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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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Zachariae R, Christiansen P, Amidi A, Wu L, Ventzel L, Tauber N, Von Heymann A, Skjødt Rafn B, Fassov J, Juul T, Christensen P, Johansen C. The time has come for national clinical practice guidelines for managing late effects after cancer and cancer treatment. Acta Oncol 2024; 63:491-493. [PMID: 38910334 PMCID: PMC11332514 DOI: 10.2340/1651-226x.2024.40787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 05/23/2024] [Indexed: 06/25/2024]
Affiliation(s)
- Robert Zachariae
- Unit for Psychooncology and Health Psychology, Department of Oncology, Aarhus University Hospital, Aarhus, Denmark; Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark; Danish Breast Cancer Group Center for Late Effects (DCCL), Aarhus University Hospital, Aarhus, Denmark.
| | - Peer Christiansen
- Danish Breast Cancer Group Center for Late Effects (DCCL), Aarhus University Hospital, Aarhus, Denmark; Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Ali Amidi
- Unit for Psychooncology and Health Psychology, Department of Oncology, Aarhus University Hospital, Aarhus, Denmark; Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Lisa Wu
- Unit for Psychooncology and Health Psychology, Department of Oncology, Aarhus University Hospital, Aarhus, Denmark; Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Lise Ventzel
- Department of Oncology, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Nina Tauber
- Unit for Psychooncology and Health Psychology, Department of Oncology, Aarhus University Hospital, Aarhus, Denmark; Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Annika Von Heymann
- Center for Cancer Late Effects (CASTLE), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Bolette Skjødt Rafn
- Center for Cancer Late Effects (CASTLE), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Janne Fassov
- Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Therese Juul
- Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Christensen
- Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Christoffer Johansen
- Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
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Schroyen G, Sleurs C, Ottenbourgs T, Leenaerts N, Nevelsteen I, Melis M, Smeets A, Deprez S, Sunaert S. Changes in leukoencephalopathy and serum neurofilament after (neo)adjuvant chemotherapy for breast cancer. Transl Oncol 2023; 37:101769. [PMID: 37651891 PMCID: PMC10480307 DOI: 10.1016/j.tranon.2023.101769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 08/21/2023] [Accepted: 08/21/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Previous case studies have provided evidence for chemotherapy-induced leukoencephalopathy in patients with breast cancer. However, prospective research is lacking. Hence, we investigated leukoencephalopathy before and after chemotherapy and its association with a serum neuroaxonal damage marker. METHODS This prospective cohort study included 40 patients receiving chemotherapy for breast cancer, and two age- and education-matched control groups, recruited between 2018 and 2021 (31-64 years of age). The latter control groups consisted of 39 chemotherapy-naïve patients and 40 healthy women. Fluid-attenuated inversion-recovery magnetic resonance imaging was used for lesion volumetry (total, juxtacortical, periventricular, infratentorial, and deep white matter) and blood serum to measure neurofilament light chain (NfL) levels. Acquisition took place pre-chemotherapy and three months and one-year post-chemotherapy, or at corresponding intervals. Within/between group differences were compared using robust mixed-effects modeling, and associations between total lesion volume and serum-NfL with linear regression. RESULTS Stronger increases in deep white matter lesion volumes were observed shortly post-chemotherapy, compared with healthy women (ßstandardized=0.09, pFDR<0.001). Increases in total lesion volume could mainly be attributed to enlargement of existing lesions (mean±SD, 0.12±0.16 mL), rather than development of new lesions (0.02±0.02 mL). A stronger increase in serum-NfL concentration was observed shortly post-chemotherapy compared with both control groups (ß>0.70, p<0.004), neither of which showed any changes over time, whereas a decrease was observed compared with healthy women one-year post-chemotherapy (ß=-0.54, p = 0.002). Serum-NfL concentrations were associated with lesion volume one-year post-chemotherapy (or at matched timepoint; ß=0.36, p = 0.010), whereas baseline or short-term post-therapy levels or changes were not. CONCLUSION These results underscore the possibility of chemotherapy-induced leukoencephalopathy months post-treatment, as well as the added value of serum-NfL as a prognostic marker for peripheral/central neurotoxicity. TRANSLATIONAL RELEVANCE Previous case studies have provided evidence of chemotherapy-induced leukoencephalopathy in patients with breast cancer. However, prospective studies to estimate longitudinal changes are currently missing. In this study, we used longitudinal fluid-attenuated inversion-recovery magnetic resonance imaging to assess white matter lesion volumes in patients treated for non-metastatic breast cancer and healthy women. Our findings demonstrate that chemotherapy-treated patients exhibit stronger increases in lesion volumes compared with healthy women, specifically in deep white matter, at three months post-chemotherapy. Increases could mainly be attributed to enlargement of existing lesions, rather than development of new lesions. Last, serum concentrations of neurofilament light chain, a neuroaxonal damage marker, increased shortly after chemotherapy and long-term post-chemotherapy levels were associated with lesion volumes. These findings highlight the potential of this non-invasive serum marker as a prognostic marker for peripheral and/or central neurotoxicity. Implementation in clinical practice could aid in therapeutic decisions, assessing disease activity, or monitoring treatment response.
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Affiliation(s)
- Gwen Schroyen
- KU Leuven, Leuven Brain Institute, Leuven, Belgium; University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium; KU Leuven, Department of Imaging and Pathology, Translational MRI, Leuven, Belgium
| | - Charlotte Sleurs
- KU Leuven, Leuven Brain Institute, Leuven, Belgium; University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium; Tilburg University, Department of Cognitive Neuropsychology, Tilburg, the Netherlands; KU Leuven, Department of Oncology, Leuven, Belgium
| | - Tine Ottenbourgs
- KU Leuven, Department of Imaging and Pathology, Translational MRI, Leuven, Belgium
| | - Nicolas Leenaerts
- KU Leuven, Leuven Brain Institute, Leuven, Belgium; KU Leuven, Department of Neurosciences, Mind-Body Research, Leuven, Belgium; KU Leuven, University Psychiatric Center, Leuven, Belgium; University Hospitals Leuven, Department of Psychiatry, Leuven, Belgium
| | - Ines Nevelsteen
- University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium; KU Leuven, Department of Oncology, Leuven, Belgium; University Hospitals Leuven, Department of Oncology, Surgical Oncology, Leuven, Belgium
| | - Michelle Melis
- KU Leuven, Leuven Brain Institute, Leuven, Belgium; University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium; KU Leuven, Department of Imaging and Pathology, Translational MRI, Leuven, Belgium
| | - Ann Smeets
- University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium; KU Leuven, Department of Oncology, Leuven, Belgium; University Hospitals Leuven, Department of Oncology, Surgical Oncology, Leuven, Belgium
| | - Sabine Deprez
- KU Leuven, Leuven Brain Institute, Leuven, Belgium; University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium; KU Leuven, Department of Imaging and Pathology, Translational MRI, Leuven, Belgium.
