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Wang LY, Hu SL, Yao ZF, Xue M, Lu ZQ, Xiao-ju Z, Ding Y. Correlation between cancer-related cognitive impairment and resting cerebral glucose metabolism in patients with ovarian cancer. Heliyon 2024; 10:e34106. [PMID: 39113970 PMCID: PMC11305194 DOI: 10.1016/j.heliyon.2024.e34106] [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: 10/09/2023] [Revised: 07/02/2024] [Accepted: 07/03/2024] [Indexed: 08/10/2024] Open
Abstract
Background An increasing number of research have applied neuroimaging techniques to explore the potential neurobiological mechanism of Cancer-related cognitive impairment (CRCI). Purpose To explore the correlation between resting brain glucose metabolism and CRCI using 18F-FDG PET/CT in ovarian cancer (OC) patients. Methods From December 2021 to March 2022, 38 patients with OC were selected as the study group, and 38 healthy women of the same age (±1 year) who underwent routine physical examination using PET/CT were selected as the control group. Patients received further assessment with the Montreal Cognitive Assessment Scale (MoCA) and Perceived Deficit Questionnaire (PDQ). Independent sample t-test and Spearman correlation were conducted for data analysis. Results The resting brain glucose metabolism in the OC group was significantly lower than in the healthy controls. 60.52 % patients had neuropsychological impairment and retrospective memory were the most serious perceived cognitive impairments. The resting brain glucose metabolism in OC patients did not significantly correlate with neuropsychological performance but had significant positive correlation with subjective cognitive evaluation. Discussion Resting glucose metabolism was low in OC patients and associated with subjective cognitive impairment but not objective neuropsychological test results. 18F-FDG PET/CT can be used to evaluate brain function in OC patients and provide reliable imaging indicators for early recognition of and intervention for changes in cognitive function.
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Affiliation(s)
- Li-ying Wang
- Department of Nursing, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
- School of Nursing, Fudan University, Shanghai, 200032, China
| | - Si-long Hu
- Department of Nuclear Medicine, Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Zhi-feng Yao
- Department of Nuclear Medicine, Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Mei Xue
- Department of Nursing, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Zhen-qi Lu
- Department of Nursing, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Zhang Xiao-ju
- Department of Nursing, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Yan Ding
- Department of Nursing, Obstetrics & Gynecology Hospital of Fudan University, Shanghai, 200090, China
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Wang L, Ding Y, Zhang Y, Chen Y, Xue M, Wang X. The association between neuropsychological impairment, self-perceived cognitive deficit, symptoms, and health related quality of life in newly diagnosed ovarian cancer patients. Asia Pac J Oncol Nurs 2024; 11:100447. [PMID: 38798881 PMCID: PMC11127092 DOI: 10.1016/j.apjon.2024.100447] [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: 01/20/2024] [Accepted: 03/18/2024] [Indexed: 05/29/2024] Open
Abstract
Objective To assess cognitive function in patients newly diagnosed with ovarian cancer (OC) before treatment and explore the relationship between neuropsychological impairment, self-perceived cognitive deficit, symptoms, and health-related quality of life in them. Methods From May 2021 to February 2022, 105 women newly diagnosed with OC were enrolled in the Cancer Center of Fudan University, Shanghai, China. Objective and subjective cognitive functions were assessed using the Montreal Cognitive Assessment (MoCA) scale and Perceptual Deficits Questionnaire (PDQ). Symptoms and quality of life were evaluated using the Memorial Symptom Assessment Scale (MSAS) and Functional Assessment of Cancer Therapy-Ovarian Cancer (FACT-O), respectively. Results This study included 105 newly diagnosed OC patients, with an average age of 49.73 (±8.48) years. Of these, 72.38% had impaired neuropsychological test scores, especially in delayed recall, abstraction, and visuospatial/executive function. Retrospective, and prospective memory were the most serious perceived deficits. The results of the MoCA test were not associated with PDQ (Rs = -0.180, P = 0.067) and significantly correlated with the distress index, physiological and total scores of the MSAS, and emotional well- being of the FACT-O. The PDQ positively correlated with all MSAS dimensions but not with the FACT-O. Conclusion The incidence of neuropsychological impairment in patients newly diagnosed with OC was high, with no association with self-perceived cognitive deficits. It is recommended that healthcare providers include cognitive impairment in symptom management in this population, who may benefit from early assessment, prevention, and intervention.
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Affiliation(s)
- Liying Wang
- School of Nursing, Fudan University, Shanghai, China
- Department of Nursing, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yan Ding
- School of Nursing, Fudan University, Shanghai, China
- Department of Nursing, Obstetrics & Gynecology Hospital of Fudan University, Shanghai, China
| | - Yi Zhang
- Department of Nursing, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yaqiong Chen
- Department of Nursing, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Mei Xue
- Department of Nursing, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xia Wang
- Department of Nursing, Obstetrics & Gynecology Hospital of Fudan University, Shanghai, China
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Lomeli N, Pearre DC, Cruz M, Di K, Ricks-Oddie JL, Bota DA. Cisplatin induces BDNF downregulation in middle-aged female rat model while BDNF enhancement attenuates cisplatin neurotoxicity. Exp Neurol 2024; 375:114717. [PMID: 38336286 PMCID: PMC11087041 DOI: 10.1016/j.expneurol.2024.114717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 01/04/2024] [Accepted: 02/06/2024] [Indexed: 02/12/2024]
Abstract
Cancer-related cognitive impairments (CRCI) are neurological complications associated with cancer treatment, and greatly affect cancer survivors' quality of life. Brain-derived neurotrophic factor (BDNF) plays an essential role in neurogenesis, learning and memory. The reduction of BDNF is associated with the decrease in cognitive function in various neurological disorders. Few pre-clinical studies have reported on the effects of chemotherapy and medical stress on BDNF levels and cognition. The present study aimed to compare the effects of medical stress and cisplatin on serum BDNF levels and cognitive function in 9-month-old female Sprague Dawley rats to age-matched controls. Serum BDNF levels were collected longitudinally during cisplatin treatment, and cognitive function was assessed by novel object recognition (NOR) 14 weeks post-cisplatin initiation. Terminal BDNF levels were collected 24 weeks after cisplatin initiation. In cultured hippocampal neurons, we screened three neuroprotective agents, riluzole (an approved treatment for amyotrophic lateral sclerosis), as well as the ampakines CX546 and CX1739. We assessed dendritic arborization by Sholl analysis and dendritic spine density by quantifying postsynaptic density-95 (PSD-95) puncta. Cisplatin and exposure to medical stress reduced serum BDNF levels and impaired object discrimination in NOR compared to age-matched controls. Pharmacological BDNF augmentation protected neurons against cisplatin-induced reductions in dendritic branching and PSD-95. Ampakines (CX546 and CX1739) and riluzole did not affect the antitumor efficacy of cisplatin in vitro. In conclusion, we established the first middle-aged rat model of cisplatin-induced CRCI, assessing the contribution of medical stress and longitudinal changes in BDNF levels on cognitive function, although future studies are warranted to assess the efficacy of BDNF enhancement in vivo on synaptic plasticity. Collectively, our results indicate that cancer treatment exerts long-lasting changes in BDNF levels, and support BDNF enhancement as a potential preventative approach to target CRCI with therapeutics that are FDA approved and/or in clinical study for other indications.
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Affiliation(s)
- Naomi Lomeli
- Department of Neurology, University of California Irvine, Irvine, CA, USA
| | - Diana C Pearre
- Gynecologic Oncology, Providence Specialty Medical Group, Burbank, CA, USA
| | - Maureen Cruz
- Department of Neurology, University of California Irvine, Irvine, CA, USA
| | - Kaijun Di
- Department of Neurology, University of California Irvine, Irvine, CA, USA
| | - Joni L Ricks-Oddie
- Center for Statistical Consulting, Department of Statistics, University of California Irvine, Irvine, CA, USA; Biostatistics, Epidemiology and Research Design Unit, Institute for Clinical and Translational Sciences, University of California Irvine, Irvine, CA, USA
| | - Daniela A Bota
- Department of Neurology, University of California Irvine, Irvine, CA, USA; Chao Family Comprehensive Cancer Center, University of California Irvine, Irvine, CA, USA.
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4
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Hammer MJ, Cooper BA, Chen LM, Wright AA, Pozzar R, Blank SV, Cohen B, Dunn L, Paul S, Conley YP, Levine JD, Miaskowski C. Identification of distinct symptom profiles in patients with gynecologic cancers using a pre-specified symptom cluster. Support Care Cancer 2023; 31:485. [PMID: 37480403 DOI: 10.1007/s00520-023-07954-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 07/17/2023] [Indexed: 07/24/2023]
Abstract
PURPOSE Pain, fatigue, sleep disturbance, and depression are four of the most common symptoms in patients with gynecologic cancer. The purposes were to identify subgroups of patients with distinct co-occurring pain, fatigue, sleep disturbance, and depression profiles (i.e., pre-specified symptom cluster) in a sample of patients with gynecologic cancer receiving chemotherapy and assess for differences in demographic and clinical characteristics, as well as the severity of other common symptoms and QOL outcomes among these subgroups. METHODS Patients completed symptom questionnaires prior to their second or third cycle of chemotherapy. Latent profile analysis was used to identify subgroups of patients using the pre-specified symptom cluster. Parametric and nonparametric tests were used to evaluate for differences between the subgroups. RESULTS In the sample of 233 patients, two distinct latent classes were identified (i.e., low (64.8%) and high (35.2%)) indicating lower and higher levels of symptom burden. Patients in high class were younger, had child care responsibilities, were unemployed, and had a lower annual income. In addition, these women had a higher body mass index, a higher comorbidity burden, and a lower functional status. Patients in the high class reported higher levels of anxiety, as well as lower levels of energy and cognitive function and poorer quality of life scores. CONCLUSIONS This study identified a number of modifiable and non-modifiable risk factors associated with membership in the high class. Clinicians can use this information to refer patients to dieticians and physical therapists for tailored interventions.
