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Kesler SR, Henneghan AM, Prinsloo S, Palesh O, Wintermark M. Neuroimaging based biotypes for precision diagnosis and prognosis in cancer-related cognitive impairment. Front Med (Lausanne) 2023; 10:1199605. [PMID: 37720513 PMCID: PMC10499624 DOI: 10.3389/fmed.2023.1199605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 08/15/2023] [Indexed: 09/19/2023] Open
Abstract
Cancer related cognitive impairment (CRCI) is commonly associated with cancer and its treatments, yet the present binary diagnostic approach fails to capture the full spectrum of this syndrome. Cognitive function is highly complex and exists on a continuum that is poorly characterized by dichotomous categories. Advanced statistical methodologies applied to symptom assessments have demonstrated that there are multiple subclasses of CRCI. However, studies suggest that relying on symptom assessments alone may fail to account for significant differences in the neural mechanisms that underlie a specific cognitive phenotype. Treatment plans that address the specific physiologic mechanisms involved in an individual patient's condition is the heart of precision medicine. In this narrative review, we discuss how biotyping, a precision medicine framework being utilized in other mental disorders, could be applied to CRCI. Specifically, we discuss how neuroimaging can be used to determine biotypes of CRCI, which allow for increased precision in prediction and diagnosis of CRCI via biologic mechanistic data. Biotypes may also provide more precise clinical endpoints for intervention trials. Biotyping could be made more feasible with proxy imaging technologies or liquid biomarkers. Large cross-sectional phenotyping studies are needed in addition to evaluation of longitudinal trajectories, and data sharing/pooling is highly feasible with currently available digital infrastructures.
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Affiliation(s)
- Shelli R. Kesler
- Division of Adult Health, School of Nursing, The University of Texas at Austin, Austin, TX, United States
- Department of Diagnostic Medicine, Dell School of Medicine, The University of Texas at Austin, Austin, TX, United States
- Department of Oncology, Dell School of Medicine, The University of Texas at Austin, Austin, TX, United States
| | - Ashley M. Henneghan
- Division of Adult Health, School of Nursing, The University of Texas at Austin, Austin, TX, United States
- Department of Oncology, Dell School of Medicine, The University of Texas at Austin, Austin, TX, United States
| | - Sarah Prinsloo
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Oxana Palesh
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, United States
| | - Max Wintermark
- Department of Neuroradiology, The University of Texas MD Anderson Cancer, Houston, TX, United States
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Guran E, Hu J, Wefel JS, Chung C, Cata JP. Perioperative considerations in patients with chemotherapy-induced cognitive impairment: a narrative review. Br J Anaesth 2022; 129:909-922. [PMID: 36270848 DOI: 10.1016/j.bja.2022.08.037] [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: 05/08/2022] [Revised: 08/01/2022] [Accepted: 08/23/2022] [Indexed: 11/02/2022] Open
Abstract
Patients with cancer may suffer from a decline in their cognitive function after various cancer therapies, including surgery, radiation, and chemotherapy, and in some cases, this decline in cognitive function persists even years after completion of treatment. Chemobrain or chemotherapy-induced cognitive impairment, a well-established clinical syndrome, has become an increasing concern as the number of successfully treated cancer patients has increased significantly. Chemotherapy-induced cognitive impairment can originate from direct neurotoxicity, neuroinflammation, and oxidative stress, resulting in alterations in grey matter volume, white matter integrity, and brain connectivity. Surgery has been associated with exacerbating the inflammatory response associated with chemotherapy and predisposes patients to develop postoperative cognitive dysfunction. As the proportion of patients living longer after these therapies increases, the magnitude of impact and growing concern of post-treatment cognitive dysfunction in these patients has also come to the fore. We review the clinical presentation, potential mechanisms, predisposing factors, diagnostic methods, neuropsychological testing, and imaging findings of chemotherapy-induced cognitive impairment and its intersection with postoperative cognitive dysfunction.
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Affiliation(s)
- Ekin Guran
- Department of Anaesthesiology and Reanimation, University of Health Sciences, Ankara Oncology Training and Research Hospital, Ankara, Turkey; Anaesthesiology and Surgical Oncology Research Group, Houston, TX, USA
| | - Jian Hu
- Department of Cancer Biology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey S Wefel
- Department of Neuro-Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Caroline Chung
- Department of Neuro-Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Juan P Cata
- Anaesthesiology and Surgical Oncology Research Group, Houston, TX, USA; Department of Anaesthesiology and Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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3
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Lu Y, Luo X, Yang D, Li Y, Gong T, Li B, Cheng J, Chen R, Guo X, Yuan W. Effects of probiotic supplementation on related side effects after chemoradiotherapy in cancer patients. Front Oncol 2022; 12:1032145. [PMID: 36387216 PMCID: PMC9650500 DOI: 10.3389/fonc.2022.1032145] [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: 08/30/2022] [Accepted: 10/11/2022] [Indexed: 02/11/2024] Open
Abstract
OBJECTIVES Chemotherapy and radiotherapy generally cause serious adverse side effects in cancer patients, thereby affecting subsequent treatment. Numerous studies have shown that taking probiotics is an option for preventing and treating these side effects. In this investigation, a meta-analysis of the effects of oral probiotics on side effects brought on by radiotherapy, chemotherapy, or chemoradiotherapy treatment will be carried out. METHODS Two researchers independently and carefully reviewed all pertinent studies that were published before June 30, 2022 and were accessible on PubMed, Embase, Cochrane Library, and the Web of Science. Moreover, the Cochrane Collaboration's Tool was used to evaluate the risk of bias. Utilizing Review Manager software version 5.4, data were retrieved from eligible studies to evaluate their merits and determine odds ratios (OR) and 95% confidence intervals (CIs) (RevMan 5.4). RESULTS 2 097 patients from 16 randomized controlled trials were extracted, and standard meta-analysis methods were used to examine the data. Compared with the placebo groups, oral probiotics significantly reduced the side effects caused by radiotherapy and chemotherapy on various types of cancer, such as head and neck cancer, pelvic and abdominal cancer, breast cancer, lung cancer, etc. (OR: 0.31, 95% CI: 0.20 - 0.48; P < 0.005). Further analysis found that the incidence of diarrhea in patients with pelvic and abdominal cancers (OR: 0.32, 95% CI: 0.16 - 0.65; P < 0.005) and the frequency of oral mucositis in patients with head and neck tumors were also significantly lower (OR: 0.28, 95% CI: 0.18 - 0.43; P < 0.005) after the oral administration of probiotics. This suggests that probiotics have a positive influence on the treatment of side effects after chemoradiotherapy. Additionally, a funnel plot revealed that there was no significant publication bias in this study. CONCLUSIONS Probiotics may help to reduce the occurrence of cancer therapy-related side effects, especially oral mucositis in head and neck tumors and diarrhea in patients with pelvic and abdominal tumors. However, given the small number of clinical trials involved, additional randomized, double-blind, multicentric trials in a larger population are required. This paper may assist researchers in improving trial design in the selection of probiotic strains and selecting appropriate patients who may benefit from probiotic treatments.
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Affiliation(s)
- Yongkai Lu
- Department of Radiation Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
- Department of Nutrition and Food Safety, School of Public Health, Xi’an Jiaotong University, Xi’an, China
| | - Xiaoqin Luo
- Department of Nutrition and Food Safety, School of Public Health, Xi’an Jiaotong University, Xi’an, China
| | - Di Yang
- Department of Radiation Oncology, Shaanxi Provincial Tumor Hospital, Affiliated Hospital of Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Yi Li
- Department of Radiation Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Tuotuo Gong
- Department of Radiation Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Binglin Li
- Department of Obstetrics and Gynecology, Xi'an Central Hospital, The Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Jian Cheng
- Department of Obstetrics and Gynecology, Xi'an Central Hospital, The Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Ruijuan Chen
- Department of Radiation Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
- Department of Obstetrics and Gynecology, Xi'an Central Hospital, The Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Xin Guo
- Department of Neurology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Wei Yuan
- Department of Radiation Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
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[Chemotherapy-induced cognitive impairment in breast cancer patients-risk factors and therapy]. Strahlenther Onkol 2022; 198:667-669. [PMID: 35482033 DOI: 10.1007/s00066-022-01933-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2022] [Indexed: 11/27/2022]
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Hammers DB, Kostadinova R, Unverzagt FW, Apostolova LG. Assessing and validating reliable change across ADNI protocols. J Clin Exp Neuropsychol 2022; 44:85-102. [PMID: 35786312 PMCID: PMC9308719 DOI: 10.1080/13803395.2022.2082386] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 05/23/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Reliable change methods can aid in determining whether changes in cognitive performance over time are meaningful. The current study sought to develop and cross-validate 12-month standardized regression-based (SRB) equations for the neuropsychological measures commonly administered in the Alzheimer's Disease Neuroimaging Initiative (ADNI) longitudinal study. METHOD Prediction algorithms were developed using baseline score, retest interval, the presence/absence of a 6-month evaluation, age, education, sex, and ethnicity in two different samples (n = 192 each) of robustly cognitively intact community-dwelling older adults from ADNI - matched for demographic and testing factors. The developed formulae for each sample were then applied to one of the samples to determine goodness-of-fit and appropriateness of combining samples for a single set of SRB equations. RESULTS Minimal differences were seen between Observed 12-month and Predicted 12-month scores on most neuropsychological tests from ADNI, and when compared across samples the resultant Predicted 12-month scores were highly correlated. As a result, samples were combined and SRB prediction equations were successfully developed for each of the measures. CONCLUSIONS Establishing cross-validation for these SRB prediction equations provides initial support of their use to detect meaningful change in the ADNI sample, and provides the basis for future research with clinical samples to evaluate potential clinical utility. While some caution should be considered for measuring true cognitive change over time - particularly in clinical samples - when using these prediction equations given the relatively lower coefficients of stability observed, use of these SRBs reflects an improvement over current practice in ADNI.
