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Rick O, Gerhardt A, Schilling G. Cancer-Related Cognitive Dysfunction: A Narrative Review for Clinical Practice. Oncol Res Treat 2024; 47:218-223. [PMID: 38471462 DOI: 10.1159/000538277] [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: 07/19/2023] [Accepted: 03/06/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Cancer-related cognitive dysfunction (CRCD) is a major functional disorder in patients with cancer. This central nervous dysfunction is found in up to 60% of patients after tumour therapy, often significantly limits the quality of life, and significantly impedes participation in working life. For this reason, diagnosis and treatment of CRCD are of central importance. This narrative review is intended to provide an overview and support for practical clinical care with regard to diagnostics and therapeutic options. SUMMARY In Germany, CRCD has received insufficient attention in clinical practice due to the lack of guidelines for diagnosis and therapy. The pathophysiology is complex and cannot be explained by chemotherapeutic treatment alone. In addition to the tumour disease as such and the tumour therapy, psychological factors such as anxiety and depression as well as sleep disorders also play a significant role. Today, it is known that in addition to age, molecular genetic changes also have an effect on cognitive function. Morphologically, CRCD can be located in the frontal cortex and hippocampus. In addition to easy-to-use screening instruments such as the visual analogue scale, validated questionnaires such as the Questionnaire of Subjectively Experienced Deficits in Attention (FEDA) developed in Germany are also available. These allow the suspected diagnosis to be substantiated and the patient to be referred to further neurological, neuropsychological, or psycho-oncological diagnostics. Within the framework of further neuropsychological diagnostics, the International Cognition and Cancer Task Force (ICCTF) recommends testing learning, memory, processing speed, and executive functions. From the authors' point of view, a step-by-step diagnosis is recommended in order to avoid overdiagnosis. In clinical practice, graduation according to the "Common Terminology Criteria for Adversity Events" (CTCAE Version 5.0) is suitable for assessing the degree of severity. Cognitive training should be behaviourally oriented and include regular practice of cognitive skills to restore attention, psychomotor speed, memory, and executive functions. The best evidence is currently found for web-based training programmes that can be used by the patient at home. There is also evidence for mindfulness training and physical exercises. In particular, the combination of these three therapeutic elements currently seems to be the optimal treatment strategy for CRCD. KEY MESSAGES Cognitive dysfunction should be given much more attention in the clinical care of cancer patients. Diagnostic tools for this purpose and evidence-based therapeutic interventions are available. In the future, networks should be created that allow for better care of patients with CRCD.
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Affiliation(s)
- Oliver Rick
- Klinik Reinhardshöhe, Bad Wildungen, Germany
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Daniel E, Deng F, Patel SK, Sedrak MS, Young J, Kim H, Razavi M, Sun CL, Root JC, Ahles TA, Dale W, Chen BT. Effect of chemotherapy on hippocampal volume and shape in older long-term breast cancer survivors. Front Aging Neurosci 2024; 16:1347721. [PMID: 38524113 PMCID: PMC10957749 DOI: 10.3389/fnagi.2024.1347721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/20/2024] [Indexed: 03/26/2024] Open
Abstract
Purpose The objective of this study was to assess changes in hippocampal volume and shape in older long-term breast cancer survivors who were exposed to chemotherapy 5-15 years prior. Methods This study recruited female long-term breast cancer survivors aged 65 years or older with a history of chemotherapy (C+), age-matched breast cancer survivors who did not receive chemotherapy (C-), and healthy controls (HC). The participants were recruited 5-15 years after chemotherapy at time point 1 (TP1) and were followed up for 2 years at time point 2 (TP2). Assessments included hippocampal volume and shape from brain MRI scans and neuropsychological (NP) tests. Results At TP1, each of the three groups was comprised of 20 participants. The C+ group exhibited a hippocampal volume loss estimated in proportion with total intracranial volume (ICV) in both the left and right hemispheres from TP1 to TP2. Regarding the hippocampal shape at TP1, the C+ group displayed inward changes compared to the control groups. Within the C+ group, changes in right hippocampal volume adjusted with ICV were positively correlated with crystalized composite scores (R = 0.450, p = 0.044). Additionally, in C+ groups, chronological age was negatively correlated with right hippocampal volume adjusted with ICV (R = -0.585, p = 0.007). Conclusion The observed hippocampal volume reduction and inward shape deformation within the C+ group may serve as neural basis for cognitive changes in older long-term breast cancer survivors with history of chemotherapy treatment.
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Affiliation(s)
- Ebenezer Daniel
- Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, CA, United States
| | - Frank Deng
- Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, CA, United States
| | - Sunita K. Patel
- Department of Population Science, City of Hope National Medical Center, Duarte, CA, United States
| | - Mina S. Sedrak
- Department of Medicine, Division of Hematology-Oncology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, United States
| | - Jonathan Young
- Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, CA, United States
| | - Heeyoung Kim
- Center for Cancer and Aging, City of Hope National Medical Center, Duarte, CA, United States
| | - Marianne Razavi
- Department of Supportive Care Medicine, City of Hope National Medical Center, Duarte, CA, United States
| | - Can-Lan Sun
- Center for Cancer and Aging, City of Hope National Medical Center, Duarte, CA, United States
| | - James C. Root
- Neurocognitive Research Laboratory, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Tim A. Ahles
- Neurocognitive Research Laboratory, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - William Dale
- Center for Cancer and Aging, City of Hope National Medical Center, Duarte, CA, United States
- Department of Supportive Care Medicine, City of Hope National Medical Center, Duarte, CA, United States
| | - Bihong T. Chen
- Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, CA, United States
- Center for Cancer and Aging, City of Hope National Medical Center, Duarte, CA, United States
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Chen VCH, Chuang W, Tsai YH, McIntyre RS, Weng JC. Longitudinal assessment of chemotherapy-induced brain connectivity changes in cerebral white matter and its correlation with cognitive functioning using the GQI. Front Neurol 2024; 15:1332984. [PMID: 38385045 PMCID: PMC10879440 DOI: 10.3389/fneur.2024.1332984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/23/2024] [Indexed: 02/23/2024] Open
Abstract
Objective Breast cancer was the most prevalent type of cancer and had the highest incidence rate among women worldwide. The wide use of adjuvant chemotherapy might have a detrimental effect on the human brain and result in chemotherapy-related cognitive impairment (CICI) among breast cancer patients. Furthermore, prior to chemotherapy, patients reported cancer-related cognitive impairment (CRCI), which might be due to physiological factors or mood symptoms. The present longitudinal study aimed to investigate microstructural and macroscale white matter alterations by generalized q-sampling imaging (GQI). Methods The participants were categorized into a pre-chemotherapy group (BB) if they were diagnosed with primary breast cancer and an age-matched noncancer control group (HC). Some participants returned for follow-up assessment. In the present follow up study, 28 matched pairs of BB/BBF (follow up after chemotherapy) individuals and 28 matched pairs of HC/HCF (follow up) individuals were included. We then used GQI and graph theoretical analysis (GTA) to detect microstructural alterations in the whole brain. In addition, we evaluated the relationship between longitudinal changes in GQI indices and neuropsychological tests as well as psychiatric comorbidity. Findings The results showed that disruption of white matter integrity occurred in the default mode network (DMN) of patients after chemotherapy, such as in the corpus callosum (CC) and middle frontal gyrus (MFG). Furthermore, weaker connections between brain regions and lower segregation ability were observed in the post-chemotherapy group. Significant correlations were observed between neuropsychological tests and white matter tracts of the CC, MFG, posterior limb of the internal capsule (PLIC) and superior longitudinal fasciculus (SLF). Conclusion The results provided evidence of white matter alterations in breast cancer patients, and they may serve as potential imaging markers of cognitive changes. In the future, the study may be beneficial to create and evaluate strategies designed to maintain or improve cognitive function in breast cancer patients undergoing chemotherapy.
