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Wang Y, Du X, Gong Y, Jiang Y, Zheng Y. Influencing factors of cancer-related fatigue in acute leukemia patients: A cross-sectional study. Heliyon 2023; 9:e22813. [PMID: 38144341 PMCID: PMC10746407 DOI: 10.1016/j.heliyon.2023.e22813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/14/2023] [Accepted: 11/20/2023] [Indexed: 12/26/2023] Open
Abstract
Purpose To investigate influencing factors of cancer-related fatigue (CRF) in adult patients with acute leukemia (AL). Methods A total of 288 adult patients diagnosed with acute leukemia in West China Hospital were included in this study. A cross-sectional survey, including the Clinical Information Questionnaire, the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), Pittsburgh Sleep Quality Index (PSQI), and Hospital Anxiety and Depression Scale (HAD), was provided to the patients. Hierarchical multiple linear regression analyses were conducted to evaluate the associations of the variable factors and the AL patients' CRF. Results The CRF score of AL patients was 33.25 ± 10.35. Gender, age, albumin level, depression, anxiety status of the patients and treatment cycles were identified as influencing factors of CRF in AL patients (P < 0.05). The CRF level of acute leukemia patients in the complete remission group was lower than that of patients who were not achieving complete remission. Depression, anxiety, age, employment, albumin, and sleep disturbance were independent influencing factors for CRF in patients who were not achieving complete remission. Conclusions Acute leukemia patients who are female, older, hypoalbuminemia,or in the induction therapy have a higher risk of developing a high degree of CRF. Clinical staff should pay more attention to the CRF of patients who were not achieving complete remission. Early screening and aggressive intervention could be adopted in caring for these patients.
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Affiliation(s)
- Yingli Wang
- Department of Hematology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, China
| | - Xinwen Du
- Department of Hematology, West China Hospital, Sichuan University, China
| | - Yuping Gong
- Department of Hematology, West China Hospital, Sichuan University, China
| | - Yan Jiang
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, China
| | - Yuhuan Zheng
- Department of Hematology, West China Hospital, Sichuan University, China
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2
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Oppegaard KR, Armstrong TS, Anguera JA, Kober KM, Debr LK, Laister RC, Saligan LN, Ayala AP, Kuruvilla J, Alm MW, Byker WH, Miaskowski C, Mayo SJ. Blood-Based Biomarkers of Cancer-Related Cognitive Impairment in Non-Central Nervous System Cancer: A Scoping Review. Crit Rev Oncol Hematol 2022; 180:103822. [PMID: 36152911 DOI: 10.1016/j.critrevonc.2022.103822] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/17/2022] [Accepted: 09/19/2022] [Indexed: 11/24/2022] Open
Abstract
This scoping review was designed to synthesize the extant literature on associations between subjective and/or objective measures of cancer-related cognitive impairment (CRCI) and blood-based biomarkers in adults with non-central nervous system cancers. The literature search was done for studies published from the start of each database searched (i.e., MEDLINE, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, grey literature) through to October 20, 2021. A total of 95 studies are included in this review. Of note, a wide variety of biomarkers were evaluated. Most studies evaluated patients with breast cancer. A variety of cognitive assessment measures were used. The most consistent significant findings were with various subjective and objective measures of CRCI and levels of interleukin-6 and tumor necrosis factor. Overall, biomarker research is in an exploratory phase. However, this review synthesizes findings and proposes directions for future research.
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Affiliation(s)
- Kate R Oppegaard
- University of California San Francisco, School of Nursing, Department of Physiological Nursing, USA
| | - Terri S Armstrong
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, USA
| | - Joaquin A Anguera
- University of California San Francisco, Department of Neurology and Psychiatry, USA
| | - Kord M Kober
- University of California San Francisco, School of Nursing, Department of Physiological Nursing, USA
| | - Lynch Kelly Debr
- University of Florida, College of Nursing, USA; University of Florida Health Cancer Center, USA
| | - Rob C Laister
- Princess Margaret Health Center, University Health Network, Canada
| | - Leorey N Saligan
- Symptoms Biology Unit, Division of Intramural Research, National Institutes of Health, USA
| | | | - John Kuruvilla
- Princess Margaret Health Center, University Health Network, Canada
| | - Mark W Alm
- Toronto General Hospital, University Health Network, Canada
| | | | - Christine Miaskowski
- University of California San Francisco, School of Medicine, Department of Anesthesia and Perioperative Care, USA
| | - Samantha J Mayo
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Canada.
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3
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Onzi GR, D'Agustini N, Garcia SC, Guterres SS, Pohlmann PR, Rosa DD, Pohlmann AR. Chemobrain in Breast Cancer: Mechanisms, Clinical Manifestations, and Potential Interventions. Drug Saf 2022; 45:601-621. [PMID: 35606623 DOI: 10.1007/s40264-022-01182-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 11/26/2022]
Abstract
Among the potential adverse effects of breast cancer treatment, chemotherapy-related cognitive impairment (CRCI) has gained increased attention in the past years. In this review, we provide an overview of the literature regarding CRCI in breast cancer, focusing on three main aspects. The first aspect relates to the molecular mechanisms linking individual drugs commonly used to treat breast cancer and CRCI, which include oxidative stress and inflammation, reduced neurogenesis, reduced levels of specific neurotransmitters, alterations in neuronal dendrites and spines, and impairment in myelin production. The second aspect is related to the clinical characteristics of CRCI in patients with breast cancer treated with different drug combinations. Data suggest the incidence rates of CRCI in breast cancer vary considerably, and may affect more than 50% of treated patients. Both chemotherapy regimens with or without anthracyclines have been associated with CRCI manifestations. While cross-sectional studies suggest the presence of symptoms up to 20 years after treatment, longitudinal studies confirm cognitive impairments lasting for at most 4 years after the end of chemotherapy. The third and final aspect is related to possible therapeutic interventions. Although there is still no standard of care to treat CRCI, several pharmacological and non-pharmacological approaches have shown interesting results. In summary, even if cognitive impairments derived from chemotherapy resolve with time, awareness of CRCI is crucial to provide patients with a better understanding of the syndrome and to offer them the best care directed at improving quality of life.
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Affiliation(s)
- Giovana R Onzi
- Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Av. Ipiranga 2752, Porto Alegre, RS, 90610-000, Brazil.
| | - Nathalia D'Agustini
- Programa de Pós-Graduação em Patologia da Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| | - Solange C Garcia
- Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Av. Ipiranga 2752, Porto Alegre, RS, 90610-000, Brazil
| | - Silvia S Guterres
- Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Av. Ipiranga 2752, Porto Alegre, RS, 90610-000, Brazil
| | - Paula R Pohlmann
- Lombardi Comprehensive Cancer Center, MedStar Georgetown University Hospital, Washington, DC, USA
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Daniela D Rosa
- Programa de Pós-Graduação em Patologia da Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
- Serviço de Oncologia, Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
| | - Adriana R Pohlmann
- Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Av. Ipiranga 2752, Porto Alegre, RS, 90610-000, Brazil.
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4
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Krishnan S, Sarda S, Kunzweiler C, Wu M, Sundaresan S, Huynh L, Duh MS, Escalante CP. Literature Review of Fatigue Scales and Association with Clinically Meaningful Improvements in Outcomes Among Patients With and Without Paroxysmal Nocturnal Hemoglobinuria. Adv Ther 2022; 39:1959-1975. [PMID: 35316499 PMCID: PMC9056457 DOI: 10.1007/s12325-022-02111-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 03/02/2022] [Indexed: 11/15/2022]
Abstract
Introduction Paroxysmal nocturnal hemoglobinuria (PNH) is a rare blood disorder characterized by anemia and debilitating fatigue. Limited evidence characterizes the association between hemoglobin, an indicator of anemia and disease activity, and patient-reported fatigue scales. This review identifies benchmarks for clinically meaningful improvements in patients with and without PNH. Methods MEDLINE, Embase, Cochrane, and PsycINFO databases were searched along with Google Scholar to identify publications for patients with and without PNH. Full-text articles and conference abstracts of clinical trials or observational studies that examined patient-reported fatigue or associations between fatigue and hemoglobin were included. Results Fourteen publications were included in this study. Four clinical trials conducted in patients with PNH reported that patients achieved and sustained clinically meaningful improvements in fatigue. However, these studies did not examine the association between fatigue and hemoglobin. Ten studies conducted in patients with cancer and anemia (with or without chemotherapy) demonstrated an association between increased hemoglobin and improvements in fatigue (P < 0.05). The greatest incremental gain in fatigue improvement was observed when hemoglobin increased from 11 to 12 g/dL. Conclusion Evidence among patients with cancer without PNH demonstrates that increased hemoglobin levels are associated with clinically significant improvements in fatigue. Future studies should validate this relationship among patients with PNH. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-022-02111-7.
