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Garland SN, Tulk J, Savard J, Rash JA, Browne S, Urquhart R, Seal M, Thoms J, Laing K. Randomized Controlled Trial of Virtually Delivered Cognitive Behavioral Therapy for Insomnia to Address Perceived Cancer-Related Cognitive Impairment in Cancer Survivors. J Clin Oncol 2024; 42:2094-2104. [PMID: 38552188 DOI: 10.1200/jco.23.02330] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/18/2023] [Accepted: 02/07/2024] [Indexed: 06/07/2024] Open
Abstract
PURPOSE Comorbid insomnia and cancer-related cognitive impairment (CRCI) are experienced by up to 26% of individuals diagnosed with cancer. This study examined the efficacy and durability of cognitive behavioral therapy for insomnia (CBT-I) on perceived CRCI in cancer survivors. METHODS Atlantic Canadian cancer survivors with insomnia and CRCI were randomly assigned to receive seven weekly virtual CBT-I sessions (n = 63) or placed in a waitlist control group (n = 69) to receive treatment after the waiting period. Participants completed assessments at baseline, 1 month (mid-treatment), and 2 months (post-treatment). Age- and education-adjusted mixed-effects models using intention-to-treat principles assessed change at post-treatment. Data from both groups were then pooled to assess the durability of effects at 3 and 6 months. A mediation analysis examined whether change in insomnia symptoms mediated the effect of CBT-I on cognitive outcomes. RESULTS The mean age of the sample was 60 years, 77% were women, and breast cancer was the most common diagnosis (41%). The treatment group reported an 11.35-point reduction in insomnia severity, compared with a 2.67-point reduction in the waitlist control group (P < .001). The treatment group had a greater overall improvement than the waitlist control on perceived cognitive impairment (P < .001; d = 0.75), cognitive abilities (P < .001; d = 0.92), and impact on quality of life (P < .001; d = 1.01). These improvements were maintained at follow-up. Change in insomnia symptoms fully mediated the effect of CBT-I on subjective cognitive outcomes. CONCLUSION Treating insomnia with CBT-I produces clinically meaningful and durable improvements in CRCI. There is an urgent need increase access to evidence-based treatment for insomnia in cancer centers and the community.
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Affiliation(s)
- Sheila N Garland
- Department of Psychology, Faculty of Science, Memorial University, St John's, NL
- Discipline of Oncology, Faculty of Science, Memorial University, St John's, NL
| | - Joshua Tulk
- Department of Psychology, Faculty of Science, Memorial University, St John's, NL
| | - Josée Savard
- School of Psychology, Université Laval, Quebec, QC, Canada
- CHU de Québec-Université Laval Research Center, Quebec, QC, Canada
| | - Joshua A Rash
- Department of Psychology, Faculty of Science, Memorial University, St John's, NL
| | | | - Robin Urquhart
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS
| | - Melanie Seal
- Discipline of Oncology, Faculty of Science, Memorial University, St John's, NL
| | - John Thoms
- Discipline of Oncology, Faculty of Science, Memorial University, St John's, NL
| | - Kara Laing
- Discipline of Oncology, Faculty of Science, Memorial University, St John's, NL
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Galitzia A, Maccaferri M, Mauro FR, Murru R, Marasca R. Chronic Lymphocytic Leukemia: Management of Adverse Events in the Era of Targeted Agents. Cancers (Basel) 2024; 16:1996. [PMID: 38893115 PMCID: PMC11171383 DOI: 10.3390/cancers16111996] [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: 04/14/2024] [Revised: 05/20/2024] [Accepted: 05/22/2024] [Indexed: 06/21/2024] Open
Abstract
The treatment landscape for CLL has undergone a profound transformation with the advent of targeted agents (TAs) like Bruton's Tyrosine Kinase inhibitors (BTKis) and BCL-2 inhibitors (BCL-2is). These agents target crucial cellular pathways in CLL, offering superior efficacy over traditional chemo-immunotherapy, which has led to improved progression-free and overall survival rates. This advancement promises enhanced disease control and potentially normal life expectancy for many patients. However, the journey is not without challenges, as these TAs are associated with a range of adverse events (AEs) that can impact treatment efficacy and patient quality of life. This review focuses on detailing the various AEs related to TA management in CLL, evaluating their frequency and clinical impact. The aim is to present a comprehensive guide to the effective management of these AEs, ensuring optimal tolerability and efficacy of TAs. By reviewing the existing literature and consolidating findings, we provide insights into AE management, which is crucial for maximizing patient outcomes in CLL therapy.
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Affiliation(s)
- Andrea Galitzia
- Hematology and Stem Cell Transplantation Unit, Ospedale San Francesco, 08100 Nuoro, Italy;
| | - Monica Maccaferri
- Hematology Unit, Department of Oncology and Hematology, A.O.U of Modena, Policlinico, 41125 Modena, Italy; (M.M.); (R.M.)
| | - Francesca Romana Mauro
- Hematology, Department of Translational and Precision Medicine, Sapienza University, 00185 Rome, Italy;
| | - Roberta Murru
- Hematology and Stem Cell Transplantation Unit, Ospedale Oncologico A. Businco, ARNAS G. Brotzu, 09134 Cagliari, Italy
| | - Roberto Marasca
- Hematology Unit, Department of Oncology and Hematology, A.O.U of Modena, Policlinico, 41125 Modena, Italy; (M.M.); (R.M.)
- Department of Medical and Surgical Sciences, Section of Hematology, University of Modena and Reggio Emilia, 41121 Modena, Italy
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3
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Serini S, Calviello G. Potential of Natural Phenolic Compounds against Doxorubicin-Induced Chemobrain: Biological and Molecular Mechanisms Involved. Antioxidants (Basel) 2024; 13:486. [PMID: 38671933 PMCID: PMC11047710 DOI: 10.3390/antiox13040486] [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: 03/29/2024] [Revised: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
Chemotherapy-induced cognitive impairment or "chemobrain" is a prevalent long-term complication of chemotherapy and one of the more devastating. Most of the studies performed so far to identify the cognitive dysfunctions induced by antineoplastic chemotherapies have been focused on treatment with anthracyclines, frequently administered to breast cancer patients, a population that, after treatment, shows a high possibility of long survival and, consequently, of chemobrain development. In the last few years, different possible strategies have been explored to prevent or reduce chemobrain induced by the anthracycline doxorubicin (DOX), known to promote oxidative stress and inflammation, which have been strongly implicated in the development of this brain dysfunction. Here, we have critically analyzed the results of the preclinical studies from the last few years that have evaluated the potential of phenolic compounds (PheCs), a large class of natural products able to exert powerful antioxidant and anti-inflammatory activities, in inhibiting DOX-induced chemobrain. Several PheCs belonging to different classes have been shown to be able to revert DOX-induced brain morphological damages and deficits associated with learning, memory, and exploratory behavior. We have analyzed the biological and molecular mechanisms implicated and suggested possible future perspectives in this research area.
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Affiliation(s)
- Simona Serini
- Department of Translational Medicine and Surgery, Section of General Pathology, School of Medicine and Surgery, Università Cattolica del Sacro Cuore, Largo F. Vito, 00168 Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito, 00168 Rome, Italy
| | - Gabriella Calviello
- Department of Translational Medicine and Surgery, Section of General Pathology, School of Medicine and Surgery, Università Cattolica del Sacro Cuore, Largo F. Vito, 00168 Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito, 00168 Rome, Italy
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Fowler ME, Murdaugh D, Harmon C, Al-Obaidi M, Sharafeldin N, Bhatia S, Giri S, Williams GR. Longitudinal changes in patient-reported cognitive complaints among older adults with gastrointestinal malignancies - results from the Cancer and Aging Resilience Evaluation (CARE) Registry. J Cancer Surviv 2024; 18:521-530. [PMID: 36114326 PMCID: PMC10020125 DOI: 10.1007/s11764-022-01254-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/31/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE Longitudinal change in patient-reported cognitive complaints (CC) in older adults with cancer is poorly understood. The purpose of this study was to evaluate early longitudinal CC and predictors among older adults with cancer. METHODS We examined early CC change on the PROMIS® Short Form4a Cognitive Function among adults ≥ 60 years with GI cancer enrolled in the Cancer and Aging Resilience Evaluation (CARE) undergoing geriatric assessment (GA) at baseline and one 3-6-month follow-up. Multivariable linear regression examined associations of demographics, socioeconomics, GA domains, baseline cognitive score, and treatment toxicities on follow-up cognitive score. Bayesian analysis of covariance (ANCOVA) determined best fitting model. RESULTS A total of 218 participants were included. The median follow-up was 3.7 months, the mean age was 69.2 ± 7.1, and 57.3% were male. The most common cancer was colorectal (30.7%) with most stage III/IV (73.7%). About half (51.8%) had stable cognition baseline to follow-up (follow-up t-score ± 5 points of baseline), 20.6% improved (≥ 5 increase), and 27.5% declined (≥ 5 decrease). After adjustment, there were no significant baseline predictors of follow-up cognitive t-score. Baseline t-score was the best-fitting predictor of follow-up t-score. CONCLUSIONS In this first study, examining early change in CC among older adults with cancer, ~ 28% exhibited cognitive decline. Baseline cognition is the most important early predictor of follow-up cognition. Longer follow-up is needed to identify long-term predictors of CC change in cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS Cognitive decline, even early, may occur in many older adults with cancer. Baseline and regular follow-up assessments of cognitive symptoms are an important component of survivorship care.
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Affiliation(s)
- Mackenzie E Fowler
- Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Donna Murdaugh
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Christian Harmon
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mustafa Al-Obaidi
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Noha Sharafeldin
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Pediatrics, Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Smith Giri
- Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Grant R Williams
- Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
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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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Zhao S, Zhang J, Wan H, Tao C, Hu M, Liang W, Xu Z, Xu B, Zhang J, Wang G, Li P, Lyu G, Gong Y. Role of Chinese Acupuncture in the Treatment for Chemotherapy-Induced Cognitive Impairment in Older Patients With Cancer: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e53853. [PMID: 38329790 PMCID: PMC10884956 DOI: 10.2196/53853] [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: 10/21/2023] [Revised: 01/06/2024] [Accepted: 01/11/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Older patients with cancer experience cognitive impairment and a series of neurocognitive symptoms known as chemobrain due to chemotherapy. Moreover, older populations are disproportionately affected by chemobrain and heightened negative mental health outcomes after cytotoxic chemical drug therapy. Chinese acupuncture is an emerging therapeutic option for chemotherapy-induced cognitive impairment in older patients with cancer, despite limited supporting evidence. OBJECTIVE Our study aims to directly contribute to the existing knowledge of this novel Chinese medicine mode in older patients with cancer enrolled at the Department of Oncology/Chinese Medicine, Nanjing First Hospital, China, thereby establishing the basis for further research. METHODS This study involves a 2-arm, prospective, randomized, assessor-blinded clinical trial in older patients with cancer experiencing chemobrain-related stress and treated with Chinese acupuncture from September 30, 2023, to December 31, 2025. We will enroll 168 older patients with cancer with clinically confirmed chemobrain. These participants will be recruited through screening by oncologists for Chinese acupuncture therapy and evaluation. Electroacupuncture will be performed by a registered practitioner of Chinese medicine. The electroacupuncture intervention will take about 30 minutes every session (2 sessions per week over 8 weeks). For the experimental group, the acupuncture points are mainly on the head, limbs, and abdomen, with a total of 6 pairs of electrically charged needles on the head, while for the control group, the acupuncture points are mainly on the head and limbs, with only 1 pair of electrically charged needles on the head. RESULTS Eligible participants will be randomized to the control group or the experimental group in 1:1 ratio. The primary outcome of this intervention will be the scores of the Montreal Cognitive Assessment. The secondary outcomes, that is, attentional function and working memory will be determined by the Digit Span Test scores. The quality of life of the patients and multiple functional assessments will also be evaluated. These outcomes will be measured at 2, 4, 6, and 8 weeks after the randomization. CONCLUSIONS This efficacy trial will explore whether Chinese electroacupuncture can prevent chemobrain, alleviate the related symptoms, and improve the quality of life of older patients with cancer who are undergoing or are just going to begin chemotherapy. The safety of this electroacupuncture intervention for such patients will also be evaluated. Data from this study will be used to promote electroacupuncture application in patients undergoing chemotherapy and support the design of further real-world studies. TRIAL REGISTRATION ClinicalTrials.gov NCT05876988; https://clinicaltrials.gov/ct2/show/NCT05876988. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/53853.
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Affiliation(s)
- Sunyan Zhao
- Department of Oncology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jing Zhang
- Department of Oncology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Haijun Wan
- Department of Gastroenterology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Chenjie Tao
- Department of Oncology, Eastern Hepatobiliary Hospital, Naval Medical University, Shanghai, China
| | - Meng Hu
- Department of Medical Oncology, Liyang People's Hospital, Liyang, China
| | - Wei Liang
- Department of Oncology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Zhi Xu
- Medical Affairs, ICON Public Limited Company (ICON Plc), Beijing, China
| | - Bingguo Xu
- Division of Chinese Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jiaying Zhang
- Division of Chinese Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Guoxin Wang
- Division of Chinese Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Ping Li
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Guangmei Lyu
- Information Centre, Jiangsu Health Vocational College, Nanjing, China
| | - Yongling Gong
- Department of Oncology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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Zhou X, Zhang X, Zhong T, Zhou M, Gao L, Chen L. Prevalence and associated factors of chemotherapy-related cognitive impairment in older breast cancer survivors. J Adv Nurs 2024; 80:484-499. [PMID: 37675947 DOI: 10.1111/jan.15842] [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: 05/13/2023] [Revised: 08/11/2023] [Accepted: 08/23/2023] [Indexed: 09/08/2023]
Abstract
AIMS To examine the prevalence and associated factors of chemotherapy-related cognitive impairment (CRCI) in older breast cancer survivors (BCS). DESIGN Systematic review. DATA SOURCES We searched EMBASE, PubMed, PsychInfo, CINAHL, Cochrance Library, Web of Science, CNKI and SinoMed, without language restrictions, for studies published from the establishment of the database to September 2022. REVIEW METHODS Two researchers independently examined the full texts, data extraction and quality assessment, and any discrepancies were resolved through discussion with a third reviewer. Quality of evidence was assessed using the Newcastle-Ottawa Scale and the Agency for Healthcare Research and Quality Scale. RESULTS The seven included studies showed that the estimated prevalence of CRCI in older BCS ranged from 18.6% to 27% on objective neuropsychological tests and from 7.6% to 49% on subjective cognitive assessments. The areas most affected were attention, memory, executive functioning and processing speed. CRCI was associated with 10 factors in six categories, including sociodemographic (e.g. age, education level), physiological (e.g. sleep disorders, fatigue and comorbidities), psychological (e.g. anxiety, depression), treatment modalities (e.g. chemotherapy cycles, chemotherapy regimens), genetic (e.g. APOE2, APOE4) and lifestyle factor (e.g. physical inactivity). CONCLUSION CRCI is multifactorial and has a relatively high prevalence. However, the results of subjective and objective cognitive examinations were inconsistent, possibly due to variations in tools used to evaluate different definitions of CRCI. Nevertheless, as there are few published studies of older BCS, this conclusion still require verification by well-designed studies in the future. IMPACT We found that the prevalence of CRCI in older adults is relatively high and multifactorial, providing evidence for further health care for this population. NO PATIENT OR PUBLIC CONTRIBUTION There was no patient or public involvement.