| | - Stefan Sunaert
- KU Leuven, Leuven Brain Institute, Leuven, Belgium; KU Leuven, Department of Imaging and Pathology, Translational MRI, Leuven, Belgium; University Hospitals Leuven, Department of Radiology, Leuven, Belgium
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de Ruiter MB, Deardorff RL, Blommaert J, Chen BT, Dumas JA, Schagen SB, Sunaert S, Wang L, Cimprich B, Peltier S, Dittus K, Newhouse PA, Silverman DH, Schroyen G, Deprez S, Saykin AJ, McDonald BC. Brain gray matter reduction and premature brain aging after breast cancer chemotherapy: a longitudinal multicenter data pooling analysis. Brain Imaging Behav 2023; 17:507-518. [PMID: 37256494 PMCID: PMC10652222 DOI: 10.1007/s11682-023-00781-7] [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] [Accepted: 04/29/2023] [Indexed: 06/01/2023]
Abstract
Brain gray matter (GM) reductions have been reported after breast cancer chemotherapy, typically in small and/or cross-sectional cohorts, most commonly using voxel-based morphometry (VBM). There has been little examination of approaches such as deformation-based morphometry (DBM), machine-learning-based brain aging metrics, or the relationship of clinical and demographic risk factors to GM reduction. This international data pooling study begins to address these questions. Participants included breast cancer patients treated with (CT+, n = 183) and without (CT-, n = 155) chemotherapy and noncancer controls (NC, n = 145), scanned pre- and post-chemotherapy or comparable intervals. VBM and DBM examined GM volume. Estimated brain aging was compared to chronological aging. Correlation analyses examined associations between VBM, DBM, and brain age, and between neuroimaging outcomes, baseline age, and time since chemotherapy completion. CT+ showed longitudinal GM volume reductions, primarily in frontal regions, with a broader spatial extent on DBM than VBM. CT- showed smaller clusters of GM reduction using both methods. Predicted brain aging was significantly greater in CT+ than NC, and older baseline age correlated with greater brain aging. Time since chemotherapy negatively correlated with brain aging and annual GM loss. This large-scale data pooling analysis confirmed findings of frontal lobe GM reduction after breast cancer chemotherapy. Milder changes were evident in patients not receiving chemotherapy. CT+ also demonstrated premature brain aging relative to NC, particularly at older age, but showed evidence for at least partial GM recovery over time. When validated in future studies, such knowledge could assist in weighing the risks and benefits of treatment strategies.
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Affiliation(s)
- Michiel B de Ruiter
- Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Rachael L Deardorff
- Center for Neuroimaging, Department of Radiology and Imaging Sciences, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, and Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jeroen Blommaert
- Department of Oncology, KU Leuven, Leuven, Belgium and Research Foundation Flanders (FWO), Brussels, Belgium
| | - Bihong T Chen
- City of Hope National Medical Center, Duarte, CA, USA
| | | | - Sanne B Schagen
- Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, Netherlands
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Stefan Sunaert
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Lei Wang
- Wexner Medical Center, Ohio State University, Columbus, OH, USA
| | | | | | - Kim Dittus
- University of Vermont Cancer Center, University of Vermont, Burlington, VT, USA
| | - Paul A Newhouse
- Center for Cognitive Medicine, Vanderbilt University Medical Center and Geriatric Research Educational and Clinical Center, Tennessee Valley VA Health System, Nashville, TN, USA
| | | | - Gwen Schroyen
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
- Leuven Cancer Institute, KU Leuven, Leuven, Belgium
| | - Sabine Deprez
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
- Leuven Cancer Institute, KU Leuven, Leuven, Belgium
| | - Andrew J Saykin
- Center for Neuroimaging, Department of Radiology and Imaging Sciences, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, and Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Brenna C McDonald
- Center for Neuroimaging, Department of Radiology and Imaging Sciences, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, and Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, Indianapolis, IN, USA.
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Fleming B, Edison P, Kenny L. Cognitive impairment after cancer treatment: mechanisms, clinical characterization, and management. BMJ 2023; 380:e071726. [PMID: 36921926 DOI: 10.1136/bmj-2022-071726] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Cognitive impairment is a debilitating side effect experienced by patients with cancer treated with systemically administered anticancer therapies. With around 19.3 million new cases of cancer worldwide in 2020 and the five year survival rate growing from 50% in 1970 to 67% in 2013, an urgent need exists to understand enduring side effects with severe implications for quality of life. Whereas cognitive impairment associated with chemotherapy is recognized in patients with breast cancer, researchers have started to identify cognitive impairment associated with other treatments such as immune, endocrine, and targeted therapies only recently. The underlying mechanisms are diverse and therapy specific, so further evaluation is needed to develop effective therapeutic interventions. Drug and non-drug management strategies are emerging that target mechanistic pathways or the cognitive deficits themselves, but they need to be rigorously evaluated. Clinically, consistent use of objective diagnostic tools is necessary for accurate diagnosis and clinical characterization of cognitive impairment in patients treated with anticancer therapies. This should be supplemented with clinical guidelines that could be implemented in daily practice. This review summarizes the recent advances in the mechanisms, clinical characterization, and novel management strategies of cognitive impairment associated with treatment of non-central nervous system cancers.