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Affiliation(s)
- Vincent Chin-Hung Chen
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Wei Chuang
- Department of Medical Imaging and Radiological Sciences, and Department of Artificial Intelligence, Chang Gung University, Taoyuan, Taiwan
| | - Yuan-Hsiung Tsai
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Roger S. McIntyre
- Mood Disorder Psychopharmacology Unit, University Health Network, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Departments of Psychiatry and Pharmacology, University of Toronto, Toronto, ON, Canada
| | - Jun-Cheng Weng
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Department of Medical Imaging and Radiological Sciences, and Department of Artificial Intelligence, Chang Gung University, Taoyuan, Taiwan
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Lin Y, Wang S, Zhang L, Yang Q. Elucidating the relationship between breast cancer and brain cortical structure: a Mendelian randomization study. Cereb Cortex 2024; 34:bhad498. [PMID: 38112592 DOI: 10.1093/cercor/bhad498] [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: 11/08/2023] [Revised: 12/02/2023] [Accepted: 12/03/2023] [Indexed: 12/21/2023] Open
Abstract
Cancer-associated cognitive impairment is a significant challenge for individuals who have survived breast cancer, affecting their quality of life. In this study, we conducted an inaugural comprehensive Mendelian randomization analysis discerning the causal relationship between breast cancer, including its two subtypes, and the cerebral cortical structure. Our analysis indicated that estrogen receptor-negative breast cancer significantly decreased surface area (β = -593.01 mm2, 95% CI: -1134.9 to -51.1 mm2, P = 0.032). At the regional level, estrogen receptor-negative breast cancer showed a significant association with surface area and thickness in 17 cortical regions. These regions included the insula, posterior cingulate, superior frontal, precuneus, fusiform, lateral occipital, and rostral middle frontal. Specifically, estrogen receptor-negative breast cancer had a significant impact on decreasing the surface area of the insula without considering global weight (β = -14.09 mm2, 95% CI: -22.91 to -5.27 mm2, P = 0.0017). The results from meta-analysis and LD Score Regression provide support for our findings. This investigation unveils the correlations between breast cancer, its various subcategories, and the cerebral cortical structure. Notably, breast cancer of the estrogen receptor-negative variety may elicit more widespread cerebral atrophy.
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Affiliation(s)
- Yilong Lin
- Department of Breast Surgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian 361003, China
| | - Songsong Wang
- Department of Urology, Zhongshan Hospital Affiliated to Xiamen University, School of Medicine, Xiamen University, Xiamen 361000, China
| | - Liyi Zhang
- Department of Breast Surgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian 361003, China
| | - Qingmo Yang
- Department of Breast Surgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian 361003, China
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Hu Y, Yu H, Lai Y, Liu J, Tan Y, Lei W, Zhang J, Zhou X, Cao Y, Tang Y, Liu D, Zhang J. Longitudinal trajectory of amplitude of low-frequency fluctuation changes in breast cancer patients during neoadjuvant chemotherapy-A preliminary prospective study. Brain Res Bull 2024; 206:110845. [PMID: 38101650 DOI: 10.1016/j.brainresbull.2023.110845] [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: 09/20/2023] [Revised: 11/15/2023] [Accepted: 12/12/2023] [Indexed: 12/17/2023]
Abstract
There is growing evidence that the amplitude of low-frequency fluctuation (ALFF) changes in breast cancer patients after chemotherapy. However, longitudinal changes in ALFF during chemotherapy are unclear. To assess the trajectory of ALFF changes during chemotherapy, 36 breast cancer patients underwent both resting-state functional magnetic resonance imaging and neuropsychological testing at three time points, including before neoadjuvant chemotherapy (NAC) (time point 0, TP0), after one cycle of NAC (before the second cycle of NAC, TP1), and upon completion of NAC (pre-operation, TP2). Healthy controls (HC) received the same assessments at matching time points. We compared the longitudinal changes of ALFF in the NAC and two HC groups. In the NAC group, compared with TP0, ALFF values in the right orbital part of the inferior frontal gyrus, left medial orbital part of the superior frontal gyrus, right insula, left medial part of the superior frontal gyrus, and right middle frontal gyrus declined significantly at TP1 and TP2. Compared with TP1, there were no significant changes in ALFF values at TP2. In the two HC groups, there were no significant changes in ALFF at corresponding intervals. We concluded that for breast cancer patients receiving NAC, ALFF values declined significantly in some brain regions after one cycle of NAC and then remained stable until the completion of NAC, and most of the brain regions with ALFF changes were located in the frontal lobe.
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Affiliation(s)
- Yixin Hu
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Hong Yu
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Yong Lai
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Jiang Liu
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Yong Tan
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Weiwei Lei
- Department of Intensive Care, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Jing Zhang
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Xiaoyu Zhou
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Ying Cao
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Yu Tang
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Daihong Liu
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China.
| | - Jiuquan Zhang
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China.
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Yao S, Zhang Q, Yao X, Zhang X, Pang L, Yu S, Cheng H. Advances of neuroimaging in chemotherapy related cognitive impairment (CRCI) of patients with breast cancer. Breast Cancer Res Treat 2023:10.1007/s10549-023-07005-y. [PMID: 37329458 DOI: 10.1007/s10549-023-07005-y] [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: 04/13/2023] [Accepted: 05/30/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Chemotherapy related cognitive impairment (CRCI) has seriously affected the quality of life (QOL) of patients with breast cancer (BCs), thus the neurobiological mechanism of CRCI attracted widespread attention. Previous studies have found that chemotherapy causes CRCI through affecting brain structure, function, metabolism, and blood perfusion. FINDINGS A variety of neuroimaging techniques such as functional magnetic resonance imaging (fMRI), event-related potential (ERP), near-infrared spectroscopy (NIRS) have been widely applied to explore the neurobiological mechanism of CRCI. CONCLUSION This review summarized the progress of neuroimaging research in BCs with CRCI, which provides a theoretical basis for further exploration of CRCI mechanism, disease diagnosis and symptom intervention in the future. Multiple neuroimaging techniques for CRCI research.
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Affiliation(s)
- Senbang Yao
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Cancer and Cognition Laboratory, Anhui Medical University, Hefei, Anhui, China
| | - Qianqian Zhang
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Cancer and Cognition Laboratory, Anhui Medical University, Hefei, Anhui, China
| | - Xinxin Yao
- Hefei Cancer Hospital, Chinese Academy of Sciences, Hefei, Anhui, China
| | - Xiuqing Zhang
- Hefei Cancer Hospital, Chinese Academy of Sciences, Hefei, Anhui, China
| | - Lulian Pang
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Cancer and Cognition Laboratory, Anhui Medical University, Hefei, Anhui, China
| | - Sheng Yu
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Cancer and Cognition Laboratory, Anhui Medical University, Hefei, Anhui, China
| | - Huaidong Cheng
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.
- Department of Oncology, Shenzhen Hospital of Southern Medical University, Shenzhen, Guangdong, China.
- Shenzhen Clinical Medical School, Southern Medical University, Shenzhen, Guangdong, China.
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Chen VCH, Chuang W, Chen CW, Tsai YH, McIntyre RS, Weng JC. Detecting microstructural alterations of cerebral white matter associated with breast cancer and chemotherapy revealed by generalized q-sampling MRI. Front Psychiatry 2023; 14:1161246. [PMID: 37363171 PMCID: PMC10289548 DOI: 10.3389/fpsyt.2023.1161246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/22/2023] [Indexed: 06/28/2023] Open
Abstract
Objective Previous studies have discussed the impact of chemotherapy on the brain microstructure. There is no evidence of the impact regarding cancer-related psychiatric comorbidity on cancer survivors. We aimed to evaluate the impact of both chemotherapy and mental health problem on brain microstructural alterations and consequent cognitive dysfunction in breast cancer survivors. Methods In this cross-sectional study conducted in a tertiary center, data from 125 female breast cancer survivors who had not received chemotherapy (BB = 65; 49.86 ± 8.23 years) and had received chemotherapy (BA = 60; 49.82 ± 7.89 years) as well as from 71 age-matched healthy controls (47.18 ± 8.08 years) was collected. Chemotherapeutic agents used were docetaxel and epirubicin. We used neuropsychological testing and questionnaire to evaluate psychiatric comorbidity, cognitive dysfunction as well as generalized sampling imaging (GQI) and graph theoretical analysis (GTA) to detect microstructural alterations in the brain. Findings Cross-comparison between groups revealed that neurotoxicity caused by chemotherapy and cancer-related psychiatric comorbidity may affect the corpus callosum and middle frontal gyrus. In addition, GQI indices were correlated with the testing scores of cognitive function, quality of life, anxiety, and depression. Furthermore, weaker connections between brain regions and lower segregated ability were found in the post-treatment group. Conclusion This study suggests that chemotherapy and cancer-related mental health problem both play an important role in the development of white matter alterations and cognitive dysfunction.