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Affiliation(s)
- Dustin B. Hammers
- Indiana University School of Medicine, Department of Neurology, Indianapolis, IN, USA
| | - Ralitsa Kostadinova
- Indiana University School of Medicine, Department of Neurology, Indianapolis, IN, USA
| | | | - Liana G. Apostolova
- Indiana University School of Medicine, Department of Neurology, Indianapolis, IN, USA
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Juan Z, Chen J, Ding B, Yongping L, Liu K, Wang L, Le Y, Liao Q, Shi J, Huang J, Wu Y, Ma D, Ouyang W, Tong J. Probiotic supplement attenuates chemotherapy-related cognitive impairment in patients with breast cancer: a randomised, double-blind, and placebo-controlled trial. Eur J Cancer 2021; 161:10-22. [PMID: 34896904 DOI: 10.1016/j.ejca.2021.11.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 11/03/2021] [Accepted: 11/08/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Chemotherapy-related cognitive impairment (CRCI) is highly prevalent in patients with cancer and is associated with poor outcomes and quality of life. To date, the management of CRCI remains a clinical challenge. Herein, we aim to determine the preventive effects of probiotics on CRCI development and underlying mechanisms. METHODS We conducted a randomised, double-blind and placebo-controlled trial (ChiCTR-INQ-17014181) of 159 patients with breast cancer and further investigated the underlying mechanism in a pre-clinical setting. From 2018 to 2019, patients with breast cancer (Stage I-III) who needed adjuvant chemotherapy were screened, enrolled and randomly assigned to receive either probiotics or placebo (three capsules, twice/day) during chemotherapy. Their cognition, anxiety and depression were assessed with well-established assays; their plasma biomarkers, metabolites and faecal microbiota compositions were measured. In addition, the systemic effects of the metabolites found in the clinical trial on long-term potentiation, synapse injury, oxidative stress and glial activation were assessed in rats. RESULTS Probiotics supplement significantly decreased the incidence of CRCI, improved the allover cognitive functions, changed the gut microbial composition and modulated nine plasma metabolite changes. Among these metabolites, p-Mentha-1,8-dien-7-ol, Linoelaidyl carnitine and 1-aminocyclopropane-1-carboxylic acid were negatively correlated with the occurrence of CRCI. Furthermore, probiotics supplement increased plasma p-Mentha-1,8-dien-7-ol in rats. Administration of exogenous p-Mentha-1,8-dien-7-ol significantly alleviated chemotherapy-induced long-term potentiation impairment, synapse injury, oxidative stress and glial activation in the hippocampus of rats. CONCLUSION Our data indicated that probiotics supplement prevents the occurrence of CRCI in patients with breast cancer via modulating plasma metabolites, including p-Mentha-1,8-dien-7-ol. TRIAL REGISTRATION Chinese Clinical Trial Registry (ChiCTR-INQ-17014181) [http://www.chictr.org.cn/showproj.aspx?proj=24294].
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Affiliation(s)
- Zhang Juan
- Department of Anesthesiology, Third Xiangya Hospital, Central South University, Changsha, Hunan, 410013, PR China; Hunan Province Key Laboratory of Brain Homeostasis, Third Xiangya Hospital, Central South University, Changsha, Hunan, 410013, PR China
| | - Jie Chen
- Center for Experimental Medicine, Third Xiangya Hospital, Central South University, Changsha, Hunan, 410013, PR China; Department of Anatomy and Neurobiology, School of Basic Medical Sciences, Central South University, Changsha, Hunan, 410013, PR China
| | - Boni Ding
- Department of Breast and Thyroid Surgery, Third Xiangya Hospital, Central South University, Changsha, Hunan, 410013, PR China
| | - Liang Yongping
- Department of Medical Imaging (Ultrasound), Third Xiangya Hospital, Central South University, Changsha, Hunan, 410013, PR China
| | - Kai Liu
- Department of Anesthesiology, Third Xiangya Hospital, Central South University, Changsha, Hunan, 410013, PR China; Hunan Province Key Laboratory of Brain Homeostasis, Third Xiangya Hospital, Central South University, Changsha, Hunan, 410013, PR China
| | - Ling Wang
- Department of Breast and Thyroid Surgery, Third Xiangya Hospital, Central South University, Changsha, Hunan, 410013, PR China
| | - Yuan Le
- Department of Anesthesiology, Third Xiangya Hospital, Central South University, Changsha, Hunan, 410013, PR China; Hunan Province Key Laboratory of Brain Homeostasis, Third Xiangya Hospital, Central South University, Changsha, Hunan, 410013, PR China
| | - Qin Liao
- Department of Anesthesiology, Third Xiangya Hospital, Central South University, Changsha, Hunan, 410013, PR China; Hunan Province Key Laboratory of Brain Homeostasis, Third Xiangya Hospital, Central South University, Changsha, Hunan, 410013, PR China
| | - Jingcheng Shi
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, 410078, PR China
| | - Jufang Huang
- Department of Anatomy and Neurobiology, School of Basic Medical Sciences, Central South University, Changsha, Hunan, 410013, PR China
| | - Yuhui Wu
- Department of Breast Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, PR China
| | - Daqing Ma
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, UK
| | - Wen Ouyang
- Department of Anesthesiology, Third Xiangya Hospital, Central South University, Changsha, Hunan, 410013, PR China; Hunan Province Key Laboratory of Brain Homeostasis, Third Xiangya Hospital, Central South University, Changsha, Hunan, 410013, PR China.
| | - Jianbin Tong
- Department of Anesthesiology, Third Xiangya Hospital, Central South University, Changsha, Hunan, 410013, PR China; Hunan Province Key Laboratory of Brain Homeostasis, Third Xiangya Hospital, Central South University, Changsha, Hunan, 410013, PR China.
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Lambert M, Wurz A, Smith AM, Fang Z, Brunet J. Preliminary Evidence of Improvement in Adolescent and Young Adult Cancer Survivors' Brain Health Following Physical Activity: A Proof-of-Concept Sub-Study. Brain Plast 2021; 7:97-109. [PMID: 34868876 PMCID: PMC8609486 DOI: 10.3233/bpl-210124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Cognitive impairment is common among adolescent and young adult (AYA) cancer survivors. Physical activity (PA) may help mitigate cognitive impairment post-treatment by positively impacting two indicators of general brain health: fractional anisotropy (FA) and functional connectivity (FC). As part of a two-arm, mixed-methods pilot randomized controlled trial (RCT), this sub-study was designed to provide preliminary proof-of-concept evidence for the effects of PA on FA and FC among AYA cancer survivors post-treatment to help inform decisions about proceeding to larger trials. Methods: AYA cancer survivors who had completed cancer treatment and who were enrolled in a larger pilot RCT comparing a 12-week PA intervention to a waitlist control group, were invited to participate in this sub-study. Sub-study participants completed diffusion tensor imaging and resting-state functional magnetic resonance imaging prior to randomization and post-intervention. Data were analyzed with descriptive statistics, independent component analysis, and paired sample t-tests. Results: Post-intervention, participants showed increases in FA of the bilateral hippocampal cingulum, left anterior corona radiata, middle cingulum, left anterior thalamic radiation, and left cerebellum. A decrease in overall FC of the default mode network and increases in the cerebellar and visual networks were also noted post-intervention (p < .05). Conclusion: Results provide preliminary evidence for the possible positive effects of PA on FA and FC among AYA cancer survivors post-treatment. On the basis of these results, larger trials assessing the effects of PA on specific brain health indicators, as captured by FA and FC, among AYA cancer survivors are appropriate and warranted.
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Affiliation(s)
- Maude Lambert
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Amanda Wurz
- School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | - Andra M Smith
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Zhuo Fang
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Jennifer Brunet
- School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada.,Cancer Therapeutic Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Institut du savoir Montfort, Hôpital Montfort, Ottawa, Ontario, Canada
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Buskbjerg CR, Amidi A, Agerbaek M, Gravholt CH, Hosseini SMH, Zachariae R. Cognitive changes and brain connectomes, endocrine status, and risk genotypes in testicular cancer patients-A prospective controlled study. Cancer Med 2021; 10:6249-6260. [PMID: 34390226 PMCID: PMC8446403 DOI: 10.1002/cam4.4165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/12/2021] [Accepted: 07/15/2021] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE Previous research has indicated cognitive decline (CD) among testicular cancer patients (TCPs), even in the absence of chemotherapy, but little is known about the underlying pathophysiology. The present study assessed changes in cognitive functions and structural brain connectomes in TCPs and explored the associations between cognitive changes and endocrine status and hypothesized risk genotypes. METHODS Thirty-eight newly orchiectomized TCPs and 21 healthy controls (HCs) comparable to TCPs in terms of age and years of education underwent neuropsychological testing, structural MRI, and a biological assessment at baseline and 6 months later. Cognitive change was assessed with a neuropsychological test battery and determined using a standardized regression-based approach, with substantial change defined as z-scores ≤-1.64 or ≥1.64. MRI scans and graph theory were used to evaluate changes in structural brain connectomes. The associations of cognitive changes with testosterone levels, androgen receptor gene (AR) CAG repeat length, and genotypes (APOE, COMT, and BDNF) were explored. RESULTS Compared with HCs, TCPs showed higher rates of substantial decline on processing speed and visuospatial ability and higher rates of substantial improvement on verbal recall and visuospatial learning (p < 0.05; OR = 8.15-15.84). Brain network analysis indicated bilateral thalamic changes in node degree in HCs, but not in TCPs (p < 0.01). In TCPs, higher baseline testosterone levels predicted decline in verbal memory (p < 0.05). No effects were found for AR CAG repeat length, APOE, COMT, or BDNF. CONCLUSIONS The present study confirms previous findings of domain-specific CD in TCPs following orchiectomy, but also points to domain-specific improvements. The results do not indicate changes in brain connectomes or endocrine status to be the main drivers of CD. Further studies evaluating the mechanisms underlying CD in TCPs, including the possible role of the dynamics of the hypothalamic-pituitary-gonadal axis, are warranted.
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Affiliation(s)
- Cecilie R. Buskbjerg
- Unit for Psychooncology and Health PsychologyDepartment of Psychology and Behavioral SciencesAarhus UniversityAarhusDenmark
| | - Ali Amidi
- Unit for Psychooncology and Health PsychologyDepartment of Psychology and Behavioral SciencesAarhus UniversityAarhusDenmark
| | - Mads Agerbaek
- Department of OncologyAarhus University HospitalAarhusDenmark
| | - Claus H. Gravholt
- Department of EndocrinologyAarhus University HospitalAarhusDenmark
- Department of Molecular MedicineAarhus University HospitalAarhusDenmark
| | - SM Hadi Hosseini
- Department of Psychiatry and Behavioral SciencesSchool of MedicineStanford UniversityStanfordCaliforniaUSA
| | - Robert Zachariae
- Unit for Psychooncology and Health PsychologyDepartment of Psychology and Behavioral SciencesAarhus UniversityAarhusDenmark
- Department of OncologyAarhus University HospitalAarhusDenmark
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Janelsins MC, Mohamed M, Peppone LJ, Magnuson A, Belcher EK, Melnik M, Dakhil S, Geer J, Kamen C, Minasian L, Reagan PM, Mohile SG, Morrow GR, Ahles TA, Heckler CE. Longitudinal Changes in Cognitive Function in a Nationwide Cohort Study of Patients With Lymphoma Treated With Chemotherapy. J Natl Cancer Inst 2021; 114:47-59. [PMID: 34255086 PMCID: PMC8755506 DOI: 10.1093/jnci/djab133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 04/29/2021] [Accepted: 07/12/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Cancer-related cognitive decline (CRCD) is an important clinical problem, but limited research exists on assessment of cognitive function in patients with lymphoma. METHODS The overall objective of this nationwide, prospective, observational study conducted in the National Cancer Institute Community Clinical Oncology Research Program (NCORP) was to assess changes in memory, attention, and executive function in patients with lymphoma from pre- (A1) to postchemotherapy (A2) and to 6 months postchemotherapy (A3). Individuals without cancer served as noncancer controls, paired to patients by age and sex, and assessed at the same time-equivalent points. Longitudinal linear mixed models (LMM) including A1, A2, and A3 and adjusting for age, education, race, sex, cognitive reserve score, baseline anxiety, and depressive symptoms were fit. We assessed changes in patients compared with control participants without cancer and assessed differences in cognitive function in those patients with Hodgkin vs non-Hodgkin disease and by disease subtype. All statistical tests were 2-sided. RESULTS Patients with lymphoma (n = 248) and participants without cancer serving as controls (n = 212) were recruited from 19 NCORP sites. From pre- to postchemotherapy and from prechemotherapy to 6 months follow-up, patients reported more cognitive problems over time compared with controls (Functional Assessment of Cancer-Therapy-Cognitive Function [FACT-Cog] perceived cognitive impairment effect size (ES) = 0.83 and 0.84 for A1 to A2 and A1 to A3, respectively; P < .001; single-item cognitive symptoms ES range = 0.55 to 0.70 inclusive of A1 to A2 and A1 to A3; P < .001); the complaints were more pronounced in women with lymphoma compared with men with lymphoma (FACT-Cog Perceived Cognitive Impairment (PCI) score group-by-time-by-sex interaction, P = .007). Patients with lymphoma also performed statistically significantly less well on tests of verbal memory and delayed recall, attention and executive function, and telephone-based category fluency. CONCLUSION Patients with lymphoma experience worse patient-reported and objectively assessed cognitive function from prechemotherapy to 6-month follow-up compared with age- and sex-paired controls without cancer assessed at similar time intervals.
