1
|
Yu J, Chen J, Wang B, Wen H, Li H, Wu Y, Hu R. Symptom experience and self-management strategies of adults undergoing hematopoietic stem cell transplantation after hospital discharge: A longitudinal qualitative study. Eur J Oncol Nurs 2024; 72:102666. [PMID: 39163757 DOI: 10.1016/j.ejon.2024.102666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 07/09/2024] [Accepted: 07/10/2024] [Indexed: 08/22/2024]
Abstract
PURPOSE To explore the symptom experience and self-management strategies of adults undergoing hematopoietic stem cell transplantation after hospital discharge. METHODS A longitudinal qualitative study was employed. A heterogeneous sample of 22 patients who underwent hematopoietic stem cell transplantation from August 2022 to April 2023 were included. Semi-structured interviews were conducted at three time points post-discharge and provided a dataset of 56 interviews. The content analysis method was used for manual analysis. This study followed the COREQ checklist. RESULTS The data from this study were categorized into four themes and 14 subthemes: (1) complexity and multidimensionality of symptom experience: diversity, dynamism, continuity, relatedness, and functional loading; (2) multiple variations in symptom self-management; (3) barriers to symptom self-management: limited access to information resources, insufficient awareness and skills in symptom self-management, lack of economic and social support, and difficulties in medical visits and reviews; and (4) facilitators of symptom self-management: perceived benefits, experience-driven, and peer experiences. CONCLUSION Patients undergoing hematopoietic stem cell transplantation experience multiple and complex symptom experiences after hospital discharge, and their symptom self-management remains challenging. The findings underscore the necessity for healthcare professionals to regularly and consistently evaluate the symptoms and self-management practices of patients undergoing hematopoietic stem cell transplantation and execute focused interventions to alleviate their symptom load and enhance their long-term well-being.
Collapse
Affiliation(s)
- Jiejie Yu
- The School of Nursing, Fujian Medical University, Fuzhou, China
| | - Jingyi Chen
- The School of Nursing, Fujian Medical University, Fuzhou, China
| | - Binbin Wang
- The School of Nursing, Fujian Medical University, Fuzhou, China
| | - Hongmei Wen
- The School of Nursing, Fujian Medical University, Fuzhou, China
| | - Hao Li
- The School of Nursing, Fujian Medical University, Fuzhou, China
| | - Yong Wu
- Department of Hematology, Fujian Medical University Union Hospital, Fuzhou, China.
| | - Rong Hu
- The School of Nursing, Fujian Medical University, Fuzhou, China.
| |
Collapse
|
2
|
Nakamura ZM, Ali NT, Crouch A, Dhillon H, Federico A, Gates P, Grech L, Kesler SR, Ledbetter L, Mantovani E, Mayo S, Ng DQ, Pembroke L, Pike KE, Tamburin S, Tan CJ, Toh YL, Yang Y, Von Ah D, Allen DH. Impact of Cognitive Rehabilitation on Cognitive and Functional Outcomes in Adult Cancer Survivors: A Systematic Review. Semin Oncol Nurs 2024; 40:151696. [PMID: 39048409 PMCID: PMC11402594 DOI: 10.1016/j.soncn.2024.151696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 06/20/2024] [Accepted: 06/21/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVES This systematic review (PROSPERO CRD42021275421) synthesized evidence on the efficacy of cognitive rehabilitation on cognitive and functional outcomes in adult cancer survivors. METHODS Articles were identified though PubMed/MEDLINE, EMBASE, PsycINFO, and Web of Science from inception through June 30, 2023. Studies included participants ≥18 years old, diagnosed with cancer. Primary outcomes were validated measures of subjective and objective cognition. Articles were dual reviewed for eligibility and data extraction. Risk of bias was assessed with the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields. RESULTS The search yielded 3,811 articles; 65 full-text articles were reviewed; 53 articles (15 cognitive training, 14 strategy-based, 21 combinations, three inpatient rehabilitation), representing 52 unique studies, were included. Positive effects were observed in at least one objective cognitive measure in 93% of strategy training, 81% of cognitive training, 79% of combination rehabilitation interventions. Positive effects were observed in subjective cognition in 100% of strategy training, 55% of cognitive training, and 92% of combination interventions. Among studies with comparator groups, processing speed improved in 60% of cognitive training studies, while strategy training did not improve processing speed; otherwise, cognitive domain effects were similar between intervention types. Impact on functional outcomes was inconclusive. CONCLUSIONS Cognitive rehabilitation appear beneficial for cancer-related cognitive impairment (CRCI). Differential effects on specific cognitive domains (eg, processing speed) and subjective cognition may exist between intervention types. IMPLICATIONS FOR NURSING PRACTICE Nurses should increase patient and provider awareness of the benefits of cognitive rehabilitation for CRCI.