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Affiliation(s)
- Ben Fleming
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Paul Edison
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
- College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Laura Kenny
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
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6
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Koevoets EW, Geerlings MI, Monninkhof EM, Mandl R, Witlox L, van der Wall E, Stuiver MM, Sonke GS, Velthuis MJ, Jobsen JJ, van der Palen J, Bos MEMM, Göker E, Menke-Pluijmers MBE, Sommeijer DW, May AM, de Ruiter MB, Schagen SB. Effect of physical exercise on the hippocampus and global grey matter volume in breast cancer patients: A randomized controlled trial (PAM study). Neuroimage Clin 2022; 37:103292. [PMID: 36565574 PMCID: PMC9800528 DOI: 10.1016/j.nicl.2022.103292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 12/06/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Physical exercise in cancer patients is a promising intervention to improve cognition and increase brain volume, including hippocampal volume. We investigated whether a 6-month exercise intervention primarily impacts total hippocampal volume and additionally hippocampal subfield volumes, cortical thickness and grey matter volume in previously physically inactive breast cancer patients. Furthermore, we evaluated associations with verbal memory. METHODS Chemotherapy-exposed breast cancer patients (stage I-III, 2-4 years post diagnosis) with cognitive problems were included and randomized in an exercise intervention (n = 70, age = 52.5 ± 9.0 years) or control group (n = 72, age = 53.2 ± 8.6 years). The intervention consisted of 2x1 hours/week of supervised aerobic and strength training and 2x1 hours/week Nordic or power walking. At baseline and at 6-month follow-up, volumetric brain measures were derived from 3D T1-weighted 3T magnetic resonance imaging scans, including hippocampal (subfield) volume (FreeSurfer), cortical thickness (CAT12), and grey matter volume (voxel-based morphometry CAT12). Physical fitness was measured with a cardiopulmonary exercise test. Memory functioning was measured with the Hopkins Verbal Learning Test-Revised (HVLT-R total recall) and Wordlist Learning of an online cognitive test battery, the Amsterdam Cognition Scan (ACS Wordlist Learning). An explorative analysis was conducted in highly fatigued patients (score of ≥ 39 on the symptom scale 'fatigue' of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire), as previous research in this dataset has shown that the intervention improved cognition only in these patients. RESULTS Multiple regression analyses and voxel-based morphometry revealed no significant intervention effects on brain volume, although at baseline increased physical fitness was significantly related to larger brain volume (e.g., total hippocampal volume: R = 0.32, B = 21.7 mm3, 95 % CI = 3.0 - 40.4). Subgroup analyses showed an intervention effect in highly fatigued patients. Unexpectedly, these patients had significant reductions in hippocampal volume, compared to the control group (e.g., total hippocampal volume: B = -52.3 mm3, 95 % CI = -100.3 - -4.4)), which was related to improved memory functioning (HVLT-R total recall: B = -0.022, 95 % CI = -0.039 - -0.005; ACS Wordlist Learning: B = -0.039, 95 % CI = -0.062 - -0.015). CONCLUSIONS No exercise intervention effects were found on hippocampal volume, hippocampal subfield volumes, cortical thickness or grey matter volume for the entire intervention group. Contrary to what we expected, in highly fatigued patients a reduction in hippocampal volume was found after the intervention, which was related to improved memory functioning. These results suggest that physical fitness may benefit cognition in specific groups and stress the importance of further research into the biological basis of this finding.
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Affiliation(s)
- E W Koevoets
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands; Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - M I Geerlings
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands; Department of General Practice, Amsterdam UMC, Amsterdam, the Netherlands
| | - E M Monninkhof
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - R Mandl
- Department of Psychiatry, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - L Witlox
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - E van der Wall
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - M M Stuiver
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands; Center for Quality of Life, Netherlands Cancer Institute, Amsterdam, the Netherlands; Center of Expertise Urban Vitality, Faculty of Health, University of Applied Sciences, Amsterdam, the Netherlands
| | - G S Sonke
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - M J Velthuis
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - J J Jobsen
- Medical School Twente, Medisch Spectrum Twente, Enschede, the Netherlands
| | - J van der Palen
- Medical School Twente, Medisch Spectrum Twente, Enschede, the Netherlands; Department of Research Methodology, Measurement, Universiteit Twente, Enschede, the Netherlands
| | - M E M M Bos
- Department of Medical Oncology, ErasmusMC Cancer Institute, Rotterdam, the Netherlands
| | - E Göker
- Department of Medical Oncology, Alexander Monro Hospital, Bilthoven, the Netherlands
| | | | - D W Sommeijer
- Department of Internal Medicine, Flevohospital, Almere, the Netherlands; Department of Medical Oncology, Amsterdam UMC, Amsterdam, the Netherlands
| | - A M May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - M B de Ruiter
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - S B Schagen
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands; Brain and Cognition Group, University of Amsterdam, Amsterdam, the Netherlands.