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Affiliation(s)
- Michelle C Janelsins
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY, USA,Correspondence to: Michelle C. Janelsins, PhD, MPH, University of Rochester Medical Center, James P. Wilmot Cancer Institute, Associate Professor, Department of Surgery, Division of Supportive Care in Cancer, Associate Professor of Neuroscience, Oncology and Radiation Oncology, 265 Crittenden Blvd, CU 420658, Rochester, NY 14642, USA (e-mail: )
| | - Mostafa Mohamed
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY, USA
| | - Luke J Peppone
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY, USA
| | - Allison Magnuson
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY, USA
| | - Elizabeth K Belcher
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY, USA
| | - Marianne Melnik
- Cancer Research Consortium of West Michigan NCI Community Oncology Research Program, Grand Rapids, MI, USA
| | - Shaker Dakhil
- Wichita NCI Community Oncology Research Program, Wichita, KS, USA
| | - Jodi Geer
- Metro Minnesota Community Oncology Research Program, Saint Louis Park, MN, USA
| | - Charles Kamen
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY, USA
| | | | - Patrick M Reagan
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY, USA
| | - Supriya G Mohile
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY, USA
| | - Gary R Morrow
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY, USA
| | - Tim A Ahles
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Charles E Heckler
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY, USA
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Buskbjerg CR, Amidi A, Buus S, Gravholt CH, Hadi Hosseini SM, Zachariae R. Androgen deprivation therapy and cognitive decline-associations with brain connectomes, endocrine status, and risk genotypes. Prostate Cancer Prostatic Dis 2021; 25:208-218. [PMID: 34088994 DOI: 10.1038/s41391-021-00398-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/30/2021] [Accepted: 05/19/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Evidence suggests that prostate cancer (PC) patients undergoing androgen deprivation therapy (ADT) are at risk for cognitive decline (CD), but the underlying mechanisms are less clear. In the present study, changes in cognitive performance and structural brain connectomes in PC patients undergoing ADT were assessed, and associations of cognitive changes with endocrine status and risk genotypes were explored. METHODS Thirty-seven PC patients underwent cognitive assessment, structural MRI, and provided blood samples prior to ADT and after 6 months of treatment. Twenty-seven age- and education-matched healthy controls (HCs) underwent the same assessments. CD was determined using a standardized regression-based approach and defined as z-scores ≤ -1.64. Changes in brain connectomes were evaluated using graph theory. Associations of CD with testosterone levels and genotypes (APOE, COMT, BDNF) were explored. RESULTS Compared with HCs, PC patients demonstrated reduced testosterone levels (p < 0.01) and higher rates of decline for 13 out of 15 cognitive outcomes, with three outcomes related to two cognitive domains, i.e., verbal memory and visuospatial learning and memory, reaching statistical significance (p ≤ 0.01-0.04). Testosterone level changes did not predict CD. COMT Met homozygote PC patients evidenced larger reductions in visuospatial memory compared with Val carriers (p = 0.02). No between-group differences were observed in brain connectomes across time, and no effects were found of APOE and BDNF. CONCLUSIONS Our results indicate that PC patients undergoing ADT may evidence CD, and that COMT Met homozygotes may be at increased risk of CD. The results did not reveal changes in brain connectomes or testosterone levels as underlying mechanisms. More research evaluating the role of ADT-related disruption of the dynamics of the hypothalamic-pituitary-gonadal axis is needed.
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Affiliation(s)
- Cecilie R Buskbjerg
- Unit for Psychooncology and Health Psychology, Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark.
| | - Ali Amidi
- Unit for Psychooncology and Health Psychology, Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
| | - Simon Buus
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Claus H Gravholt
- Department of Endocrinology, Aarhus University Hospital, Aarhus, Denmark.,Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - S M Hadi Hosseini
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, CA, USA
| | - Robert Zachariae
- Unit for Psychooncology and Health Psychology, Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark.,Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
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11
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Cancer-related cognitive impairment (CRCI), depression and quality of life in gynecological cancer patients: a prospective study. Arch Gynecol Obstet 2021; 303:1581-1588. [PMID: 33404703 DOI: 10.1007/s00404-020-05896-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 11/10/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE Cancer-related cognitive impairment (CRCI) has been reported in non-central nervous system neoplasms survivors. The purpose of this study was to evaluate the perception of cognitive decrement in patients undergoing surgical and / or medical therapy for gynecological cancers. METHODS All women diagnosed with primary gynecological cancer and undergoing active medical treatment have been enrolled in a prospective study. Before starting treatment (T1) and 6 months after the end of treatment (T2), patients were interviewed to evaluate the effects of cancer treatment on perceived cognitive function (using FACT-Cog -version 3), on depression (using Beck Depression Inventory-II test) and on quality of life (using EORTC-QLQC-30). Age, education level, marital status, lifestyle, menopausal state at diagnosis, cancer type, cancer FIGO stage, treatment modality was also recorded. The differences between baseline and post-treatment results have been evaluated with Student's t test. The results have been stratified by the menopausal state at diagnosis, type of tumor (endometrial, cervical, ovarian, vulvar) disease stage and type of treatment (chemotherapy or radiotherapy). RESULTS Seventy-three patients were included. A significant reduction in perceived cognitive impairments was demonstrated at T2 (CogPCI: 61.35 ± 13.83 vs 55.05 ± 16.56; p < 0.05). On the contrary, a significant improvement was shown in depression state (BDII: 21.14 ± 11.23 vs 12.82 ± 12.33, p < 0.005). The menopausal state at surgery, tumor site, stage and treatment modality seem to influence the variables analyzed. CONCLUSION CRCI is a true risk also in gynecological cancer survivors. The cognitive impairment does not seem to be dependent on depression state after treatment or to a menopausal condition. Assessing cognitive decline in cancer survivorship is essential for ensuring the optimum quality of life and functioning.
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12
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Bai L, Yu E. A narrative review of risk factors and interventions for cancer-related cognitive impairment. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:72. [PMID: 33553365 PMCID: PMC7859819 DOI: 10.21037/atm-20-6443] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Cancer-related cognitive impairment (CRCI) refers to a series of cognitive impairment symptoms associated with alternations in brain structure and function, caused by a non-central nervous system malignant tumor and its related treatment. CRCI may present as memory loss, impaired concentration, difficulty in multitasking and word retrieval, and reduced comprehension speed. CRCI has become one of the prevalent factors that compromise the quality of life for cancer survivors. Different treatments, including surgery, chemotherapy, radiotherapy, endocrine therapy, and targeted drugs, may contribute to CRCI. Meanwhile, patients’ factors, including emotional challenges and genetic makeup, also contribute to the development of CRCI. The condition can be treated with using stimulants methylphenidate and modafinil, metabolites of nicotine: cotinine, antidepressants of fluoxetine and fluvoxamine, dementia drug of donepezil, and antioxidants ZnSO4, n-acetyl cysteine, propofol, and Chinese herbal of silver leaf medicine. Psychotherapies, including meditation and relaxation, cognitive rehabilitation training, along with physical therapies, including aerobic exercise, resistance training, balance training, yoga, qigong, tai chi electroencephalogram biofeedback, and acupuncture, are also beneficial in alleviating cancer-related cognitive impairment symptoms. In recent years, researchers have focused on factors related to the condition and on the available interventions. However, most research was conducted independently, and no review has yet summarized the latest findings. This review details and discusses the status of related factors and potential treatments for CRCI. We also supply specific recommendations to facilitate future research and integration in this field.
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Affiliation(s)
- Lu Bai
- Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China.,Institute of Cancer and Basic Medicine, Chinese Academy of Sciences, Beijing, China
| | - Enyan Yu
- Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China.,Institute of Cancer and Basic Medicine, Chinese Academy of Sciences, Beijing, China
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13
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Abstract
Impaired neurocognitive function is an increasingly recognized morbidity in patients who have cancer. Cancer treatments, psychosocial stressors, and the malignancy itself can alter brain function. The mechanisms by which this occurs are under active investigation. Although there is a growing appreciation of its prevalence and causes, there remain limited therapeutic options for the treatment of neurocognitive dysfunction in this population. A persistent scientific and clinical effort to understand its mechanisms and impact is critical to the care of oncology patients.
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Affiliation(s)
- Rebecca A Harrison
- Department of Neuro-Oncology, The University of Texas M.D. Anderson Cancer Center, 1400 Holcombe Boulevard, Unit 0431, Houston, TX 77030, USA.
| | - Jeffrey S Wefel
- Section of Neuropsychology, Department of Neuro-Oncology, The University of Texas M.D. Anderson Cancer Center, 1400 Holcombe Boulevard, Unit 0431, Houston, TX 77030, USA
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14
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Jones RM, Pattwell SS. Future considerations for pediatric cancer survivorship: Translational perspectives from developmental neuroscience. Dev Cogn Neurosci 2019; 38:100657. [PMID: 31158802 PMCID: PMC6697051 DOI: 10.1016/j.dcn.2019.100657] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 04/26/2019] [Accepted: 05/06/2019] [Indexed: 02/06/2023] Open
Abstract
Breakthroughs in modern medicine have increased pediatric cancer survival rates throughout the last several decades. Despite enhanced cure rates, a subset of pediatric cancer survivors exhibit life-long psychological side effects. A large body of work has addressed potential mechanisms for secondary symptoms of anxiety, post-traumatic stress, impaired emotion regulation and cognitive deficits in adults. Yet, absent from many studies are the ways in which cancer treatment can impact the developing brain. Additionally, it remains less known whether typical neurobiological changes during adolescence and early adulthood may potentially buffer or exacerbate some of the known negative cancer survivorship outcomes. This review highlights genetic, animal, and human neuroimaging research across development. We focus on the neural circuitry associated with aversive learning, which matures throughout childhood, adolescence and early adulthood. We argue that along with other individual differences, the precise timing of oncological treatment insults on such neural circuitry may expose particular vulnerabilities for pediatric cancer patients. We also explore other moderators of treatment outcomes, including genetic polymorphisms and neural mechanisms underlying memory and cognitive control. We discuss how neural maturation extending into young adulthood may also provide a sensitive period for intervention to improve psychological and cognitive outcomes in pediatric cancer survivors.