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Affiliation(s)
- Xuan Zhou
- Jilin University School of Nursing, Changchun, China
| | - Xueyan Zhang
- Jilin University School of Nursing, Changchun, China
| | | | - Meng Zhou
- Jilin University School of Nursing, Changchun, China
| | - Lan Gao
- The First Hospital of Jilin University, Changchun, China
| | - Li Chen
- Jilin University School of Nursing, Changchun, China
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Daniel E, Deng F, Patel SK, Sedrak MS, Kim H, Razavi M, Sun C, Root JC, Ahles TA, Dale W, Chen BT. Brain white matter microstructural changes in chemotherapy-treated older long-term breast cancer survivors. Cancer Med 2023; 13:e6881. [PMID: 38152038 PMCID: PMC10807556 DOI: 10.1002/cam4.6881] [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: 07/06/2023] [Revised: 12/11/2023] [Accepted: 12/17/2023] [Indexed: 12/29/2023] Open
Abstract
PURPOSE To assess white matter microstructural changes in older long-term breast cancer survivors 5-15 years post-chemotherapy treatment. METHODS Breast cancer survivors aged 65 years or older who underwent chemotherapy (C+) and who did not undergo chemotherapy (C-) and age- and sex-matched healthy controls (HC) were enrolled at time point 1 (TP1) and followed for 2 years for time point 2 (TP2). All participants underwent brain MRI with diffusion tensor images and neuropsychological (NP) testing with the NIH Toolbox Cognition Battery. Tract-based spatial statistics (TBSS) analysis was performed on the diffusion tensor images to assess white matter microstructural changes with the fractional anisotropy (FA) parameter. RESULTS There were significant longitudinal alterations in FA within the C+ group over time. The C+ group showed diminished FA in the body and genu of corpus callosum, anterior corona radiate, and external capsule on both the whole brain and region of interest (ROI) based analyses after p < 0.05 family-wise error (FWE) correction. However, there were no significant group differences between the groups at TP1. Additionally, at TP1, a positive correlation (R = 0.58, p = 0.04) was observed between the FA value of the anterior corona radiata and the crystallized composite score in the C+ group. CONCLUSIONS Brain white matter microstructural alterations may be the underlying neural correlates of cognitive changes in older breast cancer survivors who had chemotherapy treatment years ago.
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Affiliation(s)
- Ebenezer Daniel
- Department of Diagnostic RadiologyCity of Hope National Medical CenterDuarteCAUSA
| | - Frank Deng
- Department of Diagnostic RadiologyCity of Hope National Medical CenterDuarteCAUSA
| | - Sunita K. Patel
- Department of Population ScienceCity of Hope National Medical CenterDuarteCAUSA
| | - Mina S. Sedrak
- Department of Medical OncologyCity of Hope National Medical CenterDuarteCAUSA
| | - Heeyoung Kim
- Center for Cancer and AgingCity of Hope National Medical CenterDuarteCAUSA
| | - Marianne Razavi
- Department of Supportive Care MedicineCity of Hope National Medical CenterDuarteCAUSA
| | - Can‐Lan Sun
- Center for Cancer and AgingCity of Hope National Medical CenterDuarteCAUSA
| | - James C. Root
- Neurocognitive Research LabMemorial Sloan Kettering Cancer CenterNew YorkNYUSA
| | - Tim A. Ahles
- Neurocognitive Research LabMemorial Sloan Kettering Cancer CenterNew YorkNYUSA
| | - William Dale
- Center for Cancer and AgingCity of Hope National Medical CenterDuarteCAUSA
- Department of Supportive Care MedicineCity of Hope National Medical CenterDuarteCAUSA
| | - Bihong T. Chen
- Department of Diagnostic RadiologyCity of Hope National Medical CenterDuarteCAUSA
- Center for Cancer and AgingCity of Hope National Medical CenterDuarteCAUSA
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9
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Aran KR, Gupta GD, Singh S. Cladribine induces apoptosis, neuroinflammation, mitochondrial oxidative stress, tau phosphorylation and Aβ (1-42) pathway in the hippocampus: An in vivo approach. J Chem Neuroanat 2023; 133:102340. [PMID: 37708945 DOI: 10.1016/j.jchemneu.2023.102340] [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: 07/01/2023] [Revised: 09/08/2023] [Accepted: 09/11/2023] [Indexed: 09/16/2023]
Abstract
Cladribine is a purine nucleoside found to enhance toxic amyloid protein and cause memory impairment. Patients following chemotherapy treatment commonly suffer from cognitive deficits more prevalent in the elderly than adults. A previous research study revealed that cladribine has a high affinity to the brain, increases the level of amyloid precursor protein, and results in learning deficits. The study was designed to validate an animal model of cladribine administration to rats through mitochondrial oxidative stress, inflammation, apoptosis, tau phosphorylation, and amyloid-β (1-42) accumulation. In this study, all rats were orally given cladribine (0.5 and 1 mg/kg) for 28 days, resulting in impaired spatial memory confirmed by behavioural activity. On day 29, all rats were euthanized, and the hippocampal tissues were isolated and used for the estimation of neuroinflammatory markers, biochemicals parameters (glutathione, catalase, lipid peroxidation, and nitrite), amyloid-β (1-42) level, neurotransmitters, and nuclear factor kappa B analysis. Cladribine administration significantly elevated cytokines release, dysbalanced neurotransmitter concentration, and promoted the Aβ accumulation and hyperphosphorylation of tau protein. Our study outcome confirmed that cladribine produces cognitive impairment via activation of Nuclear factor kappa B, mitochondrial oxidative stress and dysbalanced of the endogenous antioxidant defence system.
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Affiliation(s)
- Khadga Raj Aran
- Neuroscience Division, Department of Pharmacology, ISF College of Pharmacy (An Autonomous College), Moga, Punjab 142001, India; I. K. Gujral Punjab Technical University, Jalandhar, India
| | - G D Gupta
- Department of Pharmaceutics, ISF College of Pharmacy (An Autonomous College), Moga, Punjab, 142001, India
| | - Shamsher Singh
- Neuroscience Division, Department of Pharmacology, ISF College of Pharmacy (An Autonomous College), Moga, Punjab 142001, India.
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10
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Kleven AG, Miaskowski C, Torstveit AH, Ritchie CS, Engh ME, Andersen E, Utne I. Quality of life of older gynecologic oncology patients at the initiation of chemotherapy. Nurs Open 2023; 10:6749-6757. [PMID: 37337353 PMCID: PMC10495706 DOI: 10.1002/nop2.1921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 05/14/2023] [Accepted: 06/05/2023] [Indexed: 06/21/2023] Open
Abstract
AIM To evaluate older gynecologic oncology patients' quality of life (QOL) at the initiation of chemotherapy and compare their QOL scores with a female age-matched general population (GP) sample. DESIGN Cross-sectional. METHODS Older (n = 122) gynecologic oncology patients completed the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (QLQ-C30) that evaluates global health and five functional scales (range from 0 to 100). Differences in QOL scores between our sample and the GP were evaluated using one-sample t-tests and effect sizes were calculated using Cohen's d. RESULTS Patients' mean age was 70.7 years (±6.6). Mean scores for the function scales ranged from 58.5 (±31.1) for role function to 86.1 (±17.0) for cognitive function. Compared to the GP, our sample reported significantly lower scores for global health status, social, role and physical functioning, and a significantly higher score for cognitive functioning. No differences were found in emotional functioning scores. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Anne Grethe Kleven
- Department of Nursing and Health Promotion, Faculty of Health SciencesOsloMet ‐ Oslo Metropolitan UniversityOsloNorway
| | | | - Ann Helen Torstveit
- Department of Nursing and Health Promotion, Faculty of Health SciencesOsloMet ‐ Oslo Metropolitan UniversityOsloNorway
| | - Christine Seel Ritchie
- Division of Palliative Care and Geriatric MedicineMassachusetts General Hospital Mongan Institute Center for Aging and Serious IllnessBostonMassachusettsUSA
| | - Marie Ellström Engh
- Division Akershus University Hospital, Faculty of MedicineUniversity of OsloOsloNorway
- Department of Obstetrics and GynecologyAkershus University HospitalLørenskogNorway
| | - Elin Andersen
- Department of Nursing and Health Promotion, Faculty of Health SciencesOsloMet ‐ Oslo Metropolitan UniversityOsloNorway
| | - Inger Utne
- Department of Nursing and Health Promotion, Faculty of Health SciencesOsloMet ‐ Oslo Metropolitan UniversityOsloNorway
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11
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Liu Y, Reiken S, Dridi H, Yuan Q, Mohammad KS, Trivedi T, Miotto MC, Wedderburn-Pugh K, Sittenfeld L, Kerley Y, Meyer JA, Peters JS, Persohn SC, Bedwell AA, Figueiredo LL, Suresh S, She Y, Soni RK, Territo PR, Marks AR, Guise TA. Targeting ryanodine receptor type 2 to mitigate chemotherapy-induced neurocognitive impairments in mice. Sci Transl Med 2023; 15:eadf8977. [PMID: 37756377 DOI: 10.1126/scitranslmed.adf8977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 09/08/2023] [Indexed: 09/29/2023]
Abstract
Chemotherapy-induced cognitive dysfunction (chemobrain) is an important adverse sequela of chemotherapy. Chemobrain has been identified by the National Cancer Institute as a poorly understood problem for which current management or treatment strategies are limited or ineffective. Here, we show that chemotherapy treatment with doxorubicin (DOX) in a breast cancer mouse model induced protein kinase A (PKA) phosphorylation of the neuronal ryanodine receptor/calcium (Ca2+) channel type 2 (RyR2), RyR2 oxidation, RyR2 nitrosylation, RyR2 calstabin2 depletion, and subsequent RyR2 Ca2+ leakiness. Chemotherapy was furthermore associated with abnormalities in brain glucose metabolism and neurocognitive dysfunction in breast cancer mice. RyR2 leakiness and cognitive dysfunction could be ameliorated by treatment with a small molecule Rycal drug (S107). Chemobrain was also found in noncancer mice treated with DOX or methotrexate and 5-fluorouracil and could be prevented by treatment with S107. Genetic ablation of the RyR2 PKA phosphorylation site (RyR2-S2808A) also prevented the development of chemobrain. Chemotherapy increased brain concentrations of the tumor necrosis factor-α and transforming growth factor-β signaling, suggesting that increased inflammatory signaling might contribute to oxidation-driven biochemical remodeling of RyR2. Proteomics and Gene Ontology analysis indicated that the signaling downstream of chemotherapy-induced leaky RyR2 was linked to the dysregulation of synaptic structure-associated proteins that are involved in neurotransmission. Together, our study points to neuronal Ca2+ dyshomeostasis via leaky RyR2 channels as a potential mechanism contributing to chemobrain, warranting further translational studies.
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Affiliation(s)
- Yang Liu
- Department of Physiology and Cellular Biophysics, Clyde and Helen Wu Center for Molecular Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY 10032, USA
| | - Steven Reiken
- Department of Physiology and Cellular Biophysics, Clyde and Helen Wu Center for Molecular Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY 10032, USA
| | - Haikel Dridi
- Department of Physiology and Cellular Biophysics, Clyde and Helen Wu Center for Molecular Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY 10032, USA
| | - Qi Yuan
- Department of Physiology and Cellular Biophysics, Clyde and Helen Wu Center for Molecular Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY 10032, USA
| | - Khalid S Mohammad
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
- Present address: College of Medicine, Alfaisal University, Box 50927, Riyadh 1153, Kingdom of Saudi Arabia
| | - Trupti Trivedi
- Department of Endocrine Neoplasia and Hormonal Disorders, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Marco C Miotto
- Department of Physiology and Cellular Biophysics, Clyde and Helen Wu Center for Molecular Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY 10032, USA
| | - Kaylee Wedderburn-Pugh
- Department of Physiology and Cellular Biophysics, Clyde and Helen Wu Center for Molecular Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY 10032, USA
| | - Leah Sittenfeld
- Department of Physiology and Cellular Biophysics, Clyde and Helen Wu Center for Molecular Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY 10032, USA
| | - Ynez Kerley
- Department of Physiology and Cellular Biophysics, Clyde and Helen Wu Center for Molecular Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY 10032, USA
| | - Jill A Meyer
- Stark Neuroscience Research Institute, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Jonathan S Peters
- Stark Neuroscience Research Institute, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Scott C Persohn
- Stark Neuroscience Research Institute, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Amanda A Bedwell
- Stark Neuroscience Research Institute, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Lucas L Figueiredo
- Stark Neuroscience Research Institute, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Sukanya Suresh
- Department of Endocrine Neoplasia and Hormonal Disorders, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Yun She
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Rajesh Kumar Soni
- Proteomics and Macromolecular Crystallography Shared Resource, Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY 10032, USA
| | - Paul R Territo
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
- Stark Neuroscience Research Institute, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Andrew R Marks
- Department of Physiology and Cellular Biophysics, Clyde and Helen Wu Center for Molecular Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY 10032, USA
| | - Theresa A Guise
- Department of Endocrine Neoplasia and Hormonal Disorders, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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12
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Kesler SR, Henneghan AM, Prinsloo S, Palesh O, Wintermark M. Neuroimaging based biotypes for precision diagnosis and prognosis in cancer-related cognitive impairment. Front Med (Lausanne) 2023; 10:1199605. [PMID: 37720513 PMCID: PMC10499624 DOI: 10.3389/fmed.2023.1199605] [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: 04/03/2023] [Accepted: 08/15/2023] [Indexed: 09/19/2023] Open
Abstract
Cancer related cognitive impairment (CRCI) is commonly associated with cancer and its treatments, yet the present binary diagnostic approach fails to capture the full spectrum of this syndrome. Cognitive function is highly complex and exists on a continuum that is poorly characterized by dichotomous categories. Advanced statistical methodologies applied to symptom assessments have demonstrated that there are multiple subclasses of CRCI. However, studies suggest that relying on symptom assessments alone may fail to account for significant differences in the neural mechanisms that underlie a specific cognitive phenotype. Treatment plans that address the specific physiologic mechanisms involved in an individual patient's condition is the heart of precision medicine. In this narrative review, we discuss how biotyping, a precision medicine framework being utilized in other mental disorders, could be applied to CRCI. Specifically, we discuss how neuroimaging can be used to determine biotypes of CRCI, which allow for increased precision in prediction and diagnosis of CRCI via biologic mechanistic data. Biotypes may also provide more precise clinical endpoints for intervention trials. Biotyping could be made more feasible with proxy imaging technologies or liquid biomarkers. Large cross-sectional phenotyping studies are needed in addition to evaluation of longitudinal trajectories, and data sharing/pooling is highly feasible with currently available digital infrastructures.