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Schroyen G, Schramm G, Van Weehaeghe D, Leenaerts N, Vande Casteele T, Blommaert J, Koole M, Smeets A, Van Laere K, Sunaert S, Deprez S. Cerebral glucose changes after chemotherapy and their relation to long-term cognitive complaints and fatigue. Front Oncol 2022; 12:1021615. [PMID: 36313711 PMCID: PMC9612406 DOI: 10.3389/fonc.2022.1021615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 09/21/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose To investigate the short-term cerebral metabolic effects of intravenous chemotherapy and their association with long-term fatigue/cognitive complaints. Experimental design Using [18F]-FDG-PET/CT whole-body scans, we retrospectively quantified relative cerebral glucose metabolism before and after neoadjuvant chemotherapy in a cohort of patients treated for non-metastatic breast cancer (2009-2019). Self-report of cognitive complaints and fatigue were prospectively assessed 7 ± 3 years after therapy. Metabolic changes were estimated with i) robust mixed-effects modelling in regions-of-interest (frontal, parietal, temporal, occipital, and insular cortex) and ii) general-linear modelling of whole-brain voxel-wise outcomes. iii) The association between metabolic changes and self-reported outcomes was evaluated using linear regression-analysis. Results Of the 667 screened patients, 263 underwent PET/CT before and after chemotherapy and 183 (48 ± 9 years) met the inclusion criteria. After chemotherapy, decreased frontal and increased parietal and insular metabolism were observed (|ß|>0.273, pFDR<0.008). Separately, additional increased occipital metabolism after epiribucin+ cyclophosphamide (EC) and temporal metabolism after EC+ fluorouracil chemotherapy were observed (ß>0.244, pFDR≤0.048). Voxel-based analysis (pcluster-FWE<0.001) showed decreased metabolism in the paracingulate gyrus (-3.2 ± 3.9%) and putamen (3.1 ± 4.1%) and increased metabolism in the lateral cortex (L=2.9 ± 3.1%) and pericentral gyri (3.0 ± 4.4%). Except for the central sulcus, the same regions showed changes in EC, but not in FEC patients. Of the 97 self-reported responders, 23% and 27% experienced extreme fatigue and long-term cognitive complaints, respectively, which were not associated with metabolic changes. Conclusion Both hyper- and hypometabolism were observed after chemotherapy for breast cancer. Combined with earlier findings, this study could support inflammatory mechanisms resulting in relative hypermetabolism, mainly in the parietal/occipital cortices. As early metabolic changes did not precede long-term complaints, further research is necessary to identify vulnerable patients.
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Affiliation(s)
- Gwen Schroyen
- Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Leuven Cancer Institute, KU Leuven, Leuven, Belgium
- Department of Imaging and Pathology, Translational MRI, KU Leuven, Leuven, Belgium
- *Correspondence: Gwen Schroyen,
| | - Georg Schramm
- Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Department of Imaging and Pathology, Nuclear Medicine and Molecular Imaging, KU Leuven, Leuven, Belgium
| | - Donatienne Van Weehaeghe
- Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Department of Imaging and Pathology, Nuclear Medicine and Molecular Imaging, KU Leuven, Leuven, Belgium
- Division of Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Nicolas Leenaerts
- Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Department of Neurosciences, Mind-Body Research, KU Leuven, Leuven, Belgium
- University Psychiatric Centre, KU Leuven, Leuven, Belgium
- Department of Psychiatry, University Hospitals Leuven, Leuven, Belgium
| | - Thomas Vande Casteele
- Leuven Brain Institute, KU Leuven, Leuven, Belgium
- University Psychiatric Centre, KU Leuven, Leuven, Belgium
- Department of Psychiatry, University Hospitals Leuven, Leuven, Belgium
- Department of Neurosciences, Neuropsychiatry, KU Leuven, Leuven, Belgium
| | - Jeroen Blommaert
- Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Leuven Cancer Institute, KU Leuven, Leuven, Belgium
- Department of Oncology, Gynaecological Oncology, KU Leuven, Leuven, Belgium
| | - Michel Koole
- Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Leuven Cancer Institute, KU Leuven, Leuven, Belgium
- Department of Imaging and Pathology, Nuclear Medicine and Molecular Imaging, KU Leuven, Leuven, Belgium
| | - Ann Smeets
- Leuven Cancer Institute, KU Leuven, Leuven, Belgium
- Department of Oncology, Surgical Oncology, KU Leuven, Leuven, Belgium
- Surgical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Koen Van Laere
- Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Leuven Cancer Institute, KU Leuven, Leuven, Belgium
- Department of Imaging and Pathology, Nuclear Medicine and Molecular Imaging, KU Leuven, Leuven, Belgium
- Division of Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Stefan Sunaert
- Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Department of Imaging and Pathology, Translational MRI, KU Leuven, Leuven, Belgium
- Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Sabine Deprez
- Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Leuven Cancer Institute, KU Leuven, Leuven, Belgium
- Department of Imaging and Pathology, Translational MRI, KU Leuven, Leuven, Belgium
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Vasaghi Gharamaleki M, Mousavi SZ, Owrangi M, Gholamzadeh MJ, Kamali AM, Dehghani M, Chakrabarti P, Nami M. Neural correlates in functional brain mapping among breast cancer survivors receiving different chemotherapy regimens: a qEEG/HEG-based investigation. Jpn J Clin Oncol 2022; 52:1253-1264. [PMID: 35946328 DOI: 10.1093/jjco/hyac121] [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: 12/05/2021] [Accepted: 07/13/2022] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Post-chemotherapy cognitive impairment commonly known as 'chemobrain' or 'chemofog' is a well-established clinical disorder affecting various cognitive domains including attention, visuospatial working memory, executive function, etc. Although several studies have confirmed the chemobrain in recent years, scant experiments have evaluated the potential neurotoxicity of different chemotherapy regimens and agents. In this study, we aimed to evaluate the extent of attention deficits, one of the commonly affected cognitive domains, among breast cancer patients treated with different chemotherapy regimens through neuroimaging techniques. METHODS Breast cancer patients treated with two commonly prescribed chemotherapy regimens, Adriamycin, Cyclophosphamide and Taxol and Taxotere, Adriamycin and Cyclophosphamide, and healthy volunteers were recruited. Near-infrared hemoencephalography and quantitative electroencephalography assessments were recorded for each participant at rest and during task performance to compare the functional cortical changes associated with each chemotherapy regimen. RESULTS Although no differences were observed in hemoencephalography results across groups, the quantitative electroencephalography analysis revealed increased power of high alpha/low beta in left fronto-centro-parietal regions involved in dorsal and ventral attention networks in the Adriamycin, Cyclophosphamide and Taxol-treated group compared with the Taxotere, Adriamycin and Cyclophosphamide and control group. The Adriamycin, Cyclophosphamide and Taxol-treated cases had the highest current source density values in dorsal attention network and ventral attention network and ventral attention network-related centers in 10 and 15 Hz associated with the lowest Z-scored Fast Fourier Transform coherence in the mentioned regions. CONCLUSIONS The negatively affected neurocognitive profile in breast cancer patients treated with the Adriamycin, Cyclophosphamide and Taxol regimen proposes presumably neurotoxic sequelae of this chemotherapy regimen as compared with the Taxotere, Adriamycin and Cyclophosphamide regimen.