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Zulfiqar AA, Lorenzo Villalba N, Andres E. [Anaemia: What is its relationship with the frailty syndrome in elderly patients?]. Rev Esp Geriatr Gerontol 2020; 55:350-353. [PMID: 32247637 DOI: 10.1016/j.regg.2019.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 10/15/2019] [Accepted: 11/19/2019] [Indexed: 06/11/2023]
Abstract
Anaemia is often unexpectedly found, or in a context of investigations into a chest pain, dyspnoea, or weakness. This disorder can be considered an indicator of health status in elderly patients, and has been related to the frailty syndrome. A systematic review was conducted on the studies published in PubMed and Google Scholar databases in the period from January 1999 to May 2019. The search was limited to those studies published regarding anaemia and its relationship to the frailty syndrome. Anaemia seems to be part of the immunosenescence process that can explain frailty syndrome in association with other metabolism, endocrine, and inflammatory disorders. It was unable to be determined if anaemia is responsible for frailty or a result of it.
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Affiliation(s)
- Abrar-Ahmad Zulfiqar
- Servicio de Medicina Interna, Diabetes y Enfermedades Metabólicas, Hospital Universitario de Estrasburgo, Estrasburgo, Francia
| | - Noel Lorenzo Villalba
- Servicio de Medicina Interna, Diabetes y Enfermedades Metabólicas, Hospital Universitario de Estrasburgo, Estrasburgo, Francia.
| | - Emmanuel Andres
- Servicio de Medicina Interna, Diabetes y Enfermedades Metabólicas, Hospital Universitario de Estrasburgo, Estrasburgo, Francia
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6
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Shin KNL, Mun CY, Shariff ZM. Nutrition Indicators, Physical Function, and Health-Related Quality of Life in Breast Cancer Patients. Asian Pac J Cancer Prev 2020; 21:1939-1950. [PMID: 32711419 PMCID: PMC7573431 DOI: 10.31557/apjcp.2020.21.7.1939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 07/15/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE This study aimed to investigate how nutrition indicators and physical function may influence Health-related Quality of Life (HRQoL) of breast cancer patients undergoing treatment. METHODS This was a cross sectional study among a total of 163 breast cancer patients. Series of measurements including anthropometry, biochemical, and dietary were employed to assess patients' nutritional status while physical function was assessed by handgrip strength. HRQoL of patients was determined using European Organization for Research and Treatment of Cancer quality of life questionnaire Core 30 (EORTC-QLQ-C30) version 3.0. Multiple linear regression was used to identify factors associated with HRQoL. RESULTS Breast cancer patients perceived moderately their overall quality of life (QoL), with the mean global health status (GHS) score of 69.12. Emotional functioning was the poorest functional scale while fatigue was the most distressing symptom presented by the patients. Approximately 20% of patients had low corrected arm muscle area while more than half had low hemoglobin level. More than 90% of patients did not meet the overall dietary recommendation and had poor handgrip strength. Mid-upper arm circumference (MUAC) was associated with GHS (β: 0.906; 95% CI: 0.22, 1.56) and cognitive functioning (β: -1.543; 95% CI: -3.07, -0.01). Handgrip strength was positively associated with most of HRQoL outcomes. CONCLUSIONS Breast cancer patients reported overall good nutritional status and moderate QoL during treatment. Being well-nourished improved HRQoL and handgrip strength could be a potential proxy for functional outcomes as well as overall QoL.
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Affiliation(s)
- Krystal Ng Lu Shin
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Malaysia.
- Department of Health Education, Literacy, Promotion and Policy, National Cancer Society of Malaysia, Malaysia.
| | - Chan Yoke Mun
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Malaysia.
- Research Centre of Excellence Nutrition and Non-communicable Diseases, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Malaysia.
| | - Zalilah Mohd Shariff
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Malaysia.
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7
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Regier NG, Naik AD, Mulligan EA, Nasreddine ZS, Driver JA, Sada YHF, Moye J. Cancer-related cognitive impairment and associated factors in a sample of older male oral-digestive cancer survivors. Psychooncology 2019; 28:1551-1558. [PMID: 31134710 DOI: 10.1002/pon.5131] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 05/08/2019] [Accepted: 05/21/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVE This study examines the demographic and clinical variables associated with cancer-related cognitive impairment (CRCI) in a sample of older, male, oral-digestive cancer survivors at VA Medical Centers in Boston and Houston. METHODS A two-time point, longitudinal design was used, with cognitive assessment conducted at 6 and 18 months post-diagnosis. Using ANCOVA, the cognitive functioning of 88 older adults with head and neck, esophageal, gastric, or colorectal cancers was compared with that of 88 healthy controls. Paired t-tests examined cognitive change over time in the cancer group. Hierarchical linear regression examined variables potentially associated with cognitive impairment at 18 months. RESULTS Forty-eight percent of cancer patients exhibited cognitive impairment 6 months post-cancer diagnosis, and 40% at 18 months. Cancer survivors were impaired relative to controls on measures of sustained attention, memory, and verbal fluency at 18 months, controlling for age. Older age, low hemoglobin, and cancer-related PTSD were associated with worse cognition at 18 months. CONCLUSIONS CRCI is more frequent in older adults than reported in studies of younger adults and may be more frequent in men. Potential areas of intervention for CRCI include psychotherapy for cancer-related PTSD, treatment of anemia, and awareness of particularly vulnerable cognitive domains such as sustained attention, memory, and verbal fluency.
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Affiliation(s)
- Natalie G Regier
- Johns Hopkins School of Nursing, Baltimore, Maryland.,Johns Hopkins Center for Innovative Care in Aging, Baltimore, Maryland
| | - Aanand D Naik
- VA Boston Healthcare System, Boston, Massachusetts.,Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Elizabeth A Mulligan
- VA Boston Healthcare System, Boston, Massachusetts.,San Francisco VA Healthcare System, San Francisco, California
| | - Ziad S Nasreddine
- Service de Neurologie, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Jane A Driver
- VA Boston Healthcare System, Boston, Massachusetts.,Hematologic Malignancies Program, Dana Farber Cancer Institute, Boston, Massachusetts.,Brigham and Women's Hospital, Center for Older Adult Health, Boston, Massachusetts
| | - Yvonne H-F Sada
- Michael E. DeBakey VA Medical Center, Houston, Texas.,Baylor College of Medicine, Houston, Texas
| | - Jennifer Moye
- VA Boston Healthcare System, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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8
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Di Iulio F, Cravello L, Shofany J, Paolucci S, Caltagirone C, Morone G. Neuropsychological disorders in non-central nervous system cancer: a review of objective cognitive impairment, depression, and related rehabilitation options. Neurol Sci 2019; 40:1759-1774. [PMID: 31049790 DOI: 10.1007/s10072-019-03898-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 04/12/2019] [Indexed: 01/17/2023]
Abstract
AIM The objective of the present review was to systematically characterize the types of cognitive impairment that are found in different non-brain types of cancer as measured by objective and validated tests, and also to further examine depression and cognitive function in cancer patients and explore their available rehabilitation treatments. RESULTS A total of 29 articles were reviewed. Most of these studies suggest that chemotherapy as well as the combination of chemotherapy and hormonal therapy can influence cognition in different types of cancer patients. Breast cancer patients appear to be the most affected in neuropsychological function, specifically in terms of cognitive impairment and reduced quality of life, as compared to other non-brain solid tumours. Overall, the most impaired functions were verbal ability, memory, executive function, and motor speed. CONCLUSION Chemotherapy-related cognitive dysfunction remains under-recognized and undertreated. The various studies reported differing and non-homogenous findings with mixed results, obtained by self-reporting and web-assisted assessment, with other confounding factors such as age and depression during both cancer diagnosis and treatment. An objective neuropsychological assessment is fundamental to avoid underestimation of the extent of chemobrain. Self-reported and web-assisted assessment may ultimately result in confusion between the neuropsychological signs of chemobrain versus those of depression.
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Affiliation(s)
| | - Luca Cravello
- Centro Regionale Alzheimer ASST Rhodense, Passirana di Rho Hospital, Milan, Italy
| | | | | | - Carlo Caltagirone
- IRCCS Fondazione Santa Lucia, Rome, Italy
- Università degli Studi di Roma Tor Vergata, Rome, Italy
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9
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Nassif EF, Arsène-Henry A, Kirova YM. Brain metastases and treatment: multiplying cognitive toxicities. Expert Rev Anticancer Ther 2019; 19:327-341. [PMID: 30755047 DOI: 10.1080/14737140.2019.1582336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Thirty per cent of cancer patients develop brain metastases, with multiple combination or sequential treatment modalities available, to treat systemic or central nervous system (CNS) disease. Most patients experience toxicities as a result of these treatments, of which cognitive impairment is one of the adverse events most commonly reported, causing major impairment of the patient's quality of life. Areas covered: This article reviews the role of cancer treatments in cognitive decline of patients with brain metastases: surgery, radiotherapy, chemotherapy, targeted therapies, immunotherapies and hormone therapy. Pathological and molecular mechanisms, as well as future directions for limiting cognitive toxicities are also presented. Other causes of cognitive impairment in this population are discussed in order to refine the benefit-risk balance of each treatment modality. Expert opinion: Cumulative cognitive toxicity should be taken into account, and tailored to the patient's cognitive risk in the light of the expected survival benefit. Standardization of cognitive assessment in this context is needed in order to better appreciate each treatment's responsibility in cognitive impairment, keeping in mind disease itself impacts cognition in this context.