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Affiliation(s)
- Vincent Chin-Hung Chen
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Wei Chuang
- Department of Medical Imaging and Radiological Sciences, Department of Artificial Intelligence, Chang Gung University, Taoyuan, Taiwan
| | - Chien-Wei Chen
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yuan-Hsiung Tsai
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Roger S. McIntyre
- Mood Disorder Psychopharmacology Unit, Department of Psychiatry, University Health Network, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Departments of Psychiatry and Pharmacology, University of Toronto, Toronto, ON, Canada
| | - Jun-Cheng Weng
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Department of Medical Imaging and Radiological Sciences, Department of Artificial Intelligence, Chang Gung University, Taoyuan, Taiwan
- Medical Imaging Research Center, Institute for Radiological Research, Chang Gung University, Taoyuan, Taiwan
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Ospina-Romero M, Brenowitz WD, Glymour MM, Westrick A, Graff RE, Hayes-Larson E, Mayeda ER, Ackley SF, Kobayashi LC. Education, incident cancer, and rate of memory decline in a national sample of US adults in mid-to-later-life. J Geriatr Oncol 2023; 14:101530. [PMID: 37210786 PMCID: PMC10332197 DOI: 10.1016/j.jgo.2023.101530] [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: 08/31/2022] [Revised: 03/30/2023] [Accepted: 05/11/2023] [Indexed: 05/23/2023]
Abstract
INTRODUCTION Middle-aged and older adults who develop cancer experience memory loss following diagnosis, but memory decline in the years before and after cancer diagnosis is slower compared to their cancer-free counterparts. Educational attainment strongly predicts memory function during aging, but it is unclear whether education protects against memory loss related to cancer incidence or modifies long-term memory trajectories in middle-aged and older cancer survivors. MATERIALS AND METHODS Data were from 14,449 adults (3,248 with incident cancer, excluding non-melanoma skin cancer) aged 50+ in the population-based US Health and Retirement Study from 1998 to 2016. Memory was assessed every two years as a composite of immediate and delayed word recall tests and proxy assessments for impaired individuals. Memory scores all time points were standardized at to the baseline distribution. Using multivariate-adjusted linear mixed-effects models, we estimated rates of memory decline in the years before cancer diagnosis, shortly after diagnosis, and in the years after diagnosis. We compared rates of memory decline between incident cancer cases and age-matched cancer-free adults, overall and according to level of education (<12 years, "low"; 12 to <16 years, "intermediate"; ≥16 years, "high"). RESULTS Incident cancer diagnoses were followed by short-term declines in memory averaging 0.06 standard deviation (SD) units (95% confidence interval [CI]: -0.084, -0.036). Those with low education experienced the strongest magnitude of short-term decline in memory after diagnosis (-0.10 SD units, 95% CI: -0.15, -0.05), but this estimate was not statistically significantly different from the short-term decline in memory experienced by those with high education (-0.04 SD units, 95% CI: -0.08, 0.01; p-value for education as an effect modifier = 0.15). In the years prior to and following an incident cancer diagnosis, higher educational attainment was associated with better memory, but it did not modify the difference in rate of long-term memory decline between cancer survivors and those who remained cancer-free. DISCUSSION Education was associated with better memory function over time among both cancer survivors and cancer-free adults aged 50 and over. Low education may be associated with a stronger short-term decline in memory after a cancer diagnosis.
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Affiliation(s)
- Monica Ospina-Romero
- Department of Epidemiology and Biostatistics, University of California San Francisco, United States of America; Department of Pathology and Laboratory Medicine, University of Wisconsin, United States of America.
| | - Willa D Brenowitz
- Department of Psychiatry, University of California San Francisco, United States of America; Kaiser Permanente Center for Health Research, Portland, United States of America
| | - M Maria Glymour
- Department of Epidemiology and Biostatistics, University of California San Francisco, United States of America
| | - Ashly Westrick
- Department of Epidemiology, School of Public Health, University of Michigan, United States of America
| | - Rebecca E Graff
- Department of Epidemiology and Biostatistics, University of California San Francisco, United States of America
| | - Eleanor Hayes-Larson
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, United States of America
| | - Elizabeth Rose Mayeda
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, United States of America
| | - Sarah F Ackley
- Department of Epidemiology and Biostatistics, University of California San Francisco, United States of America
| | - Lindsay C Kobayashi
- Department of Epidemiology, School of Public Health, University of Michigan, United States of America
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Daniel E, Deng F, Patel SK, Sedrak MS, Kim H, Razavi M, Sun CL, Root JC, Ahles TA, Dale W, Chen BT. Altered gyrification in chemotherapy-treated older long-term breast cancer survivors. RESEARCH SQUARE 2023:rs.3.rs-2697378. [PMID: 37090667 PMCID: PMC10120747 DOI: 10.21203/rs.3.rs-2697378/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
Purpose The purpose of this prospective longitudinal study was to evaluate the changes in brain surface gyrification in older long-term breast cancer survivors 5 to 15 years after chemotherapy treatment. Methods Older breast cancer survivors aged ≥ 65 years treated with chemotherapy (C+) or without chemotherapy (C-) 5-15 years prior and age & sex-matched healthy controls (HC) were recruited (time point 1 (TP1)) and followed up for 2 years (time point 2 (TP2)). Study assessments for both time points included neuropsychological (NP) testing with the NIH Toolbox cognition battery and cortical gyrification analysis based on brain MRI. Results The study cohort with data for both TP1 and TP2 consisted of the following: 10 participants for the C+ group, 12 participants for the C- group, and 13 participants for the HC group. The C+ group had increased gyrification in 6 local gyrus regions including the right fusiform, paracentral, precuneus, superior, middle temporal gyri and left pars opercularis gyrus, and it had decreased gyrification in 2 local gyrus regions from TP1 to TP2 (p < 0.05, Bonferroni corrected). The C- and HC groups showed decreased gyrification only (p < 0.05, Bonferroni corrected). In C+ group, changes in right paracentral gyrification and crystalized composite scores were negatively correlated (R = -0.76, p = 0.01). Conclusions Altered gyrification could be the neural correlate of cognitive changes in older chemotherapy-treated long-term breast cancer survivors.
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Affiliation(s)
| | - Frank Deng
- City of Hope National Medical Center: City of Hope
| | | | | | - Heeyoung Kim
- City of Hope National Medical Center: City of Hope
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10
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Daniel E, Deng F, Patel SK, Sedrak MS, Kim H, Razavi M, Sun CL, Root JC, Ahles TA, Dale W, Chen BT. Cortical thinning in chemotherapy-treated older long-term breast cancer survivors. Brain Imaging Behav 2023; 17:66-76. [PMID: 36369620 PMCID: PMC10156471 DOI: 10.1007/s11682-022-00743-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2022] [Indexed: 11/13/2022]
Abstract
Cognitive decline is an increasing issue for cancer survivors, especially for older adults, as chemotherapy affects brain structure and function. The purpose of this single center study was to evaluate alterations in cortical thickness and cognition in older long-term survivors of breast cancer who had been treated with chemotherapy years ago. In this prospective cohort study, we enrolled 3 groups of women aged ≥ 65 years with a history of stage I-III breast cancer who had received adjuvant chemotherapy 5 to 15 years ago (chemotherapy group, C +), age-matched women with breast cancer but no chemotherapy (no-chemotherapy group, C-) and healthy controls (HC). All participants underwent brain magnetic resonance imaging and neuropsychological testing with the NIH Toolbox Cognition Battery at time point 1 (TP1) and again at 2 years after enrollment (time point 2 (TP2)). At TP1, there were no significant differences in cortical thickness among the 3 groups. Longitudinally, the C + group showed cortical thinning in the fusiform gyrus (p = 0.006, effect size (d) = -0.60 [ -1.86, -0.66]), pars triangularis (p = 0.026, effect size (d) = -0.43 [-1.68, -0.82]), and inferior temporal lobe (p = 0.026, effect size (d) = -0.38 [-1.62, -0.31]) of the left hemisphere. The C + group also showed decreases in neuropsychological scores such as the total composite score (p = 0.01, effect size (d) = -3.9726 [-0.9656, -6.9796], fluid composite score (p = 0.03, effect size (d) = -4.438 [-0.406, -8.47], and picture vocabulary score (p = 0.04, effect size (d) = -3.7499 [-0.0617, -7.438]. Our results showed that cortical thickness could be a candidate neuroimaging biomarker for cancer-related cognitive impairment and accelerated aging in older long-term cancer survivors.