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Affiliation(s)
- Rebecca M Jones
- The Sackler Institute for Developmental Psychobiology, Department of Psychiatry, Weill Cornell Medicine, New York, NY 10065, United States
| | - Siobhan S Pattwell
- Human Biology Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, Mailstop C3-168, Seattle, WA 98109, United States.
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15
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Durant J, Duff K, Miller JB. Regression-based formulas for predicting change in memory test scores in healthy older adults: Comparing use of raw versus standardized scores. J Clin Exp Neuropsychol 2019; 41:460-468. [PMID: 30720394 DOI: 10.1080/13803395.2019.1571169] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Standardized regression based (SRB) methods can be used to determine whether meaningful changes in performance on cognitive assessments occur over time. Both raw and standardized scores have been used in SRB models but it is unclear which score metric is most appropriate for predicting follow-up performance. The aim of the present study was to examine differences in SRB prediction formulas using raw versus standard scores on two memory tests commonly used in assessment of older adults. METHOD The sample consisted of 135 healthy older adults who underwent baseline and 1-year follow-up neuropsychological assessment including the Hopkins Verbal Learning Test-Revised and Brief Visuospatial Memory Test-Revised. Regression models were fit to predict Time 2 scores from Time 1 scores and demographic variables. Separate models were fit using raw scores and standardized scores. Akaike's information criterion (AIC) was used to determine whether models using raw or standardized scores resulted in best fit. Pearson correlation and intraclass correlation coefficients were calculated between observed and predicted scores. Mean differences between observed and predicted scores were examined using pairwise t tests. To investigate whether a similar pattern of results would be evident using prediction formulas for nonmemory tests, all analyses were also conducted for nonmemory tests. RESULTS All regression models were significant, and R2 values for memory test raw score models were larger than those generated by standardized score models. Memory test raw score models were also a better fit based on smaller AIC values. For nonmemory tests, raw score models did not consistently outperform standardized score models. All correlations between observed and predicted Time 2 scores were significant, and none of the predicted scores significantly differed from their respective observed score. CONCLUSION For each memory measure, raw score models outperformed standardized score models. For nonmemory tests, neither score metric model consistently outperformed the other.
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Affiliation(s)
- January Durant
- a Neuropsychology , Cleveland Clinic Lou Ruvo Center for Brain Health , Las Vegas , NV , USA
| | - Kevin Duff
- b Department of Neurology , Center for Alzheimer's Care, Imaging, and Research University of Utah , Salt Lake City , UT , USA
| | - Justin B Miller
- a Neuropsychology , Cleveland Clinic Lou Ruvo Center for Brain Health , Las Vegas , NV , USA
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16
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Janelsins MC, Heckler CE, Peppone LJ, Ahles TA, Mohile SG, Mustian KM, Palesh O, O’Mara AM, Minasian LM, Williams AM, Magnuson A, Geer J, Dakhil SR, Hopkins JO, Morrow GR. Longitudinal Trajectory and Characterization of Cancer-Related Cognitive Impairment in a Nationwide Cohort Study. J Clin Oncol 2018; 36:JCO2018786624. [PMID: 30240328 PMCID: PMC6225503 DOI: 10.1200/jco.2018.78.6624] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Cancer-related cognitive impairment (CRCI) is an important clinical problem in patients with breast cancer receiving chemotherapy. Nationwide longitudinal studies are needed to understand the trajectory and severity of CRCI in specific cognitive domains. PATIENTS AND METHODS The overall objective of this nationwide, prospective, observational study conducted within the National Cancer Institute Community Clinical Oncology Research Program was to assess trajectories in specific cognitive domains in patients with breast cancer (stage I-IIIC) receiving chemotherapy, from pre- (A1) to postchemotherapy (A2) and from prechemotherapy to 6 months postchemotherapy (A3); controls were assessed at the same time-equivalent points. The primary aim assessed visual memory using the Cambridge Neuropsychological Test Automated Battery Delayed Match to Sample test by longitudinal mixed models including A1, A2, and A3 and adjusting for age, education, race, cognitive reserve score, and baseline anxiety and depressive symptoms. We also assessed trajectories of CRCI in other aspects of memory as well as in attention and executive function with computerized, paper-based, and telephone-based cognitive tests. RESULTS In total, 580 patients with breast cancer (mean age, 53.4 years) and 363 controls (mean age, 52.6 years) were assessed. On the Delayed Match to Sample test, the longitudinal mixed model results revealed a significant group-by-time effect ( P < .005); patients declined over time from prechemotherapy (A1) to 6 months postchemotherapy (A3; P = .005), but controls did not change ( P = .426). The group difference between patients and controls was also significant, revealing declines in patients but not controls ( P = .017). Several other models of computerized, standard, and telephone tests indicated significantly worse performance by patients compared with controls from pre- to postchemotherapy and from prechemotherapy to 6 months postchemotherapy. CONCLUSION This nationwide study showed CRCI in patients with breast cancer affects multiple cognitive domains for at least 6 months postchemotherapy.
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Affiliation(s)
- Michelle C. Janelsins
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Supriya G. Mohile, Karen M. Mustian, Annalynn M. Williams, Allison Magnuson, and Gary R. Morrow, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Oxana Palesh, Stanford Cancer Center, Stanford, CA; Ann M. O’Mara and Lori M. Minasian, National Cancer Institute (NCI), National Institutes of Health, Rockville, MD; Jodi Geer, Metro Minnesota NCI Community Oncology Research Program (NCORP), Saint Louis Park, MN; Shaker R. Dakhil, Wichita NCORP, Wichita, KS; and Judith O. Hopkins, Southeast Clinical Oncology Research Consortium NCORP, Winston-Salem, NC
| | - Charles E. Heckler
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Supriya G. Mohile, Karen M. Mustian, Annalynn M. Williams, Allison Magnuson, and Gary R. Morrow, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Oxana Palesh, Stanford Cancer Center, Stanford, CA; Ann M. O’Mara and Lori M. Minasian, National Cancer Institute (NCI), National Institutes of Health, Rockville, MD; Jodi Geer, Metro Minnesota NCI Community Oncology Research Program (NCORP), Saint Louis Park, MN; Shaker R. Dakhil, Wichita NCORP, Wichita, KS; and Judith O. Hopkins, Southeast Clinical Oncology Research Consortium NCORP, Winston-Salem, NC
| | - Luke J. Peppone
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Supriya G. Mohile, Karen M. Mustian, Annalynn M. Williams, Allison Magnuson, and Gary R. Morrow, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Oxana Palesh, Stanford Cancer Center, Stanford, CA; Ann M. O’Mara and Lori M. Minasian, National Cancer Institute (NCI), National Institutes of Health, Rockville, MD; Jodi Geer, Metro Minnesota NCI Community Oncology Research Program (NCORP), Saint Louis Park, MN; Shaker R. Dakhil, Wichita NCORP, Wichita, KS; and Judith O. Hopkins, Southeast Clinical Oncology Research Consortium NCORP, Winston-Salem, NC
| | - Tim A. Ahles
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Supriya G. Mohile, Karen M. Mustian, Annalynn M. Williams, Allison Magnuson, and Gary R. Morrow, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Oxana Palesh, Stanford Cancer Center, Stanford, CA; Ann M. O’Mara and Lori M. Minasian, National Cancer Institute (NCI), National Institutes of Health, Rockville, MD; Jodi Geer, Metro Minnesota NCI Community Oncology Research Program (NCORP), Saint Louis Park, MN; Shaker R. Dakhil, Wichita NCORP, Wichita, KS; and Judith O. Hopkins, Southeast Clinical Oncology Research Consortium NCORP, Winston-Salem, NC
| | - Supriya G. Mohile
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Supriya G. Mohile, Karen M. Mustian, Annalynn M. Williams, Allison Magnuson, and Gary R. Morrow, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Oxana Palesh, Stanford Cancer Center, Stanford, CA; Ann M. O’Mara and Lori M. Minasian, National Cancer Institute (NCI), National Institutes of Health, Rockville, MD; Jodi Geer, Metro Minnesota NCI Community Oncology Research Program (NCORP), Saint Louis Park, MN; Shaker R. Dakhil, Wichita NCORP, Wichita, KS; and Judith O. Hopkins, Southeast Clinical Oncology Research Consortium NCORP, Winston-Salem, NC
| | - Karen M. Mustian
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Supriya G. Mohile, Karen M. Mustian, Annalynn M. Williams, Allison Magnuson, and Gary R. Morrow, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Oxana Palesh, Stanford Cancer Center, Stanford, CA; Ann M. O’Mara and Lori M. Minasian, National Cancer Institute (NCI), National Institutes of Health, Rockville, MD; Jodi Geer, Metro Minnesota NCI Community Oncology Research Program (NCORP), Saint Louis Park, MN; Shaker R. Dakhil, Wichita NCORP, Wichita, KS; and Judith O. Hopkins, Southeast Clinical Oncology Research Consortium NCORP, Winston-Salem, NC
| | - Oxana Palesh
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Supriya G. Mohile, Karen M. Mustian, Annalynn M. Williams, Allison Magnuson, and Gary R. Morrow, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Oxana Palesh, Stanford Cancer Center, Stanford, CA; Ann M. O’Mara and Lori M. Minasian, National Cancer Institute (NCI), National Institutes of Health, Rockville, MD; Jodi Geer, Metro Minnesota NCI Community Oncology Research Program (NCORP), Saint Louis Park, MN; Shaker R. Dakhil, Wichita NCORP, Wichita, KS; and Judith O. Hopkins, Southeast Clinical Oncology Research Consortium NCORP, Winston-Salem, NC
| | - Ann M. O’Mara
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Supriya G. Mohile, Karen M. Mustian, Annalynn M. Williams, Allison Magnuson, and Gary R. Morrow, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Oxana Palesh, Stanford Cancer Center, Stanford, CA; Ann M. O’Mara and Lori M. Minasian, National Cancer Institute (NCI), National Institutes of Health, Rockville, MD; Jodi Geer, Metro Minnesota NCI Community Oncology Research Program (NCORP), Saint Louis Park, MN; Shaker R. Dakhil, Wichita NCORP, Wichita, KS; and Judith O. Hopkins, Southeast Clinical Oncology Research Consortium NCORP, Winston-Salem, NC
| | - Lori M. Minasian
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Supriya G. Mohile, Karen M. Mustian, Annalynn M. Williams, Allison Magnuson, and Gary R. Morrow, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Oxana Palesh, Stanford Cancer Center, Stanford, CA; Ann M. O’Mara and Lori M. Minasian, National Cancer Institute (NCI), National Institutes of Health, Rockville, MD; Jodi Geer, Metro Minnesota NCI Community Oncology Research Program (NCORP), Saint Louis Park, MN; Shaker R. Dakhil, Wichita NCORP, Wichita, KS; and Judith O. Hopkins, Southeast Clinical Oncology Research Consortium NCORP, Winston-Salem, NC
| | - Annalynn M. Williams