Collapse
Affiliation(s)
- Zev M Nakamura
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | | | - Adele Crouch
- Indiana University School of Nursing, Indianapolis, Indiana
| | - Haryana Dhillon
- Psycho-Oncology Cooperative Research Group, Faculty of Science, The University of Sydney, New South Wales, Australia
| | - Angela Federico
- Department of Neurosciences, Biomedicine and Movement Sciences, GB Rossi Hospital, University of Verona, Verona, Italy
| | - Priscilla Gates
- Peter Mac Callum Cancer Center, Deakin University, Burwood, Victoria, Australia
| | - Lisa Grech
- School of Psychology, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | | | - Leila Ledbetter
- Duke University Medical Center Library, DUMC 3702, Durham, North Carolina
| | - Elisa Mantovani
- Department of Neurosciences, Biomedicine and Movement Sciences, GB Rossi Hospital, University of Verona, Verona, Italy
| | | | - Ding Quan Ng
- University of California Irvine, School of Pharmacy & Pharmaceutical Sciences, Irvine, CA, USA
| | - Lorna Pembroke
- School of Psychological Sciences Level 3, Australian Hearing Hub, Health and Human Sciences, Macquarie University, New South Wales, Australia
| | - Kerryn E Pike
- School of Applied Psychology, Griffith University, Gold Coast, Queensland, Australia
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, GB Rossi Hospital, University of Verona, Verona, Italy
| | - Chia Jie Tan
- College of Pharmacy, University of Utah, Salt Lake City, Utah
| | - Yi Long Toh
- Department of Pharmacy, National University of Singapore, Singapore
| | - Yesol Yang
- The Ohio State University Comprehensive Cancer Center, Colombus, Ohio
| | - Diane Von Ah
- The Ohio State University, College of Nursing, Colombus, Ohio
| | | |
Collapse
|
3
|
Aspelund SG, Halldorsdottir T, Agustsson G, Sigurdardottir Tobin HR, Wu LM, Amidi A, Johannsdottir KR, Lutgendorf SK, Telles R, Daly HF, Sigurdardottir K, Valdimarsdottir HB, Baldursdottir B. Biological and psychological predictors of cognitive function in breast cancer patients before surgery. Support Care Cancer 2024; 32:88. [PMID: 38185720 DOI: 10.1007/s00520-023-08282-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 12/18/2023] [Indexed: 01/09/2024]
Abstract
PURPOSE Research suggests that cancer-related cognitive impairment (CRCI) can occur before breast cancer (BC) treatment. The limited extant evidence suggests the underlying mechanisms could be stress-related. Potential psychological and biological predictors of CRCI prior to any BC treatment were examined. METHODS 112 treatment-naïve women with BC and 67 healthy controls (HC) completed a neuropsychological test battery to assess cognitive impairment and a self-report battery to assess cognitive complaints, cancer-related stress, depressive and anxiety symptoms. Morning and evening cortisol and α-amylase were collected from saliva. Multilinear regressions were conducted. RESULTS Treatment-naïve BC patients were more frequently impaired in verbal memory and processing speed and reported more cognitive complaints (all p < .001) than HC. BC patients and HC did not differ in overall cognitive impairment (p = .21). Steeper α-amylase, lower cancer-related stress and younger age was associated with better overall cognitive function in treatment-naïve BC patients. Higher depressive symptoms predicted higher levels of cognitive complaints in BC patients. CONCLUSION Overall, these findings suggest that stress plays a role in CRCI. This study is the first to associate α-amylase with cognitive function in cancer patients, informing future research. The findings on impairment in processing speed and verbal memory among treatment-naïve BC highlight the need to screen for such impairments among BC patients and indicate that future studies on CRCI should include baseline assessments prior to BC treatment. If replicated, these findings could inform the development and testing of appropriate interventions to decrease CRCI among cancer patients. CLINICAL TRIALS REGISTRATION NUMBER NCT04418856, date of registration: 06.05.2020.
