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Sharma A. Palliative Care and Care Partner Support in Neuro-oncology. Continuum (Minneap Minn) 2023; 29:1872-1895. [PMID: 38085902 DOI: 10.1212/con.0000000000001353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
ABSTRACT The journey for a patient with a brain tumor and their loved ones can be extremely challenging due to the high burden of physical symptoms and the emotional distress caused by the diagnosis. Optimizing quality of life by addressing symptoms and reducing this emotional distress can improve treatment tolerance and outcomes and alleviate care partner distress and burden. Symptoms in patients with central nervous system (CNS) tumors can vary in onset and intensity, ranging from headaches, seizures, and focal weakness to emotional distress and cognitive dysfunction. Additionally, care partners may demonstrate distress due to the high burden of care and need appropriate support structures and access to resources to alleviate this stress. Evidence-based recommendations are unfortunately limited given the lack of high-quality research in this area, but patients living with CNS tumors and their loved ones can benefit from early and routine symptom identification and management, compassionate and transparent communication, and practical guidance for the future. These principles are part of palliative care, a field of medicine focused on alleviating suffering in patients with serious, chronic illness. Clinicians involved in the care of patients with CNS tumors must be educated in these important primary palliative care principles. This article focuses on key symptom management, strategies for high-quality communication, a discussion of advance care planning, and an overview of end-of-life care.
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Baykal D, Çömlekçi N. Non-Pharmacologic Approaches to Sleep Problems for Palliative Care Cancer Patients: A Systematic Review. FLORENCE NIGHTINGALE JOURNAL OF NURSING 2023; 31:131-137. [PMID: 37404216 PMCID: PMC10440962 DOI: 10.5152/fnjn.2023.23051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/19/2023] [Indexed: 07/06/2023]
Abstract
OBJECTIVE This present systematic review aims to examine the effectiveness of non-pharmacological approaches to sleep problems for cancer patients in palliative care. METHOD In this review, the data of the last 5 years from 2018 to 2023 are included in Scopus, Web of Science, CINAHL, PubMed, Medline, Ulakbim National Database and Cochrane Library databases were scanned using the keywords "palliative care, sleep disorder, non-pharmacologic, insomnia, cancer, randomized controlled trial" in English and Turkish. As a result of the search, we identified 90 articles. This review was based on Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols 2015 Statement recommendations. RESULTS This current review comprised 5 randomized controlled trials. The included studies were found to examine methods such as aromatherapy, massage, therapeutic touch, and white light, leaving out other methods (sleep hygiene, exercise, etc.), which are effective in treating insomnia. We established that the methods discussed in these studies were highly effective in improving sleep quality. CONCLUSION Non-pharmacological methods for treating sleep problems in cancer patients in palliative care have been shown to be effective. We consider it important that nurses were involved in these studies. On the other hand, we would recommend that studies be conducted to evaluate the effect of other nonpharmacologic methods on sleep problems.
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Affiliation(s)
- Dilek Baykal
- Department of Nursing, Faculty of Health Sciences, Istanbul Atlas University, Istanbul, Turkey
| | - Necmiye Çömlekçi
- Department of Nursing, Faculty of Health Sciences, Bartın University, Bartın, Turkey
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3
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Zhang R, Wang DM, Liu YL, Tian ML, Zhu L, Chen J, Zhang J. Symptom management in adult brain tumours: A literature review. Nurs Open 2023. [PMID: 37120840 DOI: 10.1002/nop2.1795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 04/11/2023] [Accepted: 04/17/2023] [Indexed: 05/02/2023] Open
Abstract
AIM To review the literature related to symptom management, clinical significance and related theoretical framework systems in adult patients with brain tumours. BACKGROUND As understanding of symptoms or symptom clusters and underlying biologic mechanisms has grown, it is apparent that symptom science is moving forward. Although some progress has been made in the symptom science of solid tumours such as breast and lung neoplasms, insufficient attention has been paid to symptom management for patients suffering from brain tumours. Further research is needed to achieve effective symptom management for these patients. DESIGN A literature review with a systematic search of symptom management in adult brain tumours. METHODS Electronic data bases were searched to obtain relevant published literature on symptom management in adults with brain tumours. This was then analysed and a synthesis of relevant findings is presented. FINDINGS Four significant general themes relating to symptom management of brain tumours in adults were identified: (1) The potential theoretical foundation related to symptom management was revealed. (2) Widely accepted validated scales or questionnaires for the assessment of single symptoms or symptom clusters were recommended. (3) Several symptom clusters and the underlying biologic mechanisms have been reported. (4) Specific symptom interventions for adults with brain tumours were collected and classified as evidence-based or insufficient evidence. CONCLUSION There are still many challenges in the effective management of symptoms in adults with brain tumours. The guiding role of theoretical frameworks or models related to symptom management should be utilized in future research. Using the concept of symptom clustering for research into symptoms found in patients with brain tumours, exploring common biological mechanisms for specific symptom clusters and making full use of modern big data resources to build a strong evidence base for an effective intervention or management program may inform the management of symptoms among these patients leading to better results. NO PATIENT OR PUBLIC CONTRIBUTION This is a literature review. IMPLICATIONS FOR SYMPTOM MANAGEMENT The ultimate goal is obviously not only improving the survival rate of patients with brain tumours, but also enhancing their quality of life. Several important findings from our review include the theoretical foundations, validated assessment tools, the assessment of symptom clusters and the underlying biologic mechanism, and the identification of the evidence base for symptom interventions. These are of relevance for managers, researchers and practitioners and may function as a reference to help the effective symptom management for adults with brain tumours.