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Affiliation(s)
- Ebenezer Daniel
- Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, CA, 91010, USA
| | - Frank Deng
- Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, CA, 91010, USA
| | - Sunita K Patel
- Department of Population Science, City of Hope National Medical Center, Duarte, CA, 91010, USA
| | - Mina S Sedrak
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, CA, 91010, USA
| | - Heeyoung Kim
- Center for Cancer and Aging, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, 91010, USA
| | - Marianne Razavi
- Department of Supportive Care Medicine, City of Hope National Medical Center, Duarte, CA, 91010, USA
| | - Can-Lan Sun
- Center for Cancer and Aging, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, 91010, USA
| | - James C Root
- Neurocognitive Research Lab, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tim A Ahles
- Neurocognitive Research Lab, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - William Dale
- Center for Cancer and Aging, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, 91010, USA.,Department of Supportive Care Medicine, City of Hope National Medical Center, Duarte, CA, 91010, USA
| | - Bihong T Chen
- Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, CA, 91010, USA. .,Center for Cancer and Aging, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, 91010, USA.
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11
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Signal Variability and Cognitive Function in Older Long-Term Survivors of Breast Cancer with Exposure to Chemotherapy: A Prospective Longitudinal Resting-State fMRI Study. Brain Sci 2022; 12:brainsci12101283. [PMID: 36291217 PMCID: PMC9599386 DOI: 10.3390/brainsci12101283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 09/15/2022] [Accepted: 09/19/2022] [Indexed: 01/07/2023] Open
Abstract
The purpose of this study was to assess the effect of chemotherapy on brain functional resting-state signal variability and cognitive function in older long-term survivors of breast cancer. This prospective longitudinal study enrolled women age ≥ 65 years of age who were breast cancer survivors after exposure to chemotherapy (CH), age-matched survivors not exposed to chemotherapy, and healthy controls. Participants completed resting-state functional brain MRI and neurocognitive testing upon enrollment (timepoint 1, TP1) and again two years later (timepoint 2, TP2). There were 20 participants in each of the three groups at TP1. The CH group showed a significant decrease in SDBOLD (blood-oxygen-level-dependent signal variability in standard deviation) in the right middle occipital gyrus (ΔSDBOLD = -0.0018, p = 0.0085, q (pFDR) = 0.043 at MNI (42, -76, 17)) and right middle temporal gyrus (ΔSDBOLD = -0.0021, p = 0.0006, q (pFDR) = 0.001 at MNI (63, -39, -12)). There were negative correlations between the crystallized composite scores and SDBOLD values at the right inferior occipital gyrus (correlation coefficient r = -0.84, p = 0.001, q (pFDR) = 0.016) and right middle temporal gyrus (r = -0.88, p = 0.000, q (pFDR) = 0.017) for the CH group at TP1. SDBOLD could be a potentially useful neuroimaging marker for older long-term survivors of breast cancer with exposure to chemotherapy.
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12
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Zhou X, Tan Y, Yu H, Liu J, Lan X, Deng Y, Yu F, Wang C, Chen J, Zeng X, Liu D, Zhang J. Early alterations in cortical morphology after neoadjuvant chemotherapy in breast cancer patients: A longitudinal magnetic resonance imaging study. Hum Brain Mapp 2022; 43:4513-4528. [PMID: 35665982 PMCID: PMC9491291 DOI: 10.1002/hbm.25969] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 05/18/2022] [Accepted: 05/22/2022] [Indexed: 11/13/2022] Open
Abstract
There is growing evidence that chemotherapy may have a significant impact on the brains of breast cancer patients, causing changes in cortical morphology. However, early morphological alterations induced by chemotherapy in breast cancer patients are unclear. To investigate the patterns of those alterations, we compared female breast cancer patients (n = 45) longitudinally before (time point 0, TP0) and after (time point 1, TP1) the first cycle of neoadjuvant chemotherapy, using voxel‐based morphometry (VBM) and surface‐based morphometry (SBM). VBM and SBM alteration data underwent correlation analysis. We also compared cognition‐related neuropsychological tests in the breast cancer patients between TP0 and TP1. Reductions in gray matter volume, cortical thickness, sulcal depth, and gyrification index were found in most brain areas, while increments were found to be mainly concentrated in and around the hippocampus. Reductions of fractal dimension mainly occurred in the limbic and occipital lobes, while increments mainly occurred in the anterior and posterior central gyrus. Significant correlations were found between altered VBM and altered SBM mainly in the bilateral superior frontal gyrus. We found no significant differences in the cognition‐related neuropsychological tests before and after chemotherapy. The altered brain regions are in line with those associated with impaired cognitive domains in previous studies. We conclude that breast cancer patients showed widespread morphological alterations soon after neoadjuvant chemotherapy, despite an absence of cognitive impairments. The affected brain regions may indicate major targets of early brain damage after chemotherapy.
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Affiliation(s)
- Xiaoyu Zhou
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Yong Tan
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Hong Yu
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Jiang Liu
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Xiaosong Lan
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Yongchun Deng
- Breast Center, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Feng Yu
- Breast Center, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Chengfang Wang
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Jiao Chen
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Xiaohua Zeng
- Breast Center, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Daihong Liu
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Jiuquan Zhang
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
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13
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Wang D, Wang T, Zhu M, Sun J, Zhou Z, Chen J, Teng L. A Preliminary Study on the Relationship between Serum Heparan Sulfate and Cancer-Related Cognitive Impairment: The Moderating Role of Oxidative Stress in Patients with Colorectal Cancer. Curr Oncol 2022; 29:2681-2694. [PMID: 35448193 PMCID: PMC9025203 DOI: 10.3390/curroncol29040219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/29/2022] [Accepted: 04/04/2022] [Indexed: 11/16/2022] Open
Abstract
Cancer-related cognitive impairment (CRCI) has been frequently reported in colorectal cancer survivors. Heparan sulfate (HS) was gradually considered to be related to cognitive disorders. The effect and potential mechanism of HS on CRCI in colorectal cancer patients were unexplored. In this study, all participants were divided into a cognitive impaired group and a cognitive normal group. The concentrations of oxidative stress factors and HS in serum were detected. Associations among HS, oxidative stress factors and CRCI were evaluated. Participants with cognitive impairment exhibited increased levels of HS, GSH, SOD and MDA, compared to the patients with normal cognitive performance. The independent significant association was found between HS and CRCI after controlling for various covariates. The higher concentrations of HS were related to the decreased cognitive performance among survivors who reported higher levels of GSH (β = 0.080, p = 0.002). Moreover, the nonlinear association between the level of HS and cognitive scores was confirmed using the restricted cubic splines (p < 0.001). These results indicated that the increased concentrations of circulating HS had a nonlinear negative connection with cognitive performance in colorectal cancer survivors, which was moderated by GSH. HS might be a new biomolecule for the identification and management of patients with CRCI.
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Affiliation(s)
- Danhui Wang
- Wuxi School of Medicine, Jiangnan University, Wuxi 214122, China; (D.W.); (M.Z.); (J.S.); (Z.Z.)
| | - Teng Wang
- Department of Oncology, Affiliated Hospital of Jiangnan University, Wuxi 214122, China;
| | - Min Zhu
- Wuxi School of Medicine, Jiangnan University, Wuxi 214122, China; (D.W.); (M.Z.); (J.S.); (Z.Z.)
| | - Jun Sun
- Wuxi School of Medicine, Jiangnan University, Wuxi 214122, China; (D.W.); (M.Z.); (J.S.); (Z.Z.)
| | - Zhou Zhou
- Wuxi School of Medicine, Jiangnan University, Wuxi 214122, China; (D.W.); (M.Z.); (J.S.); (Z.Z.)
| | - Jinghua Chen
- School of Pharmaceutical Sciences, Jiangnan University, Wuxi 214122, China;
| | - Liping Teng
- Wuxi School of Medicine, Jiangnan University, Wuxi 214122, China; (D.W.); (M.Z.); (J.S.); (Z.Z.)