Collapse
Affiliation(s)
| | | | - Gudjon Agustsson
- Department of Psychology, School of Social Sciences, Reykjavik University, Reykjavik, Iceland
| | | | - Lisa M Wu
- Department of Psychology, School of Social Sciences, Reykjavik University, Reykjavik, Iceland
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Unit for Psycho-Oncology and Health Psychology, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Ali Amidi
- Unit for Psycho-Oncology and Health Psychology, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Kamilla R Johannsdottir
- Department of Psychology, School of Social Sciences, Reykjavik University, Reykjavik, Iceland
| | - Susan K Lutgendorf
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa, USA
| | - Rachel Telles
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa, USA
| | | | | | - Heiddis B Valdimarsdottir
- Department of Psychology, School of Social Sciences, Reykjavik University, Reykjavik, Iceland
- Department of Population Health Science and Policy, Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Birna Baldursdottir
- Department of Psychology, School of Social Sciences, Reykjavik University, Reykjavik, Iceland.
| |
Collapse
|
4
|
Franco-Rocha OY, Mahaffey ML, Matsui W, Kesler SR. Remote assessment of cognitive dysfunction in hematologic malignancies using web-based neuropsychological testing. Cancer Med 2023; 12:6068-6076. [PMID: 36221244 PMCID: PMC10028155 DOI: 10.1002/cam4.5331] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/21/2022] [Accepted: 09/25/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Cognitive impairment is a frequent adverse effect of cancer and its therapies. As neuropsychological assessment is not often standard of care for patients with non-CNS disease, efficient, practical assessment tools are required to track cognition across the disease course. We examined cognitive functioning using a web-based cognitive testing battery to determine if it could detect differences between patients with cancer and controls. METHODS We enrolled 22 patients with multiple myeloma (MM) or non-Hodgkin lymphoma (NHL) and 40 healthy controls (mean age = 56 ± 11 years, 52% male). Participants completed the BrainCheck cognitive testing battery and online versions of select measures from the Patient Reported Outcome Measures Information System (PROMIS) during a video conference. MANOVA was used to compare BrainCheck and PROMIS scores between groups controlling for age and sex. An exploratory linear regression analysis was conducted within the cancer group to determine potential contributors to cognitive functioning. RESULTS All participants except for one control completed the online assessment measures without difficulty. Compared to controls, the cancer group demonstrated significantly lower scores in objective and subjective cognitive function, physical functioning, and social role performance and elevated fatigue scores. Corticosteroid treatment, immunotherapy, lower physical functioning, lower income, and older age significantly contributed to lower cognitive function (adjusted R2 = 0.925, F = 19.63, p = 0.002). CONCLUSION Remote assessment of cognitive and psychosocial functioning is feasible with patients with cancer following treatments. The BrainCheck cognitive testing battery has the potential to detect differences in cognition between patients with cancer and controls.
Collapse
Affiliation(s)
- Oscar Y Franco-Rocha
- Brain Health Neuroscience Lab, School of Nursing, University of Texas at Austin, Austin, Texas, USA
| | - Misty L Mahaffey
- Department of Hematology/Oncology, Stanford Cancer Institute, Stanford Health Care, Palo Alto, California, USA
| | - William Matsui
- Department of Oncology, Dell School of Medicine, University of Texas at Austin, Austin, Texas, USA
| | - Shelli R Kesler
- Brain Health Neuroscience Lab, School of Nursing, University of Texas at Austin, Austin, Texas, USA
- Department of Oncology, Dell School of Medicine, University of Texas at Austin, Austin, Texas, USA
| |
Collapse
|
5
|
Salit RB, Schoeppner K, De Biase C, Mohammed J, Gonzales AL, Hashmi SK, Gea-Banacloche J, Savani BN, Carpenter PA, Syrjala KL. American Society for Transplantation and Cellular Therapy Return to Work Guidance Committee Recommendations for Health Care Providers Who Take Care of Hematopoietic Cell Transplantation Patients. Transplant Cell Ther 2022; 28:822-828. [PMID: 36184059 DOI: 10.1016/j.jtct.2022.09.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 12/24/2022]
Abstract
Hematopoietic cell transplantation (HCT) health care providers report a desire to improve long-term outcomes and quality of life for their patients. One of the items frequently cited by patients in terms of transitioning from being a patient back to pre-HCT life is return to work (RTW). However, these patients report little support from their health care providers in facilitating this process, and only 50% to 60% achieve RTW, at a median of 3 years post-HCT. Barriers are physical, psychological, and logistical, as well as poor communication between the patient and their employer. We convened a group of experts in survivorship, rehabilitation, social work, and psychology to draft an evidence-based document to assist health care providers in guiding their patients' RTW journey. Guidance is drawn from the existing literature for HCT and general cancer patients and is divided into pre-HCT, peri-HCT, and post-HCT categories. Collaboration among health care providers, patients, and their employers is key to this transition. Suggested referrals and evaluations also are provided. The goal is for this guidance to be continually updated as we advance the field with more HCT-specific literature.