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Affiliation(s)
- Rong Zhang
- School of Nursing, Wuhan University, Wuhan, China
- Department of Neuro-Oncology Center, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Dong-Mei Wang
- Department of Neuro-Oncology Center, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Yong-Li Liu
- Nursing Department, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Man-Li Tian
- College of Nursing, Hubei University of Medicine, Shiyan, China
| | - Ling Zhu
- Department of Neuro-Oncology Center, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Jing Chen
- Department of Neuro-Oncology Center, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Jun Zhang
- School of Nursing, Wuhan University, Wuhan, China
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4
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Semko J, Al Ghriwati N, Winter M, Merchant TE, Crabtree VM. Sleep-related challenges and family functioning in children and adolescents previously treated for craniopharyngioma. J Psychosoc Oncol 2023; 42:32-47. [PMID: 37042637 DOI: 10.1080/07347332.2023.2197433] [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] [Indexed: 04/13/2023]
Abstract
PURPOSE We investigated sleep-related challenges and their association with family functioning in children and adolescents previously treated for craniopharyngioma. DESIGN Quantitative approach using psychometrically validated measures. SAMPLE Thirty-nine children and adolescents who had been treated for craniopharyngioma and their primary caregivers. METHODS Caregivers and youth completed measures of family functioning, family routines, daytime sleepiness, and children's sleep patterns. FINDINGS Children and adolescents with craniopharyngioma had significantly higher ratings of self-reported excessive daytime sleepiness, bedtime fears/worries, and restless legs symptoms compared to their relatively healthy peers. Lack of family routines and poor family functioning were related to poor sleep-related outcomes and increased excessive daytime sleepiness. IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS Providers should consider assessing sleep difficulties in pediatric brain tumor survivors from a family systems perspective. Intervening on family-related factors may help improve sleep and other health-related outcomes, whereas intervening on sleep may help improve family functioning.
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Affiliation(s)
- Joshua Semko
- Department of Psychology, The University of Mississippi, University, MS, USA
| | - Nour Al Ghriwati
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
- Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marcia Winter
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
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5
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Martin JA, Hart NH, Bradford N, Naumann F, Pinkham MB, Pinkham EP, Holland JJ. Prevalence and management of sleep disturbance in adults with primary brain tumours and their caregivers: a systematic review. J Neurooncol 2023; 162:25-44. [PMID: 36864318 PMCID: PMC10049936 DOI: 10.1007/s11060-023-04270-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 02/14/2023] [Indexed: 03/04/2023]
Abstract
PURPOSE The aims of this systematic review were to (1) examine the prevalence, severity, manifestations, and clinical associations/risk factors of sleep disturbance in primary brain tumour (PBT) survivors and their caregivers; and (2) determine whether there are any sleep-focused interventons reported in the literature pertaining to people affected by PBT. METHODS This systematic review was registered with the international register for systematic reviews (PROSPERO: CRD42022299332). PubMed, EMBASE, Scopus, PsychINFO, and CINAHL were electronically searched for relevant articles reporting sleep disturbance and/or interventions for managing sleep disturbance published between September 2015 and May 2022. The search strategy included terms focusing on sleep disturbance, primary brain tumours, caregivers of PBT survivors, and interventions. Two reviewers conducted the quality appraisal (JBI Critical Appraisal Tools) independently, with results compared upon completion. RESULTS 34 manuscripts were eligible for inclusion. Sleep disturbance was highly prevalent in PBT survivors with associations between sleep disturbance and some treatments (e.g., surgical resection, radiotherapy, corticosteroid use), as well as other prevalent symptoms (e.g., fatigue, drowsiness, stress, pain). While the current review was unable to find any sleep-targeted interventions, preliminary evidence suggests physical activity may elicit beneficial change on subjectively reported sleep disturbance in PBT survivors. Only one manuscript that discussed caregivers sleep disturbance was identified. CONCLUSIONS Sleep disturbance is a prevalent symptom experienced by PBT survivors, yet there is a distinct lack of sleep-focused interventions in this population. This includes a need for future research to include caregivers, with only one study identified. Future research exploring interventions directly focused on the management of sleep disturbance in the context of PBT is warranted.