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Supriya G. Mohile, Karen M. Mustian, Annalynn M. Williams, Allison Magnuson, and Gary R. Morrow, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Oxana Palesh, Stanford Cancer Center, Stanford, CA; Ann M. O’Mara and Lori M. Minasian, National Cancer Institute (NCI), National Institutes of Health, Rockville, MD; Jodi Geer, Metro Minnesota NCI Community Oncology Research Program (NCORP), Saint Louis Park, MN; Shaker R. Dakhil, Wichita NCORP, Wichita, KS; and Judith O. Hopkins, Southeast Clinical Oncology Research Consortium NCORP, Winston-Salem, NC
| | - Allison Magnuson
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Supriya G. Mohile, Karen M. Mustian, Annalynn M. Williams, Allison Magnuson, and Gary R. Morrow, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Oxana Palesh, Stanford Cancer Center, Stanford, CA; Ann M. O’Mara and Lori M. Minasian, National Cancer Institute (NCI), National Institutes of Health, Rockville, MD; Jodi Geer, Metro Minnesota NCI Community Oncology Research Program (NCORP), Saint Louis Park, MN; Shaker R. Dakhil, Wichita NCORP, Wichita, KS; and Judith O. Hopkins, Southeast Clinical Oncology Research Consortium NCORP, Winston-Salem, NC
| | - Jodi Geer
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Supriya G. Mohile, Karen M. Mustian, Annalynn M. Williams, Allison Magnuson, and Gary R. Morrow, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Oxana Palesh, Stanford Cancer Center, Stanford, CA; Ann M. O’Mara and Lori M. Minasian, National Cancer Institute (NCI), National Institutes of Health, Rockville, MD; Jodi Geer, Metro Minnesota NCI Community Oncology Research Program (NCORP), Saint Louis Park, MN; Shaker R. Dakhil, Wichita NCORP, Wichita, KS; and Judith O. Hopkins, Southeast Clinical Oncology Research Consortium NCORP, Winston-Salem, NC
| | - Shaker R. Dakhil
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Supriya G. Mohile, Karen M. Mustian, Annalynn M. Williams, Allison Magnuson, and Gary R. Morrow, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Oxana Palesh, Stanford Cancer Center, Stanford, CA; Ann M. O’Mara and Lori M. Minasian, National Cancer Institute (NCI), National Institutes of Health, Rockville, MD; Jodi Geer, Metro Minnesota NCI Community Oncology Research Program (NCORP), Saint Louis Park, MN; Shaker R. Dakhil, Wichita NCORP, Wichita, KS; and Judith O. Hopkins, Southeast Clinical Oncology Research Consortium NCORP, Winston-Salem, NC
| | - Judith O. Hopkins
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Supriya G. Mohile, Karen M. Mustian, Annalynn M. Williams, Allison Magnuson, and Gary R. Morrow, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Oxana Palesh, Stanford Cancer Center, Stanford, CA; Ann M. O’Mara and Lori M. Minasian, National Cancer Institute (NCI), National Institutes of Health, Rockville, MD; Jodi Geer, Metro Minnesota NCI Community Oncology Research Program (NCORP), Saint Louis Park, MN; Shaker R. Dakhil, Wichita NCORP, Wichita, KS; and Judith O. Hopkins, Southeast Clinical Oncology Research Consortium NCORP, Winston-Salem, NC
| | - Gary R. Morrow
- Michelle C. Janelsins, Charles E. Heckler, Luke J. Peppone, Supriya G. Mohile, Karen M. Mustian, Annalynn M. Williams, Allison Magnuson, and Gary R. Morrow, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Tim A. Ahles, Memorial Sloan Kettering Cancer Center, New York, NY; Oxana Palesh, Stanford Cancer Center, Stanford, CA; Ann M. O’Mara and Lori M. Minasian, National Cancer Institute (NCI), National Institutes of Health, Rockville, MD; Jodi Geer, Metro Minnesota NCI Community Oncology Research Program (NCORP), Saint Louis Park, MN; Shaker R. Dakhil, Wichita NCORP, Wichita, KS; and Judith O. Hopkins, Southeast Clinical Oncology Research Consortium NCORP, Winston-Salem, NC
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Lambert M, Ouimet LA, Wan C, Stewart A, Collins B, Vitoroulis I, Bielajew C. Cancer-related cognitive impairment in breast cancer survivors: An examination of conceptual and statistical cognitive domains using principal component analysis. Oncol Rev 2018; 12:371. [PMID: 30294410 PMCID: PMC6170883 DOI: 10.4081/oncol.2018.371] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 08/07/2018] [Indexed: 12/25/2022] Open
Abstract
There is a great deal of variability in the composition of neuropsychological test batteries used in the assessment of cancerrelated cognitive impairment (CRCI). Not only the development of a gold standard approach for CRCI assessment would allow for easier identification of women suffering from CRCI but it would also promote optimal care for survivors. As a first step towards the development of a valid and reliable unified test battery, the objective of this study was to verify whether the theoretical domains commonly used in CRCI assessment are statistically supported, before and after breast cancer treatment. Principal component analyses (PCA) were performed on the results from 23 neuropsychological tests grouped into eight conceptual domains. For baseline data, the Kaiser-Meyer-Olkin was .82 and Bartlett's X2(253, N=95) = 949.48, P<0.001. A five-component solution explained 60.94% of the common variance. For the post-treatment data, the Kaiser-Meyer-Olkin was .83 and Bartlett's X2(253, N=95) = 1007.21, P<0.001 and a five component solution explained 62.03% of the common variance. Although a visual comparison of the theoretical model with those determined via PCA indicated important overlap between conceptual domains and statistical components, significant dissimilarities were also observed.
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18
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Duff K, Suhrie KR, Dalley BCA, Anderson JS, Hoffman JM. External validation of change formulae in neuropsychology with neuroimaging biomarkers: A methodological recommendation and preliminary clinical data. Clin Neuropsychol 2018; 33:478-489. [PMID: 29884099 DOI: 10.1080/13854046.2018.1484518] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVE Within neuropsychology, a number of mathematical formulae (e.g. reliable change index, standardized regression based) have been used to determine if change across time has reliably occurred. When these formulae have been compared, they often produce different results, but 'different' results do not necessarily indicate which formulae are 'best.' The current study sought to further our understanding of change formulae by comparing them to clinically relevant external criteria (amyloid deposition and hippocampal volume). METHOD In a sample of 25 older adults with varying levels of cognitive intactness, participants were tested twice across one week with a brief cognitive battery. Seven different change scores were calculated for each participant. An amyloid PET scan (to get a composite of amyloid deposition) and an MRI (to get hippocampal volume) were also obtained. RESULTS Deviation-based change formulae (e.g. simple discrepancy score, reliable change index with or without correction for practice effects) were all identical in their relationship to the two neuroimaging biomarkers, and all were non-significant. Conversely, regression-based change formulae (e.g. simple and complex indices) showed stronger relationships to amyloid deposition and hippocampal volume. CONCLUSIONS These results highlight the need for external validation of the various change formulae used by neuropsychologists in clinical settings and research projects. The findings also preliminarily suggest that regression-based change formulae may be more relevant than deviation-based change formulae in this context.
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Affiliation(s)
- Kevin Duff
- a Center for Alzheimer's Care, Imaging and Research, Department of Neurology , University of Utah , Salt Lake City , UT , USA
| | - Kayla R Suhrie
- a Center for Alzheimer's Care, Imaging and Research, Department of Neurology , University of Utah , Salt Lake City , UT , USA
| | - Bonnie C A Dalley
- a Center for Alzheimer's Care, Imaging and Research, Department of Neurology , University of Utah , Salt Lake City , UT , USA
| | - Jeffrey S Anderson
- b Department of Radiology , University of Utah , Salt Lake City , UT , USA
| | - John M Hoffman
- b Department of Radiology , University of Utah , Salt Lake City , UT , USA.,c Huntsman Cancer Institute, University of Utah , Salt Lake City , UT , USA
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Cognitive impairment in breast cancer survivors treated with chemotherapy depends on control group type and cognitive domains assessed: A multilevel meta-analysis. Neurosci Biobehav Rev 2017; 83:417-428. [DOI: 10.1016/j.neubiorev.2017.10.028] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 05/01/2017] [Accepted: 10/27/2017] [Indexed: 01/21/2023]
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20
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Zer A, Pond GR, Razak ARA, Tirona K, Gan HK, Chen EX, O'Sullivan B, Waldron J, Goldstein DP, Weinreb I, Hope AJ, Kim JJ, Chan KKW, Chan AK, Siu LL, Bernstein LJ. Association of Neurocognitive Deficits With Radiotherapy or Chemoradiotherapy for Patients With Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg 2017; 144:71-79. [PMID: 29167901 DOI: 10.1001/jamaoto.2017.2235] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Importance Neurocognitive deficits (NCD) have been observed in noncentral nervous system cancers, yet short- and long-term neurocognitive data on patients treated for head and neck cancer (HNC) are lacking. Objective To assess objective neurocognitive function before and after definitive radiation therapy for HNC. Design, Setting, and Participants In a prospective, longitudinal study, neurocognitive function and self-reported symptoms were assessed in 80 patients with histologically proven HNC requiring definitive chemoradiotherapy or radiotherapy and in 40 healthy controls 4 times (baseline, 6, 12, and 24 months after baseline) prior to commencing treatment at Princess Margaret Cancer Centre, Toronto, Canada. Main Outcomes and Measures Neurocognitive test scores were converted to age-corrected z scores (mean, 0; standard deviation, 1) and reported as mean scores, standardized regression-based scores, and frequencies of impairments in intellectual capacity, concentration, memory, executive function, processing speed, and motor dexterity. Multivariable analysis was used to identify factors associated with NCD 2 years after treatment. Results Eighty patients and 40 healthy controls enrolled. Analyses revealed significant differences between patient and control mean performance in some domains, with patient deficits increasing over time: intellectual capacity (Cohen d, effect sizes [95% CIs] of -0.46 [-0.64 to 0.30], -0.51 [-0.72 to -0.30], and -0.70 [-0.92 to -0.49] for time points 6, 12, and 24 months, respectively); concentration/short-term attention span (-0.19 [-0.37 to 0.00], -0.38 [-0.55 to -0.21], -0.54 [-0.71 to -0.37]); verbal memory (-0.16 [-0.33 to 0.02], -0.38 [-0.64 to -0.12], -0.53 [-0.74 to -0.32]); executive function (-0.14 [-0.27 to 0.00], -0.34 [-0.52 to -0.16], -0.43 [-0.64 to -0.22]), and global cognitive function composite (-0.38 [-0.55 to -0.22], -0.75 [-0.92 to -0.58], -1.06 [-1.26 to -0.86]). There was an increased rate of impaired global neurocognitive functioning among patients (38%) at 24 months compared with controls (0%). Neurocognitive deficits were not associated with baseline cytokines. Conclusions and Relevance Head and neck cancer survivors have neurocognitive sequelae up to 2 years after definitive chemoradiotherapy or radiation treatment. Patients and health care teams should know about such potential risks. Further research is warranted in search of strategies to avoid, reduce, and compensate for declines.