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Affiliation(s)
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, San Francisco, CA, USA
| | - Lee-May Chen
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | | | | | | | | | - Laura Dunn
- School of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Steven Paul
- School of Nursing, University of California, San Francisco, San Francisco, CA, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Christine Miaskowski
- School of Nursing, University of California, San Francisco, San Francisco, CA, USA.
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA.
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Li Z, Peng L, Li Y, Zhang J, Jiang Q. Lower tumor burden is associated with better cognitive function in patients with chronic phase chronic myeloid leukemia. Leuk Lymphoma 2022; 63:2352-2363. [PMID: 35543618 DOI: 10.1080/10428194.2022.2070912] [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: 10/18/2022]
Abstract
Cognitive function was assessed in patients with chronic myeloid leukemia in the chronic phase (CML-CP) receiving tyrosine kinase inhibitor (TKI) therapy using the Montreal Cognitive Assessment (MoCA). Cross-sectional assessments of 100 newly diagnosed patients and 584 patients receiving TKI therapy for >1 year showed that 31 (31.0%) and 191 (32.7%) patients had mild cognitive impairment, respectively. In the multivariable analyses, higher percentages of blood blasts were associated with a worse MoCA score at diagnosis [β = -0.29, 95% confidence interval (-0.54, -0.03), p = .027]; deeper molecular response [versus < major molecular response, β = 0.74 (0.07, 1.40), p = .029], better MoCA score on TKI therapy. Increased MoCA scores were observed after 12 months of TKI therapy in 42 patients who were regularly followed up (p = .005). Lower tumor burden is associated with better cognitive function in CML-CP patients both at diagnosis and during TKI therapy.
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Affiliation(s)
- Zongru Li
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Li Peng
- Department of Neurology, Peking University People's Hospital, Beijing, China
| | - Yongjie Li
- Department of Neurology, Peking University People's Hospital, Beijing, China
| | - Jun Zhang
- Department of Neurology, Peking University People's Hospital, Beijing, China
| | - Qian Jiang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China.,Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
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Goraczko A, Zurek A, Lachowicz M, Kujawa K, Zurek G. The Relationship between Cognitive Performance and Quality of Life in Elite Athletes after Spinal Cord Injury. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020948. [PMID: 35055769 PMCID: PMC8775381 DOI: 10.3390/ijerph19020948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The present investigation was designed to determine cognitive performance and quality of life (QoL) in a group of elite athletes who sustained spinal cord injury (SCI). METHODS nine participants suffering a SCI participated in the study. Different cognitive functions were evaluated through the following tests: COWAT, Digit Span, Stroop color-word and QoL through the WHOQoL-BREF scale. RESULTS Generally, participants positively assessed their overall quality of life and health status. Although the tests conducted indicate reduced cognitive function among the athletes, it did not affect the reduction in QoL. Single correlations between the results of cognitive tests and QoL could be treated as coincidental. CONCLUSIONS Despite the observed decline in selected cognitive functions, the participants positively assessed their quality of life and physical health.Reduced cognitive functioning could be influenced by the impact of sleep-disordered breathing, pain, depressive disorders and medication. This indicates the need for an individualized approach to define the patient's deficits, needs and best care. Further studies with a larger group of participants are needed.
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Affiliation(s)
- Agata Goraczko
- Department of Biostructure, Wroclaw University of Health and Sport Sciences, 51-612 Wroclaw, Poland; (A.G.); (M.L.); (K.K.)
- Clinic of Neurorehabilitation, 54-519 Wroclaw, Poland
| | - Alina Zurek
- Institute of Psychology, University of Wroclaw, 50-527 Wroclaw, Poland;
| | - Maciej Lachowicz
- Department of Biostructure, Wroclaw University of Health and Sport Sciences, 51-612 Wroclaw, Poland; (A.G.); (M.L.); (K.K.)
| | - Katarzyna Kujawa
- Department of Biostructure, Wroclaw University of Health and Sport Sciences, 51-612 Wroclaw, Poland; (A.G.); (M.L.); (K.K.)
- Clinic of Neurorehabilitation, 54-519 Wroclaw, Poland
| | - Grzegorz Zurek
- Department of Biostructure, Wroclaw University of Health and Sport Sciences, 51-612 Wroclaw, Poland; (A.G.); (M.L.); (K.K.)
- Correspondence: ; Tel.: +48-600-081-799
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Areklett EW, Fagereng E, Bruheim K, Andersson S, Lindemann K. Self-reported cognitive impairment in cervical cancer survivors: A cross-sectional study. Psychooncology 2021; 31:298-305. [PMID: 34516040 DOI: 10.1002/pon.5818] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/06/2021] [Accepted: 08/23/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Cancer-related cognitive impairment (CRCI) is a major obstacle for cervical cancer survivors, preventing the return to their social life. This study assessed the prevalence of CRCI in cervical cancer survivors and studied the association of self-reported cognitive impairment with treatment regimen and the quality of life (QoL) domains depression, anxiety, and fatigue. METHODS Six hundred twenty one cervical cancer survivors, treated with combined chemo-radiotherapy (CCRT) (n = 458) or surgery only (n = 163) were invited in this cross-sectional study. Self-reported cognitive function was assessed using the Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog). Fatigue and psychological distress were assessed using EORTC-QLQ C30 and Hospital Anxiety and Depression Scale (HADS). RESULTS Data of 254 women (40.9%) was available for the analysis. Of those, 204 (80.3%) women had received CCRT and 50 (19.7%) surgery only. In the whole cohort, 42.5% reported significant cognitive impairment. In both treatment groups cognitive complaints were significantly associated with anxiety, depression, and fatigue (all p < 0.001). CCRT was strongly associated with increased risk of CRCI (OR = 4.02, 95% CI = 1.57-10.25). Anxiety, depression, and fatigue increased the risk of CRCI by 13% (OR: 1.13, 95% CI 1.03-1.23), 16% (OR 1.16, 95% CI 1.04-1.28) and 2% (OR 1.02, 95% CI 1.00-1.03), respectively. CONCLUSION Almost half of the cervical cancer survivors after CCRT report significant cognitive impairment. CRCI is associated with other indicators of poor QoL, such as depression, anxiety and fatigue. An increased understanding of the specific cognitive domains affected and of the associated late effects like fatigue is crucial to customize successful interventions.
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Affiliation(s)
| | - Elisabeth Fagereng
- Sunnaas Rehabilitation Hospital, TRS National Resource Centre for Rare Disorders, Nesoddtangen, Norway
| | - Kjersti Bruheim
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | | | - Kristina Lindemann
- Department of Gynecological Oncology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Cancer-related cognitive impairment (CRCI), depression and quality of life in gynecological cancer patients: a prospective study. Arch Gynecol Obstet 2021; 303:1581-1588. [PMID: 33404703 DOI: 10.1007/s00404-020-05896-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 11/10/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE Cancer-related cognitive impairment (CRCI) has been reported in non-central nervous system neoplasms survivors. The purpose of this study was to evaluate the perception of cognitive decrement in patients undergoing surgical and / or medical therapy for gynecological cancers. METHODS All women diagnosed with primary gynecological cancer and undergoing active medical treatment have been enrolled in a prospective study. Before starting treatment (T1) and 6 months after the end of treatment (T2), patients were interviewed to evaluate the effects of cancer treatment on perceived cognitive function (using FACT-Cog -version 3), on depression (using Beck Depression Inventory-II test) and on quality of life (using EORTC-QLQC-30). Age, education level, marital status, lifestyle, menopausal state at diagnosis, cancer type, cancer FIGO stage, treatment modality was also recorded. The differences between baseline and post-treatment results have been evaluated with Student's t test. The results have been stratified by the menopausal state at diagnosis, type of tumor (endometrial, cervical, ovarian, vulvar) disease stage and type of treatment (chemotherapy or radiotherapy). RESULTS Seventy-three patients were included. A significant reduction in perceived cognitive impairments was demonstrated at T2 (CogPCI: 61.35 ± 13.83 vs 55.05 ± 16.56; p < 0.05). On the contrary, a significant improvement was shown in depression state (BDII: 21.14 ± 11.23 vs 12.82 ± 12.33, p < 0.005). The menopausal state at surgery, tumor site, stage and treatment modality seem to influence the variables analyzed. CONCLUSION CRCI is a true risk also in gynecological cancer survivors. The cognitive impairment does not seem to be dependent on depression state after treatment or to a menopausal condition. Assessing cognitive decline in cancer survivorship is essential for ensuring the optimum quality of life and functioning.
