive training improves cognitive functioning over time. "Aquasnap" has a beneficial effect on the perception of subjective cognitive functioning (CFQ) but the exact role of video gaming in this process remains uncertain.
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Affiliation(s)
- Anne Bellens
- Multidisciplinary Oncologic Center Antwerp (MOCA), Antwerp University Hospital, Edegem, B2650, Belgium; Centre for Oncological Research (CORE), University of Antwerp, Wilrijk, B2610, Belgium
| | - Ella Roelant
- Clinical Trial Center (CTC), CRC Antwerp, Antwerp University Hospital, University of Antwerp, Edegem, B2650, Belgium; StatUa, Center for Statistics, University of Antwerp, Antwerp, B2000, Belgium
| | - Bernard Sabbe
- Department of Psychiatry, Antwerp University, Wilrijk, Belgium
| | - Marc Peeters
- Multidisciplinary Oncologic Center Antwerp (MOCA), Antwerp University Hospital, Edegem, B2650, Belgium; Centre for Oncological Research (CORE), University of Antwerp, Wilrijk, B2610, Belgium
| | - Peter A van Dam
- Multidisciplinary Oncologic Center Antwerp (MOCA), Antwerp University Hospital, Edegem, B2650, Belgium; Centre for Oncological Research (CORE), University of Antwerp, Wilrijk, B2610, Belgium.
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9
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Kohler C, Chang M, Allemann-Su YY, Vetter M, Jung M, Jung M, Conley Y, Paul S, Kober KM, Cooper BA, Smoot B, Levine JD, Miaskowski C, Katapodi MC. Changes in Attentional Function in Patients From Before Through 12 Months After Breast Cancer Surgery. J Pain Symptom Manage 2020; 59:1172-1185. [PMID: 31953207 PMCID: PMC7239765 DOI: 10.1016/j.jpainsymman.2020.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/03/2020] [Accepted: 01/06/2020] [Indexed: 02/07/2023]
Abstract
CONTEXT Although approximately 75% of patients with breast cancer report changes in attentional function, little is known about how demographic, clinical, symptom, and psychosocial adjustment (e.g., coping) characteristics influence changes in the trajectories of attentional function over time. OBJECTIVES This study evaluated interindividual variability in the trajectories of self-reported attentional function and determined which demographic, clinical, symptom, and psychosocial adjustment characteristics were associated with initial levels and with changes in attentional function from before through 12 months after breast cancer surgery. METHODS Before surgery, 396 women were enrolled. Attentional Function Index (AFI) was completed before and nine times within the first 12 months after surgery. Hierarchical linear modeling was used to determine which characteristics were associated with initial levels and trajectories of attentional function. RESULTS Given an estimated preoperative AFI score of 6.53, for each additional month, the estimated linear rate of change in AFI score was an increase of 0.054 (P < 0.001). Higher levels of comorbidity, receipt of adjuvant chemotherapy, higher levels of trait anxiety, fatigue, and sleep disturbance, and lower levels of energy and less sense of control were associated with lower levels of attentional function before surgery. Patients who had less improvements in attentional function over time were nonwhite, did not have a lymph node biopsy, had received hormonal therapy, and had less difficulty coping with their disease. CONCLUSION Findings can be used to identify patients with breast cancer at higher risk for impaired self-reported cognitive function and to guide the prescription of more personalized interventions.