- Correspondence:
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14
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Effect of chemotherapy on default mode network connectivity in older women with breast cancer. Brain Imaging Behav 2022; 16:43-53. [PMID: 34019223 PMCID: PMC8606014 DOI: 10.1007/s11682-021-00475-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 04/25/2021] [Indexed: 02/03/2023]
Abstract
Chemotherapy may impair cognition and contribute to accelerated aging. The purpose of this study was to assess the effects of chemotherapy on the connectivity of the default mode network (DMN) in older women with breast cancer. This prospective longitudinal study enrolled women aged ≥ 60 years with stage I-III breast cancer (CTx group) and matched healthy controls (HC group). Study assessments, consisting of resting-state functional MRI (rs-fMRI) and the Picture Sequence Memory (psm) test for episodic memory from the NIH Toolbox for Cognition, were obtained at baseline and within one month after the completion of chemotherapy for the CTx group and at matched intervals for the HC group. Two-sample t-test and FDR multiple comparison were used for statistical inference. Our analysis of the CTx group (N = 19; 60-82 years of age, mean = 66.6, SD = 5.24) compared to the HC group (N = 14; 60-78 years of age, mean = 68.1, SD = 5.69) revealed weaker DMN subnetwork connectivity in the anterior brain but stronger connectivity in the posterior brain at baseline. After chemotherapy, this pattern was reversed, with stronger anterior connectivity and weaker posterior connectivity. In addition, the meta-level functional network connectivity (FNC) among the DMN subnetworks after chemotherapy was consistently weaker than the baseline FNC as seen in the couplings between anterior cingulate cortex (ACC) and retrosplenial (rSplenia) region, with ΔFNC('ACC','rSplenia')=-0.14, t value=-2.44, 95 %CI=[-0.27,-0.10], pFDR<0.05). The baseline FNC matrices of DMN subnetworks were correlated with psm scores (corr = 0.58, p < 0.05). Our results support DMN alterations as a potential neuroimaging biomarker for cancer-related cognitive impairment and accelerated aging.
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15
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Ancoli-Israel S, Liu L, Natarajan L, Rissling M, Neikrug AB, Youngstedt SD, Mills PJ, Sadler GR, Dimsdale JE, Parker BA, Palmer BW. Reductions in sleep quality and circadian activity rhythmicity predict longitudinal changes in objective and subjective cognitive functioning in women treated for breast cancer. Support Care Cancer 2021; 30:3187-3200. [PMID: 34957532 PMCID: PMC8857013 DOI: 10.1007/s00520-021-06743-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 12/03/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To examine long-term cognitive effects of chemotherapy and identify predictors among women with breast cancer (WBC). PATIENTS AND METHODS Sixty-nine WBC scheduled to receive chemotherapy, and 64 matched-controls with no cancer, participated. Objective and subjective cognition, total sleep time, nap time, circadian activity rhythms (CAR), sleep quality, fatigue, and depression were measured pre-chemotherapy (Baseline), end of cycle 4 (Cycle-4), and one-year post-chemotherapy (1-Year). RESULTS WBC showed no change in objective cognitive measures from Baseline to Cycle-4 but significantly improved from both time points to 1-Year. Matched-controls showed an increase in test performance at all time points. WBC had significantly higher self-reported cognitive dysfunction at Cycle-4 and 1-Year compared to baseline and compared to matched-controls. Worse neuropsychological functioning was predicted by less robust CARs (i.e., inconsistent 24 h pattern), worse sleep quality, longer naps, and worse cognitive complaints. Worse subjective cognition was predicted by lower sleep quality and higher fatigue and depressed mood. CONCLUSION Objective testing showed increases in performance scores from pre- and post-chemotherapy to one year later in WBC, but matched-controls showed an increase in test performance from baseline to Cycle-4 and from Cycle-4 to 1-Year, likely due to a practice effect. The fact that WBC showed no practice effects may reflect a form of learning deficit. Compared with the matched-controls, WBC reported significant worsened cognitive function. In WBC, worse objective and subjective cognitive functioning were predicted by worse sleep and sleep-related behaviors (naps and CAR). Interventions that target sleep, circadian rhythms, and fatigue may benefit cognitive function in WBC.
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Affiliation(s)
- Sonia Ancoli-Israel
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0737, USA. .,University of California, San Diego Moores Cancer Center, San Diego, CA, USA.
| | - Lianqi Liu
- Department of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Loki Natarajan
- University of California, San Diego Moores Cancer Center, San Diego, CA, USA.,Family Medicine and Public Health, University of California, San Diego, San Diego, CA, USA
| | - Michelle Rissling
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0737, USA
| | - Ariel B Neikrug
- Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, CA, USA
| | - Shawn D Youngstedt
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Paul J Mills
- Family Medicine and Public Health, University of California, San Diego, San Diego, CA, USA
| | - Georgia R Sadler
- University of California, San Diego Moores Cancer Center, San Diego, CA, USA.,Department of Surgery, University of California, San Diego, San Diego, CA, USA
| | - Joel E Dimsdale
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0737, USA.,University of California, San Diego Moores Cancer Center, San Diego, CA, USA
| | - Barbara A Parker
- University of California, San Diego Moores Cancer Center, San Diego, CA, USA.,Department of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Barton W Palmer
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0737, USA.,Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
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16
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Schroyen G, Vissers J, Smeets A, Gillebert CR, Lemiere J, Sunaert S, Deprez S, Sleurs C. Blood and neuroimaging biomarkers of cognitive sequelae in breast cancer patients throughout chemotherapy: A systematic review. Transl Oncol 2021; 16:101297. [PMID: 34896851 PMCID: PMC8681023 DOI: 10.1016/j.tranon.2021.101297] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 11/22/2021] [Indexed: 11/27/2022] Open
Abstract
Breast cancer treatment can induce alterations in blood- and neuroimaging-based markers. However, an overview of the predictive value of these markers for cognition is lacking for breast cancer survivors. This systematic review summarized studies of the last decade, using the PubMed database, evaluating blood markers, and the association between blood- or structural neuroimaging markers and cognition across the chemotherapy trajectory for primary breast cancer, following PRISMA guidelines. Forty-four studies were included. Differences were observed in all blood marker categories, from on-therapy until years post-chemotherapy. Associations were found between cognitive functioning and (1) blood markers (mainly inflammation-related) during, shortly-, or years post-chemotherapy and (2) white and gray matter metrics in frontal, temporal and parietal brain regions months up until years post-chemotherapy. Preliminary evidence exists for epigenetic and metabolic changes being associated with cognition, only after chemotherapy. This review demonstrated time-dependent associations between specific blood-based and structural neuroimaging markers with cognitive impairment in patients with breast cancer. Future studies are encouraged to include both neuroimaging- and blood markers (e.g. of neuronal integrity, epigenetics and metabolism) to predict long-term cognitive effects of chemotherapy.
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Affiliation(s)
- Gwen Schroyen
- Leuven Brain Institute, KU Leuven, Leuven, Belgium; Leuven Cancer Institute, KU Leuven, Leuven, Belgium; Department of Imaging and Pathology, KU Leuven, Leuven, Belgium.