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Affiliation(s)
- Shelli R. Kesler
- Division of Adult Health, School of Nursing, The University of Texas at Austin, Austin, TX, United States
- Department of Diagnostic Medicine, Dell School of Medicine, The University of Texas at Austin, Austin, TX, United States
- Department of Oncology, Dell School of Medicine, The University of Texas at Austin, Austin, TX, United States
| | - Ashley M. Henneghan
- Division of Adult Health, School of Nursing, The University of Texas at Austin, Austin, TX, United States
- Department of Oncology, Dell School of Medicine, The University of Texas at Austin, Austin, TX, United States
| | - Sarah Prinsloo
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Oxana Palesh
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, United States
| | - Max Wintermark
- Department of Neuroradiology, The University of Texas MD Anderson Cancer, Houston, TX, United States
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13
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Chemotherapy: how to reduce its adverse effects while maintaining the potency? Med Oncol 2023; 40:88. [PMID: 36735206 DOI: 10.1007/s12032-023-01954-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 01/18/2023] [Indexed: 02/04/2023]
Abstract
Chemotherapy is one of the widely used anticancer treatments that involves the use of powerful cytotoxic drugs to stop tumor growth by targeting rapidly dividing cells through various mechanisms, which will be elucidated in this review. Introduced during the early twentieth century, chemotherapy has since lengthened the longevity of innumerable cancer patients. However, the increase in lifespan is at the expense of quality of life as patients are at risk of developing short-term and long-term side effects following chemotherapy, such as alopecia (hair loss), chemotherapy-induced peripheral neuropathy, chemotherapy-induced nausea and vomiting, cardiotoxicity, diarrhea, infertility, and chemo brain. Currently, a number of these chemotherapy-induced adverse effects are managed through supportive care and approved treatments, while the rest of the side effects are unavoidable. Hence, chemotherapeutic drugs associated with inevitable side effects are only administered when their therapeutic role outweighs their chemotoxicity, thus severely limiting the potency of chemotherapy in treating malignancy. Therein, the potential approaches to alleviating side effects of chemotherapy ranging from pharmaceutical drugs to alternative therapies will be discussed in this review in hopes of increasing the tolerance and effectiveness of future chemotherapeutic treatments.
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14
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Carroll JE, Nakamura ZM, Small BJ, Zhou X, Cohen HJ, Ahles TA, Ahn J, Bethea TN, Extermann M, Graham D, Isaacs C, Jim HS, Jacobsen PB, McDonald BC, Patel SK, Rentscher K, Root J, Saykin AJ, Tometich DB, Van Dyk K, Zhai W, Breen EC, Mandelblatt JS. Elevated C-Reactive Protein and Subsequent Patient-Reported Cognitive Problems in Older Breast Cancer Survivors: The Thinking and Living With Cancer Study. J Clin Oncol 2023; 41:295-306. [PMID: 36179271 PMCID: PMC9839283 DOI: 10.1200/jco.22.00406] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/24/2022] [Accepted: 07/26/2022] [Indexed: 01/25/2023] Open
Abstract
PURPOSE To examine longitudinal relationships between levels of C-reactive protein (CRP) and cognition in older breast cancer survivors and noncancer controls. METHODS English-speaking women age ≥ 60 years, newly diagnosed with primary breast cancer (stage 0-III), and frequency-matched controls were enrolled from September 2010 to March 2020; women with dementia, neurologic disorders, and other cancers were excluded. Assessments occurred presystemic therapy/enrollment and at annual visits up to 60 months. Cognition was measured using the Functional Assessment of Cancer Therapy-Cognitive Function and neuropsychological testing. Mixed linear effect models tested for survivor-control differences in natural log (ln)-transformed CRP at each visit. Random effect-lagged fluctuation models tested directional effects of ln-CRP on subsequent cognition. All models controlled for age, race, study site, cognitive reserve, obesity, and comorbidities; secondary analyses evaluated if depression or anxiety affected results. RESULTS There were 400 survivors and 329 controls with CRP specimens and follow-up data (average age of 67.7 years; range, 60-90 years). The majority of survivors had stage I (60.9%), estrogen receptor-positive (87.6%) tumors. Survivors had significantly higher adjusted mean ln-CRP than controls at baseline and 12-, 24-, and 60-month visits (all P < .05). Higher adjusted ln-CRP predicted lower participant-reported cognition on subsequent visits among survivors, but not controls (P interaction = .008); effects were unchanged by depression or anxiety. Overall, survivors had adjusted Functional Assessment of Cancer Therapy-Cognitive Function scores that were 9.5 and 14.2 points lower than controls at CRP levels of 3.0 and 10.0 mg/L. Survivors had poorer neuropsychological test performance (v controls), with significant interactions with CRP only for the Trails B test. CONCLUSION Longitudinal relationships between CRP and cognition in older breast cancer survivors suggest that chronic inflammation may play a role in development of cognitive problems. CRP testing could be clinically useful in survivorship care.
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Affiliation(s)
- Judith E. Carroll
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, CA
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA
| | - Zev M. Nakamura
- Department of Psychiatry, University of North Carolina–Chapel Hill, Chapel Hill, NC
| | - Brent J. Small
- School of Aging Studies, University of South Florida, Tampa, FL
| | - Xingtao Zhou
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, DC
- Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University, Washington, DC
| | - Harvey J. Cohen
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC
| | - Tim A. Ahles
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jaeil Ahn
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, DC
- Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University, Washington, DC
| | - Traci N. Bethea
- Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University, Washington, DC
| | - Martine Extermann
- Department of Oncology, Moffitt Cancer Center, University of South Florida, Tampa, FL
| | - Deena Graham
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ
| | - Claudine Isaacs
- Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University, Washington, DC
| | | | - Paul B. Jacobsen
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Brenna C. McDonald
- Department of Radiology and Imaging Sciences, Melvin and Bren Simon Comprehensive Cancer Center, and Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, Indianapolis, IN
| | | | - Kelly Rentscher
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, CA
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA
| | - James Root
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrew J. Saykin
- Department of Radiology and Imaging Sciences, Melvin and Bren Simon Comprehensive Cancer Center, and Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, Indianapolis, IN
| | | | - Kathleen Van Dyk
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA
| | - Wanting Zhai
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, DC
- Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University, Washington, DC
| | - Elizabeth C. Breen
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, CA
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA
| | - Jeanne S. Mandelblatt
- Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University, Washington, DC
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15
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Vega JN, Newhouse PA, Conley AC, Szymkowicz SM, Gong X, Cote S, Mayer I, Taylor WD, Morimoto SS. Use of focused computerized cognitive training (Neuroflex) to improve symptoms in women with persistent chemotherapy-related cognitive impairment. Digit Health 2023; 9:20552076231192754. [PMID: 37588161 PMCID: PMC10426301 DOI: 10.1177/20552076231192754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/18/2023] [Indexed: 08/18/2023] Open
Abstract
Purpose Chemotherapy-related cognitive impairment (CRCI) is a distressing and increasingly recognized long-term sequela reported by breast cancer patients following cancer treatment. There is an urgent but unmet clinical need for treatments that improve CRCI. In this context, we proposed the use of a novel cognitive enhancement strategy called Neuroflex to target CRCI experienced by breast cancer survivors. Methods The primary aim of this pilot study was to evaluate the feasibility and acceptability of Neuroflex, a novel digital cognitive enhancement strategy, in breast and gynecologic cancer survivors with CRCI. Secondary analyses focused on whether improvements in performance on Neuroflex were associated with improvement in subjective cognitive complaints and objective cognitive performance measures. Results Participants (N = 21) completed an average of 7.42 hours of Neuroflex training per week, an average of 44.5 (±1.01) hours total, and had a 100% completion rate. Participants exhibited significant improvement in self-reported cognitive function as well as significant improvement on tasks of verbal learning and memory and auditory working memory. Participants also exhibited improvement in mood, as well as improvement on a disability assessment. Conclusions Results demonstrate feasibility and that breast cancer survivors are capable of completing a lengthy and challenging cognitive training program. Secondly, Neuroflex may confer specific cognitive benefits to both self-reported and objective performance. Results strongly support further investigation of Neuroflex in a larger controlled trial to establish efficacy for CRCI symptoms. Further studies may also result in optimization of this digital intervention for women with CRCI.
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Affiliation(s)
- Jennifer N. Vega
- Center for Cognitive Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Paul A. Newhouse
- Center for Cognitive Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Tennessee Valley Health System, Nashville, TN, USA
| | - Alexander C. Conley
- Center for Cognitive Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sarah M. Szymkowicz
- Center for Cognitive Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Xuewen Gong
- Center for Cognitive Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sarah Cote
- Department of Population Health Sciences, Division of Health Systems Innovation and Research, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Ingrid Mayer
- Department of Medicine, Vanderbilt University Medical Center/Vanderbilt–Ingram Cancer Center, Nashville, TN, USA
| | - Warren D. Taylor
- Center for Cognitive Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Tennessee Valley Health System, Nashville, TN, USA
| | - Sarah Shizuko Morimoto
- Department of Population Health Sciences, Division of Health Systems Innovation and Research, University of Utah School of Medicine, Salt Lake City, UT, USA
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16
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Yang GS, Yang K, Weaver MT, Lynch Kelly D, Dorsey SG, Jackson-Cook CK, Lyon DE. Exploring the relationship between DNA methylation age measures and psychoneurological symptoms in women with early-stage breast cancer. Support Care Cancer 2022; 31:65. [PMID: 36538110 DOI: 10.1007/s00520-022-07519-z] [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: 09/14/2021] [Accepted: 11/14/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE The epigenetic clock has been acknowledged as an indicator for molecular aging, but few studies have examined possible associations of DNA methylation (DNAm) age or age acceleration (AA) with symptom burden in individuals who are treated for cancer. This study explored the association of DNAm age or AA with psychoneurological (PN) symptoms, including cognitive impairment, fatigue, sleep disturbances, pain, and depressive symptoms, in breast cancer survivors over a 2-year period. METHODS We measured PN symptoms using reliable instruments and DNAm levels by Infinium HumanMethylation450K BeadChip (N = 72). DNAm age was calculated by the Horvath, Grim, and Hannum-based intrinsic and extrinsic age estimations. AA was defined by the residual regressing estimated epigenetic age on chronological age. Mixed regression models were fitted for AA and changes in AA to study the association over time. Separate linear regression models and a mixed-effects model were fitted for AA at each time point. RESULTS Horvath-AA, Grim-AA, and extrinsic epigenetic AA were significantly changed over time, while intrinsic epigenetic AA did not exhibit any temporal changes. Increased AA was associated with greater anxiety and fatigue, as well as worse cognitive memory, adjusting for race, BMI, income, chemotherapy, radiation therapy, and chronological age. Increased DNAm age was associated with greater anxiety over 2 years. CONCLUSION Our findings suggest DNAm age and AA may be associated with PN symptoms over the course of cancer treatment and survivorship. Some PN symptoms may be amenable to preventive interventions targeted to epigenetic clocks that influence aging-associated processes.
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Affiliation(s)
- Gee Su Yang
- University of Connecticut School of Nursing, Storrs, CT, USA
| | - Kai Yang
- Medical College of Wisconsin Department of Institute for Health and Equity Division of Biostatistics, Milwaukee, WI, USA
| | | | | | - Susan G Dorsey
- School of Nursing Department of Pain and Translational Symptom Science, University of Maryland, Baltimore, MD, USA
| | - Colleen K Jackson-Cook
- Department of Pathology & Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | - Debra E Lyon
- University of Florida College of Nursing, Gainesville, FL, USA.
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17
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Alberti P, Salvalaggio A, Argyriou AA, Bruna J, Visentin A, Cavaletti G, Briani C. Neurological Complications of Conventional and Novel Anticancer Treatments. Cancers (Basel) 2022; 14:cancers14246088. [PMID: 36551575 PMCID: PMC9776739 DOI: 10.3390/cancers14246088] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/05/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
Various neurological complications, affecting both the central and peripheral nervous system, can frequently be experienced by cancer survivors after exposure to conventional chemotherapy, but also to modern immunotherapy. In this review, we provide an overview of the most well-known adverse events related to chemotherapy, with a focus on chemotherapy induced peripheral neurotoxicity, but we also address some emerging novel clinical entities related to cancer treatment, including chemotherapy-related cognitive impairment and immune-mediated adverse events. Unfortunately, efficacious curative or preventive treatment for all these neurological complications is still lacking. We provide a description of the possible mechanisms involved to drive future drug discovery in this field, both for symptomatic treatment and neuroprotection.