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Affiliation(s)
- Carmen Kohler
- Medical Oncology, University Hospital Basel, Basel, Switzerland
| | - Ming Chang
- Department of Clinical Research, Nursing Science, University of Basel, Basel, Switzerland
| | - Yu-Yin Allemann-Su
- Department of Clinical Research, Nursing Science, University of Basel, Basel, Switzerland
| | - Marcus Vetter
- Medical Oncology, University Hospital Basel, Basel, Switzerland
| | - Miyeon Jung
- College of Nursing, Chungnam National University, Daejeon, South Korea
| | - Misook Jung
- School of Nursing, Indiana University, Indianapolis, Indiana, USA
| | - Yvette Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Steven Paul
- School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Kord M Kober
- School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Bruce A Cooper
- School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Betty Smoot
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Jon D Levine
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Christine Miaskowski
- School of Nursing, University of California San Francisco, San Francisco, California, USA.
| | - Maria C Katapodi
- Department of Clinical Research, Nursing Science, University of Basel, Basel, Switzerland; School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
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10
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Papanastasiou A, Seliniotaki T, Rizos E, Kampoli K, Ntavatzikos A, Arkadopoulos N, Tsionou C, Spandidos DA, Koumarianou A. Role of stress, age and adjuvant therapy in the cognitive function of patients with breast cancer. Oncol Lett 2019; 18:507-517. [PMID: 31289522 PMCID: PMC6540331 DOI: 10.3892/ol.2019.10361] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 05/10/2019] [Indexed: 02/05/2023] Open
Abstract
According to data largely obtained from retrospective studies, it has been postulated that chemotherapy exerts an aggravating effect on the cognitive function of patients with breast cancer. Potential individual factors related to the effects of chemotherapy on cognitive function have been indicated, such as age-related cognitive dysfunction and stress. Elderly patients differ from non-elderly patients as regards higher cognitive related comorbidities, such as dementia, as well as regarding lower stress levels, indicating that 'chemobrain' may differentially affect these two age groups. The aim of this review was to discuss the effects of stress and chemotherapy on cognitive dysfunction and identify any potential age-related differences in patients with breast cancer treated with adjuvant chemotherapy. For this purpose, a systematic review of the literature was carried out on the PubMed, Scopus and Web of Science databases. The inclusion criteria were original articles published in peer-reviewed journals, elderly and non-elderly patients with breast cancer, reporting on stress and at least one cognitive parameter pre- and/or post-treatment. Eight studies met the preset criteria and were further analyzed. In total, the data of 1,253 women were included, of whom 800 patients with breast cancer were treated with surgery only, systemic treatment only, or both. Although all the studies included a non-elderly breast cancer patient subpopulation, only two of the studies included patients over 65 years of age. All studies indicated a statistically significant association of stress with various domains of cognitive dysfunction in patients, as shown by either self-completed questionnaires, neuropsychological testing or both. An age over 60 years was linked to fewer cognitive difficulties mediated by lower levels of stress. Thus, the evidence supports the association of stress with cognitive deficits in patients with breast cancer, regardless of the type of cancer-related treatment. Therefore, stress should be appropriately addressed. However, further research is required to investigate the association of stress with cognitive function in elderly patients with breast cancer.
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Affiliation(s)
- Artemis Papanastasiou
- Second Department of Psychiatry, University General Hospital ‘ATTIKON’, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Theodora Seliniotaki
- Hematology-Oncology Unit, Fourth Department of Internal Medicine, University General Hospital ‘ATTIKON’, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Emmanouil Rizos
- Second Department of Psychiatry, University General Hospital ‘ATTIKON’, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Katerina Kampoli
- Hematology-Oncology Unit, Fourth Department of Internal Medicine, University General Hospital ‘ATTIKON’, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Anastasios Ntavatzikos
- Hematology-Oncology Unit, Fourth Department of Internal Medicine, University General Hospital ‘ATTIKON’, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Nikolaos Arkadopoulos
- Fourth Department of Surgery, University General Hospital ‘ATTIKON’, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Christina Tsionou
- Department of Breast Diseases, Maternity-Health, 15232 Athens, Greece
| | - Demetrios A. Spandidos
- Laboratory of Clinical Virology, Medical School, University of Crete, 71003 Heraklion, Greece
| | - Anna Koumarianou
- Hematology-Oncology Unit, Fourth Department of Internal Medicine, University General Hospital ‘ATTIKON’, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
- Correspondence to: Dr Anna Koumarianou, Hematology-Oncology Unit, Fourth Department of Internal Medicine, University General Hospital ‘ATTIKON’, School of Medicine, National and Kapodistrian University of Athens, 1 Rimini Street, Chaidari, 12462 Athens, Greece, E-mail:
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11
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Henderson FM, Cross AJ, Baraniak AR. 'A new normal with chemobrain': Experiences of the impact of chemotherapy-related cognitive deficits in long-term breast cancer survivors. Health Psychol Open 2019; 6:2055102919832234. [PMID: 30873289 PMCID: PMC6405778 DOI: 10.1177/2055102919832234] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Chemobrain is one of the most commonly reported side-effects of cancer treatment.