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Affiliation(s)
| | - Seyedeh Zahra Mousavi
- Students' Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Owrangi
- Students' Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Ali-Mohammad Kamali
- Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
- DANA Brain Health Institute, Iranian Neuroscience Society-Fars Chapter, Shiraz, Iran
| | - Mehdi Dehghani
- Hematology Research Center, Department of Hematology and Medical Oncology, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mohammad Nami
- Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
- DANA Brain Health Institute, Iranian Neuroscience Society-Fars Chapter, Shiraz, Iran
- Swiss Alternative Medicine, Geneva, Switzerland
- Neuroscience Center, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT AIP), City of Knowledge, Panama City, Republic of Panama
- Society for Brain Mapping and Therapeutics (SBMT), Los Angeles, CA, USA
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9
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Briley PM, Webster L, Boutry C, Cottam WJ, Auer DP, Liddle PF, Morriss R. Resting-state functional connectivity correlates of anxiety co-morbidity in major depressive disorder. Neurosci Biobehav Rev 2022; 138:104701. [PMID: 35598819 DOI: 10.1016/j.neubiorev.2022.104701] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 04/17/2022] [Accepted: 05/13/2022] [Indexed: 10/18/2022]
Abstract
Major depressive disorder (MDD) is frequently co-morbid with anxiety disorders. The co-morbid state has poorer functional outcomes and greater resistance to first line treatments, highlighting the need for novel treatment targets. This systematic review examined differences in resting-state brain connectivity associated with anxiety comorbidity in young- and middle-aged adults with MDD, with the aim of identifying novel targets for neuromodulation treatments, as these treatments are thought to work partly by altering dysfunctional connectivity pathways. Twenty-one studies met inclusion criteria, including a total of 1292 people with MDD. Only two studies included people with MDD and formally diagnosed co-morbid anxiety disorders; the remainder included people with MDD with dimensional anxiety measurement. The quality of most studies was judged as fair. Results were heterogeneous, partly due to a focus on a small set of connectivity relationships within individual studies. There was evidence for dysconnectivity between the amygdala and other brain networks in co-morbid anxiety, and an indication that abnormalities of default mode network connectivity may play an underappreciated role in this condition.
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Affiliation(s)
- P M Briley
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK; Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK.
| | - L Webster
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - C Boutry
- Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - W J Cottam
- NIHR Nottingham Biomedical Research Centre, Queen's Medical Centre, University of Nottingham, Nottingham, UK; Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK; Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - D P Auer
- NIHR Nottingham Biomedical Research Centre, Queen's Medical Centre, University of Nottingham, Nottingham, UK; Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK; Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - P F Liddle
- Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - R Morriss
- Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK; NIHR Nottingham Biomedical Research Centre, Queen's Medical Centre, University of Nottingham, Nottingham, UK
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10
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A multidisciplinary perspective on the complex interactions between sleep, circadian, and metabolic disruption in cancer patients. Cancer Metastasis Rev 2021; 40:1055-1071. [PMID: 34958429 PMCID: PMC8825432 DOI: 10.1007/s10555-021-10010-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/08/2021] [Indexed: 01/24/2023]
Abstract
Sleep is a basic need that is frequently set aside in modern societies. This leads to profound but complex physiological maladaptations in the body commonly referred to as circadian disruption, which recently has been characterized as a carcinogenic factor and reason for poor treatment outcomes, shortened survival, and reduced quality of life in cancer patients. As sleep and circadian physiology in cancer patients spans several disciplines including nursing science, neurology, oncology, molecular biology and medical technology, there is a lack of comprehensive and integrated approaches to deal with this serious and growing issue and at best a fractionated understanding of only part of the problem among researchers within each of these segments. Here, we take a multidisciplinary approach to comprehensively review the diagnosis and impact of sleep and circadian disruption in cancer patients. We discuss recent discoveries on molecular regulation of the circadian clock in healthy and malignant cells, the neurological and endocrine pathways controlling sleep and circadian rhythmicity, and their inputs to and outputs from the organism. The benefits and drawbacks of the various technologies, devices, and instruments used to assess sleep and circadian function, as well as the known consequences of sleep disruption and how sleep can be corrected in cancer patients, will be analyzed. We will throughout the review highlight the extensive crosstalk between sleep, circadian rhythms, and metabolic pathways involved in malignancy and identify current knowledge gaps and barriers for addressing the issue of sleep and circadian disruption in cancer patients. By addressing these issues, we hope to provide a foundation for further research as well as better and more effective care for the patients in the future.
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11
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Dynamic functional network connectivity reveals the brain functional alterations in lung cancer patients after chemotherapy. Brain Imaging Behav 2021; 16:1040-1048. [PMID: 34718941 DOI: 10.1007/s11682-021-00575-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 09/28/2021] [Indexed: 10/19/2022]
Abstract
This study aimed to investigate alterations of brain functional network connectivity (FNC) in lung cancer patients after chemotherapy and explore links between these FNC differences and cognitive impairment. Twenty-two lung cancer patients receiving chemotherapy and 26 healthy controls (HCs) underwent resting-state functional MRI (rs-fMRI) and neuropsychological testing. Group independent component analysis (GICA) was applied to rs-fMRI data to extract whole-brain resting state networks (RSNs). Static and dynamic FNC (dFNC) were constructed to reveal RSNs connectivity alterations between lung cancer patients and HCs group, and the correlations between the group differences in RSNs and cognitive performance were analyzed. Our findings revealed that chemotherapeutics can produce widespread connectivity abnormalities in RSNs, mainly focused on default mode network (DMN) and executive control network. Furthermore, the dFNC analysis help identify network configurations of each state and capture more chemotherapy-induced disorders of interactions between and within RSNs, which mainly includes sensorimotor network, attentional network and auditory network. In addition, after chemotherapy, the lung cancer patients spend shorter mean dwell time (MDT) in state 2. The decreased dFNC between DMN [independent component 5 (IC5)] and DMN (IC6) in the lung cancer patients after chemotherapy in state 4 was negatively correlated with Montreal Cognitive Assessment (MoCA) scores (r=-0.447, p=0.042). The dFNC analysis enrich our understanding of the neural mechanisms underlying the chemobrain, and suggested that the temporal dynamics of FNC could be a potential effective method to detect cognitive changes in lung cancer patients receiving chemotherapy.