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Affiliation(s)
- Paola Alberti
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- NeuroMI (Milan Center for Neuroscience), 20126 Milan, Italy
| | | | - Andreas A. Argyriou
- Neurology Department, Agios Andreas State General Hospital of Patras, 26335 Patras, Greece
| | - Jordi Bruna
- Neuro-Oncology Unit, Hospital Universitari de Bellvitge-ICO Hospitalet, Bellvitge Institute for Biomedical Research (IDIBELL), 08908 Barcelona, Spain
| | - Andrea Visentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, 35131 Padova, Italy
| | - Guido Cavaletti
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Chiara Briani
- Neurology Unit, Department of Neurosciences, University of Padova, 35131 Padova, Italy
- Correspondence:
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18
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Kumar H, Kumar J, Pani B, Kumar P. Multifunctional Folic acid‐coated and Doxorubicin Encapsulated Mesoporous Silica Nanocomposites (FA/DOX@Silica) for Cancer Therapeutics, Bioimaging and
invitro
Studies. ChemistrySelect 2022. [DOI: 10.1002/slct.202203113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Hemant Kumar
- Department of Chemistry Ramjas College University of Delhi Delhi 110007 India
- Department of Chemistry University of Delhi Delhi 110007 India
- Bhaskaracharya College of Applied Sciences Department of Chemistry University of Delhi Delhi 110075
| | - Jitender Kumar
- Department of Chemistry University of Delhi Delhi 110007 India
| | - Balaram Pani
- Bhaskaracharya College of Applied Sciences Department of Chemistry University of Delhi Delhi 110075
| | - Pramod Kumar
- Department of Chemistry& Chemical Science School of Physical & Material Sciences Central University of Himachal Pradesh Dharamshala 176215 India
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19
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Distinct sleep disturbance and cognitive dysfunction profiles in oncology outpatients receiving chemotherapy. Support Care Cancer 2022; 30:9243-9254. [PMID: 36066629 DOI: 10.1007/s00520-022-07350-6] [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: 03/15/2022] [Accepted: 08/24/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE Sleep disturbance and cancer-related cognitive impairment (CRCI) are two of the most common symptoms reported by patients undergoing chemotherapy. Less is known about how these symptoms co-occur and their associated risk factors. Study purposes were to identify subgroups of patients with distinct sleep disturbance and CRCI profiles and evaluate for differences among the subgroups in demographic and clinical characteristics, symptom severity scores, and QOL outcomes. METHODS A total of 1,333 oncology outpatients receiving chemotherapy completed self-report questionnaires on sleep disturbance and cognitive dysfunction six times over two cycles of chemotherapy. Latent profile analysis was used to identify distinct sleep disturbance AND cognitive dysfunction profiles. Parametric and non-parametric tests were used to evaluate for differences among the classes. RESULTS Two distinct profiles were identified (i.e., Low = low levels of both sleep disturbance and cognitive dysfunction (53.5%); High = high levels of both sleep disturbance and cognitive dysfunction (45.5%)). Patients in the High class were younger, more likely to be female, had a lower functional status and a higher level of comorbidity. In addition, these patients had a higher symptom burden and a lower quality of life. CONCLUSION Almost half of the patients undergoing chemotherapy experienced clinically meaningful levels of both symptoms. Of note, sleep disturbance is frequently overlooked by both clinicians and patients. Clinicians need to recommend cognitive rehabilitation and physical activity programs to decrease patients' symptom burden.
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20
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Wilson T, Fleischer L, Patel S, Bhatnagar A, Ahmad N, Kubicek G. Outcomes of curative treatment for head and neck squamous cell carcinoma in very elderly adults ≥80 years old. Head Neck 2022; 44:2370-2377. [PMID: 35822453 DOI: 10.1002/hed.27141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 06/02/2022] [Accepted: 06/28/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Head and neck cancer treatment can be difficult and advancing age is associated with greater frailty. It is unclear if curative treatment for very elderly patients is beneficial. This study compared outcomes to curative treatment in patients ≥80 aged with HNSCC to patients aged 70-79. METHODS Retrospective study of 114 patients diagnosed with HNSCC. Overall survival (OS), Disease-Free Survival (DFS), and local-regional control (LRC) were compared and adjusted for confounders. RESULTS Patients aged 70-79 had a higher median OS (35 months [95% CI, 19.58-50.42]) compared with patients aged ≥80 (19 months [11.72-26.28]; p = 0.008) but similar DFS and LRC. KPS < 90 was the stand-alone independent prognostic factor for OS (HR = 2.14 [1.05-4.38]). CONCLUSION Very elderly HNSCC patients (aged ≥80) can have favorable outcomes with curative therapy and advanced chronological age alone should not prohibit patients from receiving treatment. Performance status may be a greater predictor of survival outcome than age alone. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Traeden Wilson
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | | | - Shivam Patel
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Anil Bhatnagar
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Nadir Ahmad
- Division of Otolaryngology-Head & Neck Surgery, Cooper University Health Care, Camden, NJ, USA
| | - Gregory Kubicek
- Department of Radiation Oncology, MD Andersen Cancer Center at Cooper University Healthcare, Camden, NJ, USA
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21
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Akushevich I, Yashkin AP, Kravchenko J, Kertai MD. Extended anesthesia exposure for abdominal and pelvic procedures in older adults with colorectal cancer: Associations with chart dementia diagnoses. Exp Gerontol 2022; 164:111830. [PMID: 35525395 PMCID: PMC10112329 DOI: 10.1016/j.exger.2022.111830] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 05/01/2022] [Accepted: 05/02/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND We hypothesized that cumulative anesthesia exposure over the course of routine treatment of colorectal cancer in older adults can increase long-term risk of Alzheimer's disease (AD), Alzheimer's disease-related dementias (ADRD), and other chronic neurocognitive disorders (CND). METHODS We conducted a SEER-Medicare-based retrospective cohort study of 84,770 individuals age 65 years and older diagnosed with colorectal cancer between 1998 and 2007 using a proportional hazards model with inverse probability weighted estimators. The primary exploratory variable was a time-variant measure of cumulative anesthesia exposure for abdominal and pelvic procedures, updated continuously. RESULTS Our primary outcomes, AD and ADRD, occurred in 6005/84,770 (7.1%) and 14,414/83,444 (17.3%) individuals respectively. No statistically significant association was found between cumulative anesthesia exposure and AD (hazard ratio [HR], 0.993; 95% CI, 0.973-1.013). However, it was moderately associated with the risk of ADRD (HR, 1.016; 95% CI, 1.004-1.029) and some secondary outcomes including most notably: cerebral degeneration (HR, 1.048; 95% CI, 1.033-1.063), hepatic encephalopathy (HR, 1.133; 95% CI, 1.101-1.167), encephalopathy-not elsewhere classified (HR,1.095; 95% CI: 1.076-1.115), and incident/perioperative delirium (HR, 1.022; 95% CI, 1.012-1.032). Furthermore, we observed an association between perioperative delirium and increased risk of AD (HR, 2.05; 95% CI, 1.92-2.09). CONCLUSION Cumulative anesthesia exposure for abdominal and pelvic procedures was not associated with increased risk of AD directly and had a small but statistically significant association with ADRD and a number of other CNDs. Cumulative anesthesia exposure was also associated with perioperative delirium, which had an independent adverse association with AD risk.
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Affiliation(s)
- Igor Akushevich
- Biodemography of Aging Research Unit, Center for Population Health and Aging, Duke University, Durham, NC, United States
| | - Arseniy P Yashkin
- Biodemography of Aging Research Unit, Center for Population Health and Aging, Duke University, Durham, NC, United States
| | - Julia Kravchenko
- Department of Surgery, Duke University School of Medicine, Durham, NC, United States
| | - Miklos D Kertai
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, United States.
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22
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Fowler ME, Wright NC, Triebel K, Rocque GB, Irvin R, Kennedy RE. The Relationship Between Prior Cancer Diagnosis and All-Cause Dementia Progression Among US Adults. J Alzheimers Dis 2022; 88:521-535. [PMID: 35662118 DOI: 10.3233/jad-220054] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cancer-related cognitive impairment (CRCI), a frequent effect of cancer and its treatments, shares common cognitive symptoms with dementia syndromes. Cross-sectional studies demonstrate an inverse relationship between cancer and dementia. However, the longitudinal relationship between dementia decline and cancer has not been investigated. OBJECTIVE To evaluate the association between cancer and longitudinal progression of dementia. METHODS We extracted electronic health record data from July 2003 to February 2020 from a single academic medical center. We identified dementia and cancer history prior to dementia using ICD-9/10 codes. We measured cognitive decline with the Alabama Brief Cognitive Screener (ABCs). We used adjusted linear mixed models to estimate baseline cognition and rate of progression by cancer history, including differences by race. RESULTS The study included 3,809 participants with dementia, of which 672 (17.6%) had cancer history. Those with cancer history had higher baseline cognition (β: 0.62, 95% CI: -0.02-1.25), but similar rate of decline. Non-Hispanic Blacks had lower cognitive scores at baseline and throughout follow-up regardless of cancer status compared to non-Hispanic Whites and other races/ethnicities with and without cancer history. CONCLUSION In this longitudinal retrospective study, participants with cancer history demonstrate better cognition at dementia diagnosis and no difference in cognitive decline than those without cancer history. Smoking and comorbidities attenuate this association and results indicate non-Hispanic Blacks have worse cognitive outcomes in dementia regardless of cancer history than other race/ethnicity groups. Further exploration of the role of smoking, comorbidities, and race/ethnicity on cancer and dementia-related cognitive decline is needed.
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Affiliation(s)
- Mackenzie E Fowler
- Department of Epidemiology, University of Alabama, Birmingham, Birmingham, AL, USA
| | - Nicole C Wright
- Department of Epidemiology, University of Alabama, Birmingham, Birmingham, AL, USA
| | - Kristen Triebel
- Division of Neuropsychology, Department of Neurology, University of Alabama, Birmingham, Birmingham, AL, USA.,O'Neal Comprehensive Cancer Center, University of Alabama, Birmingham, Birmingham, AL, USA
| | - Gabrielle B Rocque
- O'Neal Comprehensive Cancer Center, University of Alabama, Birmingham, Birmingham, AL, USA.,Division of Hematology and Oncology, Department of Medicine, University of Alabama, Birmingham, Birmingham, AL, USA
| | - Ryan Irvin
- Department of Epidemiology, University of Alabama, Birmingham, Birmingham, AL, USA
| | - Richard E Kennedy
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama, Birmingham, Birmingham, AL, USA
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23
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Pilleron S, Alqurini N, Ferlay J, Haase KR, Hannan M, Janssen-Heijnen M, Kantilal K, Katanoda K, Kenis C, Lu-Yao G, Matsuda T, Navarrete E, Nikita N, Puts M, Strohschein FJ, Morris EJA. International trends in cancer incidence in middle-aged and older adults in 44 countries. J Geriatr Oncol 2022; 13:346-355. [PMID: 34866023 DOI: 10.1016/j.jgo.2021.11.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 08/24/2021] [Accepted: 11/22/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE We examine international incidence trends of lung, colorectal, prostate, and breast cancers, as well as all cancers combined excluding non-melanoma skin cancer (NMSC) in adults aged 50 and older, over a fifteen-year period using data from 113 high quality population-based cancer registries included in the Cancer in Five Continents (CI5) series and NORDCAN. MATERIALS AND METHODS We calculated annual incidence rates between 1998 and 2012 for ages 50-64, 65-74, and 75+, by sex and both sexes combined. We estimated average annual percentage change (AAPC) in rates using quasi-Poisson regression models. RESULTS From 1998 to 2012, incidence trends for all cancers (excluding NMSC) have increased in most countries across all age groups, with the greatest increase observed in adults aged 75+ in Ecuador (AAPC = +3%). Colorectal cancer incidence rates increased in the majority of countries, across all age groups. Lung cancer rates among females have increased but decreased for males. Prostate cancer rates have sharply increased in men aged 50-64 with AAPC between 5% and 15% in 24 countries, while decreasing in the 75+ age group in 21 countries, by up to -7% in Bahrain. Female breast cancer rates have increased across all age groups in most countries, especially in the 65-74 age group and in Asia with AAPC increasing to 7% in the Republic of Korea. CONCLUSIONS These findings assist with anticipating changing patterns and needs internationally. Due to the specific needs of older patients, it is urgent that cancer systems adapt to address their growing number.
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Affiliation(s)
- Sophie Pilleron
- Nuffield Department of Population Health, Big Data Institute, University of Oxford, Oxford, UK.
| | - Naser Alqurini
- Central Department of Primary Health Care, Geriatric Unit- Amiri Hospital, Ministry of Health, Kuwait City, Kuwait
| | - Jacques Ferlay
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Kristen R Haase
- Faculty of Applied Science, School of Nursing, University of British Columbia, Vancouver, BC, Canada.
| | - Michelle Hannan
- Department of Medical Oncology, University Hospital Waterford, Ireland.
| | - Maryska Janssen-Heijnen
- Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, the Netherlands; Department of Epidemiology, Maastricht University Medical Centre+, GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands.
| | - Kumud Kantilal
- School of Pharmacy, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK.
| | - Kota Katanoda
- Division of Cancer Statistics Integration, Center for Cancer Control and Information Services, National Cancer Center, Japan.
| | - Cindy Kenis
- Department of General Medical Oncology and Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven - University of Leuven, Leuven, Belgium.
| | - Grace Lu-Yao
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, USA; Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA; Division of International Collaborative Research, Center for Public Health Sciences, National Cancer Center, Japan.
| | - Tomohiro Matsuda
- Division of International Collaborative Research, Center for Public Health Sciences, National Cancer Center, Japan.
| | - Erna Navarrete
- Departamento de Terapia Ocupacional y Ciencia de la Ocupación, Facultad de Medicina, Universidad de Chile, Chile.
| | - Nikita Nikita
- Sidney Kimmel Cancer Center at Jefferson Health, Philadelphia, PA, USA
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto. Canada.
| | | | - Eva J A Morris
- Nuffield Department of Population Health, Big Data Institute, University of Oxford, Oxford, UK
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24
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Cognitive adverse effects of chemotherapy and immunotherapy: are interventions within reach? Nat Rev Neurol 2022; 18:173-185. [PMID: 35140379 DOI: 10.1038/s41582-021-00617-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2021] [Indexed: 02/06/2023]
Abstract
One in three people will be diagnosed with cancer during their lifetime. The community of cancer patients is growing, and several common cancers are becoming increasingly chronic; thus, cancer survivorship is an important part of health care. A large body of research indicates that cancer and cancer therapies are associated with cognitive impairment. This research has mainly concentrated on chemotherapy-associated cognitive impairment but, with the arrival of immunotherapies, the focus is expected to widen and the number of studies investigating the potential cognitive effects of these new therapies is rising. Meanwhile, patients with cognitive impairment and their healthcare providers are eagerly awaiting effective approaches to intervene against the cognitive effects of cancer treatment. In this Review, we take stock of the progress that has been made and discuss the steps that need to be taken to accelerate research into the biology underlying cognitive decline following chemotherapy and immunotherapy and to develop restorative and preventive interventions. We also provide recommendations to clinicians on how to best help patients who are currently experiencing cognitive impairment.