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Physical Mobility and Balance Performance Differs in Older Cancer Survivors With Impaired Executive Function. REHABILITATION ONCOLOGY 2021. [DOI: 10.1097/01.reo.0000000000000248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Neuroprotective effect of Mulmina™ against chemotherapy-induced cognitive decline in normal mice. Biomed Rep 2020; 14:1. [PMID: 33235718 PMCID: PMC7678637 DOI: 10.3892/br.2020.1377] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 09/14/2020] [Indexed: 12/21/2022] Open
Abstract
The aim of the present study was to evaluate a marketed formulation against chemotherapy-induced cognitive dysfunction. The formulation, Mulmina™, contains natural compounds which are known to help in improving function as well as in preventing cognitive decline. All of the phytoconstituents in the formulation have been tested individually but this is the first study where such a formulation has been evaluated against chemotherapy-induced cognitive decline (CICD) in a mouse model. CICD was induced by cyclophosphamide (50 mg/kg), methotrexate (5 mg/kg), and 5-fluorouracil (5 mg/kg) (CMF), administered intraperitonially. CMF was administered in three cycles, with one injection per week for three weeks. The decline in cognition of the mice was evaluated by a test of locomotor activity (Open Field Test) followed by a test for spatial memory (Morris Water Maze). Biochemical parameters evaluated include brain cytokine levels and BDNF levels via ELISA. Hematological counts were also performed to evaluate any changes in blood profile using a veterinary blood cell counter. Levels of oxidative stress markers with respect to catalase activity and lipid peroxidation were also evaluated in the brain using UV-spectrophotometric analysis. Mulmina™ was able to show significant improvement in cognitive function post chemotherapy when compared to the untreated animals. Apart from improvement in spatial memory, there was also an improvement in biochemical parameters. The particular combination of phytochemicals in Mulmina™ proved themselves successful in alleviating the CICD in this preliminary study and pave a path for future studies which can establish the solid grounds with respect to molecular and pharmacological basis for the mechanism of action of Mulmina™.
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Liou KT, Root JC, Garland SN, Green J, Li Y, Li QS, Kantoff PW, Ahles TA, Mao JJ. Effects of acupuncture versus cognitive behavioral therapy on cognitive function in cancer survivors with insomnia: A secondary analysis of a randomized clinical trial. Cancer 2020; 126:3042-3052. [PMID: 32320061 DOI: 10.1002/cncr.32847] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/29/2020] [Accepted: 02/20/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cancer-related cognitive impairment is a prevalent, disruptive condition potentially exacerbated by sleep disturbances. The current study was performed to evaluate the effects of acupuncture versus cognitive behavioral therapy for insomnia (CBT-I) on objective and subjective cognitive function in cancer survivors with insomnia. METHODS Using data from a randomized clinical trial (160 survivors) that compared acupuncture versus CBT-I for insomnia occurring in cancer survivors, the authors analyzed cognitive outcomes and their relationship to insomnia symptoms. Analysis was limited to 99 patients who reported baseline cognitive difficulties. Interventions were delivered over 8 weeks. Objective attention, learning, and memory were evaluated using the Buschke Selective Reminding Test. Subjective cognitive function was assessed using the Brown Attention-Deficit Disorder Scales. Insomnia symptoms were assessed using the Insomnia Severity Index. All outcomes were collected at baseline, week 8, and week 20. RESULTS From baseline to week 8, acupuncture produced statistically significant within-group improvements in objective attention (Cohen D, 0.29), learning (Cohen D, 0.31), and memory (Cohen D, 0.33) that persisted to week 20 (all P < .05), whereas CBT-I produced a statistically significant within-group improvement in objective attention from baseline to week 20 (Cohen D, 0.50; P < .05); between-group differences were not statistically significant. Both interventions produced statistically significant within-group improvements in subjective cognitive function at weeks 8 and 20 compared with baseline (all P < .001); between-group differences were not statistically significant. In the acupuncture group, patients with clinically meaningful responses with regard to insomnia symptoms demonstrated a significantly greater improvement in subjective cognitive function compared with those without clinically meaningful insomnia responses (P = .006). CONCLUSIONS Among cancer survivors with insomnia, both acupuncture and CBT-I produced significant improvements in objective and subjective cognitive function. However, the effect sizes varied and only survivors in the acupuncture group demonstrated a significant relationship between cognitive and sleep outcomes. These preliminary findings warrant further investigation to guide the personalized management of patients with cancer-related cognitive impairment.
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Affiliation(s)
- Kevin T Liou
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - James C Root
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sheila N Garland
- Department of Psychology, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Jamie Green
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yuelin Li
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Q Susan Li
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Philip W Kantoff
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Tim A Ahles
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jun J Mao
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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12
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Adnexal Tumor-Related Neurobehavioral Alterations: A Rare Case Report. Case Rep Obstet Gynecol 2020; 2020:3802940. [PMID: 32181034 PMCID: PMC7066408 DOI: 10.1155/2020/3802940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 01/13/2020] [Accepted: 02/03/2020] [Indexed: 11/18/2022] Open
Abstract
Associations between neuropsychotic changes and oncologic disease are often described as late-onset symptoms, secondary to the instituted treatment. However, neurocognitive symptoms as a clinical manifestation of adnexal tumors are still little discussed, despite the importance of these in the gynecology practice. In this article, we present a case of adnexal mass whose first clinical manifestations were neuropsychiatric alterations. Such changes led the patient to seek our health service, and after diagnosis and treatment of the ovarian mass, the patient presented remission of the symptoms.
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Miladi N, Dossa R, Dogba MJ, Cléophat-Jolicoeur MIF, Gagnon B. Psychostimulants for cancer-related cognitive impairment in adult cancer survivors: a systematic review and meta-analysis. Support Care Cancer 2019; 27:3717-3727. [PMID: 31250183 DOI: 10.1007/s00520-019-04907-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 05/31/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Cognitive impairment is recognized as a common symptom experienced by cancer survivors which impacts on quality of life (QoL) and day-to-day activities. One of the treatment options is the use of psychostimulants but the evidence supporting its use remains unclear. OBJECTIVES To identify the level of evidence of psychostimulants' effect on the management of cognitive impairment in adult cancer survivors. METHODS Electronic databases (MEDLINE, EMBASE, CENTRAL, CINAHL) and reference lists of relevant reviews were searched from inception to December 2017, with no language restrictions applied. Randomized controlled trials (RCTs), evaluating the effect of psychostimulants on cognitive impairment among cancer patients with no primary or secondary brain tumor or brain radiation, were included. The primary outcome was cognitive function changes, whereas secondary outcomes were adverse events (AEs) and QoL. RESULTS Six RCTs were included: three studies investigating methylphenidate and three modafinil, with a total of 244 and 146 patients, respectively. Due to important differences in methodologies between studies, a meta-analysis was assumed inappropriate for the primary outcome. A narrative synthesis was performed. One study using methylphenidate and two using modafinil demonstrated improvements in some cognitive functions as measured by objective cognitive assessment tests. Psychostimulants did not improve QoL and were not associated with more AEs. CONCLUSION To date, limited evidence is available to estimate the usefulness (or lack) of psychostimulants on cognitive function in this population.
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Affiliation(s)
- Nadia Miladi
- Oncology Division, CHU de Québec-Laval University Research Center, Quebec City, QC, Canada
| | - Richi Dossa
- Oncology Division, CHU de Québec-Laval University Research Center, Quebec City, QC, Canada
| | - Maman Joyce Dogba
- Oncology Division, CHU de Québec-Laval University Research Center, Quebec City, QC, Canada
| | | | - Bruno Gagnon
- Oncology Division, CHU de Québec-Laval University Research Center, Quebec City, QC, Canada.
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Yang Y, Rushton S, Woodward A, Hendrix C. Understanding on the association between informal caregiver characteristics and cognitive function of adults with cancer: a scoping review protocol. BMJ Open 2019; 9:e031842. [PMID: 31537575 PMCID: PMC6756403 DOI: 10.1136/bmjopen-2019-031842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Adults with cancer frequently report symptoms such as decline in cognitive function throughout the trajectory of illness. Patients with cognitive deficits need support and assistance from their informal caregivers and often rely on them to manage their symptoms based on their degree of deficits. Patients spend a significant amount of time with their informal caregivers and become interdependent with each other. In spite of their interdependence, it is unclear whether patients' cognitive outcomes (ie, cognitive function) are associated with their informal caregivers. Therefore, the body of literature related to the association between caregiver characteristics and cognitive function of adults with cancer needs to be fully mapped with assessment for knowledge gaps. METHODS AND ANALYSIS Methods for this scoping review was informed by the framework proposed by Arksey and O'Malley. Seven electronic databases will be searched: (1) PubMed (MEDLINE), (2) CINAHL, (3) Embase, (4) PsycINFO, (5) Scopus, (6) Sociological Abstracts and (7) ProQuest dissertation abstracts. In addition, the search for grey literature will include the conference abstracts available through Embase, Scopus and Sociological abstracts as well as dissertations available in ProQuest dissertations. All retrieved citations will be independently screened by two authors and eligibility will be determined based on inclusion and exclusion criteria at title and abstract level. Studies meeting inclusion criteria, will be screened at full text level by two reviewers followed by abstraction of included studies. Eligible studies will be collated, summarised and reported using the data charting form that research team developed. ETHICS AND DISSEMINATION This scoping review does not require ethics approval. Results of this scoping review will be disseminated via conference presentation and/or publication in a scientific journal.