| | - Julie Vissers
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Ann Smeets
- Leuven Cancer Institute, KU Leuven, Leuven, Belgium; Department of Oncology, KU Leuven, Leuven, Belgium; Surgical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Céline R Gillebert
- Leuven Brain Institute, KU Leuven, Leuven, Belgium; Department of Brain and Cognition, KU Leuven, Leuven 3000, Belgium
| | - Jurgen Lemiere
- Leuven Cancer Institute, KU Leuven, Leuven, Belgium; Department of Oncology, KU Leuven, Leuven, Belgium; Pediatric Hemato-Oncology, University Hospitals Leuven, Leuven 3000, Belgium
| | - Stefan Sunaert
- Leuven Brain Institute, KU Leuven, Leuven, Belgium; Department of Imaging and Pathology, KU Leuven, Leuven, Belgium; Radiology, University Hospitals Leuven, Leuven 3000, Belgium
| | - Sabine Deprez
- Leuven Brain Institute, KU Leuven, Leuven, Belgium; Leuven Cancer Institute, KU Leuven, Leuven, Belgium; Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Charlotte Sleurs
- Leuven Brain Institute, KU Leuven, Leuven, Belgium; Leuven Cancer Institute, KU Leuven, Leuven, Belgium; Department of Oncology, KU Leuven, Leuven, Belgium
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17
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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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18
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Magnuson A, Ahles T, Chen BT, Mandelblatt J, Janelsins MC. Cognitive Function in Older Adults With Cancer: Assessment, Management, and Research Opportunities. J Clin Oncol 2021; 39:2138-2149. [PMID: 34043437 PMCID: PMC8260910 DOI: 10.1200/jco.21.00239] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/11/2021] [Accepted: 03/25/2021] [Indexed: 12/12/2022] Open
Affiliation(s)
- Allison Magnuson
- Department of Medicine, University of Rochester Medical Center, Wilmot Cancer Institute, Rochester, NY
| | - Tim Ahles
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Bihong T. Chen
- Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, CA
| | - Jeanne Mandelblatt
- Georgetown-Lombardi Comprehensive Cancer Center, Cancer Control Program, Georgetown University Medical Center, Washington, DC
| | - Michelle C. Janelsins
- Department of Surgery, Cancer Control, University of Rochester Medical Center, Wilmot Cancer Institute, Rochester, NY
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19
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McDonald BC. Structural Neuroimaging Findings Related to Adult Non-CNS Cancer and Treatment: Review, Integration, and Implications for Treatment of Cognitive Dysfunction. Neurotherapeutics 2021; 18:792-810. [PMID: 34402034 PMCID: PMC8423886 DOI: 10.1007/s13311-021-01096-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2021] [Indexed: 12/13/2022] Open
Abstract
Cancer- and treatment-related cognitive dysfunction (CRCD) is a common challenge faced by patients diagnosed with non-central nervous system (CNS) cancer. It has become increasingly recognized that multiple factors likely play a role in these symptoms, including the cancer disease process, systemic treatments (e.g., chemotherapy and endocrine therapies), and risk factors that may predispose an individual to both cancer and cognitive dysfunction. As the field has evolved, advanced neuroimaging techniques have been applied to better understand the neural correlates of CRCD. This review focuses on structural neuroimaging findings related to CRCD in adult non-CNS cancer populations, including examination of gray matter volume/density and white matter integrity differences between cancer patients and comparison groups, as well as emerging findings regarding structural network abnormalities. Overall, this literature has demonstrated consistent findings of reduced gray matter volume/density and white matter integrity in cancer patients relative to comparison groups. These are most prominent in individuals treated with chemotherapy, though alterations have also been noted in those treated with anti-estrogen and androgen-deprivation therapies. Alterations in gray and white matter structural network connectivity have also been identified. These structural abnormalities have been observed most prominently in frontal and temporal brain regions, and have been shown to correlate with subjective and objective cognitive function, as well as with physiological and clinical variables, helping to inform understanding of CRCD mechanisms. To date, however, structural neuroimaging techniques have not been utilized in systematic studies of potential CRCD treatments, suggesting a potentially fruitful avenue for future research.
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Affiliation(s)
- Brenna C McDonald
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine and Indiana University Melvin and Bren Simon Comprehensive Cancer Center, 355 W. 16th St., GH Suite 4100, Indianapolis, IN, 46202, USA.
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Sousa H, Almeida S, Bessa J, Pereira MG. The Developmental Trajectory of Cancer-Related Cognitive Impairment in Breast Cancer Patients: A Systematic Review of Longitudinal Neuroimaging Studies. Neuropsychol Rev 2020; 30:287-309. [PMID: 32607817 DOI: 10.1007/s11065-020-09441-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 05/12/2020] [Indexed: 01/21/2023]
Abstract
This systematic review explored the neurobiological mechanisms underlying the clinical time course of cancer-related cognitive impairment (CRCI) in breast cancer patients through the review of longitudinal neuroimaging studies. Before chemotherapy, results reported no evidence for neuropsychological, structural (gray matter) and brain perfusion changes. However, functional brain alterations were evident and revealed a frontoparietal hyperactivation during working memory tasks. Fatigue and number of days since surgery were the two suggested confounding factors. Acutely after chemotherapy, this review found no evidence for neuropsychological changes while suggesting a pattern of frontal structural, perfusion and functional brain abnormalities. These findings seemed to be dependent on age, menopausal status at baseline, and fMRI task performed. Years after chemotherapy, results revealed evidence of partial neuropsychological, structural, and functional brain recovery. Regarding brain abnormality, this review suggested that it may begin quite early in the disease course, be more prominent shortly after chemotherapy and partially recover over time. Several hypotheses underlying these changes were discussed. The present review also provided important information for developing a time-specific treatment and prevention strategies and for the consideration of functional neuroimaging as a relevant tool for CRCI diagnosis, clinical monitoring, and intervention studies. The findings also suggested the need to implement studies with longitudinal designs, including a pre-treatment assessment, since cross-sectional studies were not able to detect this pattern of recovery over time, supporting only the theory of brain abnormalities, in breast cancer survivors.
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Affiliation(s)
- Helena Sousa
- Family Health & Illness Research Group, School of Psychology, University of Minho, Campus de Gualtar, 4710-057, Braga, Portugal
- Research Center in Psychology (CIPsi), School of Psychology, University of Minho, Campus de Gualtar, 4710-057, Braga, Portugal
| | - Susana Almeida
- Research Center in Psychology (CIPsi), School of Psychology, University of Minho, Campus de Gualtar, 4710-057, Braga, Portugal
- Psycho-Oncology Service, Portuguese Institute of Oncology, Porto, Portugal; Cuf Hospital, Porto; Faculty of Medicine, University of Porto, Braga, Portugal
| | - João Bessa
- Research Center in Psychology (CIPsi), School of Psychology, University of Minho, Campus de Gualtar, 4710-057, Braga, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's - PT Government Associate Laboratory, Guimarães, Braga, Portugal
| | - M Graça Pereira
- Family Health & Illness Research Group, School of Psychology, University of Minho, Campus de Gualtar, 4710-057, Braga, Portugal.
- Research Center in Psychology (CIPsi), School of Psychology, University of Minho, Campus de Gualtar, 4710-057, Braga, Portugal.
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21
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Wagner MA, Erickson KI, Bender CM, Conley YP. The Influence of Physical Activity and Epigenomics On Cognitive Function and Brain Health in Breast Cancer. Front Aging Neurosci 2020; 12:123. [PMID: 32457596 PMCID: PMC7225270 DOI: 10.3389/fnagi.2020.00123] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 04/14/2020] [Indexed: 12/17/2022] Open
Abstract
The risk of breast cancer increases with age, with the majority of women diagnosed with breast cancer being postmenopausal. It has been estimated that 25-75% of women with breast cancer experience changes in cognitive function (CF) related to disease and treatment, which compromises psychological well-being, decision making, ability to perform daily activities, and adherence to cancer therapy. Unfortunately, the mechanisms that underlie neurocognitive changes in women with breast cancer remain poorly understood, which in turn limits the development of effective treatments and prevention strategies. Exercise has great potential as a non-pharmaceutical intervention to mitigate the decline in CF in women with breast cancer. Evidence suggests that DNA methylation, an epigenetic mechanism for gene regulation, impacts CF and brain health (BH), that exercise influences DNA methylation, and that exercise impacts CF and BH. Although investigating DNA methylation has the potential to uncover the biologic foundations for understanding neurocognitive changes within the context of breast cancer and its treatment as well as the ability to understand how exercise mitigates these changes, there is a dearth of research on this topic. The purpose of this review article is to compile the research in these areas and to recommend potential areas of opportunity for investigation.