However, there is limited research into its psychosocial concomitants. This
study aimed to explore the long-term lived experience of chemobrain.
Interpretative phenomenological analysis allowed an in-depth investigation of 12
breast cancer survivors suffering from perceived cognitive deficits at least
1-year post-treatment. Themes were organised around the illness representations
framework. Commonly reported cognitive deficits related to memory, language and
processing speed, which affected participants’ sense of identity and their
interactions with others. Individual experiences were mediated by health beliefs
regarding controllability, validation and impairment trajectory.
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12
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Diminished gray matter density mediates chemotherapy dosage-related cognitive impairment in breast cancer patients. Sci Rep 2018; 8:13801. [PMID: 30218006 PMCID: PMC6138678 DOI: 10.1038/s41598-018-32257-w] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 09/05/2018] [Indexed: 12/14/2022] Open
Abstract
To investigate chemotherapy dosage-related cognitive impairment and its neural mechanisms in breast cancer (BC) patients. Twenty-eight breast cancer patients after each chemotherapy cycle and matched 29 healthy control subjects underwent structural magnetic resonance imaging. Voxel-based morphometry analysis was performed to compare group differences in the gray matter for the whole brain. Furthermore, mediation analysis was conducted to explore the role of brain structures in chemotherapy dosage-related cognitive impairment. Voxel-based morphometry analysis was performed in gray matter for the whole brain of BC patients after chemotherapy. The results revealed that the gray matter density in the left inferior frontal gyrus, right middle frontal gyrus, right fusiform area, and bilateral cerebellum was decreased in the BC patients compared to controls. The number of chemotherapy cycles was negatively associated with general cognitive capacity, verbal fluency and digit span performance in the BC patients. In addition, decreased gray matter density in the right middle frontal gyrus could mediate the chemotherapy dosage effects on verbal fluency performance. These findings indicate that the dose-response relationship between chemotherapy and cognitive impairment may depend on the decreases in gray matter density of the frontal cortical structures.
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13
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Long-term influence of adjuvant breast radiotherapy on cognitive function in breast cancer patients treated with conservation therapy. Int J Clin Oncol 2018; 24:68-77. [DOI: 10.1007/s10147-018-1330-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 08/01/2018] [Indexed: 12/22/2022]
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14
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Huang Z, Shi Y, Bao P, Cai H, Hong Z, Ding D, Jackson J, Shu XO, Dai Q. Associations of dietary intake and supplement use with post-therapy cognitive recovery in breast cancer survivors. Breast Cancer Res Treat 2018; 171:189-198. [PMID: 29744676 DOI: 10.1007/s10549-018-4805-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 04/28/2018] [Indexed: 12/28/2022]
Abstract
PURPOSE Cognitive impairment induced by cancer therapy is common and can be long lasting after completion of therapy. Little is known on factors that influence recovery from the impairment. We evaluated the associations of dietary intake and supplement use with post-therapy cognitive recovery in a large cohort of breast cancer survivors. METHODS This study included 1047 breast cancer patients aged 20-75 who were recruited to the Shanghai Breast Cancer Survival Study between 2002 and 2006 at approximately 6.5 months post-cancer diagnosis. Two cognitive assessments covering immediate memory, delayed memory, verbal fluency, and attention, were conducted at 18 and 36 months post-diagnosis. We used food frequency questionnaire to collect information on their dietary intake and supplement use between 18 and 36 months post-diagnosis. Linear regression models were used to examine the associations of dietary intake and supplement use with mean cognitive scores at 36 months post-diagnosis and with differences in cognitive scores between 18 and 36 months post-diagnosis. RESULTS Higher vegetable, fruit and fish intake, supplementation with vitamin B and vitamin E, and tea drinking were associated with higher cognitive scores, while alcohol drinking was associated with lower cognitive scores at 36 months post-diagnosis. Vegetable intake was positively associated with improvement in verbal fluency, while tea drinking and fish oil supplementation were associated with greater improvements in delayed memory between 18 and 36 months post-diagnosis. CONCLUSIONS Our results indicate that higher vegetable intake, tea drinking, and fish oil supplementation may help post-therapy cognitive recovery for cancer patients.