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25
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Miu DKY, Lam KY, Chan CO. Do Cognitively Impaired Elderly Patients with Cancer Respond Differently on Self-reported Symptom Scores? A 5-Year Retrospective Analysis. Indian J Palliat Care 2022; 28:167-173. [PMID: 35673685 PMCID: PMC9168287 DOI: 10.25259/ijpc_18_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 12/17/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: An increasing number of elderly subjects with cancer were admitted to the palliative care unit and they have suffered both distressing symptoms and cognitive impairment. We aim to identify the prevalence of cognitive impairment among elderly cancer patients receiving in-patient palliative care and to examine any difference between patients with cognitive impairment on self-reported symptoms. Materials and Methods: Subjects’ age ≥65 admitted to a palliative care unit from 01 September 2015 to 31 August 2020 was included in the study. Exclusion criteria were those with an impaired conscious state, severe cognitive impairment, or language problems that were non-communicable. Variables collected included baseline demographics, cancer diagnosis, cancer stage, mobility state using the modified Barthel index (mBI), and performance status as measured by the palliative performance scale. Cognitive impairment was defined by abbreviated mental test ≤6. Self-reported symptoms scales were measured by the Chinese version of MD Anderson Symptom Inventory and EORTC QLQ C-30 (European Organisation for Research and Treatment of Cancer, Quality of Life Core Questionnaire 30). Results: Nine hundred and ninety-one subjects with 1174 admissions were retrieved. Eight hundred and seventy-three admission episodes were included in this study. Three hundred and eight (35%) have cognitive impairment. Cognitively impaired subjects were older, showed worse physical function and performance status, and more often residing in old age homes. Independent predictors of cognitive impairment were age (OR 1.09), mBI (OR 0.96), chair/bed bound state (OR 1.79), and presence of brain metastasis (OR 2.63). They reported lower scores in pain (P < 0.001), distress (P < 0.001), sleep disturbance (P < 0.001) and nausea and vomiting (P = 0.012) in the self-reported symptoms scale. Conclusion: Elderly cancer patients with cognitive impairment were older with poorer performance status. They have reported a lower level of pain, distress, and sleep disturbance. Clinicians should be alerted to this phenomenon to tackle the unmet concomitant symptoms.
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Affiliation(s)
- Doris Ka Ying Miu
- Department of Rehabilitation and Extended Care, Wong Tai Sin Hospital, Hong Kong,
| | - Kai Yin Lam
- Department of Rehabilitation and Extended Care, Wong Tai Sin Hospital, Hong Kong,
| | - Chung On Chan
- Department of Rehabilitation and Extended Care, Wong Tai Sin Hospital, Hong Kong,
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26
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Zhang HX, Lin HH, Su D, Yang DC, Liu JY. Enzyme-Activated Multifunctional Prodrug Combining Site-Specific Chemotherapy with Light-Triggered Photodynamic Therapy. Mol Pharm 2022; 19:630-641. [PMID: 35034440 DOI: 10.1021/acs.molpharmaceut.1c00761] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Combination treatments are more effective than conventional monotherapy in combating cancer. Herein, a multifunctional prodrug BDP-L-CPT was rationally engineered and prepared by the conjugation of a boron dipyrromethene (BDP)-based photosensitizer (PS) to the active site of the chemotherapeutic drug camptothecin (CPT) via a phenyl benzoate group. After modification, the cytotoxicity of CPT was locked. Moreover, the fluorescence emission at 430 nm from the CPT component in the prodrug was substantially inhibited through the intramolecular fluorescence resonance energy transfer process. The phenyl benzoate linker in BDP-L-CPT could be selectively cleaved by exogenous carboxylesterase in phosphate-buffered saline solution and endogenous carboxylesterase overexpressed in cancer cells, which was followed by self-immolation to release free CPT. The drug release process could be monitored by the turn-on of CPT fluorescence in solution and cells. Owing to the combination of site-specific chemotherapy with light-driven photodynamic therapy, the IC50 values of the prodrug BDP-L-CPT against HepG2 human hepatocellular carcinoma and HeLa human cervical carcinoma cells were lower than those of the controls, BDP-COOH and CPT. The combined antitumor effects of the prodrug BDP-L-CPT were also observed in the mice bearing H22 tumors. Furthermore, BDP-L-CPT had a more prolonged blood circulation time in mice than CPT, which is beneficial to persistent therapy. This study may provide a promising strategy for a selective combination cancer treatment by conjugating a prodrug to a PS.
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Affiliation(s)
- Hong-Xia Zhang
- National & Local Joint Biomedical Engineering Research Center on Photodynamic Technologies, College of Chemistry, Fuzhou University, Fuzhou 350108, China
| | - Hao-Hua Lin
- National & Local Joint Biomedical Engineering Research Center on Photodynamic Technologies, College of Chemistry, Fuzhou University, Fuzhou 350108, China
| | - Dan Su
- Department of Medical Chemistry, XinYang Vocational and Technical College, Xinyang 464100, China
| | - De-Chao Yang
- National & Local Joint Biomedical Engineering Research Center on Photodynamic Technologies, College of Chemistry, Fuzhou University, Fuzhou 350108, China
| | - Jian-Yong Liu
- National & Local Joint Biomedical Engineering Research Center on Photodynamic Technologies, College of Chemistry, Fuzhou University, Fuzhou 350108, China.,Key Laboratory of Molecule Synthesis and Function Discovery, Fujian Province University, College of Chemistry, Fuzhou University, Fuzhou 350108, China.,State Key Laboratory of Photocatalysis on Energy and Environment, College of Chemistry, Fuzhou University, Fuzhou 350108, China
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27
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Machado PHA, Paixão DA, Lino RC, de Souza TR, de Souza Bontempo NJ, Sousa LM, Van Petten de Vasconcelos Azevedo F, Orsolin PC, Lima PMAP, Martins IC, da Costa Guerra JF, Teixeira SC, Araújo TG, Goulart LR, Morelli S, Guerra W, de Oliveira Júnior RJ. A selective Cu II complex with 4-fluorophenoxyacetic acid hydrazide and phenanthroline displays DNA-cleaving and pro-apoptotic properties in cancer cells. Sci Rep 2021; 11:24450. [PMID: 34961767 PMCID: PMC8712526 DOI: 10.1038/s41598-021-03909-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 12/10/2021] [Indexed: 12/30/2022] Open
Abstract
The thin line between efficacy and toxicity has challenged cancer therapy. As copper is an essential micronutrient and is important to tumor biology, CuII complexes emerged as an alternative to chemotherapy; however, its biological properties need to be better understood. Thus, we report in vitro the antitumor effects of two CuII complexes named [Cu(4-fh)(phen)(ClO4)2] (complex 1) and [Cu(4-nh)(phen)(ClO4)2]·H2O (complex 2), in which 4-fh = 4-fluorophenoxyacetic acid hydrazide; 4-nh = 4-nitrobenzoic hydrazide and phen = 1,10-phenanthroline. Both complexes presented cytotoxic activity against tumor cells, but only complex 1 showed significant selectivity. Complex 1 also induced DNA-damage, led to G0/G1 arrest and triggered apoptosis, which was initiated by an autophagy dysfunction. The significant in vitro selectivity and the action mechanism of complex 1 are noteworthy and reveal this prodrug as promising for anticancer therapy.
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Affiliation(s)
| | | | - Ricardo Campos Lino
- Instituto de Biotecnologia, Universidade Federal de Uberlândia, Uberlândia, MG, Brazil
| | | | | | - Luana Munique Sousa
- Instituto de Química, Universidade Federal de Uberlândia, Uberlândia, MG, Brazil
| | | | | | | | | | | | - Samuel Cota Teixeira
- Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia , Uberlândia, MG, Brazil.
| | | | - Luiz Ricardo Goulart
- Instituto de Biotecnologia, Universidade Federal de Uberlândia, Uberlândia, MG, Brazil
| | - Sandra Morelli
- Instituto de Biotecnologia, Universidade Federal de Uberlândia, Uberlândia, MG, Brazil
| | - Wendell Guerra
- Instituto de Química, Universidade Federal de Uberlândia, Uberlândia, MG, Brazil
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28
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Abstract
OBJECTIVES To provide an overview on the role of family caregivers (FCGs) in the care of older adults with cancer and review quality of life needs for FCGs. DATA SOURCES Journal articles, research reports, state of the science papers, position papers, and clinical guidelines from professional organizations were used. CONCLUSION The high prevalence of multiple comorbidities and the associated burden of geriatric events in older adults have a substantial impact on the quality of life of their FCGs. Practical and efficient models of comprehensive assessment, interventions, and caregiving preparedness support are needed to improve outcomes for both older adults with cancer and their FCGs. IMPLICATIONS FOR NURSING PRACTICE Oncology nurses practicing in clinical and research settings have a responsibility to prepare themselves with evidence-based knowledge and resources to include the needs of FCGs in the care provided to older adults with cancer.
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29
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Fowler ME, Marotta DA, Kennedy RE, Gerstenecker A, Gammon M, Triebel K. Reliability of self-report versus the capacity to consent to treatment instrument to make medical decisions in brain metastasis and other metastatic cancers. Brain Behav 2021; 11:e2303. [PMID: 34599852 PMCID: PMC8613414 DOI: 10.1002/brb3.2303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/25/2021] [Accepted: 07/12/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To evaluate the ability of persons with metastatic cancer to self-assess their medical decision-making capacity (MDC). To investigate this, we compared an objective measure of MDC with self-ratings and evaluated predictors of agreement. METHODS Data were obtained from a cross-sectional study of metastatic cancer patients at a large academic medical center. Across all standards of MDC, sensitivity, specificity, and reliability using Gwet's AC1 statistic were calculated using the objective measure as the gold standard. Logistic regression was used to evaluate predictors of agreement between the measures across all MDC standards. RESULTS In those with brain metastases, high sensitivity (greater than 0.7), but low specificity was observed for all standards. Poor reliability was observed across all standards. Higher age resulted in higher odds of disagreement for Standard 3 (appreciation) (OR: 1.07, 95% CI: 1.00, 1.15) and Standard 4 (reasoning) (OR: 1.05, 95% CI: 1.00, 1.10). For Standard 3, chemotherapy use and brain metastases compared to other metastases resulted in higher odds of disagreement (Chemotherapy: OR: 5.62, 95% CI: 1.37, 23.09, Brain Metastases: OR: 5.93, 95% CI: 1.28, 27.55). For Standard 5 (understanding), no predictors were associated with disagreement. CONCLUSIONS For less cognitively complex standards (e.g., appreciation), self-report may be more valid and reliable than more cognitively complex standards (e.g., reasoning or understanding). However, overall, MDC self-report in the current sample is suboptimal. Thus, the need for detailed assessment of MDC, especially when patients are older or used chemotherapy, is indicated. Other studies should be conducted to assess MDC agreement longitudinally.
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Affiliation(s)
- Mackenzie E Fowler
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Dario A Marotta
- Division of Neuropsychology, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA.,Alabama College of Osteopathic Medicine, Dothan, Alabama, USA
| | - Richard E Kennedy
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Adam Gerstenecker
- Division of Neuropsychology, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Meredith Gammon
- Division of Neuropsychology, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kristen Triebel
- Division of Neuropsychology, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA.,O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
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30
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Ibrahim SS, Abo Elseoud OG, Mohamedy MH, Amer MM, Mohamed YY, Elmansy SA, Kadry MM, Attia AA, Fanous RA, Kamel MS, Solyman YA, Shehata MS, George MY. Nose-to-brain delivery of chrysin transfersomal and composite vesicles in doxorubicin-induced cognitive impairment in rats: Insights on formulation, oxidative stress and TLR4/NF-kB/NLRP3 pathways. Neuropharmacology 2021; 197:108738. [PMID: 34339751 DOI: 10.1016/j.neuropharm.2021.108738] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 12/12/2022]
Abstract
Many cancer survivors suffer from chemotherapy-induced cognitive impairment known as 'Chemobrain'. Doxorubicin -topoisomerase II inhibitor- is widely used in breast cancer, hematological cancers and other neoplasms. However, it is reported to precipitate cognitive impairment in cancer patients via inducing oxidative stress and inflammatory response. Chrysin -5,7 dihydroxyflavone- has promising antioxidant, anti-inflammatory and anticancer properties, but suffers low bioavailability owing to its poor solubility and extensive metabolism. In the present study, chrysin was successfully formulated as transfersomal lipid vesicles and chitosan composite vesicles (CCV) exhibiting a nanometric size range, high drug entrapment efficiency, and controlled release over a 72h period. Intranasal administration of optimized chrysin formulations at a reduced dose of 0.5 mg/kg improved doxorubicin-induced memory impairment in rats evidenced by behavioral testing, inhibition of acetylcholinesterase activity and oxidative stress markers; catalase, reduced glutathione, lipid peroxidation and hydrogen peroxide. This could reduce caspase-3 expression inhibiting apoptosis. Moreover, chrysin formulations were able to inhibit doxorubicin-induced Tol-like receptor 4 (TLR4) and p65 subunit of nuclear factor kappa-light-chain-enhancer of activated B cells (NF-kB) protein expression which in turn, reduced procaspase-1, Cysteinyl Aspartate Protease-1 (caspase-1) and Interleukin-1β (IL-1β) protein expression via inhibiting Nod-like receptor pyrin containing 3 (NLRP3) inflammasome. Collectively, our findings suggest the enhanced therapeutic potential of chrysin when formulated as transfersomes and CCV against chemotherapy-induced chemobrain via hindering acetylcholinesterase, oxidative stress and TLR4-NF-kB(p65)-NLRP3 pathways.
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Affiliation(s)
- Shaimaa S Ibrahim
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Ain Shams University, 11566, Cairo, Egypt
| | - Omar G Abo Elseoud
- Drug Design Program, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Mohamed H Mohamedy
- Drug Design Program, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Mohamed M Amer
- Drug Design Program, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Youssef Y Mohamed
- Drug Design Program, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Shehab A Elmansy
- Drug Design Program, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Mohamed M Kadry
- Drug Design Program, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Ahmed A Attia
- Drug Design Program, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Ragy A Fanous
- Drug Design Program, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Mahmoud S Kamel
- Drug Design Program, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Youssef A Solyman
- Drug Design Program, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Mazen S Shehata
- Drug Design Program, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Mina Y George
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Ain Shams University, 11566, Cairo, Egypt.
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31
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Dotan E, Walter LC, Browner IS, Clifton K, Cohen HJ, Extermann M, Gross C, Gupta S, Hollis G, Hubbard J, Jagsi R, Keating NL, Kessler E, Koll T, Korc-Grodzicki B, McKoy JM, Misra S, Moon D, O'Connor T, Owusu C, Rosko A, Russell M, Sedrak M, Siddiqui F, Stella A, Stirewalt DL, Subbiah IM, Tew WP, Williams GR, Hollinger L, George GV, Sundar H. NCCN Guidelines® Insights: Older Adult Oncology, Version 1.2021. J Natl Compr Canc Netw 2021; 19:1006-1019. [PMID: 34551388 DOI: 10.6004/jnccn.2021.0043] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The NCCN Guidelines for Older Adult Oncology address specific issues related to the management of cancer in older adults, including screening and comprehensive geriatric assessment (CGA), assessing the risks and benefits of treatment, preventing or decreasing complications from therapy, and managing patients deemed to be at high risk for treatment-related toxicity. CGA is a multidisciplinary, in-depth evaluation that assesses the objective health of the older adult while evaluating multiple domains, which may affect cancer prognosis and treatment choices. These NCCN Guidelines Insights focus on recent updates to the NCCN Guidelines providing specific practical framework for the use of CGA when evaluating older adults with cancer.