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Affiliation(s)
- Jason A Martin
- Faculty of Health, School of Exercise and Nutrition Science, Queensland University of Technology, Brisbane, Australia.
| | - Nicolas H Hart
- Faculty of Health, School of Sport, Exercise and Rehabilitation, University of Technology Sydney (UTS), Sydney, Australia.,Faculty of Health, Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, Brisbane, Australia.,School of Medical and Health Sciences, Exercise Medicine Research Institute, Edith Cowan University, Perth, Australia.,College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Adelaide, Australia.,Institute for Health Research, The University of Notre Dame Australia, Perth, Australia.,Faculty of Health, Southern Cross University, Gold Coast, Australia
| | - Natalie Bradford
- Faculty of Health, Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, Brisbane, Australia
| | - Fiona Naumann
- Faculty of Health, Southern Cross University, Gold Coast, Australia
| | - Mark B Pinkham
- Radiation Oncology, Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Elizabeth P Pinkham
- Physiotherapy, Clinical Support Services, Princess Alexandra Hospital, Brisbane, Australia.,Faculty of Health, School of Nursing, Queensland University of Technology, Brisbane, Australia
| | - Justin J Holland
- Faculty of Health, School of Exercise and Nutrition Science, Queensland University of Technology, Brisbane, Australia
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6
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Zamanipoor Najafabadi AH, Dirven L, Drummond KJ, Taphoorn MJB. Health-Related Quality of Life in Intracranial Meningioma: Current Evidence and Future Directions. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1416:235-252. [PMID: 37432632 DOI: 10.1007/978-3-031-29750-2_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
Historically, largely due to the good prognosis for survival, there has been little attention paid to the possible impact of meningiomas and their treatment on health-related quality of life (HRQoL). However, in the last decade there has been increasing evidence that patients with intracranial meningiomas suffer from long-term decreases in their HRQoL. Compared with controls and normative data, meningioma patients have worse HRQoL scores both before and after intervention and continuing long term (even after >4 years of follow-up). Overall, surgery results in improvements in many aspects of HRQoL. The limited available studies investigating the impact of radiotherapy suggest that this type of treatment decreases HRQoL scores, especially in the long term. There is however only limited evidence on additional determinants of HRQoL. Patients with anatomically complex skull base meningiomas and severe comorbidities, including epilepsy, report the lowest HRQoL scores. Other tumor and sociodemographic characteristics have shown weak associations with HRQoL. Furthermore, about one-third of caregivers of meningioma patients report caregiver burden, warranting interventions to improve caregiver HRQoL. As antitumor interventions may not improve HRQoL scores to be comparable to those of the general population, more attention should be paid to the development of integrative rehabilitation and supportive care programs for meningioma patients.
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Affiliation(s)
- Amir H Zamanipoor Najafabadi
- University Neurosurgical Centre Holland, Leiden University Medical Center, Haaglanden Medical Center and Haga Teaching Hospital, Leiden and The Hague, the Netherlands.
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Katharine J Drummond
- Department of Neurosurgery, The Royal Melbourne Hospital, Department of Surgery, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia
| | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
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7
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King AL, Shuboni-Mulligan DD, Vera E, Crandon S, Acquaye AA, Boris L, Burton E, Choi A, Christ A, Grajkowska E, Jammula V, Leeper HE, Lollo N, Penas-Prado M, Reyes J, Theeler B, Wall K, Wu J, Gilbert MR, Armstrong TS. Exploring the prevalence and burden of sleep disturbance in primary brain tumor patients. Neurooncol Pract 2022; 9:526-535. [PMID: 36388423 PMCID: PMC9665069 DOI: 10.1093/nop/npac049] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND Sleep disturbance (SD) is common in patients with cancer and has been associated with worse clinical outcomes. This cross-sectional study explored the prevalence of SD in a primary brain tumor (PBT) population, identified associated demographic and clinical characteristics, and investigated co-occurrence of SD with other symptoms and mood disturbance. METHODS Demographic, clinical characteristics, MD Anderson Symptom Inventory-Brain Tumor, and Patient Reported Outcome Measurement Information System Depression and Anxiety Short-Forms were collected from PBT patients at study entry. Descriptive statistics, Chi-square tests, and independent t-tests were used to report results. RESULTS The sample included 424 patients (58% male, 81% Caucasian) with a mean age of 49 years (range 18-81) and 58% with high-grade gliomas. Moderate-severe SD was reported in 19% of patients and was associated with younger age, poor Karnofsky Performance Status, tumor progression on MRI, and active corticosteroid use. Those with moderate-severe SD had higher overall symptom burden and reported more moderate-severe symptoms. These individuals also reported higher severity in affective and mood disturbance domains, with 3 to 4 times higher prevalence of depressive and anxiety symptoms, respectively. The most frequently co-occurring symptoms with SD were, drowsiness, and distress, though other symptoms typically associated with tumor progression also frequently co-occurred. CONCLUSIONS PBT patients with moderate-severe SD are more symptomatic, have worse mood disturbance, and have several co-occurring symptoms. Targeting interventions for sleep could potentially alleviate other co-occurring symptoms, which may improve life quality for PBT patients. Future longitudinal work examining objective and detailed subjective sleep reports, as well as underlying genetic risk factors, will be important.