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Affiliation(s)
- Alona Zer
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Gregory R Pond
- Department of Biostatistics, McMaster University, Hamilton, Canada
| | - Albiruni R Abdul Razak
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Kattleya Tirona
- Department of Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Hui K Gan
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Eric X Chen
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Brian O'Sullivan
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - John Waldron
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - David P Goldstein
- Department of Otolaryngology- Head & Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Ilan Weinreb
- Department of Pathology, University Health Network, University of Toronto, Canada
| | - Andrew J Hope
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - John J Kim
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Kelvin K W Chan
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Andrew K Chan
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Lillian L Siu
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Lori J Bernstein
- Department of Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Canada
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Abstract
A growing population of cancer survivors is at risk for acute and long-term consequences resulting from cancer and its treatment. Cancer-related cognitive impairment (CRCI) typically manifests as modest deficits in attention, processing speed, executive functioning, and memory, which may persist for decades after treatment. Although some risk factors for CRCI are largely immutable (eg, genetics and demographic factors), there are many other contributors to CRCI that when appropriately addressed can result in improved cognitive functioning and quality of life. Neuropsychological assessment can help identify patient cognitive strengths and weaknesses, target psychological and behavioral contributors to CRCI, and guide treatment interventions.
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Affiliation(s)
- Tracy D Vannorsdall
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 218, Baltimore, MD 21287, USA; Department of Neurology, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 218, Baltimore, MD 21287, USA.
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22
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Amidi A, Hosseini SMH, Leemans A, Kesler SR, Agerbæk M, Wu LM, Zachariae R. Changes in Brain Structural Networks and Cognitive Functions in Testicular Cancer Patients Receiving Cisplatin-Based Chemotherapy. J Natl Cancer Inst 2017; 109:3855270. [DOI: 10.1093/jnci/djx085] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 04/04/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ali Amidi
- Unit for Psychooncology and Health Psychology, Department of Oncology and Department of Psychology and Behavioural Sciences, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - S M Hadi Hosseini
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, CA
| | - Alexander Leemans
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Shelli R Kesler
- Department of Neuro-oncology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mads Agerbæk
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Lisa M Wu
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Robert Zachariae
- Unit for Psychooncology and Health Psychology, Department of Oncology and Department of Psychology and Behavioural Sciences, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
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Park JH, Jung YS, Kim KS, Bae SH. Effects of compensatory cognitive training intervention for breast cancer patients undergoing chemotherapy: a pilot study. Support Care Cancer 2017; 25:1887-1896. [DOI: 10.1007/s00520-017-3589-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 01/16/2017] [Indexed: 12/23/2022]
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24
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Kitahata R, Nakajima S, Uchida H, Hayashida T, Takahashi M, Nio S, Hirano J, Nagaoka M, Suzuki T, Jinno H, Kitagawa Y, Mimura M. Self-rated cognitive functions following chemotherapy in patients with breast cancer: a 6-month prospective study. Neuropsychiatr Dis Treat 2017; 13:2489-2496. [PMID: 29042777 PMCID: PMC5633301 DOI: 10.2147/ndt.s141408] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
PURPOSE The purpose of the study was to evaluate subjective (self-rated), family-rated, and objective (researcher-rated) cognitive functions in patients with breast cancer after chemotherapy. METHOD We conducted a prospective study to trace self-rated cognitive functions in 30 patients with breast cancer at the completion of chemotherapy (T0) and 6 months later (T1). Subjective cognitive functions were assessed with Cognitive Failures Questionnaire (CFQ), Dysexecutive Questionnaire (DEX-S), and Everyday Memory Checklist (EMC-S) for attention, executive function, and episodic memory, respectively. Their family members also completed DEX-I and EMC-I for executive function and episodic memory, respectively. We also examined objective cognitive functions. Self-rated cognitive functions were compared with the normative data. They were compared between T0 and T1. We calculated correlation coefficients between self-rated and other cognitive functions. RESULTS At T0, 6 (20.0%) and 2 (6.7%) participants showed higher DEX-S and EMC-S scores than the normative data, respectively, while no participant had abnormal CFQ scores. At T1, DEX-S and EMC-S scores were normalized in 3 (50.0%) and 2 (100.0%) participants, respectively. No participant showed increases in CFQ scores. No changes were found in objective cognitive functions from T0 to T1. DEX-S and DEX-I or EMC-S and EMC-I scores were correlated at both T0 and T1, which did not survive multiple corrections. There was no association between subjective and objective cognitive functions. CONCLUSION Impairments in subjective cognition may be transient after chemotherapy in patients with breast cancer. Furthermore, patients and their families appear to share similar prospects on their cognitive functions.
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Affiliation(s)
- Ryosuke Kitahata
- Psychopharmacology Research Program, Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo, Japan
| | - Shinichiro Nakajima
- Psychopharmacology Research Program, Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo, Japan.,Multimodal Imaging Group - Research Imaging Centre.,Geriatric Mental Health Division, Centre for Addiction and Mental Health.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Hiroyuki Uchida
- Psychopharmacology Research Program, Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo, Japan.,Geriatric Mental Health Division, Centre for Addiction and Mental Health
| | | | | | - Shintaro Nio
- Psychopharmacology Research Program, Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo, Japan
| | - Jinichi Hirano
- Psychopharmacology Research Program, Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo, Japan
| | - Maki Nagaoka
- Psychopharmacology Research Program, Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo, Japan
| | - Takefumi Suzuki
- Psychopharmacology Research Program, Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo, Japan
| | - Hiromitsu Jinno
- Department of Surgery, School of Medicine, Teikyo University, Tokyo, Japan
| | - Yuko Kitagawa
- Department of Surgery, School of Medicine, Keio University
| | - Masaru Mimura
- Psychopharmacology Research Program, Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo, Japan
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O'Farrell E, Smith A, Collins B. Objective-subjective disparity in cancer-related cognitive impairment: does the use of change measures help reconcile the difference? Psychooncology 2016; 26:1667-1674. [DOI: 10.1002/pon.4190] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 05/02/2016] [Accepted: 06/06/2016] [Indexed: 12/22/2022]
Affiliation(s)
| | | | - Barbara Collins
- University of Ottawa; Ottawa ON Canada
- The Ottawa Hospital-Civic Campus; Ottawa ON Canada
- The Ottawa Hospital Research Institute; Ottawa ON Canada
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26
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Amidi A, Agerbæk M, Wu LM, Pedersen AD, Mehlsen M, Clausen CR, Demontis D, Børglum AD, Harbøll A, Zachariae R. Changes in cognitive functions and cerebral grey matter and their associations with inflammatory markers, endocrine markers, and APOE genotypes in testicular cancer patients undergoing treatment. Brain Imaging Behav 2016; 11:769-783. [DOI: 10.1007/s11682-016-9552-3] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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27
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Olson K, Hewit J, Slater LG, Chambers T, Hicks D, Farmer A, Grattan K, Steggles S, Kolb B. Assessing cognitive function in adults during or following chemotherapy: a scoping review. Support Care Cancer 2016; 24:3223-34. [PMID: 27067592 DOI: 10.1007/s00520-016-3215-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 04/05/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this scoping review was to determine the feasibility of conducting a systematic review of approaches for screening or assessing cognitive function that were comprehensive and that could be incorporated into clinical settings. METHODS Using the scoping review approach developed by Arksey and O'Malley, we searched Ovid Embase 1980-, Ovid PsycINFO 1806-, Ovid Health and Psychosocial Instruments 1985-, EBSCOhost CINAHL, ISI Web of Science (Science Citation Index 1900-), Social Sciences Citation Index 1900-, Conference Proceedings Citation Index -Science 1990-, Conference Proceedings Citation Index -Social Science & Humanities 1990-, Scopus 1960-, with no language restrictions. Searches were conducted in April 2009 and updated in February 2013. Studies of adults treated with chemotherapy that included at least seven of the eight domains of cognition were included. RESULTS Eleven studies met inclusion criteria. No screening tools suitable for inclusion in a clinic were identified. The studies reviewed varied by inclusion/exclusion criteria, design, and instruments for assessing cognitive function, and thus, there are not yet enough studies to warrant a systematic review on this topic.
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Affiliation(s)
- Karin Olson
- Faculty of Nursing, 3rd Level, Edmonton Clinic Health Academy, University of Alberta, 11405 - 87 Ave., Edmonton, AB, T6G 1C9, Canada.
| | - Joanne Hewit
- Cross Cancer Institute, 11560 University Avenue, Edmonton, AB, T6G 1Z2, Canada
| | - Linda G Slater
- John W. Scott Health Sciences Library, University of Alberta, 2K328 WMC, Edmonton, ABT6G 2R7, Canada
| | - Thane Chambers
- John W. Scott Health Sciences Library, University of Alberta, 2K328 WMC, Edmonton, ABT6G 2R7, Canada
| | - Deborah Hicks
- Department of Educational Policy Studies, Faculty of Education, University of Alberta, 7-104 Education North, Edmonton, AB, T6E 2G5, Canada
| | - Anna Farmer
- Department of Agricultural, Food and Nutritional Science, Human Nutrition Division, Edmonton Clinic Health Academy, University of Alberta, 11405 - 87 Ave, Edmonton, AB, T6G 1C9, Canada
| | - Kathryn Grattan
- St. Joseph's Health Care, 268 Grosvenor St, London, ON, N6A 4V2, Canada
| | - Shawn Steggles
- Department of Oncology, University of Alberta, Edmonton, AB, T6G 2R7, Canada
| | - Bryan Kolb
- Department of Neuroscience, University of Lethbridge, Lethbridge, AB, T1K3M4, Canada
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28
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Wefel JS, Kesler SR, Noll KR, Schagen SB. Clinical characteristics, pathophysiology, and management of noncentral nervous system cancer-related cognitive impairment in adults. CA Cancer J Clin 2015; 65:123-38. [PMID: 25483452 PMCID: PMC4355212 DOI: 10.3322/caac.21258] [Citation(s) in RCA: 320] [Impact Index Per Article: 35.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Answer questions and earn CME/CNE Over the past few decades, a body of research has emerged confirming what many adult patients with noncentral nervous system cancer have long reported-that cancer and its treatment are frequently associated with cancer-related cognitive impairment (CRCI). The severity of CRCI varies, and symptoms can emerge early or late in the disease course. Nonetheless, CRCI is typically mild to moderate in nature and primarily involves the domains of memory, attention, executive functioning, and processing speed. Animal models and novel neuroimaging techniques have begun to unravel the pathophysiologic mechanisms underlying CRCI, including the role of inflammatory cascades, direct neurotoxic effects, damage to progenitor cells, white matter abnormalities, and reduced functional connectivity, among others. Given the paucity of research on CRCI with other cancer populations, this review synthesizes the current literature with a deliberate focus on CRCI within the context of breast cancer. A hypothetical case-study approach is used to illustrate how CRCI often presents clinically and how current science can inform practice. While the literature regarding intervention for CRCI is nascent, behavioral and pharmacologic approaches are discussed.