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Affiliation(s)
| | | | - Ilene S Browner
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | - Katherine Clifton
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | - Cary Gross
- Yale Cancer Center/Smilow Cancer Hospital
| | - Sumati Gupta
- Huntsman Cancer Institute at the University of Utah
| | | | | | | | | | | | | | | | - June M McKoy
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | - Dominic Moon
- UT Southwestern Simmons Comprehensive Cancer Center
| | | | - Cynthia Owusu
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Ashley Rosko
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | | | - Amy Stella
- University of Wisconsin Carbone Cancer Center
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Kumar G, Dutta P, Parihar VK, Chamallamudi MR, Kumar N. Radiotherapy and Its Impact on the Nervous System of Cancer Survivors. CNS & NEUROLOGICAL DISORDERS-DRUG TARGETS 2021; 19:374-385. [PMID: 32640964 DOI: 10.2174/1871527319666200708125741] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 05/07/2020] [Accepted: 05/10/2020] [Indexed: 12/12/2022]
Abstract
Radiotherapy is routinely used for the treatment of nearly all brain tumors, but it may lead to progressive and debilitating impairments of cognitive function. The growing evidence supports the fact that radiation exposure to CNS disrupts diverse cognitive functions including learning, memory, processing speed, attention and executive functions. The present review highlights the types of radiotherapy and the possible mechanisms of cognitive deficits and neurotoxicity following radiotherapy. The review summarizes the articles from Scopus, PubMed, and Web of science search engines. Radiation therapy uses high-powered x-rays, particles, or radioactive seeds to kill cancer cells, with minimal damage to healthy cells. While radiotherapy has yielded relative success in the treatment of cancer, patients are often plagued with unwanted and even debilitating side effects from the treatment, which can lead to dose reduction or even cessation of treatment. Little is known about the underlying mechanisms responsible for the development of these behavioral toxicities; however, neuroinflammation is widely considered as one of the major mechanisms responsible for radiotherapy-induced toxicities. The present study reviews the different types of radiotherapy available for the treatment of various types of cancers and their associated neurological complications. It also summarizes the doses of radiations used in the variety of radiotherapy, and their early and delayed side effects. Special emphasis is given to the effects of various types of radiations or late side effects on cognitive impairments.
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Affiliation(s)
- Gautam Kumar
- Department of Pharmacology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal-576104, Karnataka, India
| | - Priyadarshini Dutta
- Department of Pharmacology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal-576104, Karnataka, India
| | - Vipan K Parihar
- Department of Radiation Oncology, University of California, Irvine, CA 92697- 2695, United States
| | - Mallikarjuna R Chamallamudi
- Department of Pharmacology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal-576104, Karnataka, India
| | - Nitesh Kumar
- Department of Pharmacology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal-576104, Karnataka, India
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Pilleron S, Maringe C, Charvat H, Atkinson J, Morris EJA, Sarfati D. The impact of timely cancer diagnosis on age disparities in colon cancer survival. J Geriatr Oncol 2021; 12:1044-1051. [PMID: 33863698 DOI: 10.1016/j.jgo.2021.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/01/2021] [Accepted: 04/07/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE We described the role of patient-related and clinical factors on age disparities in colon cancer survival among patients aged 50-99 using New Zealand population-based cancer registry data linked to hospitalisation data. METHOD We included 21,270 new colon cancer cases diagnosed between 1 January 2006 and 31 July 2017, followed up to end 2019. We modelled the effect of age at diagnosis, sex, ethnicity, deprivation, comorbidity, and emergency presentation on colon cancer survival by stage at diagnosis using flexible excess hazard regression models. RESULTS The excess mortality in older patients was minimal for localised cancers, maximal during the first six months for regional cancers, the first eighteen months for distant cancers, and over the three years for missing stages. The age pattern of the excess mortality hazard varied according to sex for distant cancers, emergency presentation for regional and distant cancers, and comorbidity for cancer with missing stages. Ethnicity and deprivation did not influence age disparities in colon cancer survival. CONCLUSION Factors reflecting timeliness of cancer diagnosis most affected age-related disparities in colon cancer survival, probably by impacting treatment strategy. Because of the high risk of poor outcomes related to treatment in older patients, efforts made to improve earlier diagnosis in older patients are likely to help reduce age disparities in colon cancer survival in New Zealand.
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Affiliation(s)
- Sophie Pilleron
- Dept of Public Health, School of medicine, University of Otago, Wellington, New Zealand; Nuffield Department of Population Health, University of Oxford, Big Data Institute, Old Road Campus, Oxford OX3 7LF, UK.
| | - Camille Maringe
- Inequalities in Cancer Outcomes Network, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Hadrien Charvat
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - June Atkinson
- Dept of Public Health, School of medicine, University of Otago, Wellington, New Zealand
| | - Eva J A Morris
- Nuffield Department of Population Health, University of Oxford, Big Data Institute, Old Road Campus, Oxford OX3 7LF, UK
| | - Diana Sarfati
- Dept of Public Health, School of medicine, University of Otago, Wellington, New Zealand
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Subjective cognition and mood in persistent chemotherapy-related cognitive impairment. J Cancer Surviv 2021; 16:614-623. [PMID: 33973154 DOI: 10.1007/s11764-021-01055-1] [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: 01/13/2021] [Accepted: 04/30/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Persistent chemotherapy-related cognitive impairment (CRCI) is commonly reported following cancer treatment and negatively affects quality of life. While past research has focused on potential pathophysiological mechanisms underlying this relationship, the role of psychological factors, such as mood, stress, and anxiety, in the development of persistent CRCI has received less attention. As an additional analysis of data from a trial investigating the effects of transdermal nicotine patches on cognitive performance in patients with persistent CRCI, we examined whether change in mood was associated with changes in subjective and objective cognitive functioning. METHODS Participants were randomized to either placebo (n = 11) or transdermal nicotine (n = 11) for 6 weeks, followed by 2 weeks of treatment withdrawal for a total of 8 weeks. Participants were assessed using behavioral, subjective, and objective measures of cognitive functioning and mood at five visits before, during, and after treatment. RESULTS Although we did not detect an effect of treatment assignment on mood, over the course of the study, we observed a significant improvement on measures of mood that correlated with improvement in subjective and objective cognitive performance. CONCLUSIONS We observed improvement in objective and subjective cognitive performance measures. These changes were associated with improvement in subsyndromal mood symptoms, likely resulting from participation in the trial itself. IMPLICATIONS FOR CANCER SURVIVORS These results suggest that women with persistent CRCI may benefit from support and validation of their cognitive complaints, cognitive rehabilitation/therapies into their post-cancer care. TRIAL REGISTRATION The study was registered with clinicaltrials.gov (trial registration: NCT02312943).
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Hwang SY, Kim K, Ha B, Lee D, Kim S, Ryu S, Yang J, Jung SJ. Neurocognitive Effects of Chemotherapy for Colorectal Cancer: A Systematic Review and a Meta-Analysis of 11 Studies. Cancer Res Treat 2021; 53:1134-1147. [PMID: 33735557 PMCID: PMC8524021 DOI: 10.4143/crt.2020.1191] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/16/2021] [Indexed: 12/09/2022] Open
Abstract
Purpose Chemotherapy-related cognitive impairment (CRCI) is a controversial concept not much explored on colorectal cancer patients. Materials and Methods We identified 11 prospective studies: eight studies on 696 colorectal cancer patients who received chemotherapy and three studies on 346 rectal cancer patients who received neoadjuvant chemoradiotherapy. Standardized mean differences (SMDs) of neuropsychological test results and the cognitive quality-of-life scale were calculated using random effect models. A meta-regression was conducted to investigate the association between mean study population age and effect sizes. Results The association between chemotherapy and cognitive impairment was not clear in colorectal cancer patients (SMD, 0.003; 95% confidence interval, −0.080 to 0.086). However, a meta-regression showed that older patients are more vulnerable to CRCI than younger patients (β=–0.016, p < 0.001). Conclusion Chemotherapy has an overall positive negligible effect size on the cognitive function of colorectal patients. Age is a significant moderator of CRCI.
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Affiliation(s)
| | - Kwanghyun Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | | | - Dongkyu Lee
- Yonsei University College of Medicine, Seoul, Korea
| | - Seonung Kim
- Yonsei University College of Medicine, Seoul, Korea
| | - Seongjun Ryu
- Yonsei University College of Medicine, Seoul, Korea
| | - Jisu Yang
- Department of Public Health, Yonsei University, Seoul, Korea
| | - Sun Jae Jung
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.,Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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Reese JB, Sorice KA, Zimmaro LA, Lepore SJ, Beach MC. Communication about Sexual Health in Breast Cancer: What Can We Learn from Patients' Self-Report and Clinic Dialogue? PATIENT EDUCATION AND COUNSELING 2020; 103:1821-1829. [PMID: 32349896 PMCID: PMC7423724 DOI: 10.1016/j.pec.2020.03.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 03/13/2020] [Accepted: 03/31/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Research assessing clinical communication about sexual health is limited. We compared clinical communication about sexual health across patients' self-reports and coded dialogue in breast cancer outpatients. METHODS 134 patients had clinic visits audio-recorded and coded for sexual health communication and completed self-report questionnaires immediately after the visit. Associations between the self-report and dialogue were assessed using Phi coefficient. Agreements (present/absent) and discrepancies (omissions, commissions) about discussed topics were classified and discrepancies analyzed for themes. RESULTS Sexual health was discussed in 61 of 134 patient visits (46%). Associations were significant (p < .01) but differed by topic (φ = .27-.76). 37 women (23%) had ≥ 1 self-report error. Discrepancies were common (19 omissions, 29 commissions). Patients often omitted communication about sexual concerns when such concerns were not problematic, and interpreted non-specific discussions as including specific topics of concern, even when not explicitly stated. Omissions were more common for women with lower education. CONCLUSIONS Patients' reports of whether sexual health communication occurs does not always align with observed dialogue, and may vary by personal relevance of the topic. PRACTICE IMPLICATIONS There are limitations in determining the prevalence of clinical communication about sexual health through patient self-report. Explaining sexual health terms might enhance shared understanding.
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Affiliation(s)
- Jennifer Barsky Reese
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, USA; Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, USA.
| | - Kristen A Sorice
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Lauren A Zimmaro
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Stephen J Lepore
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, USA; Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, USA
| | - Mary Catherine Beach
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
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Rogers KA, Huang Y, Ruppert AS, Abruzzo LV, Andersen BL, Awan FT, Bhat SA, Dean A, Lucas M, Banks C, Grantier C, Heerema NA, Lozanski G, Maddocks KJ, Valentine TR, Weiss DM, Jones JA, Woyach JA, Byrd JC. Phase II Study of Combination Obinutuzumab, Ibrutinib, and Venetoclax in Treatment-Naïve and Relapsed or Refractory Chronic Lymphocytic Leukemia. J Clin Oncol 2020; 38:3626-3637. [PMID: 32795224 DOI: 10.1200/jco.20.00491] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE The development of highly effective targeted agents for chronic lymphocytic leukemia offers the potential for fixed-duration combinations that achieve deep remissions without cytotoxic chemotherapy. PATIENTS AND METHODS This phase II study tested a combination regimen of obinutuzumab, ibrutinib, and venetoclax for a total of 14 cycles in both patients with treatment-naïve (n = 25) and relapsed or refractory (n = 25) chronic lymphocytic leukemia to determine the response to therapy and safety. RESULTS The primary end point was the rate of complete remission with undetectable minimal residual disease by flow cytometry in both the blood and bone marrow 2 months after completion of treatment, which was 28% in both groups. The overall response rate at that time was 84% in treatment-naïve patients and 88% in relapsed or refractory patients. At that time, 67% of treatment-naïve patients and 50% of relapsed or refractory patients had undetectable minimal residual disease in both the blood and marrow. At a median follow-up of 24.2 months in treatment-naïve patients and 21.5 months in relapsed or refractory patients, the median progression-free and overall survival times were not yet reached, with only 1 patient experiencing progression and 1 death. Neutropenia and thrombocytopenia were the most frequent adverse events, followed by hypertension. Grade 3 or 4 neutropenia was experienced by 66% of patients, with more events in the relapsed or refractory cohort. There was only 1 episode of neutropenic fever. A favorable impact on both perceived and objective cognitive performance during treatment was observed. CONCLUSION The combination regimen of obinutuzumab, ibrutinib, and venetoclax offers time-limited treatment that results in deep remissions and is now being studied in phase III cooperative group trials.