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Affiliation(s)
- Amanda L King
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Dorela D Shuboni-Mulligan
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Elizabeth Vera
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Sonja Crandon
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Alvina A Acquaye
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Lisa Boris
- Frederick National Laboratory for Cancer Research, Leidos Biomedical Research, Inc., Frederick, Maryland, USA
| | - Eric Burton
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Anna Choi
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Alexa Christ
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Ewa Grajkowska
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Varna Jammula
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Heather E Leeper
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Nicole Lollo
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Marta Penas-Prado
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Jennifer Reyes
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Brett Theeler
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Kathleen Wall
- Frederick National Laboratory for Cancer Research, Leidos Biomedical Research, Inc., Frederick, Maryland, USA
| | - Jing Wu
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Mark R Gilbert
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Terri S Armstrong
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
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8
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Secondary Narcolepsy as Worsening Sign in a Pediatric Case of Optic Pathway Glioma. CHILDREN 2022; 9:children9101455. [PMID: 36291391 PMCID: PMC9600478 DOI: 10.3390/children9101455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 09/15/2022] [Accepted: 09/20/2022] [Indexed: 12/01/2022]
Abstract
Narcolepsy, a neurologic disorder that leads to excessive daytime sleepiness, may represent a rare consequence of neoplastic lesions involving the sellar/parasellar and hypothalamic regions, the anatomical areas responsible for wakefulness. Optic pathway gliomas represent the most common neoplasm of these regions and present an excellent overall survival, while long-term neurologic impairments, such as visual loss, endocrinopathies, or sleep disorders, are the principal causes of morbidity. In this case report, we describe a non-NF1 patient suffering from a very extensive optical pathway glioma, who several years after the diagnosis in a radiological condition of stable disease, presented with severe narcolepsy, a rare complication, that led to the death of the patient.
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9
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Gall AJ, Shuboni-Mulligan DD. Keep Your Mask On: The Benefits of Masking for Behavior and the Contributions of Aging and Disease on Dysfunctional Masking Pathways. Front Neurosci 2022; 16:911153. [PMID: 36017187 PMCID: PMC9395722 DOI: 10.3389/fnins.2022.911153] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
Environmental cues (e.g., light-dark cycle) have an immediate and direct effect on behavior, but these cues are also capable of “masking” the expression of the circadian pacemaker, depending on the type of cue presented, the time-of-day when they are presented, and the temporal niche of the organism. Masking is capable of complementing entrainment, the process by which an organism is synchronized to environmental cues, if the cues are presented at an expected or predictable time-of-day, but masking can also disrupt entrainment if the cues are presented at an inappropriate time-of-day. Therefore, masking is independent of but complementary to the biological circadian pacemaker that resides within the brain (i.e., suprachiasmatic nucleus) when exogenous stimuli are presented at predictable times of day. Importantly, environmental cues are capable of either inducing sleep or wakefulness depending on the organism’s temporal niche; therefore, the same presentation of a stimulus can affect behavior quite differently in diurnal vs. nocturnal organisms. There is a growing literature examining the neural mechanisms underlying masking behavior based on the temporal niche of the organism. However, the importance of these mechanisms in governing the daily behaviors of mammals and the possible implications on human health have been gravely overlooked even as modern society enables the manipulation of these environmental cues. Recent publications have demonstrated that the effects of masking weakens significantly with old age resulting in deleterious effects on many behaviors, including sleep and wakefulness. This review will clearly outline the history, definition, and importance of masking, the environmental cues that induce the behavior, the neural mechanisms that drive them, and the possible implications for human health and medicine. New insights about how masking is affected by intrinsically photosensitive retinal ganglion cells, temporal niche, and age will be discussed as each relates to human health. The overarching goals of this review include highlighting the importance of masking in the expression of daily rhythms, elucidating the impact of aging, discussing the relationship between dysfunctional masking behavior and the development of sleep-related disorders, and considering the use of masking as a non-invasive treatment to help treat humans suffering from sleep-related disorders.