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Affiliation(s)
- Elise F Nassif
- a Department of Radiotherapy , Institut Curie , Paris , France
| | | | - Youlia M Kirova
- a Department of Radiotherapy , Institut Curie , Paris , France
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10
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Chae JW, Chua PS, Ng T, Yeo AHL, Shwe M, Gan YX, Dorajoo S, Foo KM, Loh KWJ, Koo SL, Chay WY, Tan TJY, Beh SY, Lim EH, Lee GE, Dent R, Yap YS, Ng R, Ho HK, Chan A. Association of mitochondrial DNA content in peripheral blood with cancer-related fatigue and chemotherapy-related cognitive impairment in early-stage breast cancer patients: a prospective cohort study. Breast Cancer Res Treat 2018; 168:713-721. [DOI: 10.1007/s10549-017-4640-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 12/23/2017] [Indexed: 12/24/2022]
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11
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Oh PJ. Predictors of cognitive decline in people with cancer undergoing chemotherapy. Eur J Oncol Nurs 2016; 27:53-59. [PMID: 28027862 DOI: 10.1016/j.ejon.2016.12.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 11/18/2016] [Accepted: 12/10/2016] [Indexed: 12/17/2022]
Abstract
PURPOSE The purpose of this study was to investigate the impact of demographic factors, disease/treatment-related factors, and psychological factors on cognitive function. METHOD A cross-sectional study was conducted. Participants were recruited from the oncology inpatient units of two hospitals. A convenience sample of 175 patients with cancer who underwent chemotherapy were recruited. The Everyday Cognition Scale (ECog), the Korean version of the Mini Mental State Examination (K-MMSE), Functional Assessment of Cancer Therapy-Fatigue (FACT-F) scale, Hospital Anxiety and Depression Scale (HADS), and a questionnaire to collect information about demographic, disease, and treatment information were completed. RESULTS More participants showed a mild decline in cognitive function and self-reported cognitive decline (39.4%) than had objectively confirmed decline (20%). Notably, 53.7-62.9% of the participants showed memory loss and a decline in divided attention. Demographic factors (age, sex), disease/treatment-related factors (chemotherapy cycles, fatigue), and psychological factors (depression) were predictors of cognitive decline in 49.6% of participants. CONCLUSIONS Old age and cumulative chemotherapy cycles were the main influential factors for objectively confirmed cognitive decline, and fatigue was the most common predictor of self-reported cognitive decline. Depression was one of the predictors of perceived cognitive decline, but it was not significant for objectively measured cognitive function. Thus, treatment-related factors such as fatigue had a greater impact on cognitive decline than psychological factors.
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Affiliation(s)
- Pok-Ja Oh
- Department of Nursing, Sahmyook University, 815 Kongnung-dong, Hwarang-ro, Nowon-gu, Seoul 01795, South Korea.
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12
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Morean DF, Cherney LR. Screening for Cognitive Impairment Associated with Chemotherapy for Breast Cancer. CURRENT BREAST CANCER REPORTS 2016. [DOI: 10.1007/s12609-016-0219-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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Ghoshal A, Salins N, Deodhar J, Damani A, Muckaden M. Impact of symptom control on fatigue improvement in patients with advanced cancer: A prospective observational study. PROGRESS IN PALLIATIVE CARE 2016. [DOI: 10.1080/09699260.2016.1200818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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14
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Ghoshal A, Salins N, Deodhar J, Damani A, Muckaden MA. Fatigue and Quality of Life Outcomes of Palliative Care Consultation: A Prospective, Observational Study in a Tertiary Cancer Center. Indian J Palliat Care 2016; 22:416-426. [PMID: 27803563 PMCID: PMC5072233 DOI: 10.4103/0973-1075.191766] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose: Fatigue is one of the most common symptoms seen in patients with advanced cancer. It is known to influence the Quality of Life (QoL) of patients. This study examines the interrelationship of fatigue and QoL in patients with advanced cancer on palliative care. Methods: A prospective cohort study was conducted in the outpatient clinic of the Department of Palliative Medicine from January to June 2014. Patients with advanced cancer registered with hospital palliative care unit, meeting the inclusion criteria (Eastern Cooperative Oncology Group [ECOG] ≤3, Edmonton Symptom Assessment Scale [ESAS] fatigue score ≥1), and willing to participate in the study were assessed for symptom burden (ESAS) and QoL (European Organization for Research and Treatment of Cancer QoL Core 15-Palliative module [EORTC-QoL PAL15]). All study patients received standard palliative care consultation and management. They were followed up in person or telephonically within 15–30 days from the first consult for assessment of outcomes. Results: Of a total of 500 cases assessed at baseline, 402 were available for follow-up (median age of 52 years; 51.6% male). On the EORTC-QoL PAL15 scale, overall QoL, emotional functioning, and constipation were found to be significantly associated with severity of fatigue at baseline (P < 0.05). Statistically significant improvement in fatigue score was observed (P < 0.001) at follow-up. Improvement in physical functioning and insomnia were significantly associated with better fatigue outcomes. Conclusions: Fatigue improved with the standard palliative care delivered at our specialty palliative care clinic. Certain clinical, biochemical factors and QoL aspects were associated with fatigue severity at baseline, improvement of which lead to lesser fatigue at follow-up.
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Affiliation(s)
- Arunangshu Ghoshal
- Department of Palliative Medicine, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Naveen Salins
- Department of Palliative Medicine, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Jayita Deodhar
- Department of Palliative Medicine, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Anuja Damani
- Department of Palliative Medicine, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Mary Ann Muckaden
- Department of Palliative Medicine, Tata Memorial Centre, Mumbai, Maharashtra, India
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15
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Muñoz-Langa J, De Castro J, Gascó P, Sanchez A, Esteban E, Gasent JM, Barneto I, Montalar J, Artal A, Vidal S. Chemotherapy-associated anemia in patients with lung cancer: an epidemiological, retrospective and multicenter study. Future Oncol 2015; 11:1665-74. [DOI: 10.2217/fon.15.75] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Aim: Providing epidemiological data and treatment of anemia in lung cancer patients undergoing first-line chemotherapy. Methods: Epidemiological, observational, retrospective and multicenter study carried out at 30 sites throughout Spain. Results: The prevalence of anemia (hemoglobin [Hb] level <12 g/dl) was 18.3% and the incidence 80.7%. Mean Hb levels were 13.4 g/dl (95% CI: 13.2–13.6) and 11.5 g/dl (95% CI: 11.3–11.7) at starting and at the end of chemotherapy, respectively. Of the 294 patients with anemia, 174 (59.2%) were treated. Erythropoiesis-stimulating agents were given to 90.2% patients, alone in 31.6% and combined iron in 39.7%, transfusion in 9.2% and iron and transfusion in 9.8%. Conclusion: These results suggest an appropriate and rational use of erythropoiesis-stimulating agents in the treatment of chemotherapy-associated anemia in lung cancer patients.
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Affiliation(s)
| | | | - Pere Gascó
- Hospital Clinic i Provincial, Barcelona, Spain
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16
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Acaster S, Dickerhoof R, DeBusk K, Bernard K, Strauss W, Allen LF. Qualitative and quantitative validation of the FACIT-fatigue scale in iron deficiency anemia. Health Qual Life Outcomes 2015; 13:60. [PMID: 25980742 PMCID: PMC4434873 DOI: 10.1186/s12955-015-0257-x] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 04/30/2015] [Indexed: 01/25/2023] Open
Abstract
Background Fatigue is a burdensome symptom in iron deficiency anemia (IDA). To capture the severity and impact of fatigue appropriately it must be measured using validated scales. This study evaluated the content validity and psychometric validity of the Functional Assessment of Chronic Illness Therapy - fatigue scale (FACIT-fatigue) in IDA patients. Methods Qualitative patient interviews were conducted in the United States to evaluate content validity. The psychometric properties of the FACIT-fatigue scale were investigated using data from a phase 3 clinical trial assessing ferumoxytol in patients with a history of unsatisfactory oral iron therapy or in whom oral iron cannot be used. The statistical analysis assessed the acceptability, reliability, validity and responsiveness of the FACIT-fatigue scale. Results Qualitative interviews showed that fatigue is a central concern to IDA patients and that the FACIT-fatigue scale sufficiently assessed this construct. Psychometric assessment demonstrated that the FACIT-fatigue scale was stable over time (ICC = 0.87) and internally consistent (α = 0.93). The scale demonstrated convergence with other conceptually relevant scales such as SF-36 Vitality (r = 0.74), and distinguished between known groups [i.e., treatment arms (mean difference (95 % CI) = 3.56 (1.68, 5.43), p <0.001) and high vs. low hemoglobin groups (mean difference (95 % CI) = 5.51 (8.59, 2.44) p <0.001)]. Responsiveness was also demonstrated; significant improvements in FACIT-fatigue scale scores corresponded with significant differences between minimal, moderate, and much improved vitality cohorts (p < 0.05). Conclusions This research demonstrated that the FACIT-fatigue scale has sound measurement properties and is an appropriate and interpretable assessment of fatigue among IDA patients with various underlying conditions.