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Affiliation(s)
- Jeffrey S. Wefel
- Associate Professor, Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Corresponding author: Jeffrey S. Wefel, PhD, Department of Neuro-Oncology, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 431, Houston, TX 77030;
| | - Shelli R. Kesler
- Associate Professor, Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kyle R. Noll
- Associate Professor, Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sanne B. Schagen
- Associate Professor, Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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29
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Park JH, Bae SH, Jung YS, Jung YM. Prevalence and Characteristics of Chemotherapy-related Cognitive Impairment in Patients with Breast Cancer. J Korean Acad Nurs 2015; 45:118-28. [DOI: 10.4040/jkan.2015.45.1.118] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Jin-Hee Park
- College of Nursing, Ajou University, Suwon, Korea
| | - Sun Hyoung Bae
- Department of Nursing, College of Medicine, Dong-A University, Busan, Korea
| | - Yong-Sik Jung
- Department of Surgery, School of Medicine, Ajou University, Suwon, Korea
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Kesler SR, Watson C, Koovakkattu D, Lee C, O'Hara R, Mahaffey ML, Wefel JS. Elevated prefrontal myo-inositol and choline following breast cancer chemotherapy. Brain Imaging Behav 2014; 7:501-10. [PMID: 23536015 DOI: 10.1007/s11682-013-9228-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Breast cancer survivors are at increased risk for cognitive dysfunction, which reduces quality of life. Neuroimaging studies provide critical insights regarding the mechanisms underlying these cognitive deficits as well as potential biologic targets for interventions. We measured several metabolite concentrations using (1)H magnetic resonance spectroscopy as well as cognitive performance in 19 female breast cancer survivors and 17 age-matched female controls. Women with breast cancer were all treated with chemotherapy. Results indicated significantly increased choline (Cho) and myo-inositol (mI) with correspondingly decreased N-acetylaspartate (NAA)/Cho and NAA/mI ratios in the breast cancer group compared to controls. The breast cancer group reported reduced executive function and memory, and subjective memory ability was correlated with mI and Cho levels in both groups. These findings provide preliminary evidence of an altered metabolic profile that increases our understanding of neurobiologic status post-breast cancer and chemotherapy.
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Affiliation(s)
- Shelli R Kesler
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Rd., Stanford, CA, 94305-5795, USA,
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31
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Caplette-Gingras A, Savard J, Savard MH, Ivers H. Is insomnia associated with cognitive impairments in breast cancer patients? Behav Sleep Med 2014. [PMID: 23181706 DOI: 10.1080/15402002.2012.672940] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Insomnia and cognitive impairment are both highly prevalent in breast cancer patients. This study, conducted among women treated for non-metastatic breast cancer, aimed at assessing the relationship between insomnia and cognitive functioning, measured objectively and subjectively, and evaluating the moderating role of age, educational level and intellectual potential. Sixty-three women completed a neuropsychological battery, self-report scales of cognitive functioning, 2 weeks of a daily sleep diary, and a demographic and medical questionnaire. Significant differences between women with insomnia and good sleepers were found on verbal episodic memory and executive functioning, assessed objectively, and some aspects of subjective cognitive functioning. Moreover, older age and a higher education were associated with more severe cognitive impairments related to insomnia.
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Janelsins MC, Kesler SR, Ahles TA, Morrow GR. Prevalence, mechanisms, and management of cancer-related cognitive impairment. Int Rev Psychiatry 2014; 26:102-13. [PMID: 24716504 PMCID: PMC4084673 DOI: 10.3109/09540261.2013.864260] [Citation(s) in RCA: 454] [Impact Index Per Article: 45.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This review summarizes the current literature on cancer-related cognitive impairment (CRCI) with a focus on prevalence, mechanisms, and possible interventions for CRCI in those who receive adjuvant chemotherapy for non-central nervous system tumours and is primarily focused on breast cancer. CRCI is characterized as deficits in areas of cognition including memory, attention, concentration, and executive function. Development of CRCI can impair quality of life and impact treatment decisions. CRCI is highly prevalent; these problems can be detected in up to 30% of patients prior to chemotherapy, up to 75% of patients report some form of CRCI during treatment, and CRCI is still present in up to 35% of patients many years following completion of treatment. While the trajectory of CRCI is becoming better understood, the mechanisms underlying the development of CRCI are still obscure; however, host characteristics, immune dysfunction, neural toxicity, and genetics may play key roles in the development and trajectory of CRCI. Intervention research is limited, though strategies to maintain function are being studied with promising preliminary findings. This review highlights key research being conducted in these areas, both in patient populations and in animals, which will ultimately result in better understanding and effective treatments for CRCI.
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Affiliation(s)
- Michelle C. Janelsins
- Department of Surgery, Cancer Control, University of Rochester Medical Center, Rochester, NY
- James P. Wilmot Cancer Center, Rochester, NY
| | | | - Tim A. Ahles
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Gary R. Morrow
- Department of Surgery, Cancer Control, University of Rochester Medical Center, Rochester, NY
- James P. Wilmot Cancer Center, Rochester, NY
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY
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Gehring K, Aaronson NK, Taphoorn MJ, Sitskoorn MM. Interventions for cognitive deficits in patients with a brain tumor: an update. Expert Rev Anticancer Ther 2014; 10:1779-95. [DOI: 10.1586/era.10.163] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Wefel JS, Vidrine DJ, Marani SK, Swartz RJ, Veramonti TL, Meyers CA, Hoekstra HJ, Hoekstra-Weebers JEHM, Gritz ER. A prospective study of cognitive function in men with non-seminomatous germ cell tumors. Psychooncology 2013; 23:626-33. [PMID: 24339329 DOI: 10.1002/pon.3453] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 10/14/2013] [Accepted: 10/28/2013] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Longitudinal neuropsychological assessments were performed to determine if adjuvant chemotherapy was associated with cognitive dysfunction in men with non-seminomatous germ cell tumors (NSGCT). METHODS Patients with NSGCT status post-orchiectomy that either received adjuvant chemotherapy (n = 55) or did not (n = 14) were recruited. Patients were tested before chemotherapy, 1 week post-chemotherapy (or 3 months later in the surveillance group) and 12 months after the baseline evaluation. RESULTS Compared with the surveillance group, patients treated with chemotherapy had higher rates of cognitive decline at 12 months (overall cognitive decline: 0%, 52%, and 67% in the surveillance, low exposure (LE), and high exposure (HE) group, respectively), greater number of tests that declined (mean of 0.1, 1.4, and 2.0 in the surveillance, LE, and HE group, respectively), and more frequent worsening in motor dexterity (0%, 48%, and 46% in the surveillance, LE, and HE group, respectively). Compared with the surveillance group, patients receiving more cycles of chemotherapy demonstrated worse psychomotor speed and learning and memory. Younger age was associated with greater incidence of overall cognitive decline at 12-month follow-up. CONCLUSIONS Men with NSGCT that received chemotherapy demonstrated greater rates of cognitive decline in a dose-response manner. Reductions in motor dexterity were most common. Decline in learning and memory also was evident particularly at later follow-up time points and in men receiving more chemotherapy. Men that receive chemotherapy for NSGCT are at risk for cognitive decline and may benefit from monitoring and referral for psychosocial care.
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Affiliation(s)
- Jeffrey S Wefel
- Department of Neuro-Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
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35
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O'Farrell E, MacKenzie J, Collins B. Clearing the air: a review of our current understanding of "chemo fog". Curr Oncol Rep 2013; 15:260-9. [PMID: 23483375 DOI: 10.1007/s11912-013-0307-7] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
An increasing number of cancer survivors has led to a greater interest in the long-term side effects of cancer treatments and their impact on quality of life. In particular, cognitive impairments have been frequently reported by cancer survivors as an adverse effect which they attribute to the neurotoxicity of chemotherapy and have dubbed "chemobrain" or "chemo fog." Research within the past 15-20 years has explored the many factors thought to contribute to cancer-related cognitive decline in an attempt to determine a potential cause. In spite of many confounding factors, there is growing evidence that the neurotoxicity of chemotherapy does contribute to cognitive changes. This review examines the evolution of "chemo fog" research with a look at methodological issues, the status of our current understanding, and suggestions for future research.
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Affiliation(s)
- Erin O'Farrell
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
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Park JH, Bae SH. [A meta-analysis of chemotherapy related cognitive impairment in patients with breast cancer]. J Korean Acad Nurs 2013; 42:644-58. [PMID: 23221654 DOI: 10.4040/jkan.2012.42.5.644] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the cognitive effects of chemotherapy in patients with breast cancer. METHODS Using several databases, prospective studies were collected up to August 2011. Of 2,106 publications identified, 12 met the inclusion criteria, and 8 studies were used to estimate the effect size of chemotherapy on cognitive impairment. RESULTS Twelve studies were done since 2005 and most of the research was performed in Europe or North America. Eight studies were used to generate effect size across the cognitive domains of attention/concentration, verbal and visual memory, executive function, visuospatial skill, language, and subjective cognitive function. Each of the cognitive domains showed small effect sizes (-0.02 ~ -0.26), indicating diminished cognitive function for the chemotherapy group compared with non-chemotherapy groups. CONCLUSION Finding suggests that breast cancer patients who undergo chemotherapy may experience mild cognitive decline. Further study is needed to generate knowledge and guideline for interventions to address chemotherapy related cognitive impairment in these patients.
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Affiliation(s)
- Jin Hee Park
- College of Nursing, Ajou University, Suwon, Korea
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Kesler S, Hadi Hosseini SM, Heckler C, Janelsins M, Palesh O, Mustian K, Morrow G. Cognitive training for improving executive function in chemotherapy-treated breast cancer survivors. Clin Breast Cancer 2013; 13:299-306. [PMID: 23647804 DOI: 10.1016/j.clbc.2013.02.004] [Citation(s) in RCA: 180] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 01/25/2013] [Accepted: 02/04/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND A majority of breast cancer (BC) survivors, particularly those treated with chemotherapy, experience long-term cognitive deficits that significantly reduce quality of life. Among the cognitive domains most commonly affected include executive functions (EF), such as working memory, cognitive flexibility, multitasking, planning, and attention. Previous studies in other populations have shown that cognitive training, a behavioral method for treating cognitive deficits, can result in significant improvements in a number of cognitive skills, including EF. MATERIALS AND METHODS In this study, we conducted a randomized controlled trial to investigate the feasibility and preliminary effectiveness of a novel, online EF training program in long-term BC survivors. A total of 41 BC survivors (21 active, 20 wait list) completed the 48 session training program over 12 weeks. The participants were, on average, 6 years after therapy. RESULTS Cognitive training led to significant improvements in cognitive flexibility, verbal fluency and processing speed, with marginally significant downstream improvements in verbal memory as assessed via standardized measures. Self-ratings of EF skills, including planning, organizing, and task monitoring, also were improved in the active group compared with the wait list group. CONCLUSIONS Our findings suggest that EF skills may be improved even in long-term survivors by using a computerized, home-based intervention program. These improvements may potentially include subjective EF skills, which suggest a transfer of the training program to real-world behaviors.
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Affiliation(s)
- Shelli Kesler
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, CA 94305-5795, USA.