Collapse
Affiliation(s)
- Rachel B Salit
- Fred Hutchinson Cancer Center, Seattle, Washington; University of Washington Medical Center, Seattle, Washington.
| | | | | | - Jaleel Mohammed
- Rehabilitation Association for Hematopoietic Cell Transplantation, Sheffield, United Kingdom; Lincolnshire Community Health Service NHS Trust, Lincoln, United Kingdom
| | | | - Shahrukh K Hashmi
- Mayo Clinic, Rochester, Minnesota; SSMC, Abu Dhabi, United Arab Emirates
| | | | | | - Paul A Carpenter
- Vanderbilt University Medical Center, Nashville, Tennessee; Seattle Children's Medical Center, Seattle, Washington
| | - Karen L Syrjala
- Fred Hutchinson Cancer Center, Seattle, Washington; University of Washington Medical Center, Seattle, Washington
| |
Collapse
|
6
|
Morrison CF, Drake S, Basile NL, Horn MJ, Lambert J, Myers KC, Pai AL. Symptoms of Survivors of Pediatric Hematopoietic Stem Cell Transplant by Age, Sex, and Transplant Type. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2022; 39:277-289. [PMID: 36129887 PMCID: PMC9807777 DOI: 10.1177/27527530211068746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Purpose: The purpose of this study was to describe symptoms experienced by survivors of pediatric hematopoietic stem cell transplant (HSCT), and demographic and treatment-factors associated with ongoing symptomology. Methods: Fifty pediatric survivors completed a cross-sectional pilot study. Questionnaires were administered online via REDCap to assess symptoms experienced in the last week. Survivors also consented to a medical record chart review. Results: Survivors were on average 5.4 years post-HSCT (range 1.1 to 9 years), male (58%), and Caucasian (80%) who received an allogeneic HSCT (92%). The most commonly reported symptoms were difficulty concentrating (42.5%), pain (38%), worry (38%), nervousness (37.5%), and lack of energy/fatigue (34%). Survivors reported up to 14 symptoms, with 90% of the sample experiencing at least one symptom in the previous week. Average number of symptoms varied by age group between 2.1 (8-9 years) and 6.8 (18 and older). Age and female gender were associated with higher levels of fatigue. Conclusions: The majority of survivors experienced at least one symptom in the previous week. Neuropsychological symptoms and pain endure well into survivorship that can influence outcomes such as function and health-related quality of life (HRQOL). Research is needed on biological mechanisms of ongoing symptomology, effective interventions to prevent or mitigate symptoms, and the impact of symptoms on patient outcomes including daily functioning and HRQOL. Implications Survivors of pediatric HSCT continued to experience symptoms for up to nine years. Survivors should be frequently screened for symptoms, as symptoms may affect function, learning/employment outcomes, and HRQOL.
Collapse
Affiliation(s)
- Caroline F. Morrison
- Assistant Professor, University of Cincinnati, College of Nursing, Proctor Hall, 3110 Vine Street, MLC 0038,
Cincinnati, Ohio 45267,Caroline F. Morrison, PhD, RN, Assistant
Professor, University of Cincinnati, College of Nursing, Proctor Hall, 3110 Vine
Street, MLC 0038, Cincinnati, Ohio 45267.
| | - Sarah Drake
- Clinical Research Coordinator, Cincinnati Children's Hospital Medical
Center, Division of Behavioral Medicine and Clinical Psychology
| | | | - Mary Jane Horn
- Research Associate, University of Cincinnati, College of Nursing
| | - Joshua Lambert
- Assistant Professor, Biostatistician, University of Cincinnati, College of Nursing
| | - Kasiani C. Myers
- Assistant Professor, Cincinnati Children's Hospital Medical
Center, Division of Bone Marrow Transplantation and Immune Deficiency, University of Cincinnati, College of Medicine, Department of Pediatrics
| | - Ahna L.H. Pai
- Professor, Cincinnati Children's Hospital Medical Center, Division
of Behavioral Medicine and Clinical Psychology, Director of the Wellness Center, Cancer and Blood Diseases
Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati, College of Medicine, Department of Pediatrics
| |
Collapse
|
7
|
Wu LM, Valdimarsdottir HB, Amidi A, Reid KJ, Ancoli-Israel S, Bovbjerg K, Fox RS, Walker L, Matharu A, Kaseda ET, Galvin JP, Adekola K, Winkel G, Penedo F, Redd WH. Examining the Efficacy of Bright Light Therapy on Cognitive Function in Hematopoietic Stem Cell Transplant Survivors. J Biol Rhythms 2022; 37:471-483. [PMID: 35904252 DOI: 10.1177/07487304221107833] [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: 11/16/2022]
Abstract
Patients who have undergone hematopoietic stem cell transplant (HSCT) may experience cognitive impairment that can persist after treatment. Several studies have shown that bright light therapy may improve cognition, potentially due to its effects on the circadian system via brain regions that respond preferentially to light. In this double-blind randomized controlled trial, the efficacy of bright light therapy on cognition was examined in HSCT survivors. Forty-seven HSCT survivors at an urban hospital in the United States were screened for mild cognitive impairment, randomized to either bright white light (BWL) or comparison dim red light (DRL) conditions using a block randomization approach, and instructed to use their assigned light box every morning upon awakening for 30 min for 4 weeks. Assessments occurred at baseline, the end of the second week of the intervention, the end of the intervention, and at follow-up (8 weeks later). The primary outcome was objective cognitive function as measured by a global composite score on neuropsychological tests. Secondary outcomes included cognitive performance in individual domains, self-reported cognitive function, fatigue, sleep and sleep quality, and circadian rhythm robustness. Repeated-measures linear mixed models for both objective and self-reported cognitive function indicated significant main effects for time (ps < 0.05) suggesting significant improvements in both conditions over time. Time by light condition interaction effects were not significant. Models focused on secondary outcomes yielded no significant effects. Both BWL and DRL groups demonstrated significant improvements in objective cognitive and self-reported cognitive function over time, but there was no hypothesized effect of BWL over DRL nor associations with circadian rhythm robustness. Therapeutic effects of both light conditions, practice effects, and/or placebo effects may account for the findings.Trial registration: ClinicalTrials.gov Identifier: NCT02677987 (9 February 2016).