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Affiliation(s)
- Sarah Acaster
- Oxford Outcomes, 188 Embarcadero, Suite 200, San Francisco, CA, 94105, USA.
| | - Rene Dickerhoof
- Oxford Outcomes, 188 Embarcadero, Suite 200, San Francisco, CA, 94105, USA.
| | - Kendra DeBusk
- Oxford Outcomes, 188 Embarcadero, Suite 200, San Francisco, CA, 94105, USA.
| | | | - William Strauss
- AMAG Pharmaceuticals, 1100 Winter St., Waltham, MA, 02451, USA.
| | - Lee F Allen
- AMAG Pharmaceuticals, 1100 Winter St., Waltham, MA, 02451, USA.
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Correa DD, Root JC, Baser R, Moore D, Peck KK, Lis E, Shore TB, Thaler HT, Jakubowski A, Relkin N. A prospective evaluation of changes in brain structure and cognitive functions in adult stem cell transplant recipients. Brain Imaging Behav 2014; 7:478-90. [PMID: 23329358 DOI: 10.1007/s11682-013-9221-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Hematopoietic stem cell transplantation (HSCT) is an efficacious treatment for many hematologic malignancies. However, the conditioning regimen of high-dose (HD) chemotherapy with or without total body irradiation (TBI) can be associated with neurotoxicity. In this prospective study, we used quantitative neuroimaging techniques to examine regional gray matter and ventricular volumes, and standardized neuropsychological tests to assess cognitive function before and 1 year after HSCT in 28 patients with hematologic malignancies and in ten healthy controls evaluated at similar intervals. Nineteen patients received conditioning treatment with HD chemotherapy alone and nine had both TBI and HD chemotherapy. There was a significant reduction in gray matter volume in the middle frontal gyrus bilaterally and in the left caudate nucleus in the patient group (all patients combined) but not among healthy controls over the 1-year follow-up period. There was a significant increase in left lateral ventricle volume and in total ventricle volume in the patient group, relative to healthy controls. Similar brain structural changes were seen for patients treated with HD chemotherapy alone. The neuropsychological results showed that 21% of patients could be classified as impaired at baseline. The Reliable Change Index suggested no significantly different rates of cognitive decline between patients and healthy controls. The findings suggest that HSCT patients may be at an increased risk for developing regional brain volume loss, and that subgroups may experience cognitive dysfunction prior to and 1 year following the transplant.
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Affiliation(s)
- D D Correa
- Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA,
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18
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[Treatment of cognitive impairments in oncology: a review of longitudinal controlled studies]. Bull Cancer 2014; 101:866-75. [PMID: 25062497 DOI: 10.1684/bdc.2014.1941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Various studies highlight cognitive impairments in cancer patients. This paper proposes a review of longitudinal controlled studies evaluating the efficacy of interventions aiming to reduce these cognitive impairments. Longitudinal controlled studies evaluating the efficacy of interventions aiming to reduce cognitive impairments in adult cancer patients and published between 1993 and 2013 were identified, with the exception of studies that implied patients suffering from CNS tumor or metastasis. Pharmacological interventions (n = 11) suggested the positive impact of modafinil on memory and executive functions. Non-pharmacological interventions (n = 10) suggested the positive impact of cognitive revalidation and stimulation programs, psycho-education and meditation on several memory, attentional and executive objective as well as subjective functions. Non-pharmacological interventions show more significant cognitive benefits than pharmacological interventions. Some longitudinal controlled studies support the usefulness of interventions aiming to reduce cognitive impairments in cancer patients. Further studies should evaluate the effectiveness of programs combining technics aiming to reduce cognitive impairments and psychotherapeutic technics aiming to support patients' coping with illness.
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Rodriguez Garzotto A, Cortijo Casacajares S, Pernaut C, Ruiz Ares GJ, Otero Blas I, Heine O, Turner M, Rebollo Laserna F, Cortes Funes H, Lorenz A. Erythropoiesis-stimulating agents for the treatment of chemotherapy-induced anemia: comparisons from real-world clinical experience. J Blood Med 2014; 5:43-8. [PMID: 24855398 PMCID: PMC4011805 DOI: 10.2147/jbm.s57887] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background The purpose of this paper is to report real-world data on the relative effectiveness of a biosimilar erythropoiesis-stimulating agent (ESA; Binocrit®), and other available ESAs for the treatment of chemotherapy-induced anemia. Methods Data were collected retrospectively from single centers in Spain (n=284) and Germany (n=145). Hemoglobin outcomes, transfusion requirements, and serious drug-related adverse events were assessed for each ESA. Results Hemoglobin outcomes and transfusion requirements were generally similar in the different ESA treatment groups assessed. No serious drug-related adverse events were recorded in any of the treatment groups. Conclusion These data confirm the real-world effectiveness and safety of a biosimilar ESA (Binocrit®) for the treatment of cancer patients with chemotherapy-induced anemia.
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Affiliation(s)
| | | | - Cristina Pernaut
- Hospital Universitario 12 de Octubre, Ctra Andalucía, Madrid, Spain
| | | | - Irene Otero Blas
- 1Hospital Universitario 12 de Octubre, Ctra Andalucía, Madrid, Spain
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Kholodova NB, Sotnikov VM, Dobrovol'skaia NI, Ponkratova IA. [Aspects of encephalopathy in oncologic patients after chemotherapy]. Zh Nevrol Psikhiatr Im S S Korsakova 2014; 114:84-88. [PMID: 25726785 DOI: 10.17116/jnevro201411412184-88] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To study clinical presentations and neuroimaging results in post chemotherapy encephalopathy. MATERIAL AND METHODS We examined 27 patients with cancer after chemotherapy (n=16) or chemoradiation (n=11). RESULTS AND CONCLUSION All patients complained of memory impairment, sluggish mentality, moderate headache, fatigue, sleep disorder, irritability. Their neurologic status included different organic symptoms. Post chemotherapy encephalopathy is characterized by the combination of severe cerebral asthenia and different organic neurologic symptoms with moderate cephalgic syndrome. MRT showed single and multiple loci of gliosis in the white matter.
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Affiliation(s)
- N B Kholodova
- FGBU 'Rossiĭskiĭ nauchnyĭ tsentr rentgenoradiologii' Minzdrava Rossii, Moskva
| | - V M Sotnikov
- FGBU 'Rossiĭskiĭ nauchnyĭ tsentr rentgenoradiologii' Minzdrava Rossii, Moskva
| | - N Iu Dobrovol'skaia
- FGBU 'Rossiĭskiĭ nauchnyĭ tsentr rentgenoradiologii' Minzdrava Rossii, Moskva
| | - Iu A Ponkratova
- FGBU 'Rossiĭskiĭ nauchnyĭ tsentr rentgenoradiologii' Minzdrava Rossii, Moskva
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A pilot study: application of hemoglobin and cortisol levels, and a memory test to evaluate the quality of life of breast cancer patients on chemotherapy. Int J Biol Markers 2013; 28:e348-56. [PMID: 24338719 DOI: 10.5301/jbm.5000053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2013] [Indexed: 12/24/2022]
Abstract
BACKGROUND Short-term memory (STM) decline in breast cancer patients resulting from chemotherapy was evaluated by means of blood biomarkers, a questionnaire, and a computerized STM test. METHODS This study was conducted from January 2013 to June 2013, recruiting 90 subjects: 30 breast cancer patients beginning the 3rd of 4th cycles of docetaxel and cyclophosphamide chemotherapy, 30 recovered patients (who completed 4 cycles of docetaxel for a minimum of 6 months), and 30 healthy subjects (disease-free females). The levels of hemoglobin, red and white blood cells, and cortisol in serum, and a computerized STM test were analyzed to estimate the effects of chemotherapy on STM. A questionnaire was given to all subjects to assess quality of life. RESULTS Statistically significant differences were observed for the blood parameters (hemoglobin, red and white blood cells, and cortisol levels) between healthy and on-treatment subjects (respectively 13.47 ± 0.96 g/dL vs 5.37 ± 0.38 g/dL, 4.58 ± 0.41 10(12)/L vs 2.07 ± 0.13 10(12)/L, and 6.15 ± 1.03 10(9)/L vs 0.86 ± 0.41 10(9)/L). Scores of the STM test were significantly lower for patients compared to healthy subjects. As indicated by the results of the questionnaire, breast cancer patients had a higher tendency to forget than healthy controls (X(2)=3.15; p<0.0001) and recovered subjects (X(2)=3.15; p<0.0001). CONCLUSION We found depleted levels of hemoglobin, red and white blood cells as a result of chemotherapy, and elevated levels of stress correlated with poor performances in the computerized STM test. A higher cortisol level might be an important precursor of STM deterioration. Monitoring cortisol would be beneficial for evaluating the quality of life of breast cancer patients on chemotherapy.