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Affiliation(s)
- Andrew J. Gall
- Department of Psychology and Neuroscience Program, Hope College, Holland, MI, United States
- *Correspondence: Andrew J. Gall,
| | - Dorela D. Shuboni-Mulligan
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
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10
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Shuboni-Mulligan DD, Young D, De La Cruz Minyety J, Briceno N, Celiku O, King AL, Munasinghe J, Wang H, Adegbesan KA, Gilbert MR, Smart DK, Armstrong TS. Histological analysis of sleep and circadian brain circuitry in cranial radiation-induced hypersomnolence (C-RIH) mouse model. Sci Rep 2022; 12:11131. [PMID: 35778467 PMCID: PMC9249744 DOI: 10.1038/s41598-022-15074-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 06/17/2022] [Indexed: 11/24/2022] Open
Abstract
Disrupted sleep, including daytime hypersomnolence, is a core symptom reported by primary brain tumor patients and often manifests after radiotherapy. The biological mechanisms driving the onset of sleep disturbances after cranial radiation remains unclear but may result from treatment-induced injury to neural circuits controlling sleep behavior, both circadian and homeostatic. Here, we develop a mouse model of cranial radiation-induced hypersomnolence which recapitulates the human experience. Additionally, we used the model to explore the impact of radiation on the brain. We demonstrated that the DNA damage response following radiation varies across the brain, with homeostatic sleep and cognitive regions expressing higher levels of γH2AX, a marker of DNA damage, than the circadian suprachiasmatic nucleus (SCN). These findings were supported by in vitro studies comparing radiation effects in SCN and cortical astrocytes. Moreover, in our mouse model, MRI identified structural effects in cognitive and homeostatic sleep regions two-months post-treatment. While the findings are preliminary, they suggest that homeostatic sleep and cognitive circuits are vulnerable to radiation and these findings may be relevant to optimizing treatment plans for patients.
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Affiliation(s)
| | - Demarrius Young
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Nicole Briceno
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Orieta Celiku
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Amanda L King
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jeeva Munasinghe
- Mouse Imaging Facility, National Institute of Neurological Disorder and Stroke, NIH, Bethesda, MD, USA
| | - Herui Wang
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kendra A Adegbesan
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mark R Gilbert
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - DeeDee K Smart
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Terri S Armstrong
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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11
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Jarabo P, Barredo CG, de Pablo C, Casas-Tinto S, Martin FA. Alignment between glioblastoma internal clock and environmental cues ameliorates survival in Drosophila. Commun Biol 2022; 5:644. [PMID: 35773327 PMCID: PMC9247055 DOI: 10.1038/s42003-022-03600-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 06/17/2022] [Indexed: 11/09/2022] Open
Abstract
Virtually every single living organism on Earth shows a circadian (i.e. "approximately a day") internal rhythm that is coordinated with planet rotation (i.e. 24 hours). External cues synchronize the central clock of the organism. Consequences of biological rhythm disruptions have been extensively studied on cancer. Still, mechanisms underlying these alterations, and how they favor tumor development remain largely unknown. Here, we show that glioblastoma-induced neurodegeneration also causes circadian alterations in Drosophila. Preventing neurodegeneration in all neurons by genetic means reestablishes normal biological rhythms. Interestingly, in early stages of tumor development, the central pacemaker lengthens its period, whereas in later stages this is severely disrupted. The re-adjustment of the external light:dark period to longer glioblastoma-induced internal rhythms delays glioblastoma progression and ameliorates associated deleterious effects, even after the tumor onset.
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Affiliation(s)
| | | | - Carmen de Pablo
- Cajal Institute (CSIC), Av Dr Arce 37, 28002, Madrid, Spain.,Drosophila Models for Human Disease Unit, Instituto de Salud Carlos III-IIER, 28220, Madrid, Spain
| | - Sergio Casas-Tinto
- Cajal Institute (CSIC), Av Dr Arce 37, 28002, Madrid, Spain. .,Drosophila Models for Human Disease Unit, Instituto de Salud Carlos III-IIER, 28220, Madrid, Spain.