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Affiliation(s)
- Zhezhou Huang
- Division of Non-communicable Disease and Injury, Shanghai Municipal Center for Disease Control and Prevention, 1380 Zhongshan West Road, 200336, Shanghai, China
| | - Yan Shi
- Division of Non-communicable Disease and Injury, Shanghai Municipal Center for Disease Control and Prevention, 1380 Zhongshan West Road, 200336, Shanghai, China.
| | - Pingping Bao
- Division of Non-communicable Disease and Injury, Shanghai Municipal Center for Disease Control and Prevention, 1380 Zhongshan West Road, 200336, Shanghai, China
| | - Hui Cai
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, 37203-1738, USA
| | - Zhen Hong
- Department of Neurology, Huashan Hospital, Fudan University, 200040, Shanghai, China
| | - Ding Ding
- Department of Neurology, Huashan Hospital, Fudan University, 200040, Shanghai, China
| | - James Jackson
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, 37203-1738, USA
| | - Xiao-Ou Shu
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, 37203-1738, USA
| | - Qi Dai
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, 37203-1738, USA
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15
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Lima CVC, Póvoa RMF. Mulheres Submetidas à Quimioterapia e suas Funções Cognitivas. PSICOLOGIA: CIÊNCIA E PROFISSÃO 2017. [DOI: 10.1590/1982-3703004772016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Resumo: Atualmente, o câncer representa um grande desafio científico. A quimioterapia tem sido a alternativa de tratamento de maior perspectiva para o combate ao câncer. Durante esse percurso, alterações cognitivas podem ser acarretadas e, portanto, faz-se necessário a identificação destas, já que representam complicações neurológicas com alto índice de melhora quando tratadas. O objetivo desse trabalho delimitou-se a estudar as funções executivas em mulheres com câncer de mama submetidas à quimioterapia buscando identificar aspectos como flexibilidade cognitiva, impulsividade/controle inibitório, memória operacional, planejamento, tomada de decisão, categorização e fluência. Trata-se de uma revisão de literatura a partir de levantamento de publicações dos últimos cinco anos nas bases de dados PubMed, Lilacs, Pepsico, SciELO e BVS. Foram utilizados os seguintes descritores: avaliação neuropsicológica/neuropsychological evaluation, funções executivas/functions executive, quimioterapia/chemotherapy e câncer de mama/breast cancer. Foram encontrados 18 artigos relacionados ao tema. Os estudos apontaram a existência de alterações no funcionamento executivo de mulheres submetidas à quimioterapia. Ressalta-se que essas pesquisas se diferenciaram entre si, no que se refere à caracterização da amostra e a métodos utilizados, o que demonstra pouca padronização da avaliação neuropsicológica desse domínio cognitivo. Conclui-se que os domínios cognitivos referentes às funções executivas se encontram mais prejudicados em mulheres com câncer de mama que receberam quimioterapia. Contudo, essas informações ainda são insuficientes, pois subdomínios das funções executivas precisam ser investigados com maior integralidade, a fim de se obter um maior panorama funcional. Sugere-se novos estudos acerca do rastreio das funções executivas.