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Cheung YT, Lim SR, Shwe M, Tan YP, Chan A. Psychometric properties and measurement equivalence of the English and Chinese versions of the functional assessment of cancer therapy-cognitive in Asian patients with breast cancer. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2013; 16:1001-1013. [PMID: 24041350 DOI: 10.1016/j.jval.2013.06.017] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 06/23/2013] [Accepted: 06/28/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE This study was designed to examine the psychometric properties and measurement equivalence of the English and Chinese versions of the Functional Assessment of Cancer Therapy-Cognitive Function (Version 3) (FACT-Cog) in multiethnic Asian patients with breast cancer. METHODS This prospective study involved patients with breast cancer from the National Cancer Centre Singapore. The concurrent validity of the FACT-Cog was assessed according to its strength of correlation with the validated European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire 30 cognitive functioning scale, and its association with fatigue, global health status, and anxiety. The known-group validity was assessed on the basis of receipt of chemotherapy. Factor analysis was conducted to ascertain the one-factor structure of each cognitive domain. The reliability was evaluated by using Cronbach's alpha and intraclass correlation coefficient within the cognitive domains. Multiple regression analyses were performed to compare the total scores between the two language versions, adjusting for covariates. RESULTS A total of 185 English-speaking and 143 Chinese-speaking patients were recruited. Both the English and Chinese FACT-Cog total scores correlated strongly with the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire 30 cognitive functioning scale scores (r = 0.725 and 0.646), whereas correlations with fatigue, anxiety, and global health status were weak to moderate (|r| = 0.376-0.589). Regarding the known-group validity, more severe perceived cognitive disturbance was observed among patients receiving chemotherapy than among those who were not for both versions (P = .010 and .008, respectively). Internal consistencies within the cognitive domains were high (Cronbach's α 0.707-0.929), and test-retest reliability was satisfactory for both versions (intraclass correlation coefficient 0.762 and 0.697). The measurement equivalence between the English and Chinese versions was established for all domains except the multitasking domain. CONCLUSION The English and Chinese versions of the FACT-Cog are valid, reliable, and equivalent for clinical and research use.
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Affiliation(s)
- Yin Ting Cheung
- Department of Pharmacy, National University of Singapore, Singapore; Department of Pharmacy, National Cancer Centre Singapore, Singapore
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Meadows ME, Chang G, Jones JA, Antin JR, Orav EJ. Predictors of neuropsychological change in patients with chronic myelogenous leukemia and myelodysplastic syndrome. Arch Clin Neuropsychol 2013; 28:363-74. [PMID: 23391504 PMCID: PMC3656510 DOI: 10.1093/arclin/acs141] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2012] [Indexed: 11/14/2022] Open
Abstract
This study examined the course of neuropsychological functioning in patients with chronic myelogeous leukemia (n = 91) or myelodysplastic syndrome (n = 15) who underwent standard treatment for their disease or allogeneic hematopoietic stem cell transplantation (HSCT) at baseline, 12 months, and 18 months post-treatment. At baseline, 23% of the participants (n = 75) in the longitudinal sample had Z-scores on at least one of the neuropsychological tests that were <1.4. Participants in the study showed improvement over baseline at the 12 and 18 months assessments. The average Z-scores for the six cognitive domains in the longitudinal data set over the course of the study ranged from -0.89 to 0.59. Significant predictors of change in neuropsychological test scores included age, with older participants showing less improvement over time. Other predictors included baseline cognitive domains (language, memory, and attention), previous cocaine use, disease status, intelligence quotient, and quality of life measures. Findings support previous studies in patients with hematological malignancies who showed cognitive impairments at baseline prior to HSCT. However, there was little evidence for further cognitive decline over the course of 18 months.
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Affiliation(s)
- Mary-Ellen Meadows
- Division of Cognitive and Behavioral Neurology, Brigham and Women's Hospital, Boston, MA 02115, USA.
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Scherling CS, Smith A. Opening up the window into "chemobrain": a neuroimaging review. SENSORS 2013; 13:3169-203. [PMID: 23467031 PMCID: PMC3658739 DOI: 10.3390/s130303169] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Revised: 02/05/2013] [Accepted: 02/16/2013] [Indexed: 12/27/2022]
Abstract
As more chemotherapy-treated cancer patients are reaching survivorship, side-effects such as cognitive impairment warrant research attention. The advent of neuroimaging has helped uncover a neural basis for these deficits. This paper offers a review of neuroimaging investigations in chemotherapy-treated adult cancer patients, discussing the benefits and limitations of each technique and study design. Additionally, despite the assumption given by the chemobrain label that chemotherapy is the only causative agent of these deficits, other factors will be considered. Suggestions are made on how to more comprehensively study these cognitive changes using imaging techniques, thereby promoting generalizability of the results to clinical applications. Continued investigations may yield better long-term quality of life outcomes by supporting patients' self-reports, and revealing brain regions being affected by chemotherapy.
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Affiliation(s)
- Carole S. Scherling
- Memory and Aging Center, Neurology, UCSF, Sandler Neuroscience Center, 675 Nelson Rising Lane, San Francisco, CA 94158, USA
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +1-415-476-2662; Fax: +1-415-514-2554
| | - Andra Smith
- School of Psychology, University of Ottawa, Vanier Hall, 136 Jean Jacques Lussier, Ottawa, ON K1N 6N5, Canada; E-Mail:
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Cheung YT, Shwe M, Chui WK, Chay WY, Ang SF, Dent RA, Yap YS, Lo SK, Ng RCH, Chan A. Effects of chemotherapy and psychosocial distress on perceived cognitive disturbances in Asian breast cancer patients. Ann Pharmacother 2012; 46:1645-55. [PMID: 23249868 DOI: 10.1345/aph.1r408] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND There is conflicting evidence on the effect of chemotherapy and psychosocial distress on perceived cognitive changes in cancer patients. OBJECTIVE To compare the severity of perceived cognitive disturbance in Asian breast cancer patients receiving chemotherapy and those not receiving chemotherapy, and identify clinical characteristics associated with perceived cognitive disturbances. METHODS A cross-sectional, observational study was conducted at the largest cancer center in Singapore. Breast cancer patients receiving chemotherapy and not receiving chemotherapy completed the Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog), European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ-C30), and Beck Anxiety Inventory to assess their perceived cognitive functioning, health-related quality of life, and anxiety, respectively. Multiple regression was conducted to delineate the factors associated with perceived cognitive disturbances. RESULTS A total of 85 breast cancer patients receiving chemotherapy and 81 not receiving chemotherapy were recruited. Chemotherapy patients experienced more fatigue (QLQ-C30 fatigue scores: 33.3 vs 22.2 points; p = 0.005) and moderate-to-severe anxiety (21.9% vs 8.6%; p = 0.002) compared to non-chemotherapy patients. Non-chemotherapy patients reported better perceived cognitive functioning than those who received chemotherapy (FACT-Cog scores: 124 vs 110 points, respectively; p < 0.001). Chemotherapy and endocrine therapy were strongly associated with perceived cognitive disturbances (p < 0.001 and 0.021, respectively). The interacting effect between anxiety and fatigue was moderately associated with perceived cognitive disturbances (β = -0.29; p = 0.037). CONCLUSIONS Chemotherapy and endocrine treatment were associated with significant cognitive disturbances among Asian breast cancer patients. Psychosocial factors could be used to identify cancer patients who are more susceptible to cognitive disturbances in the clinical setting.