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12
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Bekele BM, Luijendijk M, Schagen SB, de Ruiter M, Douw L. Fatigue and resting-state functional brain networks in breast cancer patients treated with chemotherapy. Breast Cancer Res Treat 2021; 189:787-796. [PMID: 34259949 PMCID: PMC8505321 DOI: 10.1007/s10549-021-06326-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/05/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE This longitudinal study aimed to disentangle the impact of chemotherapy on fatigue and hypothetically associated functional brain network alterations. METHODS In total, 34 breast cancer patients treated with chemotherapy (BCC +), 32 patients not treated with chemotherapy (BCC -), and 35 non-cancer controls (NC) were included. Fatigue was assessed using the EORTC QLQ-C30 fatigue subscale at two time points: baseline (T1) and six months after completion of chemotherapy or matched intervals (T2). Participants also underwent resting-state functional magnetic resonance imaging (rsfMRI). An atlas spanning 90 cortical and subcortical brain regions was used to extract time series, after which Pearson correlation coefficients were calculated to construct a brain network per participant per timepoint. Network measures of local segregation and global integration were compared between groups and timepoints and correlated with fatigue. RESULTS As expected, fatigue increased over time in the BCC + group (p = 0.025) leading to higher fatigue compared to NC at T2 (p = 0.023). Meanwhile, fatigue decreased from T1 to T2 in the BCC - group (p = 0.013). The BCC + group had significantly lower local efficiency than NC at T2 (p = 0.033), while a negative correlation was seen between fatigue and local efficiency across timepoints and all participants (T1 rho = - 0.274, p = 0.006; T2 rho = - 0.207, p = 0.039). CONCLUSION Although greater fatigue and lower local functional network segregation co-occur in breast cancer patients after chemotherapy, the relationship between the two generalized across participant subgroups, suggesting that local efficiency is a general neural correlate of fatigue.
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Affiliation(s)
- Biniam Melese Bekele
- Department of Anatomy and Neurosciences, Amsterdam Neuroscience, Cancer Center Amsterdam, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Maryse Luijendijk
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Brain and Cognition, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Sanne B Schagen
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Brain and Cognition, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Michiel de Ruiter
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Linda Douw
- Department of Anatomy and Neurosciences, Amsterdam Neuroscience, Cancer Center Amsterdam, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
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13
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Bernstein LJ, Edelstein K, Sharma A, Alain C. Chemo-brain: An activation likelihood estimation meta-analysis of functional magnetic resonance imaging studies. Neurosci Biobehav Rev 2021; 130:314-325. [PMID: 34454915 DOI: 10.1016/j.neubiorev.2021.08.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 07/24/2021] [Accepted: 08/23/2021] [Indexed: 11/17/2022]
Abstract
Adults with non-central nervous system (CNS) cancers frequently report problems in attention, memory and executive function during or after chemotherapy, referred to as cancer-related cognitive dysfunction (CRCD). Despite numerous studies investigating CRCD, there is no consensus regarding the brain areas implicated. We sought to determine if there are brain areas that consistently show either hyper- or hypo-activation in people treated with chemotherapy for non-CNS cancer (Chemo+). Using activation likelihood estimation on brain coordinates from 14 fMRI studies yielding 25 contrasts from 375 Chemo+ and 429 chemotherapy-naive controls while they performed cognitive tasks, the meta-analysis yielded two significant clusters which are part of the frontoparietal attention network, both showing lower activation in Chemo+. One cluster peaked in the left superior parietal cortex, extending into precuneus, inferior parietal lobule, and angular gyrus. The other peaked in the right superior prefrontal areas, extending into inferior prefrontal cortex. We propose that these observed lower activations reflect a dysfunction in mobilizing and/or sustaining attention due to depletion of cognitive resources. This could explain higher level of mental fatigue reported by Chemo+ and why cancer survivors report problems in a wide variety of cognitive domains.
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Affiliation(s)
- Lori J Bernstein
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Canada.
| | - Kim Edelstein
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Canada
| | - Alisha Sharma
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Claude Alain
- Rotman Research Institute, Baycrest Health Centre, Canada; Department of Psychology, University of Toronto, Canada
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14
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Cognitive impairment and associations with structural brain networks, endocrine status, and risk genotypes in newly orchiectomized testicular cancer patients. Brain Imaging Behav 2021; 16:199-210. [PMID: 34392471 DOI: 10.1007/s11682-021-00492-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2021] [Indexed: 01/16/2023]
Abstract
A higher incidence of cognitive impairment (CI) has previously been reported among orchiectomized testicular cancer patients (TCPs), but little is known about the underlying pathophysiology. The present study assessed CI in newly orchiectomized TCPs and explored the structural brain networks, endocrine status, and selected genotypes. Forty TCPs and 22 healthy controls (HCs) underwent neuropsychological testing and magnetic resonance imaging, and provided a blood sample. CI was defined as a z-score ≤ -2 on one neuropsychological test or ≤ -1.5 on two neuropsychological tests, and structural brain networks were investigated using graph theory. Associations of cognitive performance with brain networks, endocrine status (including testosterone levels and androgen receptor CAG repeat length), and genotypes (APOE, BDNF, COMT) were explored. Compared with HCs, TCPs performed poorer on 6 out of 15 neuropsychological tests, of which three tests remained statistically significant when adjusted for relevant between-group differences (p < 0.05). TCPs also demonstrated more CI than HCs (65% vs. 36%; p = 0.04). While global brain network analysis revealed no between-group differences, regional analysis indicated differences in node degree and betweenness centrality in several regions (p < 0.05), which was inconsistently associated with cognitive performance. In TCPs, CAG repeat length was positively correlated with delayed memory performance (r = 0.36; p = 0.02). A COMT group × genotype interaction effect was found for overall cognitive performance in TCPs, with risk carriers performing worse (p = 0.01). No effects were found for APOE, BDNF, or testosterone levels. In conclusion, our results support previous findings of a high incidence of CI in newly orchiectomized TCPs and provide novel insights into possible mechanisms.