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Affiliation(s)
- Yesol Yang
- Duke University School of Nursing, Durham, North Carolina, USA
| | - Sharron Rushton
- Division of Health Systems and Analytics, Duke University School of Nursing, Durham, North Carolina, USA
| | - Amanda Woodward
- Duke University Medical Center Library, Durham, North Carolina, USA
| | - Cristina Hendrix
- Division of Health Systems and Analytics, Duke University School of Nursing, Durham, North Carolina, USA
- GRECC, Durham Veteran Affairs Health Care System, Durham, North Carolina, USA
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Zhou Y, Qiu Y. Propofol alleviates cisplatin-related cognitive impairment. Neurol Sci 2019; 40:1645-1649. [PMID: 31016408 DOI: 10.1007/s10072-019-03895-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 04/11/2019] [Indexed: 12/13/2022]
Abstract
Chemotherapy-related cognitive impairment (CRCI) is commonly reported following the administration of chemotherapeutic agents and comprises a wide variety of neurological problems. Many patients after chemotherapy need further surgery under anesthesia. Thus, in this study, we examined whether propofol, one of the most commonly used anesthetics in surgery, could further affect the cognitive abilities in mouse CRCI models. The mice were injected intraperitoneally with cisplatin (2 mg/kg/day) for continuous 10 days and showed significantly reduced body weights. After 10 days reconversion, mice with cisplatin injection showed impaired memory retention in the inhibitory avoidance (IA) task, mimicking the CRCI in patients. Then, we found that a single injection of propofol with the sub-anesthetic dosage (50 mg/kg) but not the anesthetic dosage (250 mg/kg) could significantly alleviate the cisplatin-induced memory impairment. These results imply the possible clinical application of propofol, especially at the sub-anesthetic dosage, in the surgery of patients after chemotherapy.
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Affiliation(s)
- Yu Zhou
- Department of Anesthesiology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yimin Qiu
- Department of Anesthesiology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
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Caring for Survivors of Gynecologic Cancer: Assessment and Management of Long-term and Late Effects. Semin Oncol Nurs 2019; 35:192-201. [DOI: 10.1016/j.soncn.2019.02.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Deprez S, Kesler SR, Saykin AJ, Silverman DHS, de Ruiter MB, McDonald BC. International Cognition and Cancer Task Force Recommendations for Neuroimaging Methods in the Study of Cognitive Impairment in Non-CNS Cancer Patients. J Natl Cancer Inst 2019; 110:223-231. [PMID: 29365201 DOI: 10.1093/jnci/djx285] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 12/13/2017] [Indexed: 02/07/2023] Open
Abstract
Cancer- and treatment-related cognitive changes have been a focus of increasing research since the early 1980s, with meta-analyses demonstrating poorer performance in cancer patients in cognitive domains including executive functions, processing speed, and memory. To facilitate collaborative efforts, in 2011 the International Cognition and Cancer Task Force (ICCTF) published consensus recommendations for core neuropsychological tests for studies of cancer populations. Over the past decade, studies have used neuroimaging techniques, including structural and functional magnetic resonance imaging (fMRI) and positron emission tomography, to examine the underlying brain basis for cancer- and treatment-related cognitive declines. As yet, however, there have been no consensus recommendations to guide researchers new to this field or to promote the ability to combine data sets. We first discuss important methodological issues with regard to neuroimaging study design, scanner considerations, and sequence selection, focusing on concerns relevant to cancer populations. We propose a minimum recommended set of sequences, including a high-resolution T1-weighted volume and a resting state fMRI scan. Additional advanced imaging sequences are discussed for consideration when feasible, including task-based fMRI and diffusion tensor imaging. Important image data processing and analytic considerations are also reviewed. These recommendations are offered to facilitate increased use of neuroimaging in studies of cancer- and treatment-related cognitive dysfunction. They are not intended to discourage investigator-initiated efforts to develop cutting-edge techniques, which will be helpful in advancing the state of the knowledge. Use of common imaging protocols will facilitate multicenter and data-pooling initiatives, which are needed to address critical mechanistic research questions.
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Affiliation(s)
- Sabine Deprez
- University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Shelli R Kesler
- Department of Neuro-oncology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Andrew J Saykin
- Center for Neuroimaging, Department of Radiology and Imaging Sciences and Indiana University Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN
| | - Daniel H S Silverman
- Ahmanson Translational Imaging Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Michiel B de Ruiter
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Brenna C McDonald
- Center for Neuroimaging, Department of Radiology and Imaging Sciences and Indiana University Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN
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Lycke M, Lefebvre T, Pottel L, Pottel H, Ketelaars L, Stellamans K, Van Eygen K, Vergauwe P, Werbrouck P, Cool L, Boterberg T, Liefhooghe N, Schofield P, Debruyne PR. Subjective, but not objective, cognitive complaints impact long-term quality of life in cancer patients. J Psychosoc Oncol 2019; 37:427-440. [DOI: 10.1080/07347332.2018.1504154] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Michelle Lycke
- Department of Medical Oncology, Cancer Centre, General Hospital Groeninge, Kortrijk, Belgium
- Department of Radiation Oncology and Experimental Cancer Research, Ghent University, Ghent, Belgium
| | - Tessa Lefebvre
- Department of Medical Oncology, Cancer Centre, General Hospital Groeninge, Kortrijk, Belgium
- Department of Radiation Oncology and Experimental Cancer Research, Ghent University, Ghent, Belgium
| | - Lies Pottel
- Department of Medical Oncology, Cancer Centre, General Hospital Groeninge, Kortrijk, Belgium
| | - Hans Pottel
- Department of Public Health and Primary Care @ Kulak, Catholic University Leuven Kulak, Kortrijk, Belgium
| | - Lore Ketelaars
- Department of Neuropsychology, General Hospital Groeninge, Kortrijk, Belgium
| | - Karin Stellamans
- Department of Radiotherapy, Cancer Centre, General Hospital Groeninge, Kortrijk, Belgium
| | - Koen Van Eygen
- Department of Medical Oncology, Cancer Centre, General Hospital Groeninge, Kortrijk, Belgium
- Department of Haematology, Cancer Centre, General Hospital Groeninge, Kortrijk, Belgium
| | - Philippe Vergauwe
- Department of Gastro-Enterology, General Hospital Groeninge, Kortrijk, Belgium
| | - Patrick Werbrouck
- Department of Urology, General Hospital Groeninge, Kortrijk, Belgium
| | - Lieselot Cool
- Department of Medical Oncology, Cancer Centre, General Hospital Groeninge, Kortrijk, Belgium
| | - Tom Boterberg
- Department of Radiation Oncology and Experimental Cancer Research, Ghent University, Ghent, Belgium
| | - Nick Liefhooghe
- Department of Radiotherapy, Cancer Centre, General Hospital Groeninge, Kortrijk, Belgium
| | - Patricia Schofield
- Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, UK
| | - Philip R. Debruyne
- Department of Medical Oncology, Cancer Centre, General Hospital Groeninge, Kortrijk, Belgium
- Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, UK
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Zeng Y, Cheng ASK, Song T, Sheng X, Zhang Y, Liu X, Chan CCH. Subjective cognitive impairment and brain structural networks in Chinese gynaecological cancer survivors compared with age-matched controls: a cross-sectional study. BMC Cancer 2017; 17:796. [PMID: 29179739 PMCID: PMC5704431 DOI: 10.1186/s12885-017-3793-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 11/16/2017] [Indexed: 12/31/2022] Open
Abstract
Background Subjective cognitive impairment can be a significant and prevalent problem for gynaecological cancer survivors. The aims of this study were to assess subjective cognitive functioning in gynaecological cancer survivors after primary cancer treatment, and to investigate the impact of cancer treatment on brain structural networks and its association with subjective cognitive impairment. Methods This was a cross-sectional survey using a self-reported questionnaire by the Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog) to assess subjective cognitive functioning, and applying DTI (diffusion tensor imaging) and graph theoretical analyses to investigate brain structural networks after primary cancer treatment. Results A total of 158 patients with gynaecological cancer (mean age, 45.86 years) and 130 age-matched non-cancer controls (mean age, 44.55 years) were assessed. Patients reported significantly greater subjective cognitive functioning on the FACT-Cog total score and two subscales of perceived cognitive impairment and perceived cognitive ability (all p values <0.001). Compared with patients who had received surgery only and non-cancer controls, patients treated with chemotherapy indicated the most altered global brain structural networks, especially in one of properties of small-worldness (p = 0.004). Reduced small-worldness was significantly associated with a lower FACT-Cog total score (r = 0.412, p = 0.024). Increased characteristic path length was also significantly associated with more subjective cognitive impairment (r = −0.388, p = 0.034). Conclusion When compared with non-cancer controls, a considerable proportion of gynaecological cancer survivors may exhibit subjective cognitive impairment. This study provides the first evidence of brain structural network alteration in gynaecological cancer patients at post-treatment, and offers novel insights regarding the possible neurobiological mechanism of cancer-related cognitive impairment (CRCI) in gynaecological cancer patients. As primary cancer treatment can result in a more random organisation of structural brain networks, this may reduce brain functional specificity and segregation, and have implications for cognitive impairment. Future prospective and longitudinal studies are needed to build upon the study findings in order to assess potentially relevant clinical and psychosocial variables and brain network measures, so as to more accurately understand the specific risk factors related to subjective cognitive impairment in the gynaecological cancer population. Such knowledge could inform the development of appropriate treatment and rehabilitation efforts to ameliorate cognitive impairment in gynaecological cancer survivors.