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Affiliation(s)
- Kerry A Rogers
- Division of Hematology, The Ohio State University, Columbus, OH.,The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Ying Huang
- Division of Hematology, The Ohio State University, Columbus, OH
| | - Amy S Ruppert
- Division of Hematology, The Ohio State University, Columbus, OH
| | - Lynne V Abruzzo
- Department of Pathology, The Ohio State University, Columbus, OH
| | | | - Farrukh T Awan
- Division of Hematology, The Ohio State University, Columbus, OH
| | - Seema A Bhat
- Division of Hematology, The Ohio State University, Columbus, OH
| | - Allison Dean
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Margaret Lucas
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Christin Banks
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Cara Grantier
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Nyla A Heerema
- Department of Pathology, The Ohio State University, Columbus, OH
| | - Gerard Lozanski
- Department of Pathology, The Ohio State University, Columbus, OH
| | - Kami J Maddocks
- Division of Hematology, The Ohio State University, Columbus, OH
| | | | - David M Weiss
- Department of Psychology, The Ohio State University, Columbus, OH
| | - Jeffrey A Jones
- Division of Hematology, The Ohio State University, Columbus, OH
| | - Jennifer A Woyach
- Division of Hematology, The Ohio State University, Columbus, OH.,The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - John C Byrd
- Division of Hematology, The Ohio State University, Columbus, OH.,The Ohio State University Comprehensive Cancer Center, Columbus, OH
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Ekström MP, Palmqvist S, Currow DC, Sjøgren P, Kurita GP, Jakobsen G, Kaasa S, Hjermstad M. Mild to Moderate Cognitive Impairment Does Not Affect the Ability to Self-Report Important Symptoms in Patients With Cancer: A Prospective Longitudinal Multinational Study (EPCCS). J Pain Symptom Manage 2020; 60:346-354.e2. [PMID: 32179133 DOI: 10.1016/j.jpainsymman.2020.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 03/04/2020] [Accepted: 03/06/2020] [Indexed: 11/29/2022]
Abstract
CONTEXT Patients with advanced cancer commonly suffer from both distressing symptoms and cognitive impairment, but the effect of cognitive impairment on the reliability and validity of symptom self-report is unknown. OBJECTIVES To evaluate the reliability and validity of symptom self-report in cancer outpatients with and without mild to moderate cognitive impairment. METHODS This was an analysis of the longitudinal European Palliative Care Cancer Symptom study of adults with incurable cancer in specialized palliative care (30 centers across 12 countries). Patients who could not comply with the study because of severe cognitive impairment were excluded. Cognitive status on the Mini-Mental State Examination short version and nine symptoms (pain, tiredness, drowsiness, nausea, appetite, breathlessness, depression, anxiety, and well-being) using the revised Edmonton Symptom Assessment System were self-reported at baseline and one-month follow-up. Reliability was analyzed using intraclass correlation coefficients and validity using regression of each symptom with health-related quality of life (HrQoL) measured with European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 for Palliative Care. RESULTS A total of 1047 patients were included: mean age of 62.9 years; 54.4% women; main cancer types were of digestive organs (26.6%), breast (21.6%), and lungs (21.2%). Cognitive impairment was present in 181 (17.3%) at baseline and associated with worse self-reported tiredness, drowsiness, appetite, and depression. Reliability (intraclass correlation coefficient) and validity (associations with HrQoL) were similar between people with/without cognitive impairment across the nine symptoms, except breathlessness, which showed a weaker relation to HrQoL in patients with cognitive impairment. Findings were robust in sensitivity analyses and after controlling for potential confounders. CONCLUSION In advanced cancer, self-report of nine major symptoms was reliable and valid also in people with mild-to-moderate cognitive impairment. TRIAL REGISTRATION ClinicalTrials.gov database (NCT01362816).
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Affiliation(s)
- Magnus P Ekström
- Division of Respiratory Medicine and Allergology, Department of Clinical Sciences, Lund University, Lund, Sweden.
| | - Sebastian Palmqvist
- Department of Clinical Sciences in Malmö, Clinical Memory Research Unit, Lund University, Lund, Sweden; Department of Neurology, Skåne University Hospital, Lund, Sweden
| | - David C Currow
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Per Sjøgren
- Section of Palliative Medicine, Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Geana P Kurita
- Department of Oncology, Palliative Research Group, Rigshospitalet Copenhagen University Hospital, Rigshospitalet, Denmark; Department of Neuroanaesthesiology, Multidisciplinary Pain Centre, Rigshospitalet Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Gunnhild Jakobsen
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology and Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Stein Kaasa
- Department of Cancer Research and Molecular Medicine, European Palliative Care Research Centre (PRC), Faculty of Medicine, Norwegian University of Science and Technology (NTNU) and St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Marianne Hjermstad
- Department of Oncology, Regional Centre for Excellence in Palliative Care, Oslo University Hospital, Oslo, Norway; Department of Oncology, European Palliative Care Research Centre, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Root JC, Campbell C, Rocha-Cadman X, Kasven-Gonzalez N, Maloy M, Flynn J, Devlin SM, Jakubowski AA. Pretransplantation Cognitive Dysfunction in Advanced-Age Hematologic Cancers: Predictors and Associated Outcomes. Biol Blood Marrow Transplant 2020; 26:1497-1504. [PMID: 32447045 DOI: 10.1016/j.bbmt.2020.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/11/2020] [Accepted: 05/13/2020] [Indexed: 11/28/2022]
Abstract
Patients presenting for treatment of hematologic cancers may be at increased risk for cognitive dysfunction before allogeneic hematopoietic stem cell transplantation (HSCT) due to advanced age, previous chemotherapy treatment, deconditioning, and fatigue. Cognitive dysfunction may affect treatment decision making, ability to recall or follow post-HSCT treatment recommendations and overall survival (OS). A total of 448 patients admitted for HSCT between 2011 and 2014 were administered the Montreal Cognitive Assessment (MoCA) by occupational therapists during admission before transplantation, and 260 were reassessed following transplantation and before discharge. We examined select predictor variables, including age, Karnofsky Performance Status, sex, disease type, psychotropic medications, and select outcome variables, including OS, and nonrelapse mortality (NRM). Before transplantation, 36.4% of patients met criteria for cognitive dysfunction. Age was found to be a significant predictor, along with disease type (myelodysplastic syndrome [MDS], myeloproliferative disorder [MPD]). No significant association was found between cognitive dysfunction and OS or NRM. Longitudinal analysis from pretransplantation to post-transplantation indicated significant decline following HSCT. Notably, one-third of the study cohort showed cognitive dysfunction at hospital discharge. A significant proportion of HSCT candidates present with cognitive dysfunction, with older patients and those diagnosed with MDS and MPD at greatest risk in this cohort. Attention to cognitive dysfunction before transplantation may alert the treatment team to high-risk cases that require increased oversight, inclusion by caregivers, and referral to occupational therapy at discharge. Longitudinal follow-up studies are needed to clarify the specific effect of HSCT on cognitive dysfunction and the impact of cognitive dysfunction on transplantation outcomes.
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Affiliation(s)
- James C Root
- Department of Psychiatry and Behavioral Sciences, Weill Cornell Medical College, New York, New York.
| | - Claudine Campbell
- Department of Neurology, Weill Cornell Medical College, New York, New York
| | | | | | - Molly Maloy
- Health Informatics, Weill Cornell Medical College, New York, New York
| | - Jessica Flynn
- Department of Epidemiology and Biostatistics, Weill Cornell Medical College, New York, New York
| | - Sean M Devlin
- Department of Epidemiology and Biostatistics, Weill Cornell Medical College, New York, New York
| | - Ann A Jakubowski
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, New York, New York
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Utilizing Melatonin to Alleviate Side Effects of Chemotherapy: A Potentially Good Partner for Treating Cancer with Ageing. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2020; 2020:6841581. [PMID: 32566095 PMCID: PMC7260648 DOI: 10.1155/2020/6841581] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/14/2019] [Accepted: 05/27/2019] [Indexed: 02/07/2023]
Abstract
Persistent senescence seems to exert detrimental effects fostering ageing and age-related disorders, such as cancer. Chemotherapy is one of the most valuable treatments for cancer, but its clinical application is limited due to adverse side effects. Melatonin is a potent antioxidant and antiageing molecule, is nontoxic, and enhances the efficacy and reduces the side effects of chemotherapy. In this review, we first summarize the mitochondrial protective role of melatonin in the context of chemotherapeutic drug-induced toxicity. Thereafter, we tabulate the protective actions of melatonin against ageing and the harmful roles induced by chemotherapy and chemotherapeutic agents, including anthracyclines, alkylating agents, platinum, antimetabolites, mitotic inhibitors, and molecular-targeted agents. Finally, we discuss several novel directions for future research in this area. The information compiled in this review will provide a comprehensive reference for the protective activities of melatonin in the context of chemotherapy drug-induced toxicity and will contribute to the design of future studies and increase the potential of melatonin as a therapeutic agent.
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Systematic review of cognitive sequelae of non-central nervous system cancer and cancer therapy. J Cancer Surviv 2020; 14:464-482. [PMID: 32146576 DOI: 10.1007/s11764-020-00870-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 02/22/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The aim of this review is to provide an updated overview of chemotherapy-related cognitive impairment (CRCI) in patients with cancer outside central nervous system (CNS), its incidence and prevalence, the cognitive pattern in neuropsychological studies, neuroimaging findings, and the relationship between chemobrain and aging. Methodological limitations of studies are also discussed. METHODS This review was guided by the PRISMA statement. The MEDLINE and Scopus databases were employed to search articles about CRCI in non-CNS cancer patients published from January 2004 to September 2019. Two types of research were reviewed: prospective studies addressing the effects of chemotherapy on cognition and systematic reviews about factors related with CRCI, also as neuroimaging findings and current available treatments. RESULTS Fifty-nine studies meeting the criteria were analyzed: 47 were longitudinal studies on cancer and cognition and 12 were reviews on risk factors, neuroimaging, and treatment. The majority of studies find cognitive impairment in patients with cancer treated with chemotherapy. The body of the literature on breast cancer is the most abundant, but there are also studies on colorectal, testicular, and lung cancer. Neuroimaging studies show changes in structure and activation in patients undergoing chemotherapy. Non-pharmacological treatment is effective for improving cognition and quality of life. CONCLUSIONS The occurrence of CRCI during the course of treatment in people with different types of cancer is frequent. Some risk factors have been identified, but CRCI is a complex phenomenon, with mediating factors related to cancer and treatment and moderating factors related with lifestyle and health. IMPLICATIONS FOR CANCER SURVIVORS This review highlights the importance of recognizing that this cognitive dysfunction is frequent, mild to moderate in nature but with great impact on quality of life.
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La Carpia D, Liperoti R, Guglielmo M, Di Capua B, Devizzi LF, Matteucci P, Farina L, Fusco D, Colloca G, Di Pede P, Ferrara ML, Hohaus S, Bernabei R, Ripamonti CI. Cognitive decline in older long-term survivors from Non-Hodgkin Lymphoma: a multicenter cross-sectional study. J Geriatr Oncol 2020; 11:790-795. [PMID: 32008957 DOI: 10.1016/j.jgo.2020.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 06/12/2019] [Accepted: 01/08/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To compare cognition in a group of older long-term survivors from Non-Hodgkin Lymphoma (NHL) and in a corresponding group of non-cancer controls of the same age. Functional status, polypharmacy and multimorbidity were also evaluated. METHODS A cross-sectional study was performed in a population of 63 outpatient long-term survivors from NHL, aged 65 or more and 61 non-cancer controls. Socio-demographic, clinical and functional data were collected. Cognitive function was assessed through neuropsychological tests. RESULTS NHL survivors showed a slightly worse functional status than controls, they were affected by more chronic conditions (3.4 vs 2.3; p = .003) and were taking a higher number of medications (3.4 vs 2.3; p = .03). The Mini Mental State Examination (MMSE) was not significantly different between the groups. NHL survivors performed worse than controls in executive functioning (Trail Making Test B-A 47.9 vs 32.1 p = .04, OR for Stroop test time over 75th percentile in survivors: 2.66; CI 95% 1.04-6.61; OR for Multiple Features Target Cancellation time over 75th percentile in survivors: 2.84; CI 95% 1.10-7.31). A small, statistically significant difference was also observed in verbal memory scores between the two groups. . CONCLUSIONS The findings of this study suggest that, compared with non-cancer controls, older survivors from NHL may have a lower cognitive performance, especially in the executive functioning and attention domains, regardless of multimorbidity and polypharmacy. Further evidence from larger samples is needed to confirm such findings and better characterize cognitive decline in NHL survivors.
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Affiliation(s)
| | - Rosa Liperoti
- Department of Geriatrics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mauro Guglielmo
- Oncology-Supportive Care Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | - Beatrice Di Capua
- Department of Geriatrics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Paola Matteucci
- Haematology Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | - Lucia Farina
- Haematology Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | - Domenico Fusco
- Department of Geriatrics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppe Colloca
- Radiation Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Patricia Di Pede
- Oncology-Supportive Care Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Stephan Hohaus
- Haematology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Roberto Bernabei
- Department of Geriatrics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carla Ida Ripamonti
- Oncology-Supportive Care Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
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44
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Bohn L, McFall GP, Wiebe SA, Dixon RA. Body mass index predicts cognitive aging trajectories selectively for females: Evidence from the Victoria Longitudinal Study. Neuropsychology 2020; 34:388-403. [PMID: 31999164 DOI: 10.1037/neu0000617] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Elevated body weight in midlife is an established risk factor for accelerated cognitive decline, impairment, and dementia. Research examining the impact of later-life body mass index (BMI) on normal cognitive aging has produced mixed results. There is a need for longitudinal designs, replication across multiple cognitive domains, and consideration of BMI effects in the context of important moderators. The present research examined (a) BMI prediction of neuropsychological performance and decline in executive function (EF), neurocognitive speed, and memory and (b) sex stratification of BMI effects. METHOD Participants (n = 869; 573 females; M age = 71.75, range = 53-85 years) were older adults from the Victoria Longitudinal Study. Latent growth modeling was used to examine BMI as a predictor of level and change in three latent variables of cognition. The data were then stratified by sex to test whether BMI effects differed for females and males. We adjusted for selected medical, psychosocial, and demographic characteristics. RESULTS Higher BMI predicted less decline in EF, neurocognitive speed, and memory. Interestingly, when the data were stratified by sex, higher BMI predicted less neuropsychological decline across domains for females only. BMI was unrelated to cognitive aging trajectories for males. CONCLUSIONS We found that elevated BMI was a risk-reducing factor for cognitive decline only for females. Results may be used to enhance the precision with which intervention protocols may target specific subgroups of older adults. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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45
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Jen WP, Chen HM, Lin YS, Chern Y, Lee YC. Twist1 Plays an Anti-apoptotic Role in Mutant Huntingtin Expression Striatal Progenitor Cells. Mol Neurobiol 2019; 57:1688-1703. [PMID: 31813126 DOI: 10.1007/s12035-019-01836-x] [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: 07/28/2019] [Accepted: 11/12/2019] [Indexed: 10/25/2022]
Abstract
The Twist basic helix-loop-helix transcription factor 1 (Twist1) has been implicated in embryogenesis and carcinogenesis, due to its effects on cell proliferation and anti-apoptosis signaling. Interestingly, a connection between Twist1 and neurotoxicity was recently made in mutant huntingtin (mHtt)-expressing primary cortical neurons; however, the role of Twist1 in Huntington's disease (HD)-affected striatal neurons remains undescribed. In this study, we evaluated the expression and function of Twist1 in the R6/2 HD mouse model, which expresses the polyQ-expanded N-terminal portion of human HTT protein, and a pair of striatal progenitor cell lines (STHdhQ109 and STHdhQ7), which express polyQ-expanded or non-expanded full-length mouse Htt. We further probed upstream signaling events and Twist1 anti-apoptotic function in the striatal progenitor cell lines. Twist1 was increased in mHtt-expressing striatal progenitor cells (STHdhQ109) and was correlated with disease progression in striatum and cortex brain regions of R6/2 mice. In the cell model, downregulation of Twist1 induced death of STHdhQ109 cells but had no effect on wild-type striatal progenitor cells (STHdhQ7). Twist1 knockdown stimulated caspase-3 activation and apoptosis. Furthermore, we found that signal transducer and activator of transcription 3 (STAT3) were increased in HD striatal progenitor cells and acted as an upstream regulator of Twist1. As such, inhibition of STAT3 induced apoptosis in HD striatal progenitor cells. Our results suggest that mHtt upregulates STAT3 to induce Twist1 expression. Upregulated Twist1 inhibits apoptosis, which may protect striatal cells from death during disease progression. Thus, we propose that Twist1 might play a protective role against striatal degeneration in HD.