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16
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Recent cancer treatment and memory decline in older adults: An analysis of the 2002-2012 Health and Retirement Study. J Geriatr Oncol 2017; 9:186-193. [PMID: 29174632 DOI: 10.1016/j.jgo.2017.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 09/19/2017] [Accepted: 10/27/2017] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Few studies have examined the impact of cancer treatment on cognitive trajectories in the growing population of older adults diagnosed with and surviving cancer. This study examined whether recent cancer and its treatment accelerated memory decline in older adults. MATERIALS AND METHODS We conducted a secondary analysis of observations drawn from the Health and Retirement Study (2002-2012), a population-based sample of older adults in the United States. Changes in immediate (IWR) and delayed word recall (DWR) scores were estimated by latent growth modeling in individuals who never had cancer (n=10,939) or had been diagnosed with cancer between 2000 and 2002 and received treatment with some combination of radiation and/or surgery (n=240), chemotherapy only (n=34), or chemotherapy and some combination of radiation and/or surgery (n=64). RESULTS In the period immediately following treatment, individuals reporting a recent cancer treated with chemotherapy and surgery/radiation experienced significantly more rapid decline in IWR (b =-0.34, SE =0.17, p=0.047) and DWR (b=-0.38, SE=0.19, p=0.049) than the non-cancer group. Sensitivity analyses addressing mortality selection and memory-related disease at baseline attenuated the strength of these associations. There were no other statistically significant differences in estimated linear or quadratic slope by cancer status or treatment. CONCLUSION Our results support a potential association between recent cancer treatment and trajectories of memory decline in older adults and provide guidance on the interpretation of statistical estimates from panel studies of health and aging.
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17
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Muzzatti B, Giovannini L, Flaiban C, Cattaruzza N, Annunziata MA. Cognitive functioning in long-term cancer survivorship: A survey utilizing both standardized neuropsychological and self-report measures. APPLIED NEUROPSYCHOLOGY-ADULT 2017; 26:173-180. [PMID: 29099636 DOI: 10.1080/23279095.2017.1387551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Since long-term cancer survivorship is a reality for an increasing number of people, understanding their cognitive functioning is useful for both research and clinical purposes. This study described the cognitive functioning of Italian long-term cancer survivors, using both an objective standardized battery and a self-report questionnaire. A total of 136 Italian adults 5+ years free from cancer and its treatments were administered the Esame Neuropsicologico Breve, the Self-Assessment Scale of Cognitive Functioning, and assessments of other psychological dimensions. A total amount of 15% of the sample showed impaired performance on 2+ of the assessed cognitive functions, and 32% had 1+ impaired function. The subjective perception of their cognitive functioning was worse in the present sample, compared to the normative data (p < 0.001). Cognitive functioning, objectively and subjectively measured were significantly correlated (p = 0.006). The number of tests scored outside the normal range correlated positively with depression (p = 0.042) and negatively with both the estimated total IQ (p < 0.001) and with estimated performance IQ (p = 0.001). Self-perceived cognitive functioning correlated positively (p < 0.001) with depression, anxiety, and fatigue. These data document how cognitive difficulties may remain for a long time in cancer patients, who are likely to continue to subjectively perceive themselves as impaired, although sometimes to a greater extent than objective impairment.