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Affiliation(s)
- Yingchun Zeng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China.,Research Institute of Gynecology and Obstetrics, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Andy S K Cheng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China.
| | - Ting Song
- Department of Radiology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiujie Sheng
- Research Institute of Gynecology and Obstetrics, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yang Zhang
- School of Nursing, Guangzhou Medical University, Guangzhou, China
| | - Xiangyu Liu
- Department of Nursing, Hunan Cancer Hospital, The Third Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Chetwyn C H Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China
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22
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Klemp JR, Myers JS, Fabian CJ, Kimler BF, Khan QJ, Sereika SM, Stanton AL. Cognitive functioning and quality of life following chemotherapy in pre- and peri-menopausal women with breast cancer. Support Care Cancer 2017; 26:575-583. [PMID: 28849337 DOI: 10.1007/s00520-017-3869-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 08/21/2017] [Indexed: 11/12/2022]
Abstract
PURPOSE The purpose of the study was to prospectively examine changes in subjective and objective cognitive functions and quality of life (QOL) for pre- and peri-menopausal women receiving chemotherapy for breast cancer and to explore potential predictors of cognitive changes. METHODS Participants were assessed as follows: prior to chemotherapy (T1), after cycle 3 (T2), within 2-3 weeks of completing adjuvant chemotherapy (T3) (N = 20), and 8+ years later (T4; n = 18). Objective cognitive function was measured with the High Sensitivity Cognitive Screen (T1, T3, T4). Subjective measures for cognitive function, depressive symptoms, fatigue, and mental and physical QOL were assessed at all time points. Estradiol levels were measured at T1, T2, and T3. The Functional Assessment of Cancer Therapy-Cognition and the MD Anderson Cancer Symptom Inventory item for neuropathy were administered at T4. RESULTS No significant changes in objective cognitive function were found. However, participants reported decreased cognitive function over the course of treatment accompanied by depressive symptoms and fatigue. Depression and fatigue returned to near-baseline levels at T4, but over half of the participants continued to report mild to moderate depression. Estradiol levels were not associated with cognitive function. Neuropathy and higher body mass index (BMI) were associated with persistent cognitive complaints at T4 (adjusted R 2 = 0.712, p = 0.001). Higher QOL was correlated with better subjective cognitive function (r = 0.705, p = 0.002) and lower body mass index (r = - 0.502, p = 0.017) at T4. CONCLUSIONS Further investigation of BMI, neuropathy, and depressive symptoms as predictors of persistent cognitive dysfunction following chemotherapy for breast cancer is warranted.
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Affiliation(s)
- Jennifer R Klemp
- University of Kansas Cancer Center, 2330 Shawnee Mission, Parkway, Westwood, KS, 66205, USA
| | - Jamie S Myers
- University of Kansas School of Nursing, 3901 Rainbow Blvd, MS 4043, Kansas City, KS, 66160, USA. .,School of Nursing, University of Pittsburgh, 360 Victoria Building, 3500 Victoria Street, Pittsburgh, PA, 15261, USA.
| | - Carol J Fabian
- University of Kansas Cancer Center, 2330 Shawnee Mission, Parkway, Westwood, KS, 66205, USA
| | - Bruce F Kimler
- University of Kansas Medical Center, 3901 Rainbow Blvd, MS 4033, Kansas City, KS, 66160, USA
| | - Qamar J Khan
- University of Kansas Cancer Center, 2330 Shawnee Mission, Parkway, Westwood, KS, 66205, USA
| | - Susan M Sereika
- School of Nursing, University of Pittsburgh, 360 Victoria Building, 3500 Victoria Street, Pittsburgh, PA, 15261, USA
| | - Annette L Stanton
- Department of Psychology, University of California, 1285 Franz Hall, Los Angeles, CA, 90095-1563, USA
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Zeng Y, Cheng ASK, Liu X, Chan CCH. Title: Cervical cancer survivors' perceived cognitive complaints and supportive care needs in mainland China: a qualitative study. BMJ Open 2017. [PMID: 28645952 PMCID: PMC5577865 DOI: 10.1136/bmjopen-2016-014078] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES This study explores Chinese cervical cancer survivors' perceived cognitive complaints and relevant supportive care needs after primary cancer treatment. DESIGN This study utilised a qualitative research design. A semi-structured interview was used to probe cervical cancer patients' perceived cognitive complaints and supportive care needs. SETTING This study was conducted at a secondary cancer care centre located in South China. PARTICIPANTS 31 women with cervical cancer after primary cancer treatment, aged 18-60 years, were purposively selected using non-random sampling procedures. RESULTS 31 cervical cancer survivors joined this study. Of these, 20 women (64.5%) reported cognitive complaints after cancer treatment. The most common complaint was loss of concentration (n=17, 85.0%). Perceived contributing factors to these cognitive complaints included chemotherapy (n=15, 75.0%) and ageing (n=8, 40.0%). These cognitive problems most commonly impacted daily living (n=20, 100%). Common supportive care needs included symptom management strategies (n=11, 55.0%) and counselling services (n=8, 40.0%). CONCLUSION This study adds new insight into the growing body of research on cognitive complaints by cancer survivors, in particular Chinese cervical cancer survivors. Improved understanding of cognitive complaints could subsequently facilitate the development of relevant therapeutic interventions for prevention as well as the provision of supportive care services, such as educational and counselling services, to reduce cognitive impairment in women with cervical cancer.
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Affiliation(s)
- Yingchun Zeng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
- Research Institute of Gynaecology and Obstetrics, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Andy SK Cheng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Xiangyu Liu
- Department of Nursing, Hunan Cancer Hospital, Changsha, China
| | - Chetwyn CH Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
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Lomeli N, Di K, Czerniawski J, Guzowski JF, Bota DA. Cisplatin-induced mitochondrial dysfunction is associated with impaired cognitive function in rats. Free Radic Biol Med 2017; 102:274-286. [PMID: 27908784 PMCID: PMC5308450 DOI: 10.1016/j.freeradbiomed.2016.11.046] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 11/22/2016] [Accepted: 11/27/2016] [Indexed: 02/08/2023]
Abstract
PURPOSE Chemotherapy-related cognitive impairment (CRCI) is commonly reported following the administration of chemotherapeutic agents and comprises a wide variety of neurological problems. No effective treatments for CRCI are currently available. Here we examined the mechanisms involving cisplatin-induced hippocampal damage following cisplatin administration in a rat model and in cultured rat hippocampal neurons and neural stem/progenitor cells (NSCs). We also assessed the protective effects of the antioxidant, N-acetylcysteine in mitigating these damages. EXPERIMENTAL DESIGN Adult male rats received 6mg/kg cisplatin in the acute studies. In chronic studies, rats received 5mg/kg cisplatin or saline injections once per week for 4 weeks. N-acetylcysteine (250mg/kg/day) or saline was administered for five consecutive days during cisplatin treatment. Cognitive testing was performed 5 weeks after treatment cessation. Cisplatin-treated cultured hippocampal neurons and NSCs were examined for changes in mitochondrial function, oxidative stress production, caspase-9 activation, and neuronal dendritic spine density. RESULTS Acute cisplatin treatment reduced dendritic branching and spine density, and induced mitochondrial degradation. Rats receiving the chronic cisplatin regimen showed impaired performance in contextual fear conditioning, context object discrimination, and novel object recognition tasks compared to controls. Cisplatin induced mitochondrial DNA damage, impaired respiratory activity, increased oxidative stress, and activated caspase-9 in cultured hippocampal neurons and NSCs. N-acetylcysteine treatment prevented free radical production, ameliorated apoptotic cellular death and dendritic spine loss, and partially reversed the cisplatin-induced cognitive impairments. CONCLUSIONS Our results suggest that mitochondrial dysfunction and increased oxidative stress are involved in cisplatin-induced cognitive impairments. Therapeutic agents, such as N-acetylcysteine, may be effective in mitigating the deleterious effects of cisplatin.
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Affiliation(s)
- Naomi Lomeli
- Department of Pathology & Laboratory Medicine, University of California Irvine, Irvine, CA, USA.
| | - Kaijun Di
- Department of Neurological Surgery, University of California Irvine, Irvine, CA, USA; Chao Family Comprehensive Cancer Center, University of California Irvine, Irvine, CA, USA.
| | - Jennifer Czerniawski
- Department of Neurobiology & Behavior, University of California Irvine, Irvine, CA, USA; Center for the Neurobiology of Learning & Memory, University of California Irvine, Irvine, CA, USA.
| | - John F Guzowski
- Department of Neurobiology & Behavior, University of California Irvine, Irvine, CA, USA; Center for the Neurobiology of Learning & Memory, University of California Irvine, Irvine, CA, USA.
| | - Daniela A Bota
- Department of Pathology & Laboratory Medicine, University of California Irvine, Irvine, CA, USA; Department of Neurological Surgery, University of California Irvine, Irvine, CA, USA; Chao Family Comprehensive Cancer Center, University of California Irvine, Irvine, CA, USA; Department of Neurology, University of California Irvine, Irvine, CA, USA.
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John T, Lomeli N, Bota DA. Systemic cisplatin exposure during infancy and adolescence causes impaired cognitive function in adulthood. Behav Brain Res 2016; 319:200-206. [PMID: 27851909 DOI: 10.1016/j.bbr.2016.11.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 11/01/2016] [Accepted: 11/07/2016] [Indexed: 12/20/2022]
Abstract
Cancer survivors diagnosed during infancy and adolescence may be at risk for chemotherapy-related cognitive impairments (CRCI), however the effects of pediatric chemotherapy treatment on adulthood cognitive function are not well understood. Impairments in memory, attention and executive function affect 15-50% of childhood leukemia survivors related to methotrexate exposure. Systemic cisplatin is used to treat a variety of childhood and adult cancers, yet the risk and extent of cognitive impairment due to platinum-based chemotherapy in pediatric patients is unknown. Systemic cisplatin penetrates the CNS, induces hippocampal synaptic damage, and leads to neuronal and neural stem/progenitor cell (NSC) loss. Survivors of non-leukemic cancers may be at risk for significant cognitive impairment related to cisplatin-driven neurotoxicity. We sought to examine the long-term effects of systemic cisplatin administration on cognitive function when administered during infancy and adolescence in a rat model. We performed cognitive testing in adult rats exposed to systemic cisplatin during either infancy or adolescence. Rats treated as adolescents showed significantly poor retrieval of a novel object as compared to controls. Further, cisplatin-treated infants and adolescents showed poor contextual discrimination as compared to controls, and an impaired response to cued fear conditioning. Ultimately, systemic cisplatin exposure resulted in more profound impairments in cognitive function in rats treated during adolescence than in those treated during infancy. Further, exposure to cisplatin during adolescence affected both hippocampus and amygdala dependent cognitive function, suggesting a more global cognitive dysfunction at this age.