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Yennu S, Urbauer DL, Bruera E. Factors associated with the severity and improvement of fatigue in patients with advanced cancer presenting to an outpatient palliative care clinic. BMC Palliat Care 2012; 11:16. [PMID: 22985058 PMCID: PMC3515470 DOI: 10.1186/1472-684x-11-16] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 09/13/2012] [Indexed: 12/22/2022] Open
Abstract
Background The aim of this study was to determine factors associated with the severity of cancer related fatigue (CRF) and predictors of improvement of CRF at the first follow-up visit in patients with advanced cancer referred to outpatient palliative care clinic (OPC). Methods We reviewed the records of consecutive patients with advanced cancer presenting to OPC. Edmonton Symptom Assessment System (ESAS) scores were obtained at the initial and subsequent visits between January 2003 and December 2008. All patients received interdisciplinary care led by palliative medicine specialists following an institutional protocol. Fatigue improvement was defined as a reduction of ≥2 points in ESAS score relative to the baseline. Descriptive statistics were used to summarize patient characterstics. Univariate analyses were performed and only significant variables were included in multivariate regression analysis to determine factors associated with severity and improvement in CRF. Results A total of 1778 evaluable patients were analyzed (median age, 59 years; 52% male). The median time between visits was 15 days. Median fatigue scores on the ESAS were 6 at baseline and 5 at follow-up. Severity of all ESAS items and low serum albumin were associated with fatigue at baseline (p < 0.0001). The improvement of fatigue was observed in 586 patients (33%). The hierarchical model showed that fatigue improved over time (b = −0.009; p = 0.0009). low appetite (odds ratio [OR] = 1.09 per point; p = 0.0113) and genitourinary cancer (OR = 1.74 per point; p = 0.0458) were significantly associated with improvement of fatigue. Conclusions CRF is strongly associated with physical and emotional symptoms. Genitourinary cancer and low appetite at baseline were associated with successful improvement of fatigue.
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Affiliation(s)
- Sriram Yennu
- Department of Palliative Care and Rehabilitation Medicine, Unit 1414, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA.
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The impact of fatigue and anemia on functional status in older cancer patients treated with chemotherapy. J Geriatr Oncol 2012. [DOI: 10.1016/j.jgo.2012.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Cheung YT, Chui WK, Chan A. Neuro-cognitive impairment in breast cancer patients: pharmacological considerations. Crit Rev Oncol Hematol 2011; 83:99-111. [PMID: 22015329 DOI: 10.1016/j.critrevonc.2011.09.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Revised: 08/15/2011] [Accepted: 09/14/2011] [Indexed: 10/16/2022] Open
Abstract
Post-chemotherapy cognitive impairment has been an issue of concern in cancer survivors. While most reviews are focused on patient-related factors, it is proposed that drug-related factors may also be determinants. The objective of this review is to study the relationship between the types and dose intensities of chemotherapy regimens on cognitive impairment in breast cancer patients through a systematic literature search. Eighteen prospective studies were selected. The types, dose intensities and durations of chemotherapy regimens received by subjects were compared against prevalence results obtained in individual studies. It was observed that the duration of impairment varied across different generations of chemotherapy regimens. Concurrent administration of multiple cytotoxic agents can lead to a synergistic decline on cognition. Current clinical evidence is insufficient to evaluate the relationship between the types, dose intensities of chemotherapy regimens and cognitive impairment. More investigation is needed to examine the role of pharmacological factors in chemotherapy-associated cognitive changes.
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Affiliation(s)
- Yin Ting Cheung
- Department of Pharmacy, National University of Singapore, Singapore
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Argyriou AA, Assimakopoulos K, Iconomou G, Giannakopoulou F, Kalofonos HP. Either called "chemobrain" or "chemofog," the long-term chemotherapy-induced cognitive decline in cancer survivors is real. J Pain Symptom Manage 2011; 41:126-39. [PMID: 20832978 DOI: 10.1016/j.jpainsymman.2010.04.021] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Revised: 04/20/2010] [Accepted: 04/21/2010] [Indexed: 11/20/2022]
Abstract
CONTEXT In recent years, there is growing evidence in the medical literature to support an association between administration of commonly used chemotherapeutic agents and an increased risk for cognitive impairment. OBJECTIVES We herein critically summarize data relating to the pathophysiological mechanisms by which chemotherapy may induce cognitive impairment in patients surviving from solid tumors. The clinical and epidemiological characteristics and the proposed management strategies to counter chemotherapy-induced cognitive impairment (CICI) also are presented. METHODS References for this review were identified by searches of PubMed from 1995 until December 2009 with related terms. RESULTS Both the pathogenetic mechanisms and the overall clinical nature of CICI remain vaguely defined. Findings indicate that CICI is a relatively common event that, in most of the cases, remains underdiagnosed, thereby adversely affecting the quality of life of patients with cancer. Effective pharmacological interventions toward the symptomatic or prophylactic management of CICI also are lacking. CONCLUSION Either called "chemobrain" or "chemofog," the long-term CICI in cancer survivors is real. The need for multidisciplinary care interventions toward a timely diagnosis and management of CICI is clearly warranted.
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Affiliation(s)
- Andreas A Argyriou
- Department of Neurology, Saint Andrew's General Hospital of Patras, Patras, Greece; Division of Oncology, Department of Medicine, University Hospital, University of Patras Medical School, Rion-Patras, Greece
| | | | - Gregoris Iconomou
- Division of Oncology, Department of Medicine, University Hospital, University of Patras Medical School, Rion-Patras, Greece
| | - Fotini Giannakopoulou
- Division of Oncology, Department of Medicine, University Hospital, University of Patras Medical School, Rion-Patras, Greece
| | - Haralabos P Kalofonos
- Division of Oncology, Department of Medicine, University Hospital, University of Patras Medical School, Rion-Patras, Greece
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Balducci L. Anemia, fatigue and aging. Transfus Clin Biol 2010; 17:375-81. [PMID: 21067951 DOI: 10.1016/j.tracli.2010.09.169] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Accepted: 09/19/2010] [Indexed: 10/18/2022]
Abstract
Aging is associated with increased incidence and prevalence of both cancer and anemia. Cancer and aging may conspire in making anemia more frequent and more severe. This article reviews the causes and the consequences of anemia in the older individual. The most common causes include chronic inflammation that is a typical manifestation of aging, iron deficiency that may be due to chronic hemorrhage, malabsorption and Helicobacter pylori infection, cobalamin deficiency from malabsorption and renal insufficiency. Other causes of anemia whose prevalence is not well established include myelodysplasia, copper deficiency, hypothyroidism, and sarcopenia. Anemia is associated with increased risk of mortality, functional dependence, dementia, falls, and chemotherapy-related toxicity. When correcting the anemia of older cancer patients one should remember that the erythropoietic stimulating agents (ESA) may stimulate cancer growth and cause thrombosis. These products may be safe when given exclusively to patients receiving chemotherapy and when the hemoglobin levels are maintained below 12 g/dL.
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Affiliation(s)
- L Balducci
- H Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Dr, Tampa, FL 33612, USA.
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Abstract
Many different words are used to describe fatigue. It is unclear whether these word descriptors represent the same cancer symptom or dimension. The objective of this study was to identify clinical associations of three fatigue word descriptors (FWDs): 'easy fatigue', 'weakness', and 'lack of energy' (LOE). One thousand consecutive palliative medicine patients completed a 38-item symptom checklist. The prevalence of the three FWDs alone and in combination was calculated. Spearman correlations assessed associations between FWDs. Logistic regression analysis identified univariable and multivariable predictors for each FWD. Survival was estimated using the Kaplan-Meier method, individually and for 0-1 versus 2-3 FWDs, and compared using log-rank tests. The prevalence of easy fatigue was 69%, weakness 66%, and LOE 61%. Correlations between the FWDs were high (0.65-0.79). In multivariable models, clinical associations (particularly neuro-psychiatric symptoms and performance status) of the FWDs were variable. Weakness was associated with performance status, but not anxiety or depression. LOE was associated with anxiety and depression, but not performance status. Fatigue was associated with depression, but not anxiety or performance status. All FWDs were associated with dry mouth, early satiety, sleep problems, and weight loss. The worst survival was associated with two or three reported FWDs compared with none or one (P < 0.001). Weakness and LOE had distinct clinical associations that differed from fatigue. Evaluation of fatigue should use multiple descriptors (particularly weakness), as they are not synonymous. Further research is necessary to identify biological associations for discrete FWDs.