Collapse
Affiliation(s)
- Lisa M Wu
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Aarhus Institute of Advanced Studies, Aarhus University, Aarhus, Denmark.,Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Heiddis B Valdimarsdottir
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, New York, USA.,Department of Psychology, Reykjavik University, Reykjavik, Iceland
| | - Ali Amidi
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Kathryn J Reid
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sonia Ancoli-Israel
- Department of Psychiatry, School of Medicine, University of California San Diego, San Diego, California, USA
| | - Katrin Bovbjerg
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Rina S Fox
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,College of Nursing, The University of Arizona, Tucson, Arizona, USA
| | - Lauren Walker
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Amreen Matharu
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Erin T Kaseda
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - John P Galvin
- Department of Internal Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Kehinde Adekola
- Division of Hematology and Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Gary Winkel
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Frank Penedo
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida, USA
| | - William H Redd
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| |
Collapse
|
8
|
Change in Patients' Perceived Cognition Following Chimeric Antigen Receptor T-Cell Therapy for Lymphoma. Transplant Cell Ther 2022; 28:401.e1-401.e7. [PMID: 35580732 PMCID: PMC9339228 DOI: 10.1016/j.jtct.2022.05.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 04/13/2022] [Accepted: 05/10/2022] [Indexed: 12/17/2022]
Abstract
Chimeric antigen receptor (CAR) T-cell therapy can lead to durable responses in patients with relapsed/refractory hematologic malignancies. Immune effector cell-associated neurotoxicity syndrome (ICANS) and cytokine release syndrome (CRS) are common and may place patients at risk for longer-term cognitive impairment. This study examined changes in cognition in the first year after CD19-directed CAR T-cell therapy for lymphoma, as well as CAR T-cell therapy-specific risk-factors (e.g., ICANS, CRS) and nonspecific risk factors (e.g., baseline quality of life, frailty) for worsening cognition. Patients' perceived cognition was assessed at baseline and at days 90 and 360. Clinical variables were abstracted from medical records. Piecewise mixed models were used to examine acute change (i.e., within 90 days) and longer-term change (i.e., from 90 days to 360 days) in cognition, as well as to explore risk factors for worsening cognition. Among 118 participants (mean age 61, 59% male), mean levels of perceived cognition did not change from baseline to day 90 (P> .05) but worsened from day 90 to day 360 in global cognition and in the domains of memory, language, organization, and divided attention (P< .05). Although statistically significant, changes were small (d values 0.15-0.28). Greater baseline fatigue, anxiety, and depression were associated with worse global cognition at day 90 (P< .01). Patients with more severe ICANS post-CART reported worse global cognition at day 360 (P< .05), although there were no differences in perceived cognition by severity of CRS (P> .05). Other putative risk factors were not associated with acute or longer-term changes in perceived cognition (P> .05). CAR T-cell therapy recipients reported delayed deterioration in several cognitive domains, although changes were small. These findings may be useful when educating future patients on what to expect when receiving CAR T-cell therapy.