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Affiliation(s)
- Tami John
- University of California, Irvine/CHOC Children's Hospital, 1201W. La Veta Avenue, Orange, CA 92868, USA.
| | - Naomi Lomeli
- Department of Pathology and Laboratory Medicine, University of California, Irvine, CA, USA.
| | - Daniela A Bota
- Department of Neurology, Department of Neurological Surgery, Chao Family Comprehensive Cancer Center, University of California, Sprague Hall B200, Irvine, CA, 92697-4775, USA.
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Sleurs C, Deprez S, Emsell L, Lemiere J, Uyttebroeck A. Chemotherapy-induced neurotoxicity in pediatric solid non-CNS tumor patients: An update on current state of research and recommended future directions. Crit Rev Oncol Hematol 2016; 103:37-48. [PMID: 27233118 DOI: 10.1016/j.critrevonc.2016.05.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 03/21/2016] [Accepted: 05/10/2016] [Indexed: 11/26/2022] Open
Abstract
Neurocognitive sequelae are known to be induced by cranial radiotherapy and central-nervous-system-directed chemotherapy in childhood Acute Lymphoblastic Leukemia (ALL) and brain tumor patients. However, less evidence exists for solid non-CNS-tumor patients. To get a better understanding of the potential neurotoxic mechanisms of non-CNS-directed chemotherapy during childhood, we performed a comprehensive literature review of this topic. Here, we provide an overview of preclinical and clinical studies investigating neurotoxicity associated with chemotherapy in the treatment of pediatric solid non-CNS tumors. Research to date suggests that chemotherapy has deleterious biological and psychological effects, with animal studies demonstrating histological evidence for neurotoxic effects of specific agents and human studies demonstrating acute neurotoxicity. Although the existing literature suggests potential neurotoxicity throughout neurodevelopment, research into the long-term neurocognitive sequelae in survivors of non-CNS cancers remains limited. Therefore, we stress the critical need for neurodevelopmental focused research in children who are treated for solid non-CNS tumors, since they are at risk for potential neurocognitive impairment.
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Affiliation(s)
- Charlotte Sleurs
- Department of Pediatric Hematology and Oncology, University Hospital Leuven, Leuven, Belgium; Department of Radiology, University Hospital Leuven, Leuven, Belgium.
| | - Sabine Deprez
- Department of Radiology, University Hospital Leuven, Leuven, Belgium
| | - Louise Emsell
- Department of Radiology, University Hospital Leuven, Leuven, Belgium
| | - Jurgen Lemiere
- Department of Pediatric Hematology and Oncology, University Hospital Leuven, Leuven, Belgium; Department of Child & Adolescent Psychiatry, University Hospital Leuven, Leuven, Belgium
| | - Anne Uyttebroeck
- Department of Pediatric Hematology and Oncology, University Hospital Leuven, Leuven, Belgium
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Van Arsdale A, Rosenbaum D, Kaur G, Pinto P, Kuo DYS, Barrera R, Goldberg GL, Nevadunsky NS. Prevalence and factors associated with cognitive deficit in women with gynecologic malignancies. Gynecol Oncol 2016; 141:323-328. [DOI: 10.1016/j.ygyno.2016.03.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 02/01/2016] [Accepted: 03/01/2016] [Indexed: 12/25/2022]
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Cognitive function during and six months following chemotherapy for front-line treatment of ovarian, primary peritoneal or fallopian tube cancer: An NRG oncology/gynecologic oncology group study. Gynecol Oncol 2015; 139:541-5. [PMID: 26456812 DOI: 10.1016/j.ygyno.2015.10.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 09/30/2015] [Accepted: 10/03/2015] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Changes in cognitive function have been identified in and reported by many cancer survivors. These changes have the potential to impact patient quality of life and functional ability. This prospective longitudinal study was designed to quantify the incidence of change in cognitive function in newly diagnosed ovarian cancer patients throughout and following primary chemotherapy. METHODS Eligible patients had newly diagnosed, untreated ovarian cancer and had planned to receive chemotherapy. Web-based and patient reported cognitive assessments and quality of life questionnaires were conducted prior to chemotherapy, prior to cycle four, after cycle six, and six months after completion of primary therapy. RESULTS Two-hundred-thirty-one evaluable patients entered this study between May 2010 and October 2011. At the cycle 4 time point, 25.2% (55/218) of patients exhibited cognitive impairment in at least one domain. At the post-cycle 6 and 6-month follow up time points, 21.1% (44/208) and 17.8% (30/169) of patients, respectively, demonstrated impairment in at least one domain of cognitive function. There were statistically significant, but clinically small, improvements in processing speed (p<0.001) and attention (p<0.001) but not in motor response time (p=0.066), from baseline through the six-month follow up time period. CONCLUSIONS This was a large, prospective study designed to measure cognitive function in ovarian cancer. A subset of patients had evidence of cognitive decline from baseline during chemotherapy treatment in this study as measured by the web-based assessment; however, changes were generally limited to no more than one domain.
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Survivors of gynecologic malignancies: impact of treatment on health and well-being. J Cancer Surviv 2015; 10:261-70. [PMID: 26245979 DOI: 10.1007/s11764-015-0472-9] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 07/09/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE While overall survival from gynecologic malignancies has greatly improved over the last three decades, required treatments can lead to multiple health issues for survivors. Our objective was to identify health concerns that gynecologic cancer survivors face. METHODS A systematic, stratified sample of women with gynecologic malignancies was surveyed for 18 health issues occurring before, during, or after treatment. The impact of clinical features and treatment modality on health issues was assessed through multivariate logistic regression models. RESULTS Of 2,546 surveys mailed, 622 were not received by eligible subjects secondary to invalid address, incorrect diagnosis, or death. Thus, 1924 survivors potentially received surveys. Of the 1,029 surveys (53.5%) completed, median age was 59 years; diagnoses included 29% cervical, 26% endometrial, 26% ovarian/primary peritoneal/fallopian tube, 12.1% vulvar, and 5.4% vaginal cancers. The most frequently reported health issues included fatigue (60.6%), sleep disturbance (54.9%), urinary difficulties (50.9%), sexual dysfunction (48.4%), neurologic issues (45.4%), bowel complaints (42.0%), depression (41.3%), and memory problems (41.2%). These rankings were consistent with patients' self-reported rankings of "highest impact" personal issues. After controlling for demographic and clinical variables, multivariate analyses revealed that treatment modality impacted the odds of experiencing a given health issue. CONCLUSIONS Our study demonstrates that gynecologic cancer survivors experience a high frequency of health conditions and highlights the association between treatment modality and specific health concerns. IMPLICATIONS FOR CANCER SURVIVORS The study findings highlight the multiple health concerns experienced by gynecologic cancer survivors and suggest the potential for developing interventions to mitigate these concerns in survivorship.
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Berger M, Nadler JW, Browndyke J, Terrando N, Ponnusamy V, Cohen HJ, Whitson HE, Mathew JP. Postoperative Cognitive Dysfunction: Minding the Gaps in Our Knowledge of a Common Postoperative Complication in the Elderly. Anesthesiol Clin 2015; 33:517-50. [PMID: 26315636 DOI: 10.1016/j.anclin.2015.05.008] [Citation(s) in RCA: 170] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Postoperative cognitive dysfunction (POCD) is a common complication associated with significant morbidity and mortality in elderly patients. There is much interest in and controversy about POCD, reflected partly in the increasing number of articles published on POCD recently. Recent work suggests surgery may also be associated with cognitive improvement in some patients, termed postoperative cognitive improvement (POCI). As the number of surgeries performed worldwide approaches 250 million per year, optimizing postoperative cognitive function and preventing/treating POCD are major public health issues. In this article, we review the literature on POCD and POCI, and discuss current research challenges in this area.