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Affiliation(s)
- Barbara Muzzatti
- a Centro di Riferimento Oncologico , Unit of Oncological Psychology , Aviano , Italy
| | - Lorena Giovannini
- a Centro di Riferimento Oncologico , Unit of Oncological Psychology , Aviano , Italy
| | - Cristiana Flaiban
- a Centro di Riferimento Oncologico , Unit of Oncological Psychology , Aviano , Italy
| | - Nicoletta Cattaruzza
- a Centro di Riferimento Oncologico , Unit of Oncological Psychology , Aviano , Italy
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18
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The anticancer estrogen receptor antagonist tamoxifen impairs consolidation of inhibitory avoidance memory through estrogen receptor alpha. J Neural Transm (Vienna) 2017; 124:1331-1339. [DOI: 10.1007/s00702-017-1785-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 08/27/2017] [Indexed: 12/20/2022]
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19
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Huang Z, Zheng Y, Bao P, Cai H, Hong Z, Ding D, Jackson J, Shu XO, Dai Q. Aging, obesity, and post-therapy cognitive recovery in breast cancer survivors. Oncotarget 2017; 8:12364-12373. [PMID: 27738306 PMCID: PMC5355351 DOI: 10.18632/oncotarget.12565] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 10/03/2016] [Indexed: 12/22/2022] Open
Abstract
Therapy-induced cognitive impairment is prevalent and long-lasting in cancer survivors, but factors affecting post-therapy cognitive recovery are unclear. We conducted this study to evaluate the associations of age, body mass index (BMI), waist-to-hip ratio (WHR), and physical activity (PA) with post-therapy cognitive changes in a population-based breast cancer (BC) survivor cohort. We collected information on PA, weight, height, waist and hip circumferences of 1286 BC survivors aged 20-75. We assessed their cognitive functions, including immediate memory, delayed memory, verbal fluency, and attention, at 18 and 36 months after cancer diagnosis. Linear regression models were used to examine the associations of age, BMI, WHR and PA with mean changes in cognitive scores from 18- to 36-month follow-up interview. We found that the post-therapy cognitive changes differed by age and obesity status. Verbal fluency and attention improved in younger patients aged <60 and non-abdominally obese patients, but deteriorated in older patients aged ≥60 (i.e. verbal fluency and attention) and abdominally obese patients (i.e. verbal fluency). Memory improved in all patients, with a smaller improvement in obese patients compared with normal-weight patients. No significant association was found between PA and post-therapy cognitive change. Due to the novelty of our findings and the limitations of our study, further research, including intervention trials, is warranted to confirm the causal relationship between obesity and cognitive impairments.
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Affiliation(s)
- Zhezhou Huang
- Department of Elderly Health, Division of Noncommunicable Disease and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Ying Zheng
- Department of Cancer Control and Prevention, Division of Noncommunicable Disease and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Pingping Bao
- Department of Noncommunicable Disease Surveillance, Division of Noncommunicable Disease and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Hui Cai
- Department of Medicine, Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Zhen Hong
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Ding Ding
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - James Jackson
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Xiao-Ou Shu
- Department of Medicine, Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Qi Dai
- Department of Medicine, Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
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20
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Mandelblatt JS, Clapp JD, Luta G, Faul LA, Tallarico MD, McClendon TD, Whitley JA, Cai L, Ahles TA, Stern RA, Jacobsen PB, Small BJ, Pitcher BN, Dura-Fernandis E, Muss HB, Hurria A, Cohen HJ, Isaacs C. Long-term trajectories of self-reported cognitive function in a cohort of older survivors of breast cancer: CALGB 369901 (Alliance). Cancer 2016; 122:3555-3563. [PMID: 27447359 PMCID: PMC5113662 DOI: 10.1002/cncr.30208] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 04/24/2016] [Accepted: 05/02/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND The number of survivors of breast cancer aged ≥65 years (“older”) is growing, but to the authors' knowledge, little is known regarding the cognitive outcomes