Collapse
|
9
|
Oppegaard K, Harris CS, Shin J, Paul SM, Cooper BA, Chan A, Anguera JA, Levine J, Conley Y, Hammer M, Miaskowski CA, Chan RJ, Kober KM. Cancer-related cognitive impairment is associated with perturbations in inflammatory pathways. Cytokine 2021; 148:155653. [PMID: 34388477 PMCID: PMC10792770 DOI: 10.1016/j.cyto.2021.155653] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 02/06/2023]
Abstract
Cancer-related cognitive impairment (CRCI) is a significant problem for patients receiving chemotherapy. While a growing amount of pre-clinical and clinical evidence suggests that inflammatory mechanisms underlie CRCI, no clinical studies have evaluated for associations between CRCI and changes in gene expression. Therefore, the purpose of this study was to evaluate for differentially expressed genes and perturbed inflammatory pathways across two independent samples of patients with cancer who did and did not report CRCI. The Attentional Function Index (AFI) was the self-report measure used to assess CRCI. AFI scores of <5 and of >7.5 indicate low versus high levels of cognitive function, respectively. Of the 185 patients in Sample 1, 49.2% had an AFI score of <5 and 50.8% had an AFI score of >7.5. Of the 158 patients in Sample 2, 50.6% had an AFI score of <5 and 49.4% had an AFI score of >7.5. Data from 182 patients in Sample 1 were analyzed using RNA-seq. Data from 158 patients in Sample 2 were analyzed using microarray. Twelve KEGG signaling pathways were significantly perturbed between the AFI groups, five of which were signaling pathways related to inflammatory mechanisms (e.g., cytokine-cytokine receptor interaction, tumor necrosis factor signaling). This study is the first to describe perturbations in inflammatory pathways associated with CRCI. Findings highlight the role of cytokines both in terms of cytokine-specific pathways, as well as pathways involved in cytokine production and cytokine activation. These findings have the potential to identify new targets for therapeutics and lead to the development of interventions to improve cognition in patients with cancer.
Collapse
Affiliation(s)
- Kate Oppegaard
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA 94143-0610, USA.
| | - Carolyn S Harris
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA 94143-0610, USA.
| | - Joosun Shin
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA 94143-0610, USA.
| | - Steven M Paul
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA 94143-0610, USA.
| | - Bruce A Cooper
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA 94143-0610, USA.
| | - Alexandre Chan
- School of Pharmacy and Pharmaceutical Sciences, University of California Irvine, 147B Bison Modular, Irvine, CA 92697, USA.
| | - Joaquin A Anguera
- School of Medicine, University of California, 675 Nelson Rising Lane, San Francisco, CA 94158, USA.
| | - Jon Levine
- School of Medicine, University of California, 675 Nelson Rising Lane, San Francisco, CA 94158, USA; School of Dentistry, University of California, 513 Parnassus Ave, MSB, San Francisco, CA 94117, USA.
| | - Yvette Conley
- School of Nursing, University of Pittsburgh, 440 Victoria Building, 3500 Victoria Street, Pittsburgh, PA 15261, USA.
| | - Marilyn Hammer
- Dana-Farber Cancer Institute, 450 Brookline Avenue, LW523, Boston, MA 02215, USA.
| | - Christine A Miaskowski
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA 94143-0610, USA; School of Medicine, University of California, 675 Nelson Rising Lane, San Francisco, CA 94158, USA.
| | - Raymond J Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park SA5042, Australia.
| | - Kord M Kober
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA 94143-0610, USA.
| |
Collapse
|
10
|
Marques ADCB, Machado CAM, Tomim DH, Guimarães PRB, Felix JVC, Kalinke LP. Assessment of quality of life three years from hematopoietic stem cell transplant. Rev Esc Enferm USP 2021; 55:e20200270. [PMID: 34477195 DOI: 10.1590/1980-220x-reeusp-2020-0270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 05/06/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess the domains of quality of life related to hematologic cancer patient health in the first three years from autologous and allogeneic hematopoietic stem cell transplantation. METHOD A prospective cohort from September 2013 to February 2019 at a reference service in Latin America with 55 patients. The instruments Quality of Life Questionnaire Core C30 and Functional Assessment Cancer Therapy - Bone Marrow Transplantation were used. For data analysis, Generalized Linear Mixed Model was used. RESULTS The domains global and overall quality of life presented the lowest scores in the pancytopenia phase: 59.3 and 91.4 in autologous, 55.3 and 90.3 in allogeneic. The mixed method analysis has shown that there was a significant change in scores between the phases throughout the treatment (p< 0.05). CONCLUSION Health-related quality of life presented significant changes in the domains between the phases throughout time. Understanding these results enables nursing interventions directed at the domains which were damaged during treatment.