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Affiliation(s)
- Miles Berger
- Department of Anesthesiology, Duke University Medical Center, Duke South, Orange Zone, Room 4317, Durham, NC 27710, USA.
| | - Jacob W Nadler
- Department of Anesthesiology, Duke University Medical Center, Duke South, Orange Zone, Room 4317, Durham, NC 27710, USA
| | - Jeffrey Browndyke
- Department of Anesthesiology, Duke University Medical Center, Duke South, Orange Zone, Room 4317, Durham, NC 27710, USA
| | - Niccolo Terrando
- Department of Anesthesiology, Duke University Medical Center, Duke South, Orange Zone, Room 4317, Durham, NC 27710, USA
| | - Vikram Ponnusamy
- Department of Anesthesiology, Duke University Medical Center, Duke South, Orange Zone, Room 4317, Durham, NC 27710, USA
| | - Harvey Jay Cohen
- Department of Anesthesiology, Duke University Medical Center, Duke South, Orange Zone, Room 4317, Durham, NC 27710, USA
| | - Heather E Whitson
- Department of Anesthesiology, Duke University Medical Center, Duke South, Orange Zone, Room 4317, Durham, NC 27710, USA
| | - Joseph P Mathew
- Department of Anesthesiology, Duke University Medical Center, Duke South, Orange Zone, Room 4317, Durham, NC 27710, USA
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Dietrich J, Prust M, Kaiser J. Chemotherapy, cognitive impairment and hippocampal toxicity. Neuroscience 2015; 309:224-32. [PMID: 26086545 DOI: 10.1016/j.neuroscience.2015.06.016] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 05/23/2015] [Accepted: 06/08/2015] [Indexed: 12/19/2022]
Abstract
Cancer therapies can be associated with significant central nervous system (CNS) toxicity. While radiation-induced brain damage has been long recognized both in pediatric and adult cancer patients, CNS toxicity from chemotherapy has only recently been acknowledged. Clinical studies suggest that the most frequent neurotoxic adverse effects associated with chemotherapy include memory and learning deficits, alterations of attention, concentration, processing speed and executive function. Preclinical studies have started to shed light on how chemotherapy targets the CNS both on cellular and molecular levels to disrupt neural function and brain plasticity. Potential mechanisms include direct cellular toxicity, alterations in cellular metabolism, oxidative stress, and induction of pro-inflammatory processes with subsequent disruption of normal cellular and neurological function. Damage to neural progenitor cell populations within germinal zones of the adult CNS has been identified as one of the key mechanisms by which chemotherapy might exert long-lasting and progressive neurotoxic effects. Based on the important role of the hippocampus for maintenance of brain plasticity throughout life, several experimental studies have focused on the study of chemotherapy effects on hippocampal neurogenesis and associated learning and memory. An increasing body of literature from both animal studies and neuroimaging studies in cancer patients suggests a possible relationship between chemotherapy induced hippocampal damage and the spectrum of neurocognitive deficits and mood alterations observed in cancer patients. This review aims to briefly summarize current preclinical and neuroimaging studies that are providing a potential link between the neurotoxic effects of chemotherapy and hippocampal dysfunction, highlighting challenges and future directions in this field of investigation.
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Affiliation(s)
- J Dietrich
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - M Prust
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - J Kaiser
- Institute of Medical Psychology, Medical Faculty, Goethe University, Heinrich-Hoffmann-Str. 10, 60528 Frankfurt am Main, Germany
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Walter AC, Gunderson CC, Vesely SK, Algan O, Sughrue M, Slaughter KN, Moore KN. Central nervous system metastasis in gynecologic cancer: symptom management, prognosis and palliative management strategies. Gynecol Oncol 2015; 136:472-7. [PMID: 25752572 DOI: 10.1016/j.ygyno.2014.12.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 11/25/2014] [Accepted: 12/01/2014] [Indexed: 10/23/2022]
Abstract
INTRODUCTION CNS metastasis (CNSmet) with gynecologic malignancy (GM) is associated with poor prognosis and symptom burden. Two prognostic indices, the recursive partitioning analysis (RPA) and graded prognostic assessment (GPA), used in other solid tumors to guide intervention options were evaluated among GM patients. METHODS Retrospective chart review was performed to identify patients with primary GM diagnosed with CNSmet from 2005-2014. RPA and GPA were applied and evaluated for goodness of fit. Long-term survivors (LTS) were those with survival time from CNSmet ≥9 months. RESULTS 35 patients were identified with median age of 62 years (range, 41-78). The majority had ovarian cancer (54%). Median survival was 4.5 months (0.1-25.9), and median time from initial diagnosis was 2.6 years (0-19.6). Presenting symptoms varied but headache (57%) and altered mental status (23%) were most common. 37% had a solitary CNS lesion, 31% had 2-8, and 31% >8. 57% were treated with WBRT, 14% with stereotactic radiosurgery (SRS), and 20% with combinations of treatments, and 2 elected for hospice. 27% (9/33) of the patients were LTS. The GPA was not significantly associated with patient outcome (p=0.46). The RPA predicted time to death (p=.0010). CONCLUSION Prognostic indices used to guide therapeutic interventions perform poorly in GM. Detection and aggressive symptom management are critical in maintaining QOL. Multidisciplinary consultation is critical to optimize outcomes and symptom control.
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Affiliation(s)
- Adam C Walter
- Division of Gynecologic Oncology, University of Oklahoma, Stephenson Cancer Center, 800 NE 10th Street Suite 5050, Oklahoma City, OK 73104, United States.
| | - Camille C Gunderson
- Division of Gynecologic Oncology, University of Oklahoma, Stephenson Cancer Center, 800 NE 10th Street Suite 5050, Oklahoma City, OK 73104, United States
| | - Sara K Vesely
- Division of Biostatistics, University of Oklahoma, 801 NE 13th Street, Oklahoma City, OK 73126, United States
| | - Ozer Algan
- Division of Radiation Oncology, University of Oklahoma, Stephenson Cancer Center, 800 NE 10th Street Suite L100, Oklahoma City, OK 73104, United States
| | - Michael Sughrue
- Department of Neurosurgery, University of Oklahoma, 1000 N. Lincoln Boulevard Suite 4000, Oklahoma City, OK 73104, United States
| | - Katrina N Slaughter
- Division of Gynecologic Oncology, University of Oklahoma, Stephenson Cancer Center, 800 NE 10th Street Suite 5050, Oklahoma City, OK 73104, United States
| | - Kathleen N Moore
- Division of Gynecologic Oncology, University of Oklahoma, Stephenson Cancer Center, 800 NE 10th Street Suite 5050, Oklahoma City, OK 73104, United States
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Wefel JS, Kesler SR, Noll KR, Schagen SB. Clinical characteristics, pathophysiology, and management of noncentral nervous system cancer-related cognitive impairment in adults. CA Cancer J Clin 2015; 65:123-38. [PMID: 25483452 PMCID: PMC4355212 DOI: 10.3322/caac.21258] [Citation(s) in RCA: 320] [Impact Index Per Article: 35.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Answer questions and earn CME/CNE Over the past few decades, a body of research has emerged confirming what many adult patients with noncentral nervous system cancer have long reported-that cancer and its treatment are frequently associated with cancer-related cognitive impairment (CRCI). The severity of CRCI varies, and symptoms can emerge early or late in the disease course. Nonetheless, CRCI is typically mild to moderate in nature and primarily involves the domains of memory, attention, executive functioning, and processing speed. Animal models and novel neuroimaging techniques have begun to unravel the pathophysiologic mechanisms underlying CRCI, including the role of inflammatory cascades, direct neurotoxic effects, damage to progenitor cells, white matter abnormalities, and reduced functional connectivity, among others. Given the paucity of research on CRCI with other cancer populations, this review synthesizes the current literature with a deliberate focus on CRCI within the context of breast cancer. A hypothetical case-study approach is used to illustrate how CRCI often presents clinically and how current science can inform practice. While the literature regarding intervention for CRCI is nascent, behavioral and pharmacologic approaches are discussed.
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Affiliation(s)
- Jeffrey S. Wefel
- Associate Professor, Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Corresponding author: Jeffrey S. Wefel, PhD, Department of Neuro-Oncology, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 431, Houston, TX 77030;
| | - Shelli R. Kesler
- Associate Professor, Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kyle R. Noll
- Associate Professor, Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sanne B. Schagen
- Associate Professor, Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Vaessen TJ, Overeem S, Sitskoorn MM. Cognitive complaints in obstructive sleep apnea. Sleep Med Rev 2015; 19:51-8. [DOI: 10.1016/j.smrv.2014.03.008] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 03/25/2014] [Accepted: 03/26/2014] [Indexed: 12/01/2022]
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Janelsins MC, Kesler SR, Ahles TA, Morrow GR. Prevalence, mechanisms, and management of cancer-related cognitive impairment. Int Rev Psychiatry 2014; 26:102-13. [PMID: 24716504 PMCID: PMC4084673 DOI: 10.3109/09540261.2013.864260] [Citation(s) in RCA: 446] [Impact Index Per Article: 44.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This review summarizes the current literature on cancer-related cognitive impairment (CRCI) with a focus on prevalence, mechanisms, and possible interventions for CRCI in those who receive adjuvant chemotherapy for non-central nervous system tumours and is primarily focused on breast cancer. CRCI is characterized as deficits in areas of cognition including memory, attention, concentration, and executive function. Development of CRCI can impair quality of life and impact treatment decisions. CRCI is highly prevalent; these problems can be detected in up to 30% of patients prior to chemotherapy, up to 75% of patients report some form of CRCI during treatment, and CRCI is still present in up to 35% of patients many years following completion of treatment. While the trajectory of CRCI is becoming better understood, the mechanisms underlying the development of CRCI are still obscure; however, host characteristics, immune dysfunction, neural toxicity, and genetics may play key roles in the development and trajectory of CRCI. Intervention research is limited, though strategies to maintain function are being studied with promising preliminary findings. This review highlights key research being conducted in these areas, both in patient populations and in animals, which will ultimately result in better understanding and effective treatments for CRCI.