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Affiliation(s)
- Wei-Ping Jen
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, 11490, Taiwan.,Institute of Cellular and Organismic Biology, Academia Sinica, Taipei, 11529, Taiwan.,Institute of Biomedical Sciences, Academia Sinica, Taipei, 11529, Taiwan
| | - Hui-Mei Chen
- Institute of Biomedical Sciences, Academia Sinica, Taipei, 11529, Taiwan
| | - Yow-Sien Lin
- Institute of Biomedical Sciences, Academia Sinica, Taipei, 11529, Taiwan
| | - Yijuang Chern
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, 11490, Taiwan.,Institute of Biomedical Sciences, Academia Sinica, Taipei, 11529, Taiwan
| | - Yi-Ching Lee
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, 11490, Taiwan. .,Institute of Cellular and Organismic Biology, Academia Sinica, Taipei, 11529, Taiwan.
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46
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Vega JN, Albert KM, Mayer IA, Taylor WD, Newhouse PA. Nicotinic treatment of post-chemotherapy subjective cognitive impairment: a pilot study. J Cancer Surviv 2019; 13:673-686. [PMID: 31338732 PMCID: PMC6993088 DOI: 10.1007/s11764-019-00786-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 07/04/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Persistent chemotherapy-related cognitive impairment (pCRCI) is commonly reported following cancer treatment and negatively affects quality of life; however, there is currently no pharmacological treatment indicated for pCRCI. This pilot study obtained preliminary data regarding the use of transdermal nicotine patches as a therapeutic strategy for women with pCRCI to (1) reduce subjective cognitive complaints and (2) enhance objective cognitive performance in breast, colon, lymphoma, or ovarian cancer survivors with pCRCI. METHODS Participants were randomized to either placebo (n = 11) or transdermal nicotine (n = 11) for 6 weeks, followed by 2 weeks of treatment withdrawal for a total of 8 weeks. Participants were assessed using both subjective and objective measures of cognitive functioning at five visits before, during, and after treatment. RESULTS Over the course of the study, women in both groups improved substantially in severity of self-reported cognitive complaints measured by Functional Assessment of Cancer Therapy-Cognitive Function Perceived Cognitive Impairments regardless of treatment arm. Additionally, objective cognitive performance measures improved in both groups; however, there was no significant difference in improvement between groups. CONCLUSIONS Due to a large placebo response, we were unable to determine if a drug effect was present. However, we did observe substantial improvement in self-reported cognitive symptoms, likely resulting from factors related to participation in the trial rather than specific drug treatment effects. TRIAL REGISTRATION The study was registered with clinicaltrials.gov (trial registration: NCT02312943). IMPLICATIONS FOR CANCER SURVIVORS These results suggest that women with pCRCI can exhibit improvement in subjective cognition, with attention paid to symptoms and close follow-up over a short period of time.
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Affiliation(s)
- Jennifer N Vega
- Center for Cognitive Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, 1601 23rd Ave. South, Nashville, TN, 37212, USA.
| | - Kimberly M Albert
- Center for Cognitive Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, 1601 23rd Ave. South, Nashville, TN, 37212, USA
| | - Ingrid A Mayer
- Department of Medicine, Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Warren D Taylor
- Center for Cognitive Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, 1601 23rd Ave. South, Nashville, TN, 37212, USA
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Tennessee Valley Health System, Nashville, TN, USA
| | - Paul A Newhouse
- Center for Cognitive Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, 1601 23rd Ave. South, Nashville, TN, 37212, USA
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Tennessee Valley Health System, Nashville, TN, USA
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47
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Flood J, O'Hanlon S, Gibb M, O'Donovan A. Caring for patients with dementia undergoing radiation therapy–A national audit. J Geriatr Oncol 2019; 10:811-818. [DOI: 10.1016/j.jgo.2019.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 03/22/2019] [Accepted: 04/03/2019] [Indexed: 10/27/2022]
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48
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Toh YL, Shariq Mujtaba J, Bansal S, Yeo A, Shwe M, Lau AJ, Chan A. Prechemotherapy Levels of Plasma Dehydroepiandrosterone and Its Sulfated Form as Predictors of Cancer-Related Cognitive Impairment in Patients with Breast Cancer Receiving Chemotherapy. Pharmacotherapy 2019; 39:553-563. [PMID: 30892712 PMCID: PMC6635742 DOI: 10.1002/phar.2259] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Study Objective Dehydroepiandrosterone (DHEA) and its sulfated form (DHEAS)—jointly referred to as DHEA(S)—are neurosteroids known to regulate brain development and function that have been found to be positively correlated with cognitive function. It is unknown whether prechemotherapy plasma DHEA(S) levels are associated with the onset of cancer‐related cognitive impairment (CRCI). The objective of this study was to evaluate whether an association exists between prechemotherapy plasma DHEA(S) levels and onset of CRCI in patients with breast cancer receiving chemotherapy. Design Multicenter, prospective cohort study. Setting Two specialized cancer centers in Singapore. Patients Eighty‐one patients with early‐stage breast cancer (stages I–III) who had no prior exposure to chemotherapy and/or radiotherapy and were scheduled to receive anthracycline‐based or taxane‐based chemotherapy treatment with curative intent. Measurements and Main Results Patients completed assessments for self‐perceived and objective cognitive function at three time points: prechemotherapy (T1), during chemotherapy (T2), and after chemotherapy (T3). Plasma samples were collected prior to chemotherapy, and DHEA(S) levels were quantified by using ultra–high‐performance liquid chromatography–tandem mass spectrometry. Multivariable logistic regression was used to adjust for clinically important factors and to evaluate the association between prechemotherapy plasma DHEA(S) levels and CRCI. Mean ± SD age was 48.9 ± 9.3 years, with 27.8% of patients experiencing clinically significant cognitive impairment based on global Functional Assessment of Cancer Therapy–Cognitive Function scores. The mean ± SD prechemotherapy plasma DHEAS and DHEA levels were 1.61 ± 0.91 μmol/L and 19.21 ± 13.13 nmol/L, respectively. Prechemotherapy DHEAS levels were found to be associated with impairment in the self‐perceived cognitive domains of verbal fluency (adjusted odds ratio [OR] 0.27, 95% confidence interval [CI] 0.08–0.96) and mental acuity (adjusted OR 0.25, 95% CI 0.08–0.74). Conversely, DHEA levels were not associated with impairment in any cognitive subdomains. Conclusion Our findings suggest that patients with higher prechemotherapy DHEAS levels had lower odds of developing self‐perceived cognitive impairment. Future studies are required to further investigate the effect of DHEA(S) on specific cognitive domains and to validate our findings in independent cohorts.
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Affiliation(s)
- Yi Long Toh
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore
| | | | - Sumit Bansal
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore
| | - Angie Yeo
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore
| | - Maung Shwe
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore.,Department of Pharmacy, National Cancer Centre Singapore, Singapore
| | - Aik Jiang Lau
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore.,Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Alexandre Chan
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore.,Department of Pharmacy, National Cancer Centre Singapore, Singapore.,Oncology Academic Clinical Program, Duke-National University of Singapore Medical School, Singapore
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49
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Dionne-Odom JN, Ejem D, Wells R, Barnato AE, Taylor RA, Rocque GB, Turkman YE, Kenny M, Ivankova NV, Bakitas MA, Martin MY. How family caregivers of persons with advanced cancer assist with upstream healthcare decision-making: A qualitative study. PLoS One 2019; 14:e0212967. [PMID: 30865681 PMCID: PMC6415885 DOI: 10.1371/journal.pone.0212967] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 02/12/2019] [Indexed: 12/27/2022] Open
Abstract
Aims Numerous healthcare decisions are faced by persons with advanced cancer from diagnosis to end-of-life. The family caregiver role in these decisions has focused on being a surrogate decision-maker, however, little is known about the caregiver’s role in supporting upstream patient decision-making. We aimed to describe the roles of family caregivers in assisting community-dwelling advanced cancer patients with healthcare decision-making across settings and contexts. Methods Qualitative study using one-on-one, semi-structured interviews with community-dwelling persons with metastatic cancer (n = 18) and their family caregivers (n = 20) recruited from outpatient oncology clinics of a large tertiary care academic medical center, between October 2016 and October 2017. Transcribed interviews were analyzed using a thematic analysis approach. Findings Caregivers averaged 56 years and were mostly female (95%), white (85%), and the patient’s partner/spouse (70%). Patients averaged 58 years and were mostly male (67%) in self-reported “fair” or “poor” health (50%) with genitourinary (33%), lung (17%), and hematologic (17%) cancers. Themes describing family member roles in supporting patients’ upstream healthcare decision-making were: 1) seeking information about the cancer, its trajectory, and treatments options; 2) ensuring family and healthcare clinicians have a common understanding of the patient’s treatment plan and condition; 3) facilitating discussions with patients about their values and the framing of their illness; 5) posing “what if” scenarios about current and potential future health states and treatments; 6) addressing collateral decisions (e.g., work arrangements) resulting from medical treatment choices; 6) originating healthcare-related decision points, including decisions about seeking emergency care; and 7) making healthcare decisions for patients who preferred to delegate healthcare decisions to their family caregivers. Conclusions These findings highlight a previously unreported and understudied set of critical decision partnering roles that cancer family caregivers play in patient healthcare decision-making. Optimizing these roles may represent novel targets for early decision support interventions for family caregivers.
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Affiliation(s)
- J. Nicholas Dionne-Odom
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- * E-mail:
| | - Deborah Ejem
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Rachel Wells
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Amber E. Barnato
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, United States of America
| | - Richard A. Taylor
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Gabrielle B. Rocque
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Yasemin E. Turkman
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Matthew Kenny
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Nataliya V. Ivankova
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Marie A. Bakitas
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Michelle Y. Martin
- Center for Innovation in Health Equity Research, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
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50
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Mandelblatt JS, Small BJ, Luta G, Hurria A, Jim H, McDonald BC, Graham D, Zhou X, Clapp J, Zhai W, Breen E, Carroll JE, Denduluri N, Dilawari A, Extermann M, Isaacs C, Jacobsen PB, Kobayashi LC, Holohan Nudelman K, Root J, Stern RA, Tometich D, Turner R, VanMeter JW, Saykin AJ, Ahles T. Cancer-Related Cognitive Outcomes Among Older Breast Cancer Survivors in the Thinking and Living With Cancer Study. J Clin Oncol 2018; 36:JCO1800140. [PMID: 30281396 PMCID: PMC7237199 DOI: 10.1200/jco.18.00140] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine treatment and aging-related effects on longitudinal cognitive function in older breast cancer survivors. METHODS Newly diagnosed nonmetastatic breast cancer survivors (n = 344) and matched controls without cancer (n = 347) 60 years of age and older without dementia or neurologic disease were recruited between August 2010 and December 2015. Data collection occurred during presystemic treatment/control enrollment and at 12 and 24 months through biospecimens; surveys; self-reported Functional Assessment of Cancer Therapy-Cognitive Function; and neuropsychological tests that measured attention, processing speed, and executive function (APE) and learning and memory (LM). Linear mixed-effects models tested two-way interactions of treatment group (control, chemotherapy with or without hormonal therapy, and hormonal therapy) and time and explored three-way interactions of ApoE (ε4+ v not) by group by time; covariates included baseline age, frailty, race, and cognitive reserve. RESULTS Survivors and controls were 60 to 98 years of age, were well educated, and had similar baseline cognitive scores. Treatment was related to longitudinal cognition scores, with survivors who received chemotherapy having increasingly worse APE scores ( P = .05) and those initiating hormonal therapy having lower LM scores at 12 months ( P = .03) than other groups. These group-by-time differences varied by ApoE genotype, where only ε4+ survivors receiving hormone therapy had short-term decreases in adjusted LM scores (three-way interaction P = .03). For APE, the three-way interaction was not significant ( P = .14), but scores were significantly lower for ε4+ survivors exposed to chemotherapy (-0.40; 95% CI, -0.79 to -0.01) at 24 months than ε4+ controls (0.01; 95% CI, 0.16 to 0.18; P < .05). Increasing age was associated with lower baseline scores on all cognitive measures ( P < .001); frailty was associated with baseline APE and self-reported decline ( P < .001). CONCLUSION Breast cancer systemic treatment and aging-related phenotypes and genotypes are associated with longitudinal decreases in cognitive function scores in older survivors. These data could inform treatment decision making and survivorship care planning.
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Affiliation(s)
- Jeanne S. Mandelblatt
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Brent J. Small
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Gheorghe Luta
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Arti Hurria
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Heather Jim
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Brenna C. McDonald
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Deena Graham
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Xingtao Zhou
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Jonathan Clapp
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Wanting Zhai
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Elizabeth Breen
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Judith E. Carroll
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Neelima Denduluri
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Asma Dilawari
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Martine Extermann
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Claudine Isaacs
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Paul B. Jacobsen
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Lindsay C. Kobayashi
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Kelly Holohan Nudelman
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - James Root
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Robert A. Stern
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Danielle Tometich
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Raymond Turner
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - John W. VanMeter
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Andrew J. Saykin
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
| | - Tim Ahles
- Jeanne S. Mandelblatt, Gheorghe Luta, Xingtao Zhou, Jonathan Clapp, Wanting Zhai, Asma Dilawari, Claudine Isaacs, Lindsay C. Kobayashi, Raymond Turner, and John W. VanMeter, Georgetown University; Asma Dilawari, MedStar Washington Hospital Center, Washington, DC; Brent J. Small, Heather Jim, and Martine Extermann, Moffitt Cancer Center, Tampa, FL; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte; Elizabeth Breen and Judith E. Carroll, University of California, Los Angeles, Los Angeles, CA; Brenna C. McDonald, Kelly Holohan Nudelman, Danielle Tometich, and Andrew J. Saykin, Indiana University School of Medicine, Indianapolis, IN; Deena Graham, John Theurer Cancer Center, Hackensack, NJ; Neelima Denduluri, US Oncology, Arlington, VA; Paul B. Jacobsen, National Cancer Institute, Bethesda, MD; James Root and Tim Ahles, Memorial Sloan Kettering Cancer Center; James Root, Weill Medical College of Cornell University, New York, NY; and Robert A. Stern, Boston University, Boston, MA
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