Collapse
|
11
|
Janicsák H, Ungvari GS, Gazdag G. Psychosocial aspects of hematopoietic stem cell transplantation. World J Transplant 2021; 11:263-276. [PMID: 34316451 PMCID: PMC8290998 DOI: 10.5500/wjt.v11.i7.263] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/18/2021] [Accepted: 06/18/2021] [Indexed: 02/06/2023] Open
Abstract
Hematopoietic stem cell transplantation (HSCT) has become a conventional and potentially curative treatment for various hematological diseases. As more sophisticated procedures have been developed and mortality rates have decreased, attention has shifted to the psychosocial challenges associated with transplantation. The psychosocial difficulties accompanying transplantation are addressed in the context of both quality of life (QOL) and psychopathological research. Among the psychiatric comorbidities of HSCT, anxiety, depression, sleep and sexual disorders, delirium and post-traumatic stress disorder are the most studied conditions. Recently, more attention has been focused on the psychosocial burden of caregivers. Devising recommendations for the management of psychiatric symptoms and psychosocial interventions in HSCT sufferers and close relatives is a major concern to consultation–liaison psychiatrists and transplant teams. This review synthesizes and critically evaluates the current literature on the psychosocial aspects of HSCT and appraises the clinical significance of these outcomes. Issues of QOL assessment; psychosocial functioning and QOL in the course of HSCT; impact of graft-versus-host disease and other predictors of QOL and psychosocial functioning; comorbid psychiatric disorders; and interventions to maintain or improve QOL and reduce psychopathology and psychosocial burden on family members are presented.
Collapse
Affiliation(s)
- Henrietta Janicsák
- Department of Psychiatry and Psychiatric Rehabilitation, Jahn Ferenc South Pest Hospital, Budapest 1204, Hungary
| | - Gabor S Ungvari
- Division of Psychiatry, University of Notre Dame, Fremantle 6009, Australia
- Division of Psychiatry, School of Medicine, University of Western Australia, Perth 6009, Australia
| | - Gábor Gazdag
- Department of Psychiatry and Psychiatric Rehabilitation, Jahn Ferenc South Pest Hospital, Budapest 1204, Hungary
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Semmelweis University, Budapest 1083, Hungary
| |
Collapse
|
12
|
Understanding the Process and Challenges for Return-to-Work Post-Hematopoietic Cell Transplantation from a Musculoskeletal Perspective: A Narrative Review. Occup Ther Int 2021; 2021:5568513. [PMID: 34316293 PMCID: PMC8277503 DOI: 10.1155/2021/5568513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 05/02/2021] [Accepted: 06/18/2021] [Indexed: 12/20/2022] Open
Abstract
The current paper seeks to inform healthcare professionals on how adapting various components of return to work (RTW) programs that are already in use by other musculoskeletal rehabilitation settings can help optimize return to work process for patients with or without musculoskeletal manifestations, posthematopoietic cell transplantation. Since there is no universally agreed RTW structure for hematopoietic cell transplant patients, a narrative approach has been taken utilizing evidence from the existing musculoskeletal return to work assessment publications to help draw parallel for the hematopoietic cell transplant patients. Databases were searched including PUBMED, CINHAL, AMED, SCOPUS, and Cochrane using keywords RTW, functional restoration program, hematopoietic cell transplant, bone marrow transplant, stem cell transplant, and musculoskeletal functional assessment. The authors have managed to outline and propose a structured RTW assessment and monitoring program which can aid in getting patients back to employment by utilizing the functional capacity and job evaluation to help hematopoietic cell transplantation patients reintegrate socially. Patients undergoing hematopoietic cell transplant require additional support and a robust assessment system to allow safe RTW. The proposed model of RTW assessment can prove to be beneficial in helping patients return to work safely. Clinical Significance. To acknowledge the individuality in functional limitation is important in determining not only the rehab needs but also the RTW capabilities. The proposed RTW plan not only promotes an individualized approach to patients but also provides a structure for return to work assessments for hematopoietic cell transplantation patients, thus, eliminating the need for guess work by healthcare professionals. In line with the International Classification of Functioning, Disability, and Health (ICF) recommendations, a RTW assessment combined with a job evaluation helps healthcare professionals and stakeholders to understand the unique challenges and strengths of a patient and thereby design an individualized therapy approach.