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Affiliation(s)
- Monica A. Wagner
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States
| | - Kirk I. Erickson
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, United States
- Discipline of Exercise Science, College of Science, Health, Engineering and Education, Murdoch University, Perth Campus, Murdoch, WA, Australia
| | | | - Yvette P. Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States
- Department of Human Genetics, University of Pittsburgh, Pittsburgh, PA, United States
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22
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Wagner LI, Gray RJ, Sparano JA, Whelan TJ, Garcia SF, Yanez B, Tevaarwerk AJ, Carlos RC, Albain KS, Olson JA, Goetz MP, Pritchard KI, Hayes DF, Geyer CE, Dees EC, McCaskill-Stevens WJ, Minasian LM, Sledge GW, Cella D. Patient-Reported Cognitive Impairment Among Women With Early Breast Cancer Randomly Assigned to Endocrine Therapy Alone Versus Chemoendocrine Therapy: Results From TAILORx. J Clin Oncol 2020; 38:1875-1886. [PMID: 32271671 DOI: 10.1200/jco.19.01866] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Cancer-related cognitive impairment (CRCI) is common during adjuvant chemotherapy and may persist. TAILORx provided a novel opportunity to prospectively assess patient-reported cognitive impairment among women with early breast cancer who were randomly assigned to chemoendocrine therapy (CT+E) versus endocrine therapy alone (E), allowing us to quantify the unique contribution of chemotherapy to CRCI. METHODS Women with a 21-gene recurrence score of 11 to 25 enrolled in TAILORX were randomly assigned to CT+E or E. Cognitive impairment was assessed among a subgroup of 552 evaluable women using the 37-item Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog) questionnaire, administered at baseline, 3, 6, 12, 24, and 36 months. The FACT-Cog included the 20-item Perceived Cognitive Impairment (PCI) scale, our primary end point. Clinically meaningful changes were defined a priori and linear regression was used to model PCI scores on baseline PCI, treatment, and other factors. RESULTS FACT-Cog PCI scores were significantly lower, indicating more impairment, at 3, 6, 12, 24, and 36 months compared with baseline for both groups. The magnitude of PCI change scores was greater for CT+E than E at 3 months, the prespecified primary trial end point, and at 6 months, but not at 12, 24, and 36 months. Tests of an interaction between menopausal status and treatment were nonsignificant. CONCLUSION Adjuvant CT+E is associated with significantly greater CRCI compared with E at 3 and 6 months. These differences abated over time, with no significant differences observed at 12 months and beyond. These findings indicate that chemotherapy produces early, but not sustained, cognitive impairment relative to E, providing reassurance to patients and clinicians in whom adjuvant chemotherapy is indicated to reduce recurrence risk.
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Affiliation(s)
| | - Robert J Gray
- ECOG-ACRIN Cancer Research Group Biostatistics Center, Boston, MA
| | - Joseph A Sparano
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
| | - Timothy J Whelan
- McMaster University, Canadian Cancer Trials Group, Hamilton, Ontario, Canada
| | | | - Betina Yanez
- Northwestern University School of Medicine, Chicago, IL
| | | | - Ruth C Carlos
- The University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | - Kathy S Albain
- Loyola University Chicago Stritch School of Medicine, Maywood, IL
| | - John A Olson
- University of Maryland School of Medicine, Baltimore, MD
| | | | - Kathleen I Pritchard
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Daniel F Hayes
- The University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | - Charles E Geyer
- Virginia Commonwealth University Massey Cancer Center Minority/Underserved National Cancer Institute Community Oncology Research Program, Richmond, VA
| | | | | | | | | | - David Cella
- Northwestern University School of Medicine, Chicago, IL
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23
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Lange M, Joly F, Vardy J, Ahles T, Dubois M, Tron L, Winocur G, De Ruiter M, Castel H. Cancer-related cognitive impairment: an update on state of the art, detection, and management strategies in cancer survivors. Ann Oncol 2019; 30:1925-1940. [PMID: 31617564 PMCID: PMC8109411 DOI: 10.1093/annonc/mdz410] [Citation(s) in RCA: 278] [Impact Index Per Article: 55.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Advances in diagnostic and therapeutic strategies in oncology have significantly increased the chance of survival of cancer patients, even those with metastatic disease. However, cancer-related cognitive impairment (CRCI) is frequently reported in patients treated for non-central nervous system cancers, particularly during and after chemotherapy. DESIGN This review provides an update of the state of the art based on PubMed searches between 2012 and March 2019 on 'cognition', 'cancer', 'antineoplastic agents' or 'chemotherapy'. It includes the most recent clinical, imaging and pre-clinical data and reports management strategies of CRCI. RESULTS Evidence obtained primarily from studies on breast cancer patients highlight memory, processing speed, attention and executive functions as the most cognitive domains impaired post-chemotherapy. Recent investigations established that other cancer treatments, such as hormone therapies and targeted therapies, can also induce cognitive deficits. Knowledge regarding predisposing factors, biological markers or brain functions associated with CRCI has improved. Factors such as age and genetic polymorphisms of apolipoprotein E, catechol-O-methyltransferase and BDNF may predispose individuals to a higher risk of cognitive impairment. Poor performance on neuropsychological tests were associated with volume reduction in grey matter, less connectivity and activation after chemotherapy. In animals, hippocampus-based memory and executive functions, mediated by the frontal lobes, were shown to be particularly susceptible to the effects of chemotherapy. It involves altered neurogenesis, mitochondrial dysfunction or brain cytokine response. An important next step is to identify strategies for managing cognitive difficulties, with primary studies to assess cognitive training and physical exercise regimens. CONCLUSIONS CRCI is not limited to chemotherapy. A multidisciplinary approach has improved our knowledge of the complex mechanisms involved. Nowadays, studies evaluating cognitive rehabilitation programmes are encouraged to help patients cope with cognitive difficulties and improve quality of life during and after cancer.
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Affiliation(s)
- M. Lange
- INSERM, U1086, ANTICIPE, 14000 Caen,Clinical Research Department, Centre François Baclesse, 14000 Caen,Cancer and Cognition Platform, Ligue Nationale Contre le Cancer, 14000 Caen
| | - F. Joly
- INSERM, U1086, ANTICIPE, 14000 Caen,Clinical Research Department, Centre François Baclesse, 14000 Caen,Cancer and Cognition Platform, Ligue Nationale Contre le Cancer, 14000 Caen,Medical Oncology Department, CHU de Caen, 14000 Caen, France,Correspondence to: Prof. Florence Joly, Medical Oncology Department, Inserm U1086 Anticipe, Centre François Baclesse, 3 avenue Général Harris, Caen 14000, France. Tel: +33-2-3145-5002;
| | - J Vardy
- Concord Cancer Centre, Concord Repatriation General Hospital, Sydney, New South Wales,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - T. Ahles
- Neurocognitive Research Lab, Memorial Sloan Kettering Cancer Center, New York, USA
| | - M. Dubois
- Cancer and Cognition Platform, Ligue Nationale Contre le Cancer, 14000 Caen,Normandie University, UNIROUEN, INSERM, DC2N, 76000 Rouen,Institute for Research and Innovation in Biomedicine (IRIB), 76000 Rouen
| | - L. Tron
- INSERM, U1086, ANTICIPE, 14000 Caen,Cancer and Cognition Platform, Ligue Nationale Contre le Cancer, 14000 Caen,CHU de Caen, 14000 Caen, France
| | - G. Winocur
- Baycrest Centre, Rotman Research Institute, Toronto,Department of Psychology, Trent University, Peterborough,Department of Psychology and Psychiatry, University of Toronto, Toronto, Canada
| | - M.B. De Ruiter
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - H. Castel
- Cancer and Cognition Platform, Ligue Nationale Contre le Cancer, 14000 Caen,Normandie University, UNIROUEN, INSERM, DC2N, 76000 Rouen,Institute for Research and Innovation in Biomedicine (IRIB), 76000 Rouen
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24
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Chen BT, Ye N, Wong CW, Patel SK, Jin T, Sun CL, Rockne RC, Kim H, Root JC, Saykin AJ, Ahles TA, Holodny AI, Prakash N, Mortimer J, Sedrak MS, Waisman J, Yuan Y, Li D, Vazquez J, Katheria V, Dale W. Effects of chemotherapy on aging white matter microstructure: A longitudinal diffusion tensor imaging study. J Geriatr Oncol 2019; 11:290-296. [PMID: 31685415 DOI: 10.1016/j.jgo.2019.09.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 08/20/2019] [Accepted: 09/25/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE We aimed to use diffusion tensor imaging (DTI) to detect alterations in white matter microstructure in older patients with breast cancer receiving chemotherapy. METHODS We recruited women age ≥60 years with stage I-III breast cancer (chemotherapy [CT] group; n = 19) to undergo two study assessments: at baseline and within one month after chemotherapy. Each assessment consisted of a brain magnetic resonance imaging scan with DTI and neuropsychological (NP) testing using the National Institutes of Health (NIH) Toolbox Cognition Battery. An age- and sex-matched group of healthy controls (HC, n = 14) underwent the same assessments at matched intervals. Four DTI parameters (fractional anisotropy [FA], mean diffusivity [MD], axial diffusivity [AD], and radial diffusivity [RD]) were calculated and correlated with NP testing scores. RESULTS For CT group but not HCs, we detected statistically significant increases in MD and RD in the genu of the corpus callosum from time point 1 to time point 2 at p < 0.01, effect size:0.3655 and 0.3173, and 95% confidence interval: from 0.1490 to 0.5821, and from 0.1554 to 0.4792, for MD and RD respectively. AD values increased for the CT group and decreased for the HC group over time, resulting in significant between-group differences (p = 0.0056, effect size:1.0215, 95% confidence interval: from 0.2773 to 1.7657). There were no significant correlations between DTI parameters and NP scores (p > 0.05). CONCLUSIONS We identified alterations in white matter microstructures in older women with breast cancer undergoing chemotherapy. These findings may potentially serve as neuroimaging biomarkers for identifying cognitive impairment in older adults with cancer.