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12
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Sparasci D, Napoli I, Rossi L, Pereira-Mestre R, Manconi M, Treglia G, Marandino L, Ottaviano M, Turco F, Mangan D, Gillessen S, Vogl UM. Prostate Cancer and Sleep Disorders: A Systematic Review. Cancers (Basel) 2022; 14:cancers14071784. [PMID: 35406556 PMCID: PMC8997021 DOI: 10.3390/cancers14071784] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/23/2022] [Accepted: 03/29/2022] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Longer survival times for prostate cancer patients due to efficient treatments consisting of local radiotherapy, prostatectomy and androgen-deprivation therapy, as well as androgen-receptor-targeted agents, increases the importance of side effect management. Sleep disturbances are higher in this group than the general population and no clear mechanism(s) explains this. This systematic review finds a reported effect in 14 of 16 included studies on sleep quality changes for these patients. All reported treatments showed some kind of negative effect on sleep quality, including ADT. Limitations are discussed and recommendations made for progressing the understanding and then for mitigation strategies of these side effects. Abstract Prostate cancer (PCa) treatment involves multiple strategies depending on the disease’s stage. Androgen deprivation therapy (ADT) remains the gold standard for advanced and metastatic stages. Sleep quality has been suggested as being additionally influenced also by local radiotherapy, prostatectomy and androgen-receptor (AR)-targeted agents. We performed a systematic review exploring the landscape of studies published between 1 January 1990 and 31 July 2021, investigating sleep disturbances in PCa patients receiving active treatments, including the influence of hormonal therapy on sleep quality as a factor affecting their quality of life. Out of 45 articles identified, 16 studies were selected, which recruited patients with PCa, undergoing active treatment in either a prospective longitudinal or cross-sectional study. Development of sleep disorders or changes in sleep quality were reported in 14 out of 16 trials included. Only five trials included objective measurements such as actigraphy, mostly at one time point and without a baseline assessment. Limitations to be addressed are the small number of existing trials, lack of randomized trials and heterogeneity of methodologies used. This systematic review outlines the lack of prospective trials investigating sleep disorders, with a rigorous methodology, in homogeneous cohorts of PCa patients. Future trials are needed to clarify the prevalence and impact of this side effect of PCa treatments.
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Affiliation(s)
- Davide Sparasci
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland; (D.S.); (M.M.)
| | - Ilenia Napoli
- Oncology Institute of Southern Switzerland (IOSI), Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland; (I.N.); (L.R.); (R.P.-M.); (L.M.); (M.O.); (F.T.); (D.M.); (S.G.)
- Radiation Oncology Unit, Department of Biomedical, Dental Science, Morphological and Functional Imaging, University Hospital Messina, 98122 Messina, Italy
| | - Lorenzo Rossi
- Oncology Institute of Southern Switzerland (IOSI), Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland; (I.N.); (L.R.); (R.P.-M.); (L.M.); (M.O.); (F.T.); (D.M.); (S.G.)
| | - Ricardo Pereira-Mestre
- Oncology Institute of Southern Switzerland (IOSI), Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland; (I.N.); (L.R.); (R.P.-M.); (L.M.); (M.O.); (F.T.); (D.M.); (S.G.)
- Institute of Oncology Research (IOR), 6500 Bellinzona, Switzerland
| | - Mauro Manconi
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland; (D.S.); (M.M.)
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland;
- Department of Neurology, University Hospital Inselspital, 3010 Bern, Switzerland
| | - Giorgio Treglia
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland;
- Academic Education, Research and Innovation Area, General Directorate, Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, 1005 Lausanne, Switzerland
| | - Laura Marandino
- Oncology Institute of Southern Switzerland (IOSI), Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland; (I.N.); (L.R.); (R.P.-M.); (L.M.); (M.O.); (F.T.); (D.M.); (S.G.)
- Department of Medical Oncology, IRCCS San Raffaele Hospital, 20132 Milan, Italy
| | - Margaret Ottaviano
- Oncology Institute of Southern Switzerland (IOSI), Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland; (I.N.); (L.R.); (R.P.-M.); (L.M.); (M.O.); (F.T.); (D.M.); (S.G.)
- Department of Clinical Medicine and Surgery, University Federico II of Naples, 80138 Naples, Italy
| | - Fabio Turco
- Oncology Institute of Southern Switzerland (IOSI), Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland; (I.N.); (L.R.); (R.P.-M.); (L.M.); (M.O.); (F.T.); (D.M.); (S.G.)
- Department of Oncology, Division of Medical Oncology, University of Turin San Luigi Gonzaga Hospital, Regione Gonzole, 10043 Orbassano, Italy
| | - Dylan Mangan
- Oncology Institute of Southern Switzerland (IOSI), Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland; (I.N.); (L.R.); (R.P.-M.); (L.M.); (M.O.); (F.T.); (D.M.); (S.G.)
