Preventing adverse information effects on health outcomes: A self-affirmation intervention reduced information-induced cognitive decline in gastrointestinal cancer patients

Spontaneous self-affirmation: an adaptive coping strategy for people with chronic pain

OBJECTIVES

Self-affirmation may be a promising treatment strategy for improving clinical outcomes. This study examined the association between self-affirmation and self-reported health status among people with chronic pain.

METHODS

In this cross-sectional study, 768 treatment seeking people (female 67.2%, mean age=50.4 years with SD of 17.1, White/Caucasian 59.9%) completed surveys using a learning healthcare system. Measures included spontaneous self-affirmation (SSA) items, PROMIS® outcome measures, and Pain Catastrophizing Scale (PCS). Multiple regressions were conducted to examine if strength-based SSA, value-based SSA, and their interaction would predict perceived health status and pain coping strategy. Sensitivity analysis was done by performing additional regressions with covariates (age, sex, race/ethnicity, and education). Lastly, exploratory analysis examined if average SSA scores would have a linear relationship with perceived health status.

RESULTS

The strength x value-based SSA interaction significantly predicted the PROMIS-depression, anxiety, and social isolation T-scores (ps≤0.007), but not anger T-scores (p=0.067). Specifically, greater tendency to use both SSA styles predicted less symptoms of depression, anxiety and social isolation. This interaction remained significant when controlling for the covariates. The two SSA styles and their interaction did not significantly predict pain interference, sleep disturbance, fatigue, average pain rating and PCS scores (ps≥0.054). Exploratory analysis revealed SSA average scores did not have a significant linear relationship with perceived health status.

CONCLUSIONS

The current study showed self-affirmation as being associated with better psychosocial health, but not associated with physical health and pain catastrophizing among patients with chronic pain. Our findings suggested the potential benefit of incorporating strength- and value-based affirmations in pain intervention approaches.

Interventions promoting cognitive function in patients experiencing cancer related cognitive impairment: A systematic review

OBJECTIVE

To examine the effect of interventions used to enhance cognitive function in patients experiencing cancer-related cognitive impairment.

METHODS

Studies including adults with a non-metastatic cancer who have received chemotherapy as part of their treatment and who have undergone interventions targeting cancer-related cognitive impairment were included. Studies involving patients with metastatic cancer and pre-existing cognitive deficits were excluded. Academic Search Complete, CINAHL Plus with full text, MEDLINE, Education Full Text, PsycARTICLES, PsycINFO, and ERIC were searched for studies published between January 2011 and September 2022. Data extraction and quality appraisal were conducted by two authors and cross-checked by the review team. Quality appraisal was conducted using 12 items from the Mixed Methods Appraisal Tool. Findings were presented narratively without meta-analysis.

RESULTS

Thirty-one studies were included. Interventions were categorised as integrative/complementary, cognitive behavioural therapy and compensatory strategies, exercise, psychoeducational/psychosocial, brain-training, and pharmacological. Over 100 instruments were identified, including the Functional Assessment of Cancer Therapy-Cognitive, Trail Making Tests-A and B, and instruments measuring secondary outcomes, including depression. Instruments often measured attention and concentration, language, memory, executive function, and/or patient-reported outcomes. Improvements were reported, with most studies measuring some or various aspects of cognitive functioning and very few studies measuring all domains of cognitive functioning, making it difficult to draw definitive conclusions about effectiveness.

CONCLUSIONS

Various interventions are available to treat cancer-related cognitive impairment. Outcome measurement was inconsistent and future research should prioritise using standardised measures. Current evidence, whilst not being definitive, suggests that certain interventions show greater promise than others, including cognitive behavioural therapy and brain training.

Nonpharmacological interventions for cancer-related cognitive impairment in adult cancer patients: A network meta-analysis

BACKGROUND

Conventional meta-analyses can only provide direct comparison evidence, and the best options of nonpharmacological interventions for cancer-related cognitive impairment remain largely unknown.

OBJECTIVES

To evaluate the comparative effects of all known nonpharmacological interventions for cancer-related cognitive impairment, and to rank the best intervention options for adult non- central nervous system cancer patients with cancer-related cognitive impairment.

DESIGN

Systematic review with a new analytic approach of network meta-analysis.

DATA SOURCES

Six electronic databases were searched for randomized controlled trials from January 2010 to July 2019.

REVIEW METHODS

Literature screening, data extraction and quality appraisal was undertaken systematically by two independent reviewers. Quantitative network meta-analysis performed to analyze key study outcomes. The primary outcome was the effectiveness of interventions on subjective cognitive function, and the secondary outcome was the safety of nonpharmacological interventions for cancer-related cognitive impairment.

RESULTS

There were 29 eligible randomized controlled trials searched, and a total of 10 interventions identified. All 29 randomized controlled trials that were included had no reported significant adverse events, therefore, these 10 nonpharmacological interventions are safe for cancer-related cognitive impairment management. In terms of effectiveness, the pooled overall effects were in favor of these 10 nonpharmacological interventions. The most effective interventions included meditation, cognitive training, cognitive rehabilitation, and exercise interventions, with a mean difference of effective size plus 95% confidence interval 10.26 (1.53, 19.00), 5.02 (1.41, 8.63), 4.88 (0.65, 9.11), and 3.82 (0.52, 7.13), respectively. Other treatment effects did not show statistically significant differences.

CONCLUSIONS

This network meta-analysis found that meditation interventions, cognitive training, cognitive rehabilitation, and exercise were the most effective interventions for adult non-central nervous system cancer patients to manage cancer-related cognitive impairment. Results of this network meta-analysis contribute evidence-based data to inform medical decision-making.