Collapse
|
13
|
Mayo SJ, Rourke SB, Atenafu EG, Vitorino R, Chen C, Kuruvilla J. Computerized cognitive training in post-treatment hematological cancer survivors: a feasibility study. Pilot Feasibility Stud 2021; 7:36. [PMID: 33514444 PMCID: PMC7847007 DOI: 10.1186/s40814-021-00778-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 01/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Computerized cognitive training (CCT) programs have shown some effectiveness in alleviating cognitive symptoms in long-term cancer survivors. For patients presenting with cognitive symptoms in the early post-treatment phase, the benefit of CCT is unclear. To assess the possibility of testing the effectiveness of CCT in the early post-treatment period, our aim was to investigate the feasibility of an 8-week home-based, online CCT intervention among patients who have recently completed treatment for hematological malignancy. METHODS This study was a single-arm, non-blinded, feasibility study. All participants were provided with the CCT intervention for an 8-week period. Feasibility was evaluated based on participant adherence and patient perceptions of the intervention, assessed through responses to an acceptability questionnaire and semi-structured interviews at the end of the intervention period. RESULTS The feasibility study included 19 patients who had completed treatment for hematological malignancy at a Canadian tertiary cancer center. Adherence to the CCT intervention was limited, with only one participant meeting the criteria for intervention adherence. At the end of the intervention period, participants characterized the program as easy to follow (92%) and felt well-prepared for how to complete the exercises (100%). In semi-structured interviews, participants highlighted post-treatment barriers to intervention adherence that included symptom burden and competing time demands. Participants also suggested improvements to the intervention that could help maintain adherence despite these barriers, such as fostering a sense of accountability, providing personalized feedback and coaching, and enabling opportunities for peer support. CONCLUSIONS Participation in CCT can be challenging in the post-treatment period for hematological cancers. Further research on the effectiveness of CCT in this setting may require the implementation of strategies that support participants' engagement with the intervention in the context of symptoms and competing demands, such as establishing a minimum dose requirement and integrating approaches to help promote and sustain motivation.
Collapse
Affiliation(s)
- Samantha J Mayo
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College St., Suite 130, Toronto, ON, M5T 1P8, Canada. .,Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
| | - Sean B Rourke
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Eshetu G Atenafu
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Rita Vitorino
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Christine Chen
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - John Kuruvilla
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
14
|
Identification of the Knowledge Structure of Cancer Survivors' Return to Work and Quality of Life: A Text Network Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249368. [PMID: 33327622 PMCID: PMC7765104 DOI: 10.3390/ijerph17249368] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/10/2020] [Accepted: 12/13/2020] [Indexed: 11/17/2022]
Abstract
This study aimed to understand the trends in research on the quality of life of returning to work (RTW) cancer survivors using text network analysis. Titles and abstracts of each article were examined to extract terms, including "cancer survivors", "return to work", and "quality of life", which were found in 219 articles published between 1990 and June 2020. Python and Gephi software were used to analyze the data and visualize the networks. Keyword ranking was based on the frequency, degree centrality, and betweenness centrality. The keywords commonly ranked at the top included "breast", "patients", "rehabilitation", "intervention", "treatment", and "employment". Clustering results by grouping nodes with high relevance in the network led to four clusters: "participants and method", "type of research and variables", "RTW and education in adolescent and young adult cancer survivors", and "rehabilitation program". This study provided a visualized overview of the research on cancer survivors' RTW and quality of life. These findings contribute to the understanding of the flow of the knowledge structure of the existing research and suggest directions for future research.
Collapse
|
15
|
Baumann E, Kuba K, Götze H, Mehnert-Theuerkauf A, Esser P. Initial validation of the German version of the Attentional Function Index in a sample of haematological cancer survivors. Eur J Cancer Care (Engl) 2020; 29:e13226. [PMID: 31958365 DOI: 10.1111/ecc.13226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 12/19/2019] [Accepted: 12/19/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To date, no German instrument exists to assess subjective levels of cancer-related cognitive impairments (CRCI) in cancer survivors. We translated the validated Attentional Function Index (AFI) into German and explored its psychometric properties. METHODS The validation sample consisted of 1,111 haematological cancer survivors mainly recruited from two cancer registries. Factorial structure was explored using principal component analysis, internal consistency via Cronbach's α, construct validity through correlational analyses (Pearson's r) and associations of patient characteristics with the AFI score via regression analyses. RESULTS In line with the original version, we revealed three factors, that is "effective action" (seven items), "attentional lapses" (three items) and "interpersonal effectiveness" (three items). The overall reliability α was .91. Verifying construct validity, the AFI score correlated positively with cognitive functioning (r = .64, p ≤ .01) and global QoL (r = .44, p ≤ .01), but negatively with fatigue (r = -.60, p ≤ .01) and depressive symptomatology (r = -.6, p ≤ .01). Older age (β = .12, p < .001), higher comorbidity (β = -.07, p = .02) and being male patient (β = .07, p = .01) were significantly associated with the AFI scores, but effect sizes were small. CONCLUSION The German translation of the AFI shows good psychometric properties and thus may be reasonably applied to measure the subjective level of CRCI in German-speaking oncological populations.
Collapse
Affiliation(s)
- Esther Baumann
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Katharina Kuba
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Heide Götze
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Anja Mehnert-Theuerkauf
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Peter Esser
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| |
Collapse
|