- Division of Population Health, University of Manchester, Manchester M13 9PL, UK
| | - Silke Gillessen
- Oncology Institute of Southern Switzerland (IOSI), Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland; (I.N.); (L.R.); (R.P.-M.); (L.M.); (M.O.); (F.T.); (D.M.); (S.G.)
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland;
| | - Ursula Maria Vogl
- Oncology Institute of Southern Switzerland (IOSI), Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland; (I.N.); (L.R.); (R.P.-M.); (L.M.); (M.O.); (F.T.); (D.M.); (S.G.)
- Correspondence:
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Non-Canonical Cannabinoid Receptors with Distinct Binding and Signaling Properties in Prostate and Other Cancer Cell Types Mediate Cell Death. Int J Mol Sci 2022; 23:ijms23063049. [PMID: 35328467 PMCID: PMC8954350 DOI: 10.3390/ijms23063049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 03/04/2022] [Accepted: 03/05/2022] [Indexed: 02/01/2023] Open
Abstract
Cannabinoids exert anti-cancer actions; however, the underlying cytotoxic mechanisms and the cannabinoid receptors (CBRs) involved remain unclear. In this study, CBRs were characterized in several cancer cell lines. Radioligand binding screens surprisingly revealed specific binding only for the non-selective cannabinoid [3H]WIN-55,212-2, and not [3H]CP-55,940, indicating that the expressed CBRs exhibit atypical binding properties. Furthermore, [3H]WIN-55,212-2 bound to a single site in all cancer cells with high affinity and varying densities. CBR characteristics were next compared between human prostate cancer cell lines expressing low (PC-3) and high (DU-145) CBR density. Although mRNA for canonical CBRs was detected in both cell lines, only 5 out of 15 compounds with known high affinity for canonical CBRs displaced [3H]WIN-55,212-2 binding. Functional assays further established that CBRs in prostate cancer cells exhibit distinct signaling properties relative to canonical Gi/Go-coupled CBRs. Prostate cancer cells chronically exposed to both CBR agonists and antagonists/inverse agonists produced receptor downregulation, inconsistent with actions at canonical CBRs. Treatment of DU-145 cells with CBR ligands increased LDH-release, decreased ATP-dependent cell viability, and produced mitochondrial membrane potential depolarization. In summary, several cancer cell lines express CBRs with binding and signaling profiles dissimilar to canonical CBRs. Drugs selectively targeting these atypical CBRs might exhibit improved anti-cancer properties.
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Crooms RC, Johnson MO, Leeper H, Mehta A, McWhirter M, Sharma A. Easing the Journey-an Updated Review of Palliative Care for the Patient with High-Grade Glioma. Curr Oncol Rep 2022; 24:501-515. [PMID: 35192120 DOI: 10.1007/s11912-022-01210-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 12/26/2022]
Abstract
PURPOSE OF REVIEW High-grade gliomas (HGG) are rare brain tumors that cause disproportionate suffering and mortality. Palliative care, whose aim is to relieve the symptoms and stressors of serious illness, may benefit patients with HGG and their families. In this review, we summarize the extant literature and provide recommendations for addressing the symptom management and communication needs of brain tumor patients and their caregivers at key points in the illness trajectory: initial diagnosis; during upfront treatment; disease recurrence; end-of-life period; and after death during bereavement. RECENT FINDINGS Patients with HGG experience highly intrusive symptoms, cognitive and functional decline, and emotional and existential distress throughout the disease course. The caregiver burden is also substantial during the patient's illness and after death. There is limited evidence to guide the palliative management of these issues. Palliative care is likely to benefit patients with HGG, yet further research is needed to optimize the delivery of palliative care in neuro-oncology.
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Affiliation(s)
- Rita C Crooms
- Department of Neurology, Icahn School of Medicine at Mount Sinai, 1468 Madison Ave, 1052, NY, 10029, New York, USA.,Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Margaret O Johnson
- Department of Neurosurgery, Duke University Medical Center, Trent Drive 047 Baker House, Durham, NC, 27710, USA.,The Preston Robert Tirsch Brain Tumor Center, Duke University Medical Center, Trent Drive 047 Baker House, NC, 27710, Durham, USA
| | - Heather Leeper
- Neuro-Oncology Branch, National Institutes of Health, National Cancer Institute, 9030 Old Georgetown Rd, Bloch Bldg 82, Bethesda, MD, 20892, USA
| | - Ambereen Mehta
- Palliative Care Program, Division of Medicine, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, 21224, MD, USA.,Division of Medicine, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, 21224, MD, USA
| | - Michelle McWhirter
- Palliative Care Program, Division of Medicine, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, 21224, MD, USA.,Department of Social Work, Johns Hopkins Bayview Medical Center, Baltimore, 21224, MD, USA
| | - Akanksha Sharma
- Department of Translational Neurosciences, Pacific Neuroscience Institute/Saint John's Cancer Institute, 2200 Santa Monica Blvd, Santa Monica, CA, 90404, USA.