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Affiliation(s)
- Bihong T Chen
- Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, CA 91010, United States; Center for Cancer and Aging, City of Hope National Medical Center, Duarte, CA 91010, United States.
| | - Ningrong Ye
- Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, CA 91010, United States.
| | - Chi Wah Wong
- Center for Informatics, City of Hope National Medical Center, Duarte, CA 91010, United States.
| | - Sunita K Patel
- Department of Population Science, City of Hope National Medical Center, Duarte, CA 91010, United States.
| | - Taihao Jin
- Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, CA 91010, United States.
| | - Can-Lan Sun
- Center for Cancer and Aging, City of Hope National Medical Center, Duarte, CA 91010, United States.
| | - Russell C Rockne
- Division of Mathematical Oncology, City of Hope National Medical Center, Duarte, CA 91010, United States.
| | - Heeyoung Kim
- Center for Cancer and Aging, City of Hope National Medical Center, Duarte, CA 91010, United States.
| | - James C Root
- Neurocognitive Research Lab, Memorial Sloan Kettering Cancer Center, New York, NY, United States.
| | - Andrew J Saykin
- Center for Neuroimaging, Indiana University School of Medicine, Indianapolis, IN, United States.
| | - Tim A Ahles
- Neurocognitive Research Lab, Memorial Sloan Kettering Cancer Center, New York, NY, United States.
| | - Andrei I Holodny
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, United States.
| | - Neal Prakash
- Division of Neurology, City of Hope National Medical Center, Duarte, CA 91010, United States.
| | - Joanne Mortimer
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, CA 91010, United States.
| | - Mina S Sedrak
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, CA 91010, United States.
| | - James Waisman
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, CA 91010, United States.
| | - Yuan Yuan
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, CA 91010, United States.
| | - Daneng Li
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, CA 91010, United States.
| | - Jessica Vazquez
- Center for Cancer and Aging, City of Hope National Medical Center, Duarte, CA 91010, United States.
| | - Vani Katheria
- Center for Cancer and Aging, City of Hope National Medical Center, Duarte, CA 91010, United States.
| | - William Dale
- Center for Cancer and Aging, City of Hope National Medical Center, Duarte, CA 91010, United States; Department of Supportive Care Medicine, City of Hope National Medical Center, Duarte, CA 91010, United States.
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25
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Breast cancer and aging: Standing on the shoulders of a giant. J Geriatr Oncol 2019; 11:212-216. [PMID: 31201096 DOI: 10.1016/j.jgo.2019.05.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 05/20/2019] [Indexed: 11/20/2022]
Abstract
With the aging of the US population, the number of individuals age 65 or older who will be diagnosed with breast cancer is expected to rise. Despite this, older adults with breast cancer remain severely under-represented in cancer clinical trials. Numerous studies have highlighted disparites in care experienced by older patients with breast cancer. Dr. Arti Hurria was one of the most influential leaders in oncology to shed light on this vunerable and growing population. By uniting the fields of geriatrics and oncology, she brought together a powerful community of like-minded individuals and, through collaborative research, pioneered the current day approach and care of older patients with cancer. In this review, we highlight Dr. Hurria's contribution in breast oncology. Specifically, we describe her work on functional and cognitive effects of breast cancer therapy, shared-decision making, toxicity risk prediction, and breast cancer therapeutics.
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26
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Chen BT, Jin T, Patel SK, Ye N, Ma H, Wong CW, Rockne RC, Root JC, Saykin AJ, Ahles TA, Holodny AI, Prakash N, Mortimer J, Waisman J, Yuan Y, Li D, Sedrak MS, Vazquez J, Katheria V, Dale W. Intrinsic brain activity changes associated with adjuvant chemotherapy in older women with breast cancer: a pilot longitudinal study. Breast Cancer Res Treat 2019; 176:181-189. [PMID: 30989462 DOI: 10.1007/s10549-019-05230-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 04/09/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE Older cancer patients are at increased risk of cancer-related cognitive impairment. The purpose of this study was to assess the alterations in intrinsic brain activity associated with adjuvant chemotherapy in older women with breast cancer. METHODS Chemotherapy treatment (CT) group included sixteen women aged ≥ 60 years (range 60-82 years) with stage I-III breast cancers, who underwent both resting-state functional magnetic resonance imaging (rs-fMRI) and neuropsychological testing with NIH Toolbox for Cognition before adjuvant chemotherapy, at time point 1 (TP1), and again within 1 month after completing chemotherapy, at time point 2 (TP2). Fourteen age- and sex-matched healthy controls (HC) underwent the same assessments at matched intervals. Three voxel-wise rs-fMRI parameters: amplitude of low-frequency fluctuation (ALFF), fractional ALFF (fALFF), and regional homogeneity, were computed at each time point. The changes in rs-fMRI parameters from TP1 to TP2 for each group, the group differences in changes (the CT group vs. the HC group), and the group difference in the baseline rs-fMRI parameters were assessed. In addition, correlative analysis between the rs-fMRI parameters and neuropsychological testing scores was also performed. RESULTS In the CT group, one brain region, which included parts of the bilateral subcallosal gyri and right anterior cingulate gyrus, displayed increased ALFF from TP1 to TP2 (cluster p-corrected = 0.024); another brain region in the left precuneus displayed decreased fALFF from TP1 to TP2 (cluster level p-corrected = 0.025). No significant changes in the rs-fMRI parameters from TP1 to TP2 were observed in the HC group. Although ALFF and fALFF alterations were observed only in the CT group, none of the between-group differences in rs-fMRI parameter changes reached statistical significance. CONCLUSIONS Our study results of ALFF and fALFF alterations in the chemotherapy-treated women suggest that adjuvant chemotherapy may affect intrinsic brain activity in older women with breast cancer.
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Affiliation(s)
- Bihong T Chen
- Department of Diagnostic Radiology, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, 91010, USA.
- Center for Cancer and Aging, City of Hope National Medical Center, Duarte, CA, USA.
| | - Taihao Jin
- Department of Diagnostic Radiology, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, 91010, USA
| | - Sunita K Patel
- Department of Population Science, City of Hope National Medical Center, Duarte, CA, USA
| | - Ningrong Ye
- Department of Diagnostic Radiology, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, 91010, USA
| | - Huiyan Ma
- Center for Cancer and Aging, City of Hope National Medical Center, Duarte, CA, USA
| | - Chi Wah Wong
- Center for Informatics, City of Hope National Medical Center, Duarte, CA, USA
| | - Russell C Rockne
- Division of Mathematical Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - James C Root
- Neurocognitive Research Lab, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew J Saykin
- Center for Neuroimaging, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Tim A Ahles
- Neurocognitive Research Lab, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrei I Holodny
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Neal Prakash
- Division of Neurology, City of Hope National Medical Center, Duarte, CA, USA
| | - Joanne Mortimer
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - James Waisman
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Yuan Yuan
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Daneng Li
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Mina S Sedrak
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Jessica Vazquez
- Center for Cancer and Aging, City of Hope National Medical Center, Duarte, CA, USA
| | - Vani Katheria
- Center for Cancer and Aging, City of Hope National Medical Center, Duarte, CA, USA
| | - William Dale
- Center for Cancer and Aging, City of Hope National Medical Center, Duarte, CA, USA
- Department of Supportive Care Medicine, City of Hope National Medical Center, Duarte, CA, USA
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