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15
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Mzayek Y, de Ruiter MB, Oldenburg HSA, Reneman L, Schagen SB. Measuring decline in white matter integrity after systemic treatment for breast cancer: omitting skeletonization enhances sensitivity. Brain Imaging Behav 2021; 15:1191-1200. [PMID: 32705463 PMCID: PMC8286227 DOI: 10.1007/s11682-020-00319-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Chemotherapy for non-central nervous system cancers is associated with abnormalities in brain structure and function. Diffusion tensor imaging (DTI) allows for studying in vivo microstructural changes in brain white matter. Tract-based spatial statistics (TBSS) is a widely used processing pipeline in which DTI data are typically normalized to a generic DTI template and then 'skeletonized' to compensate for misregistration effects. However, this approach greatly reduces the overall white matter volume that is subjected to statistical analysis, leading to information loss. Here, we present a re-analysis of longitudinal data previously analyzed with standard TBSS (Menning et al., BIB 2018, 324-334). For our current approach, we constructed a pipeline with an optimized registration method in Advanced Normalization Tools (ANTs) where DTI data are registered to a study-specific, high-resolution T1 template and the skeletonization step is omitted. In a head to head comparison, we show that with our novel approach breast cancer survivors who had received chemotherapy plus or minus endocrine therapy (BC + SYST, n = 26) showed a global decline in overall FA that was not present in breast cancer survivors who did not receive systemic therapy (BC-SYST, n = 23) or women without a cancer diagnosis (no cancer controls, NC, n = 30). With the standard TBSS approach we did not find any group differences. Moreover, voxel-based analysis for our novel pipeline showed a widespread decline in FA in the BC + SYST compared to the NC group. Interestingly, the BC-SYST group also showed a decline in FA compared to the NC group, although in much less voxels. These results were not found with the standard TBSS approach. We demonstrate that a modified processing pipeline makes DTI data more sensitive to detecting changes in white matter integrity in non-CNS cancer patients after treatment, particularly chemotherapy.
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Affiliation(s)
- Yasmin Mzayek
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Brain and Cognition, Department of Psychology, University of Amsterdam, Nieuwe Achtergracht 129 B, Amsterdam, The Netherlands
| | - Michiel B de Ruiter
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Hester S A Oldenburg
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Liesbeth Reneman
- Department of Radiology, Location AMC, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Sanne B Schagen
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
- Brain and Cognition, Department of Psychology, University of Amsterdam, Nieuwe Achtergracht 129 B, Amsterdam, The Netherlands.
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16
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Lifetime prevalence of suicidal attempt among homeless individuals in North America: a meta-analysis. J Affect Disord 2021; 287:341-349. [PMID: 33813254 DOI: 10.1016/j.jad.2021.03.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/10/2021] [Accepted: 03/19/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Homelessness is a compelling public health problem, and homeless individuals are at increased risk for attempting suicide. However, the reported lifetime prevalence of suicidal attempt among homeless individuals in North America varied considerably. Therefore, this meta-analysis aimed to estimate the pooled lifetime prevalence of suicidal attempt among homeless individuals in North America and explore factors that may moderate this estimation. METHODS The protocol was registered in PROSPERO database (CRD42018102593). A systematic literature search was conducted in the electronic databases of PubMed, Embase, Web of Science, PsycINFO, and Google Scholar. Observational studies exploring the lifetime prevalence of suicidal attempt among homeless individuals in North America were included. Heterogeneity across studies was evaluated using the Cochran Q test and quantified using the I2 statistic. Subgroup analyses were performed to identify possible sources of heterogeneity. RESULTS Twenty-two eligible studies with a total of 9,727 homeless individuals were included, of which 2,986 reported having attempted suicide in their lifetime. A high degree of heterogeneity (I2=96.4%, P<0.001) was observed, and the pooled lifetime prevalence was 31.83% (95% confidence interval: 26.87%-36.99%). Subgroup analyses showed that the heterogeneity was quite low when estimating the pooled lifetime prevalence of suicidal attempt among heterosexual (I2=0.0, P=0.401) and non-heterosexual homeless individuals (I2=0.0, P=0.405). LIMITATIONS All eligible studies were exclusively conducted in the US and Canada. CONCLUSIONS Nearly three tenths of homeless individuals in North America have attempted suicide in their lifetime, and the differences in sexual orientation might have contributed to the heterogeneity.
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17
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Jia P, Pan X, Liu F, He P, Zhang W, Liu L, Zou Y, Chen L. Land use mix in the neighbourhood and childhood obesity. Obes Rev 2021; 22 Suppl 1:e13098. [PMID: 32743975 PMCID: PMC7988622 DOI: 10.1111/obr.13098] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 12/21/2022]
Abstract
Land use mix (LUM) in the neighbourhood is an important aspect for promoting healthier lifestyles and consequently reducing the risk for childhood obesity. However, findings of the association between LUM and childhood obesity remain controversial. A literature search was conducted on Cochrane Library, PubMed and Web of Science for articles published before 1 January 2019. In total, 25 cross-sectional and two longitudinal studies were identified. Among them, Geographic Information Systems were used to measure LUM in 15 studies, and perceived LUM was measured in 12 studies. Generally, most studies revealed an association between a higher LUM and higher PA levels and lower obesity rates, although some studies also reported null or negative associations. The various exposure and outcome assessment have limited the synthesis to obtain pooled estimates. The evidence remains scare on the association between LUM and children's weight status, and more longitudinal studies are needed to examine the independent pathways and causality between LUM and weight-related behaviours/outcomes.