of these individuals. METHODS A cohort of cognitively intact older survivors with nonmetastatic, invasive breast cancer was recruited from 78 sites from 2004 through 2011; approximately 83.7% of the survivors (1280 survivors) completed baseline assessments. Follow‐up data were collected at 6 months and annually for up to 7 years (median, 4.1 years). Cognitive function was self‐reported using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ‐C30); scores ranged from 0 to 100, with a higher score indicating better function. Group‐based trajectory modeling determined trajectories; women were assigned to a trajectory group based on the highest predicted probability of membership. Multinomial logistic regression evaluated the association between receipt of chemotherapy (with or without hormonal treatment) and trajectory group. RESULTS Survivors were aged 65 to 91 years; approximately 41% received chemotherapy. There were 3 cognitive trajectories: “maintained high” (42.3% of survivors); “phase shift” (50.1% of survivors), with scores slightly below but parallel to maintained high; and “accelerated decline” (7.6% of survivors), with the lowest baseline scores and greatest decline (from 71.7 [standard deviation, 19.8] to 58.3 [standard deviation, 21.9]). The adjusted odds of being in the accelerated decline group (vs the maintained high group) were 2.1 times higher (95% confidence interval, 1.3‐3.5) for survivors who received chemotherapy (with or without hormonal therapy) versus those treated with hormonal therapy alone. Greater comorbidity and frailty also were found to be associated with accelerated decline. CONCLUSIONS Trajectory group analysis demonstrated that the majority of older survivors maintained good long‐term self‐reported cognitive function, and that only a small subset who were exposed to chemotherapy manifested accelerated cognitive decline. Future research is needed to determine factors that place some older survivors at risk of experiencing cognitive decline. Cancer 2016;122:3555–3563. © 2016 American Cancer Society Among older survivors of breast cancer who were followed for up to 7 years, approximately 42% reported maintaining high cognitive function, but receipt of chemotherapy (with or without hormonal therapy) appeared to double the odds of being in the group that reported accelerated cognitive decline (vs maintaining high function), compared with receiving hormonal treatment alone. Further research is needed to determine factors that place some older survivors at risk of experiencing cognitive decline.
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Affiliation(s)
- Jeanne S Mandelblatt
- Department of Oncology, Georgetown University School of Medicine, Washington, DC.,Cancer Control Program, Lombardi Comprehensive Cancer Center, Washington, DC
| | - Jonathan D Clapp
- Department of Oncology, Georgetown University School of Medicine, Washington, DC.,Cancer Control Program, Lombardi Comprehensive Cancer Center, Washington, DC
| | - Gheorghe Luta
- Cancer Control Program, Lombardi Comprehensive Cancer Center, Washington, DC.,Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University Medical Center, Washington, DC
| | - Leigh Anne Faul
- Department of Oncology, Georgetown University School of Medicine, Washington, DC.,Cancer Control Program, Lombardi Comprehensive Cancer Center, Washington, DC
| | - Michelle D Tallarico
- Department of Oncology, Georgetown University School of Medicine, Washington, DC.,Cancer Control Program, Lombardi Comprehensive Cancer Center, Washington, DC
| | - Trina D McClendon
- Department of Oncology, Georgetown University School of Medicine, Washington, DC.,Cancer Control Program, Lombardi Comprehensive Cancer Center, Washington, DC
| | - Jessica A Whitley
- Department of Oncology, Georgetown University School of Medicine, Washington, DC.,Cancer Control Program, Lombardi Comprehensive Cancer Center, Washington, DC
| | - Ling Cai
- Cancer Control Program, Lombardi Comprehensive Cancer Center, Washington, DC.,Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University Medical Center, Washington, DC
| | - Tim A Ahles
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Robert A Stern
- Department of Neurology, Neurosurgery, and Anatomy and Neurobiology, Boston University Alzheimer's Disease Center, Boston University School of Medicine, Boston, Massachusetts
| | - Paul B Jacobsen
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Brent J Small
- School of Aging Studies, University of South Florida, Tampa, Florida
| | - Brandelyn N Pitcher
- Alliance Statistics and Data Center, Duke University, Durham, North Carolina
| | - Estrella Dura-Fernandis