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Affiliation(s)
- Katherine Hauser
- The Harry R. Horvitz Center for Palliative Medicine, Section of Palliative Medicine and Supportive Oncology, Department of Solid Tumor Oncology, Cleveland Clinic Taussig Cancer Institute, USA
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The Fatigue Symptom Inventory: a systematic review of its psychometric properties. Support Care Cancer 2010; 19:169-85. [DOI: 10.1007/s00520-010-0989-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Accepted: 08/16/2010] [Indexed: 10/19/2022]
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Patients’ views about causes and preferences for the management of cancer-related fatigue—a case for non-congruence with the physicians? Support Care Cancer 2010; 19:363-70. [DOI: 10.1007/s00520-010-0826-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Accepted: 01/20/2010] [Indexed: 11/12/2022]
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Prue G, Allen J, Gracey J, Rankin J, Cramp F. Fatigue in gynecological cancer patients during and after anticancer treatment. J Pain Symptom Manage 2010; 39:197-210. [PMID: 19995675 DOI: 10.1016/j.jpainsymman.2009.06.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2008] [Revised: 06/01/2009] [Accepted: 07/13/2009] [Indexed: 11/18/2022]
Abstract
CONTEXT Research has indicated that individuals with gynecological cancer experience severe fatigue. OBJECTIVES This longitudinal survey aimed to analyze the fatigue experienced over the course of one year by a gynecological cancer population, to determine if the fatigue was more severe than that reported by females without cancer, and to identify variables associated with cancer-related fatigue (CRF). METHODS Data were collected over a 12-month period before, during, and after anticancer treatment. Fatigue was assessed using the Multidimensional Fatigue Symptom Inventory-Short Form. Participants with cancer also completed the Rotterdam Symptom Checklist. RESULTS Sixty-five cancer patients (mean age = 57.4 years, standard deviation [SD] = 13.9) and 60 control subjects (mean age = 55.4 years, SD = 13.6) participated. Descriptive analysis and repeated measurements modeling indicated that the cancer participants reported worse fatigue than the noncancer individuals before, during, and after anticancer treatment (P < 0.001) and that the level of fatigue in persons with cancer changed with time (P = 0.02). A forward stepwise regression demonstrated that psychological distress level was the only independent predictor of CRF during anticancer treatment (P < 0.00), explaining 44% of the variance in fatigue. After treatment, both psychological distress level (P < 0.00) and physical symptom distress (P = 0.03) were independent predictors of fatigue, accounting for 81% of the variance. CONCLUSION Psychological distress level is an important indicator of CRF in gynecological cancer. Interventions focused on the reduction of psychological distress may help alleviate CRF.
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Affiliation(s)
- Gillian Prue
- Institute of Nursing Research, University of Ulster, Newtownabbey, Co. Antrim, BT37 0QB, United Kingdom.
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Vearncombe KJ, Pachana NA. Impact of health, treatment and psychological factors on cognitive functioning after chemotherapy for early breast cancer. AUSTRALIAN PSYCHOLOGIST 2009. [DOI: 10.1080/00050060903096652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Katharine Jean Vearncombe
- School of Psychology, University of Queensland, St Lucia
- Wesley Research Institute, Wesley Hospital, Brisbane, Queensland, Australia
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Abstract
The objective of this study is to identify whether decline in cognitive functioning after chemotherapy in women with breast cancer is associated with health/disease, treatment, and psychological variables. Neuropsychological performance, health/disease, and treatment-related information of 136 women with breast cancer (age M = 49.38; SD = 7.92; range = 25.25-67.92) was assessed pre-chemotherapy and 1-month post-chemotherapy. The Reliable Change Index corrected for practice (RCIp) identified women whose performance significantly declined, while Pearson correlations assessed the relationship between cognitive change and predictor variables. A total of 16.9% of women showed significant decline post-chemotherapy, with affected domains including verbal learning and memory, abstract reasoning, and motor coordination. Decline in hemoglobin levels and increased anxiety over the course of chemotherapy was found to significantly predict impairment in multiple cognitive measures. Change in specific cognitive measures was significantly associated with baseline fatigue, depression, and functional well-being (r = 0.23 to 0.33; p = .01 to < .001). Although the effects are small, there is evidence that psychological and health factors may increase vulnerability to cognitive dysfunction after chemotherapy for breast cancer. Significant associations reported in this study may be useful in the identification and treatment of at-risk individuals.
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Friedman MA, Fernandez M, Wefel JS, Myszka KA, Champlin RE, Meyers CA. Course of Cognitive Decline in Hematopoietic Stem Cell Transplantation: A Within-subjects Design. Arch Clin Neuropsychol 2009; 24:689-98. [DOI: 10.1093/arclin/acp060] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Affiliation(s)
- Janette Vardy
- Department of Medical Oncology, The University of Sydney, Cancer Institute NSW, Sydney, Concord, Australia.
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Abstract
OBJECTIVES Functional dependence is a costly manifestation of aging that compromises the quality of life of elderly individuals and their caregivers. In this study, we hypothesized that fatigue may be a cause of functional dependence in older cancer patients. To establish whether fatigue was associated with dependence in 1 or more activities of daily living (ADLs) or instrumental activities of daily living (IADLs), and declining performance status (PS). In addition, we studied the prevalence of fatigue and its correlation with anemia, depression, and nutritional status. MATERIALS AND METHODS Retrospective cross-sectional study of 214 patients aged 70 and older were seen over a 3-month period by the Senior Adult Oncology Program of the H. Lee Moffitt Cancer Center in Tampa, FL. Each patient was screened with a questionnaire assessing ADLs, IADLs, PS, cognitive impairment, depression, and malnutrition. In addition, each patient underwent assessment of fatigue with the fatigue symptom inventory and a determination of complete blood counts and complete chemical panel. RESULTS Fatigue was reported by 81% of the patients. The interference score of fatigue seemed to be a mediator for dependencies in ADLs and IADLs (P < 0.001 and 0.001), and poorer PS (P < 0.001). CONCLUSIONS Fatigue is a common chronic problem for older cancer patients and may represent a major cause of functional dependence.
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A comparison of the characteristics of disease-free breast cancer survivors with or without cancer-related fatigue syndrome. Eur J Cancer 2008; 45:384-92. [PMID: 18977131 PMCID: PMC2653618 DOI: 10.1016/j.ejca.2008.09.010] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2008] [Revised: 08/29/2008] [Accepted: 09/23/2008] [Indexed: 11/24/2022]
Abstract
Purpose To determine the prevalence of cancer-related fatigue syndrome (CRFS) in a population of disease-free breast cancer survivors and to investigate the relationship between CRFS and clinical variables. Patients and methods Women (200) were recruited. All participants were between 3 months and 2 years after completion of primary therapy for breast cancer and were disease free. Subjects completed a diagnostic interview for CRFS and structured psychiatric interview. Participants also completed quality of life, mood and fatigue questionnaires, and provided a blood sample for haematological and biochemical analysis and a 24-h urine specimen for cortisol estimation. Subjects wore a wrist actigraph for 7 days to measure activity and sleep. Results Sixty women (30% of participants) were found to fulfil the criteria for CRFS. There were statistically significant differences between fatigued and non-fatigued women with respect to fatigue severity (p < 0.01), mood (p < 0.01) and quality of life scores (p < 0.05). There were significant differences in blood variables including raised total white cell count and lower sodium (all p < 0.02). There was no difference in the 24 h urinary free cortisol levels. Actigraphic data demonstrated significant differences in sleep quality and disturbance, but not in overall levels of daytime activity or circadian rhythm. Conclusion CRFS affects 30% of women after breast cancer treatment and has significant effects on quality of life and mood. There is some evidence that CRFS is related to sleep disturbance or to a persistent inflammatory or immune response.
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Laird BJA, Whyte G, Laird JH, Soutar RL, Welsh J, Fallon MT. Letter to editor: an observational study of red cell transfusion in specialist palliative care. Palliat Med 2008; 22:874-5. [PMID: 18718992 DOI: 10.1177/0269216308094521] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- BJA Laird
- Department of Haematology, Royal Hospital for Sick Children, Glasgow, UK
| | - G Whyte
- Mersey Deanery, Liverpool, UK
| | - JH Laird
- West of Scotland Deanery, Glasgow, UK
| | - RL Soutar
- Department of Haematology, Western Infirmary, Glasgow, UK
| | - J Welsh
- Beatson Oncology Centre, Glasgow, UK
| | - MT Fallon
- University of Edinburgh, Western General Hospital (CRUK), Edinburgh, UK
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Heck JE, Albert SM, Franco R, Gorin SS. Patterns of Dementia Diagnosis in Surveillance, Epidemiology, and End Results Breast Cancer Survivors Who Use Chemotherapy. J Am Geriatr Soc 2008; 56:1687-92. [DOI: 10.1111/j.1532-5415.2008.01848.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Iconomou G, Koutras A, Karaivazoglou K, Kalliolias GD, Assimakopoulos K, Argyriou AA, Ifanti A, Kalofonos HP. Effect of epoetin alpha therapy on cognitive function in anaemic patients with solid tumours undergoing chemotherapy. Eur J Cancer Care (Engl) 2008; 17:535-41. [PMID: 18707621 DOI: 10.1111/j.1365-2354.2007.00857.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The primary aim of this study was to assess whether epoetin alpha (Ea) would improve cognitive performance in a group of anaemic cancer patients receiving chemotherapy. The secondary aim was to confirm the positive impact of Ea on haematological parameters, and quality of life (QOL). Fifty patients with solid tumours and haemoglobin (Hb) <11.0 g/dL received Ea 40,000 units once weekly for 12 weeks and were administered the Mini-Mental State Examination and the European Organization for Research and Treatment of Cancer (QLQ-C30) questionnaire prior to Ea therapy and at study completion. No clinically significant alterations were observed on cognitive function during Ea treatment. Changes in cognitive function were unrelated to Hb change and there were no significant differences in cognitive performance between Ea responders and non-responders. The analyses revealed clinically significant improvements in Hb levels, physical and role function, and clinically meaningful reductions in fatigue. Hb changes were significantly associated with the magnitude of improvement in QOL parameters. The lack of a clinical benefit in cognition observed in this study during Ea treatment may redirect the focus of research from enhancing to maintaining cognitive function, since stability in cognitive performance through time may be as well clinically important.