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Affiliation(s)
- Michelle C. Janelsins
- Department of Surgery, Cancer Control, University of Rochester Medical Center, Rochester, NY
- James P. Wilmot Cancer Center, Rochester, NY
| | | | - Tim A. Ahles
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Gary R. Morrow
- Department of Surgery, Cancer Control, University of Rochester Medical Center, Rochester, NY
- James P. Wilmot Cancer Center, Rochester, NY
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY
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Schmidt M, Neuner B, Kindler A, Scholtz K, Eckardt R, Neuhaus P, Spies C. Prediction of long-term mortality by preoperative health-related quality-of-life in elderly onco-surgical patients. PLoS One 2014; 9:e85456. [PMID: 24465568 PMCID: PMC3896375 DOI: 10.1371/journal.pone.0085456] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 12/05/2013] [Indexed: 12/28/2022] Open
Abstract
Objective Aim of this study was to evaluate the association between preoperative health-related quality of life (HRQoL) and mortality in a cohort of elderly patients (>65 years) with gastrointestinal, gynecological and genitourinary carcinomas. Design Prospective cohort pilot study. Setting Tertiary university hospital in Germany. Patients Between June 2008 and July 2010 and after ethical committee approval and written informed consent, 126 patients scheduled for onco-surgery were included. Prior to surgery as well as 3 and 12 months postoperatively all participants completed the EORTC-QLQ-C30 questionnaire (measuring self-reported health-related quality of life). Additionally, demographic and clinical data including the Mini Mental State Examination (MMSE) were collected. Surgery and anesthesia were conducted according to the standard operating procedures. Primary endpoint was the cumulative mortality rate over 12 months after one year. Changes in Quality of life were considered as secondary outcome. Results Mortality after one year was 28%. In univariable and multivariable logistic regression analysis baseline HRQoL self-reported cognitive function (OR per point: 0.98; CI 95% 0.96–0.99; p = 0.024) and higher symptom burden for appetite loss (per point: OR 1.02; CI 95% 1.00–1.03; p = 0.014) were predictive for long-term mortality. Additionally the MMSE as an objective measure of cognitive impairment (per point: OR 0.69; CI 95% 0.51–0.96; p = 0.026) as well as severity of surgery (OR 0.31; CI 95% 0.11–0.93; p = 0.036) were predictive for long-term mortality. Global health status 12 months after surgery was comparable to the baseline levels in survivors despite moderate impairments in other domains. Conclusion This study showed that objective and self-reported cognitive functioning together with appetite loss were prognostic for mortality in elderly cancer patients. In addition, impaired cognitive dysfunction and severity of surgery were predictive for one-year mortality whereas in this selected population scheduled for surgery age, gender, cancer site and metastases were not.
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Affiliation(s)
- Maren Schmidt
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-University Medicine Berlin, Berlin, Germany
| | - Bruno Neuner
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-University Medicine Berlin, Berlin, Germany
| | - Andrea Kindler
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-University Medicine Berlin, Berlin, Germany
| | - Kathrin Scholtz
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-University Medicine Berlin, Berlin, Germany
| | - Rahel Eckardt
- Charité Research Group on Geriatrics, Charité-University Medicine Berlin, Berlin, Germany
| | - Peter Neuhaus
- Department of General, Visceral, and Transplantation Surgery, Charité Campus Virchow, Charité-University Medicine Berlin, Berlin, Germany
| | - Claudia Spies
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-University Medicine Berlin, Berlin, Germany
- * E-mail:
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Bender CM, Thelen BD. Cancer and Cognitive Changes: The Complexity of the Problem. Semin Oncol Nurs 2013; 29:232-7. [DOI: 10.1016/j.soncn.2013.08.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Davis J, Ahlberg FM, Berk M, Ashley DM, Khasraw M. Emerging pharmacotherapy for cancer patients with cognitive dysfunction. BMC Neurol 2013; 13:153. [PMID: 24156319 PMCID: PMC4015674 DOI: 10.1186/1471-2377-13-153] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 09/30/2013] [Indexed: 01/04/2023] Open
Abstract
Advances in the diagnosis and multi-modality treatment of cancer have increased survival rates for many cancer types leading to an increasing load of long-term sequelae of therapy, including that of cognitive dysfunction. The cytotoxic nature of chemotherapeutic agents may also reduce neurogenesis, a key component of the physiology of memory and cognition, with ramifications for the patient's mood and other cognition disorders. Similarly radiotherapy employed as a therapeutic or prophylactic tool in the treatment of primary or metastatic disease may significantly affect cognition. A number of emerging pharmacotherapies are under investigation for the treatment of cognitive dysfunction experienced by cancer patients. Recent data from clinical trials is reviewed involving the stimulants modafinil and methylphenidate, mood stabiliser lithium, anti-Alzheimer's drugs memantine and donepezil, as well as other agents which are currently being explored within dementia, animal, and cell culture models to evaluate their use in treating cognitive dysfunction.
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Affiliation(s)
| | | | | | | | - Mustafa Khasraw
- School of Medicine of Deakin University, Geelong, VIC, Australia.
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40
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Salani R. Survivorship planning in gynecologic cancer patients. Gynecol Oncol 2013; 130:389-97. [DOI: 10.1016/j.ygyno.2013.05.022] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 05/13/2013] [Accepted: 05/16/2013] [Indexed: 01/01/2023]
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Wigmore P. The effect of systemic chemotherapy on neurogenesis, plasticity and memory. Curr Top Behav Neurosci 2013; 15:211-240. [PMID: 23239468 DOI: 10.1007/7854_2012_235] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Chemotherapy has been enormously successful in treating many forms of cancer and improving patient survival rates. With the increasing numbers of survivors, a number of cognitive side effects have become apparent. These have been called "chemobrain" or "chemofog" among patient groups, who describe the symptoms as a decline in memory, concentration and executive functions. Changes which, although subtle, can cause significant distress among patients and prevent a return to the quality of life experienced before treatment. This cognitive side effect of chemotherapy was not anticipated as it had been assumed that chemotherapy agents, administered systematically, could not cross the blood-brain barrier and that the brain was therefore protected from their action. It is now realised that low concentrations of many chemotherapy agents cross the blood-brain barrier and even those that are completely prevented from doing so, can induce the production of inflammatory cytokines in peripheral tissues which in turn can cross the blood-brain barrier and impact on the brain. A large number of patient studies have shown that cognitive decline is found in a proportion of patients treated with a variety of chemotherapy agents for different types of cancer. The deficits experienced by these patients can last for up to several years and have a deleterious effect on educational attainment and ability to return to work. Imaging studies of patients after systemic chemotherapy show that this treatment produces structural and functional changes in the brain some of which seem to persist even when the cognitive deficits have ceased. This suggests that, with time, brain plasticity may be able to compensate for the deleterious effects of chemotherapy treatment. A number of mechanisms have been suggested for the changes in brain structure and function found after chemotherapy. These include both central and peripheral inflammatory changes, demyelination of white matter tracts, a reduction in stem cell proliferation in both the hippocampal neurogenic region and by oligodendrocyte precursors as well as changes in hormonal or growth factor levels. A number of possible treatments have been suggested which range from pharmacological interventions to cognitive behavioural therapies. Some of these have only been tested in animal models while others have produced varying degrees of improvement in patient populations. Currently, there is no recognised treatment and a greater understanding of the causes of the cognitive decline experienced after chemotherapy will be key to finding ways of preventing or treating the effects of chemobrain.
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Affiliation(s)
- Peter Wigmore
- School of Biomedical Sciences, Queen's Medical Centre, Nottingham, NG7 2UH, UK,
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Acevedo SF. Why, After Chemotherapy, is it Necessary to Assess Memory Using Translational Testing? BREAST CANCER-BASIC AND CLINICAL RESEARCH 2012; 6:181-90. [PMID: 23226022 PMCID: PMC3512448 DOI: 10.4137/bcbcr.s10293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
As the number of cancer survivors rises, so does the importance of understanding what happens post-chemotherapy. The evidence is clear that chemotherapy affects not only cancer cells, but also healthy cells including neurons, leading to long-term cognitive dysfunction in a large portion of survivors. In order to understand the mechanism of action and in the hope of reducing the potential neurocognitive side effects of chemotherapy, pre-clinical testing should be used more effectively. However, the field is lacking translation from clinical studies to animal models. Spatial learning and memory paradigms based on the water maze, the most commonly used rodent model, are available for translational testing in humans and could overcome this weakness. There is an overwhelming need in the field to understand whether the water maze is an adequate model for post-chemotherapy impairments or whether other paradigms should be used. This is of great importance for the understanding of the mechanisms, side effects of new drugs, appropriate pharmacotherapy, and confounding factors related to chemotherapy treatment regiments. This review is very important to both basic scientists and clinicians determining how translational paradigms are critical to future cancer research, as well as what type of paradigms are appropriate in our technically advancing society.
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Affiliation(s)
- Summer F Acevedo
- Department of Physiology, Pharmacology, and Toxicology, Psychology Program, Ponce School of Medicine and Health Sciences, Ponce, Puerto Rico
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Ahles TA, Root JC, Ryan EL. Cancer- and cancer treatment-associated cognitive change: an update on the state of the science. J Clin Oncol 2012; 30:3675-86. [PMID: 23008308 DOI: 10.1200/jco.2012.43.0116] [Citation(s) in RCA: 475] [Impact Index Per Article: 39.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Cognitive changes associated with cancer and cancer treatments have become an increasing concern. Using breast cancer as the prototype, we reviewed the research from neuropsychological, imaging, genetic, and animal studies that have examined pre- and post-treatment cognitive change. An impressive body of research supports the contention that a subgroup of patients is vulnerable to post-treatment cognitive problems. We also propose that models of aging may be a useful conceptual framework for guiding research in this area and suggest that a useful perspective may be viewing cognitive change in patients with cancer within the context of factors that influence the trajectory of normal aging.
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Affiliation(s)
- Tim A Ahles
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY 10022, USA.
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