- Polibienestar Research Institute, University of Valencia, Valencia, Spain.,Visiting Researcher, Georgetown University, Washington, DC
| | - Hyman B Muss
- Department of Medicine, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Arti Hurria
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Harvey J Cohen
- Department of Medicine, Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina
| | - Claudine Isaacs
- Department of Medicine, Georgetown University School of Medicine, Washington, DC.,Breast Cancer Program, Lombardi Comprehensive Cancer Center, Washington, DC
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21
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Wibowo E, Pollock PA, Hollis N, Wassersug RJ. Tamoxifen in men: a review of adverse events. Andrology 2016; 4:776-88. [DOI: 10.1111/andr.12197] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 03/09/2016] [Accepted: 03/12/2016] [Indexed: 12/16/2022]
Affiliation(s)
- E. Wibowo
- Vancouver Prostate Centre; Vancouver Coastal Health Research Institute; Vancouver BC Canada
| | - P. A. Pollock
- Vancouver Prostate Centre; Vancouver Coastal Health Research Institute; Vancouver BC Canada
| | - N. Hollis
- Solid Organ Transplant Clinic; Vancouver General Hospital; Vancouver BC Canada
| | - R. J. Wassersug
- Department of Urologic Sciences; University of British Columbia; Vancouver BC Canada
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22
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Cutshall SM, Cha SS, Ness SM, Stan DL, Christensen SA, Bhagra A, Price KA, Thompson CA, Hashmi SK, Chon TY, McCray TJ, Sood A, Bauer BA, Ruddy KJ. Symptom burden and integrative medicine in cancer survivorship. Support Care Cancer 2015; 23:2989-94. [PMID: 25724408 DOI: 10.1007/s00520-015-2666-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 02/15/2015] [Indexed: 01/20/2023]
Abstract
PURPOSE The purpose of the study was to learn about the level of experience with, interest in, and desire for knowledge about integrative medicine (IM) among cancer survivors. METHODS Cancer survivors attending the 2014 National Cancer Survivors Day in Rochester, MN, were recruited to participate in a one-page survey about their ongoing health concerns and symptoms, as well as their experience with, interest in, and desire for knowledge about IM. Two-sided t test was used for univariate analyses of impact of sex, time since diagnosis, and age. RESULTS Among the 260 cancer survivors, 171 persons (female, 74 %; male, 26 %) completed the survey (mean age, 64.6 years). Symptoms most commonly somewhat or more bothersome were fear of recurrence (52 %), stress (43 %), fatigue (43 %), difficulty sleeping (33 %), and weight gain (31 %). The most used IM resources were exercise (75 %), improved nutrition and diet (66 %), stress management (42 %), dietary supplementation (33 %), meditation (25 %), and massage (22 %). Older patients (age, ≥65 years) were less experienced with, interested in, and desiring of knowledge about IM techniques. Sex and time since diagnosis were not strongly predictive of most survey response categories. CONCLUSIONS Cancer survivors have adverse effects for years into survivorship. They use and express interest in various IM techniques to help manage symptoms. It is critical that oncology providers help survivors address ongoing health concerns. Education about and access to evidence-based IM techniques may have important roles in comprehensive cancer survivorship programs.
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Affiliation(s)
- Susanne M Cutshall
- Department of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
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Abstract
OBJECTIVES To examine the significance of multimorbidity in breast cancer survivors, to explore multimorbidity in treatment decisions, and survivorship, and to consider multimorbidity assessment in clinical practice. DATA SOURCES Literature review; clinical practice guidelines. CONCLUSION Multimorbidity influences treatment decisions. Breast cancer survivors report greater multimorbidity compared with other cancer survivors. Multimorbidity increases with age; there may be racial and ethnic differences. Multimorbidity is associated with symptom burden, functional decline, low adherence to surveillance, and early retirement. IMPLICATIONS FOR NURSING PRACTICE Clinical practice guidelines do not refer to multimorbidity and patient outcomes. Comprehensive geriatric assessment combined with survivorship care plan may be considered.
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Women and memory. Menopause 2015; 22:4-5. [DOI: 10.1097/gme.0000000000000386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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