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Affiliation(s)
- G Iconomou
- Division of Oncology, Department of Medicine, University of Patras Medical School, Greece
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Levy MR. Cancer Fatigue: A Neurobiological Review for Psychiatrists. PSYCHOSOMATICS 2008; 49:283-91. [DOI: 10.1176/appi.psy.49.4.283] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lee YH, Tsai YF, Lai YH, Tsai CM. Fatigue experience and coping strategies in Taiwanese lung cancer patients receiving chemotherapy. J Clin Nurs 2008; 17:876-83. [PMID: 18321286 DOI: 10.1111/j.1365-2702.2007.02021.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS The aim of this cross-sectional study was to explore fatigue levels and fatigue-coping strategies in Taiwanese lung cancer patients receiving chemotherapy. BACKGROUND Lung cancer is now recognized as one of the most common cancers in Taiwan, with a high prevalence of mortality. As chemotherapy progresses, fatigue is a common cause of symptom distress. METHODS Data on demographic and disease-related characteristics were gathered from the medical record, and data on fatigue and coping strategies were gathered by questionnaires administered to 101 lung cancer patients receiving chemotherapy. RESULTS The mean fatigue score for the total sample was 8.0 (SD = 5.0, range = 0-20), indicating light-to-moderate fatigue. The majority of patients (n = 76, 75.2%) had a baseline haemoglobin level of <or=12 g/dl and a significantly greater (t = 2.7, p < 0.01) mean fatigue score (8.5 SD 4.6) than patients with haemoglobin >12 g/dl (6.2 SD 5.7). Fatigue levels were significantly higher in patients receiving a third course of chemotherapy than in those receiving a first course (F = 3.7, p = 0.03). The most commonly used management category was energy conservation (n = 659), and the most commonly used strategy was sitting (n = 101) and lying down (n = 98). However, participants rated exercise (mean = 3.9), sleep (mean = 3.8) and walking (mean = 3.6) as the most effective. CONCLUSION This study highlighted the management of fatigue problems in lung cancer patients receiving chemotherapy, especially in respecting patients' self-report of fatigue-management strategies. Relevance to clinical practice. Health care providers should carefully assess patients for fatigue while they are receiving chemotherapy. These patients and their caregivers should be taught to notice fatigue and encouraged to choose coping strategies that reduce fatigue level, thus improving their quality of life.
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Levy M. Cancer fatigue: a review for psychiatrists. Gen Hosp Psychiatry 2008; 30:233-44. [PMID: 18433655 DOI: 10.1016/j.genhosppsych.2008.01.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2007] [Revised: 01/22/2008] [Accepted: 01/23/2008] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Cancer-related fatigue (CRF) is a ubiquitous and debilitating phenomenon for patients both during and after treatment for cancer of all types. This review will outline the complex neurobiological mechanisms underlying CRF and their relevance to various treatment routes. It will cover aspects of screening, diagnosis and treatment, including both pharmacological and behavioral interventions for CRF. The goal of the article was not to perform a comprehensive literature review or meta-analysis, but rather to integrate clinically relevant information from different areas of research related to cancer fatigue, including etiology, diagnosis and management for a nonspecialist audience. METHOD The methodology used involved broadly surveying the literature available on Medline using such search terms as "cancer," "fatigue," "cytokine" and "depression," exploring relevant articles over the past 15 years and relevant citations from these articles and focusing on recent advances in the study of CRF. RESULTS CRF occurs at high prevalence rates during and subsequent to cancer treatment. Multidisciplinary approaches are available for the assessment and management of fatigue including underlying contributory factors. CONCLUSIONS An increasing base for evidence is present to guide the management of CRF. Additional research is warranted to understand the neurobiological mechanisms, etiology and risk factors for fatigue.
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Affiliation(s)
- Mitchell Levy
- Department of Psychiatry and Behavioral Sciences, University of Washington Psychiatry and Psychology Service, Seattle Cancer Care Alliance, Seattle, WA 98105, USA.
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Vardy J, Tannock I. Cognitive function after chemotherapy in adults with solid tumours. Crit Rev Oncol Hematol 2007; 63:183-202. [PMID: 17678745 DOI: 10.1016/j.critrevonc.2007.06.001] [Citation(s) in RCA: 154] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2007] [Revised: 05/29/2007] [Accepted: 06/07/2007] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Evidence is emerging that some cancer survivors suffer cognitive impairment after chemotherapy; the cause is unknown. METHODS Here we review studies evaluating cognitive impairment in adult cancer survivors and discuss methodological challenges associated with this research. We evaluate evidence for cognitive impairment in cancer patients, the incidence of self-reported impairment, and identify potential mechanisms and confounders. RESULTS Most studies of cognitive function are cross-sectional and report impairment in 15-45% of subjects. Longitudinal studies suggest that some impairment is present prior to receiving chemotherapy, and that this worsens in some patients. The aetiology is unknown. A larger number of subjects self-report changes in cognitive function after chemotherapy; this does not correlate with objective testing. CONCLUSIONS Cognitive impairment occurs in a subset of cancer survivors and is generally subtle. Most evidence suggests an association with chemotherapy although other factors associated with the diagnosis and treatment of cancer may contribute.
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Abstract
PURPOSE/OBJECTIVES To develop a conceptual model of chemotherapy-related changes in cognitive function. DATA SOURCES MEDLINE, CINAHL, HealthStar, and PsycINFO databases. DATA SYNTHESIS Patients undergoing chemotherapy often complain of forgetfulness, absentmindedness, and an inability to focus when performing a variety of daily tasks. Changes in cognitive function have been referred to by the colloquial term "chemo-brain." The authors conducted an examination of the literature to investigate relationships among concepts and to synthesize current knowledge. CONCLUSIONS Cognitive function, defined as higher-order mental processes, may be altered along two distinct and interacting pathways: (a) the cancer diagnosis, which can lead to anxiety, stress, distress, and depression; and (b) the direct physiologic effects of cancer treatment. The Chemotherapy-Related Change in Cognitive Function conceptual model is informed by a review of literature that illustrates antecedents, moderators, mediators, and consequences that may be relevant to this issue. IMPLICATIONS FOR NURSING When a patient presents with cognitive complaints, the problems can be evaluated for intervention when an overall understanding exists of chemotherapy-related cognitive changes based on a conceptual model that continues to be informed through well-conceptualized and well-designed research.
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Affiliation(s)
- Lisa M Hess
- The College of Medicine, the Arizona Cancer Center, The University of Arizona, Tucson
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Jean-Pierre P, Figueroa-Moseley CD, Kohli S, Fiscella K, Palesh OG, Morrow GR. Assessment of cancer-related fatigue: implications for clinical diagnosis and treatment. Oncologist 2007; 12 Suppl 1:11-21. [PMID: 17573452 DOI: 10.1634/theoncologist.12-s1-11] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Cancer-related fatigue (CRF) is a highly prevalent and debilitating symptom experienced by most cancer patients during, and often for considerable periods after, treatment. The recognition of the importance of CRF to patients' psychosocial and cognitive functioning, as well as to their quality of life, has driven the development of a wide range of assessment tools for screening and diagnosis of CRF. Over 20 different measures have been used to assess CRF from either a unidimensional or multi-dimensional perspective. Unidimensional measures are often single-question scales that generally focus on identifying the occurrence and severity of CRF, whereas multidimensional measures may also examine the effect of CRF across several domains of physical, socio-emotional, and cognitive functioning. This paper provides an overview and critique of measures commonly used to assess CRF. Single-question assessment is the most commonly used and the most useful methodology. Strategies to facilitate reliable assessment of CRF are also discussed. Disclosure of potential conflicts of interest is found at the end of this article.
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Affiliation(s)
- Pascal Jean-Pierre
- Department of Radiation Oncology, University of Rochester School of Medicine and Dentistry, James P Wilmot Cancer Center, Rochester, NY 14642, USA.
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