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Affiliation(s)
- Peng Jia
- Department of Land Surveying and Geo-Informatics, The Hong Kong Polytechnic University, Hong Kong, China.,Faculty of Geo-information Science and Earth Observation, University of Twente, Enschede, The Netherlands.,International Institute of Spatial Lifecourse Epidemiology (ISLE), Hong Kong, China
| | - Xiongfeng Pan
- International Institute of Spatial Lifecourse Epidemiology (ISLE), Hong Kong, China.,Xiangya School of Public Health, Central South University, Changsha, China
| | - Fangchao Liu
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Pan He
- Department of Earth System Science, Tsinghua University, Beijing, China
| | - Weiwei Zhang
- School of Environmental Science and Engineering, Suzhou University of Science and Technology, Suzhou, China
| | - Li Liu
- Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing, China
| | - Yuxuan Zou
- International Institute of Spatial Lifecourse Epidemiology (ISLE), Hong Kong, China.,School of Geographical Sciences, Guangzhou University, Guangzhou, China
| | - Liding Chen
- State Key Laboratory of Urban and Regional Ecology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing, China
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18
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Winnard PT, Bharti SK, Sharma RK, Krishnamachary B, Mironchik Y, Penet MF, Goggins MG, Maitra A, Kamel I, Horton KM, Jacobs MA, Bhujwalla ZM. Brain metabolites in cholinergic and glutamatergic pathways are altered by pancreatic cancer cachexia. J Cachexia Sarcopenia Muscle 2020; 11:1487-1500. [PMID: 33006443 PMCID: PMC7749557 DOI: 10.1002/jcsm.12621] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/12/2020] [Accepted: 08/23/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Cachexia is a major cause of morbidity in pancreatic ductal adenocarcinoma (PDAC) patients. Our purpose was to understand the impact of PDAC-induced cachexia on brain metabolism in PDAC xenograft studies, to gain new insights into the causes of cachexia-induced morbidity. Changes in mouse and human plasma metabolites were characterized to identify underlying causes of brain metabolic changes. METHODS We quantified metabolites, detected with high-resolution 1 H magnetic resonance spectroscopy, in the brain and plasma of normal mice (n = 10) and mice bearing cachexia (n = 10) or non-cachexia (n = 9) inducing PDAC xenografts as well as in human plasma obtained from normal individuals (n = 24) and from individuals with benign pancreatic disease (n = 20) and PDAC (n = 20). Statistical significance was defined as a P value ≤0.05. RESULTS The brain metabolic signature of cachexia-inducing PDAC was characterized by a significant depletion of choline of -27% and -21% as well as increases of glutamine of 13% and 9% and formate of 21% and 14%, relative to normal controls and non-cachectic tumour-bearing mice, respectively. Good to moderate correlations with percent weight change were found for choline (r = 0.70), glutamine (r = -0.58), and formate (r = -0.43). Significant choline depletion of -38% and -30%, relative to normal controls and non-cachectic tumour-bearing mice, respectively, detected in the plasma of cachectic mice likely contributed to decreased brain choline in cachectic mice. Similarly, relative to normal controls and patients with benign disease, choline levels in human plasma samples of PDAC patients were significantly lower by -12% and -20% respectively. A comparison of plasma metabolites from PDAC patients with and without weight loss identified significant changes in glutamine metabolism. CONCLUSIONS Disturbances in metabolites of the choline/cholinergic and glutamine/glutamate/glutamatergic neurotransmitter pathways may contribute to morbidity. Metabolic normalization may provide strategies to reduce morbidity. The human plasma metabolite changes observed may lead to the development of companion diagnostic markers to detect PDAC and PDAC-induced cachexia.
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Affiliation(s)
- Paul T Winnard
- Division of Cancer Imaging Research, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Santosh Kumar Bharti
- Division of Cancer Imaging Research, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Raj Kumar Sharma
- Division of Cancer Imaging Research, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Balaji Krishnamachary
- Division of Cancer Imaging Research, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yelena Mironchik
- Division of Cancer Imaging Research, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Marie-France Penet
- Division of Cancer Imaging Research, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael G Goggins
- Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anirban Maitra
- Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,MD Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | - Ihab Kamel
- Division of Cancer Imaging Research, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Karen M Horton
- Division of Cancer Imaging Research, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael A Jacobs
- Division of Cancer Imaging Research, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Zaver M Bhujwalla
- Division of Cancer Imaging Research, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Systematic review of cognitive sequelae of non-central nervous system cancer and cancer therapy. J Cancer Surviv 2020; 14:464-482. [PMID: 32146576 DOI: 10.1007/s11764-020-00870-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 02/22/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The aim of this review is to provide an updated overview of chemotherapy-related cognitive impairment (CRCI) in patients with cancer outside central nervous system (CNS), its incidence and prevalence, the cognitive pattern in neuropsychological studies, neuroimaging findings, and the relationship between chemobrain and aging. Methodological limitations of studies are also discussed. METHODS This review was guided by the PRISMA statement. The MEDLINE and Scopus databases were employed to search articles about CRCI in non-CNS cancer patients published from January 2004 to September 2019. Two types of research were reviewed: prospective studies addressing the effects of chemotherapy on cognition and systematic reviews about factors related with CRCI, also as neuroimaging findings and current available treatments. RESULTS Fifty-nine studies meeting the criteria were analyzed: 47 were longitudinal studies on cancer and cognition and 12 were reviews on risk factors, neuroimaging, and treatment. The majority of studies find cognitive impairment in patients with cancer treated with chemotherapy. The body of the literature on breast cancer is the most abundant, but there are also studies on colorectal, testicular, and lung cancer. Neuroimaging studies show changes in structure and activation in patients undergoing chemotherapy. Non-pharmacological treatment is effective for improving cognition and quality of life. CONCLUSIONS The occurrence of CRCI during the course of treatment in people with different types of cancer is frequent. Some risk factors have been identified, but CRCI is a complex phenomenon, with mediating factors related to cancer and treatment and moderating factors related with lifestyle and health. IMPLICATIONS FOR CANCER SURVIVORS This review highlights the importance of recognizing that this cognitive dysfunction is frequent, mild to moderate in nature but with great impact on quality of life.
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Dalton SO, Johansen C. European cancer rehabilitation and survivorship, 2018: one of a kind. Acta Oncol 2019; 58:519-521. [PMID: 31035842 DOI: 10.1080/0284186x.2019.1606937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Susanne Oksbjerg Dalton
- Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Naestved, Denmark
| | - Christoffer Johansen
- Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark
- Danish Cancer Society Research Center, Unit of Survivorship Research, Copenhagen, Denmark
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