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Collins B, Mackenzie J, Kyeremanteng C. Study of the cognitive effects of chemotherapy: Considerations in selection of a control group. J Clin Exp Neuropsychol 2013; 35:435-44. [DOI: 10.1080/13803395.2013.781995] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Yeates KO, Kaizar E, Rusin J, Bangert B, Dietrich A, Nuss K, Wright M, Taylor HG. Reliable change in postconcussive symptoms and its functional consequences among children with mild traumatic brain injury. ACTA ACUST UNITED AC 2013; 166:615-22. [PMID: 22393171 DOI: 10.1001/archpediatrics.2011.1082] [Citation(s) in RCA: 118] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To examine reliable change in postconcussive symptoms and its functional consequences among children with mild traumatic brain injury (TBI) over the first year postinjury as compared with children with orthopedic injuries. DESIGN Prospective, longitudinal cohort. SETTING Emergency departments at 2 children's hospitals. PARTICIPANTS Eight- to 15-year-old children with mild TBI (n = 186) or orthopedic injuries (n = 99). MAIN EXPOSURE Closed-head or orthopedic trauma. MAIN OUTCOME MEASURES Parents rated preinjury symptoms retrospectively shortly after injury and postconcussive symptoms at 2 weeks and 3 and 12 months postinjury. A regression-based approach was used to determine whether each child displayed reliable increases in postconcussive symptoms at each postinjury occasion. Health-related quality of life was assessed at 3 and 12 months postinjury. Information regarding children's educational programming was collected at the initial and 12-month assessments. RESULTS Children with mild TBI were significantly more likely than those with orthopedic injuries to show reliable increases in both cognitive and somatic symptoms. Group differences in the likelihood of reliable increases became less common with time for somatic symptoms but persisted to 12 months postinjury for cognitive symptoms. Among children with mild TBI, reliable increases in symptoms were more common among children with loss of consciousness or abnormalities on neuroimaging. Reliable increases in symptoms were associated with significant declines in health-related quality of life and an increased likelihood of educational intervention. CONCLUSION Many children with mild TBI show reliable increases in postconcussive symptoms that are associated with significant functional impairment in their daily lives.
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Østby-Deglum M, Dahl AA. Er cytostatika skadelig for hjernen? TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2013; 133:1464-5. [DOI: 10.4045/tidsskr.13.0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Abstract
Many cancer patients develop treatment-related cognitive dysfunction that affects their quality of life and can result in diminished functional independence. There is an emerging body of transdisciplinary research demonstrating that chemotherapeutic agents can produce neurobiological changes within the brain, which are associated with a constellation of cognitive changes that can result in decreased quality of life and functional independence. The increased incidence of cancer, coupled with longer survival times, has resulted in larger numbers of cancer survivors who are struggling with this neurotoxicity. This review summarizes the neuropsychological findings in patients with breast and brain cancer who receive systemic chemotherapy as well as the recent animal and imaging research elucidating the mechanisms by which these therapies impact brain structure, function, and consequent behavior.
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Affiliation(s)
- Jeffrey S Wefel
- Department of Neuro-Oncology, MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 431, Houston, TX 77030, USA.
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Galantino ML, Greene L, Daniels L, Dooley B, Muscatello L, O'Donnell L. Longitudinal Impact of Yoga on Chemotherapy-Related Cognitive Impairment and Quality of Life in Women with Early Stage Breast Cancer: A Case Series. Explore (NY) 2012; 8:127-35. [DOI: 10.1016/j.explore.2011.12.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Indexed: 11/12/2022]
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Duff K. Evidence-based indicators of neuropsychological change in the individual patient: relevant concepts and methods. Arch Clin Neuropsychol 2012; 27:248-61. [PMID: 22382384 DOI: 10.1093/arclin/acr120] [Citation(s) in RCA: 284] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Repeated assessments are a relatively common occurrence in clinical neuropsychology. The current paper will review some of the relevant concepts (e.g., reliability, practice effects, alternate forms) and methods (e.g., reliable change index, standardized based regression) that are used in repeated neuropsychological evaluations. The focus will be on the understanding and application of these concepts and methods in the evaluation of the individual patient through examples. Finally, some future directions for assessing change will be described.
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Affiliation(s)
- Kevin Duff
- Center for Alzheimer's Care, Imaging, and Research, Department of Neurology, University of Utah, Salt Lake City, USA.
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Koppelmans V, Breteler MMB, Boogerd W, Seynaeve C, Gundy C, Schagen SB. Neuropsychological performance in survivors of breast cancer more than 20 years after adjuvant chemotherapy. J Clin Oncol 2012; 30:1080-6. [PMID: 22370315 DOI: 10.1200/jco.2011.37.0189] [Citation(s) in RCA: 351] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Adjuvant chemotherapy for breast cancer can have adverse effects on cognition shortly after administration. Whether chemotherapy has any long-term effects on cognition is largely unknown, yet it becomes increasingly relevant because of the widespread use of chemotherapy for early-stage breast cancer and the improved survival. We investigated whether cyclophosphamide, methotrexate, and fluorouracil (CMF) chemotherapy for breast cancer is associated with worse cognitive performance more than 20 years after treatment. PATIENTS AND METHODS This case-cohort study compared the cognitive performance of patients with breast cancer who had a history of adjuvant CMF chemotherapy treatment (six cycles; average time since treatment, 21 years; n = 196) to that of a population-based sample of women never diagnosed with cancer (n = 1,509). Participants were between 50 and 80 years of age. Exclusion criteria were ever use of adjuvant endocrine therapy, secondary malignancy, recurrence, and/or metastasis. RESULTS The women exposed to chemotherapy performed significantly worse than the reference group on cognitive tests of immediate (P = .015) and delayed verbal memory (P = .002), processing speed (P < .001), executive functioning (P = .013), and psychomotor speed (P = .001). They experienced fewer symptoms of depression (P < .001), yet had significantly more memory complaints on two of three measures that could not be explained by cognitive test performance. CONCLUSION Survivors of breast cancer treated with adjuvant CMF chemotherapy more than 20 years ago perform worse, on average, than random population controls on neuropsychological tests. The pattern of cognitive problems is largely similar to that observed in patients shortly after cessation of chemotherapy. This study suggests that cognitive deficits following breast cancer diagnosis and subsequent CMF chemotherapy can be long lasting.
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Sontag-Padilla LM, Dorn LD, Tissot A, Susman EJ, Beers SR, Rose SR. Executive functioning, cortisol reactivity, and symptoms of psychopathology in girls with premature adrenarche. Dev Psychopathol 2012; 24:211-23. [PMID: 22293005 PMCID: PMC3362926 DOI: 10.1017/s0954579411000782] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The study examined the interaction between early maturational timing (measured by premature adrenarche [PA]) and executive functioning and cortisol reactivity on symptoms of psychopathology. The study included 76 girls aged 6 through 8 years (mean = 7.50, SD = 0.85) with PA (n = 40) and on-time adrenarche (n = 36). Girls completed a battery of psychological and neuropsychological tests and blood sampling for cortisol. Parents completed the Child Behavior Checklist. The results demonstrated that girls with PA with lower levels of executive functioning had higher externalizing and anxious symptoms compared to other girls. In addition, girls with PA who demonstrated increases in serum cortisol had higher externalizing symptoms than those with stable patterns. Finally, girls with PA who demonstrated decreases in cortisol reported higher depressive symptoms. The findings from this study provide important information concerning the impact of cognitive functioning and stress reactivity on adjustment to early maturation in girls with PA. The results of this research may inform screening and intervention efforts for girls who may be at greatest risk for emotional and behavioral problems as a result of early maturation.
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Janelsins MC, Kohli S, Mohile SG, Usuki K, Ahles TA, Morrow GR. An update on cancer- and chemotherapy-related cognitive dysfunction: current status. Semin Oncol 2011; 38:431-8. [PMID: 21600374 DOI: 10.1053/j.seminoncol.2011.03.014] [Citation(s) in RCA: 218] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The purpose of this review is to summarize the current literature on the effects of cancer treatment-related cognitive difficulties, with a focus on the effects of chemotherapy. Numerous patients have cognitive difficulties during and after cancer treatments and, for some, these effects last years after treatment. We do not yet fully understand which factors increase susceptibility to cognitive difficulties during treatment and which cause persistent problems. We review possible contributors, including genetic and biological factors. Mostly we focus is on cognitive effects of adjuvant chemotherapy for breast cancer; however, cognitive effects of chemotherapy on the elderly and brain tumor patients are also discussed.
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Affiliation(s)
- Michelle C Janelsins
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY 14642, USA.
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Wefel JS, Vardy J, Ahles T, Schagen SB. International Cognition and Cancer Task Force recommendations to harmonise studies of cognitive function in patients with cancer. Lancet Oncol 2011; 12:703-8. [DOI: 10.1016/s1470-2045(10)70294-1] [Citation(s) in RCA: 488] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Skaali T, Fosså SD, Andersson S, Cvancarova M, Langberg CW, Lehne G, Dahl AA. Self-reported cognitive problems in testicular cancer patients: relation to neuropsychological performance, fatigue, and psychological distress. J Psychosom Res 2011; 70:403-10. [PMID: 21511070 DOI: 10.1016/j.jpsychores.2010.12.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Revised: 11/25/2010] [Accepted: 12/09/2010] [Indexed: 01/15/2023]
Abstract
OBJECTIVE There is a concern about negative cognitive effects of systemic chemotherapy. We prospectively explored self-reported cognitive problems in testicular cancer patients (TCPs) treated with and without chemotherapy. METHODS One hundred and twenty-two TCPs were interviewed about concentration and memory problems shortly after orchidectomy but before any additional treatment (baseline), and then at a median of 1 year after end of treatment (follow-up). Symptoms of psychological distress, fatigue, and peripheral neurotoxicity were assessed by questionnaires, and patients also underwent neuropsychological testing. Self-reported cognitive problems were compared between three treatments groups: no chemotherapy, one cycle of chemotherapy, and multiple cycles of chemotherapy. Variables associated with an increase of self-reported cognitive problems from baseline to follow-up were explored. RESULTS Significantly larger proportions of TCPs in the two chemotherapy groups had an increase of self-reported cognitive problems from baseline to follow-up compared to the no-chemotherapy group. Increase of self-reported cognitive problems was significantly associated with psychological distress, fatigue, lower level of education, and Raynaud-like symptoms, but not with a decline in neuropsychological test performance. CONCLUSION In this explorative study of TCPs, an increase of self-reported cognitive problems from baseline to 1-year follow-up was associated with chemotherapy and with symptoms of fatigue and psychological distress at follow-up, while no significant association was found with a decline in neuropsychological test performance.
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Affiliation(s)
- Tone Skaali
- National Resource Center for Late Effects, Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway.
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Gasquoine PG. Cognitive impairment in common, noncentral nervous system medical conditions of adults and the elderly. J Clin Exp Neuropsychol 2011; 33:486-96. [PMID: 21218318 DOI: 10.1080/13803395.2010.536759] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Common, noncentral nervous system medical conditions linked with cognitive impairment in adults and the elderly include: acute respiratory distress syndrome; cancer; chronic kidney disease; chronic obstructive pulmonary disease; coronary heart disease; hypertension; obesity (bariatric surgical candidates); obstructive sleep apnea; and type 2 diabetes. Cross-condition comparison of the nature and frequency of cognitive impairment is difficult as these conditions often coexist, and there exists no consensus as to the definition of cognitive impairment, nor the optimal number and type of neuropsychological tests required for evaluation. There is as yet no clear evidence for condition-specific profiles of cognitive impairment. Rather, a generalized profile consisting of subclinical levels of impairment in attention, processing speed, executive, and memory functions from bilateral frontal-subcortical ischemia fits across all conditions. This profile: occurs only in subgroups of patients; is inconsistently related to measures of illness severity; is unrelated to patient self-report or level of functional independence; is exacerbated by very high levels of emotional distress; and is reversible in some cases but can also progress to frank neurological disease (dementia) in others, especially the elderly, when multiple conditions coexist, and/or when medical condition severity progresses.
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Affiliation(s)
- Philip G Gasquoine
- Department of Psychology and Anthropology, University of Texas-Pan American, Edinburg, TX 78541, USA.
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