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Romigi A, Feola T, Cappellano S, De Angelis M, Pio G, Caccamo M, Testa F, Vitrani G, Centonze D, Colonnese C, Esposito V, Jaffrain-Rea ML. Sleep Disorders in Patients With Craniopharyngioma: A Physiopathological and Practical Update. Front Neurol 2022; 12:817257. [PMID: 35222233 PMCID: PMC8863754 DOI: 10.3389/fneur.2021.817257] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 12/28/2021] [Indexed: 12/11/2022] Open
Abstract
Sleep disorders (SDs) represent an important issue in patients with craniopharyngioma (CP). Nearly 70% of these patients complain of sleep-wake cycle alterations and/or excessive diurnal somnolence due to sleep-related breathing disorders, such as obstructive sleep apnea (OSA) and/or central hypersomnia, including secondary narcolepsy. SDs may severely reduce quality of life, increase disease-related cardiorespiratory and cardiovascular morbidity, and finally play a major role in increased long-term mortality reported on patients with CP. A major risk factor for SDs is represented by the hypothalamic syndrome, which may develop because of direct hypothalamic damage by the tumor itself and/or complications of the treatments, neurosurgery and/or radiotherapy, and typically includes permanent neuroendocrine dysfunctions, morbid obesity, and secondary metabolic disorders. Despite increasing attention to SDs in the general population, and in particular to OSA as a risk factor for cardio-metabolic diseases and excessive daytime somnolence, sleep evaluation is still not routinely proposed to patients with CP. Hence, SDs are often underdiagnosed and undertreated. The aim of this paper is to update current knowledge of the pathogenesis and prevalence of SDs in patients with CP and propose practical algorithms for their evaluation and management in clinical practice. Particular attention is paid to screening and diagnostic tools for appropriate characterization of SDs, identification of risk factors, and potential role of hypothalamic sparing surgery in the prevention of morbid obesity and SDs. Available tools in sleep medicine, including lifestyle interventions, drugs, and respiratory devices, are discussed, as well as the importance of optimal hormone replacement and metabolic interventions. Current limits in the diagnosis and treatment of SDs in patients with CP and possible future avenues for research agenda are also considered.
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Affiliation(s)
- Andrea Romigi
- Neuromed Institute, Istituto di Ricovero e Cura a Carattere Scientifico, Pozzilli, Italy
| | - Tiziana Feola
- Neuromed Institute, Istituto di Ricovero e Cura a Carattere Scientifico, Pozzilli, Italy
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Simone Cappellano
- Neuromed Institute, Istituto di Ricovero e Cura a Carattere Scientifico, Pozzilli, Italy
| | | | - Giacomo Pio
- Neuromed Institute, Istituto di Ricovero e Cura a Carattere Scientifico, Pozzilli, Italy
| | - Marco Caccamo
- Neuromed Institute, Istituto di Ricovero e Cura a Carattere Scientifico, Pozzilli, Italy
| | - Federica Testa
- Neuromed Institute, Istituto di Ricovero e Cura a Carattere Scientifico, Pozzilli, Italy
| | - Giuseppe Vitrani
- Neuromed Institute, Istituto di Ricovero e Cura a Carattere Scientifico, Pozzilli, Italy
| | - Diego Centonze
- Neuromed Institute, Istituto di Ricovero e Cura a Carattere Scientifico, Pozzilli, Italy
| | - Claudio Colonnese
- Neuromed Institute, Istituto di Ricovero e Cura a Carattere Scientifico, Pozzilli, Italy
| | - Vincenzo Esposito
- Neuromed Institute, Istituto di Ricovero e Cura a Carattere Scientifico, Pozzilli, Italy
- Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Marie-Lise Jaffrain-Rea
- Neuromed Institute, Istituto di Ricovero e Cura a Carattere Scientifico, Pozzilli, Italy
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
- *Correspondence: Marie-Lise Jaffrain-Rea
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Miklja Z, Gabel N, Altshuler D, Wang L, Hervey-Jumper SL, Smith S. Exercise improves health-related quality of life sleep and fatigue domains in adult high- and low-grade glioma patients. Support Care Cancer 2022; 30:1493-1500. [PMID: 34532753 PMCID: PMC10182824 DOI: 10.1007/s00520-021-06566-2] [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: 06/02/2021] [Accepted: 09/09/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE The impact of exercise on health-related quality of life (HRQOL) in patients with glioma remains unknown. We hypothesized that glioma patients with low exercise tolerance experience more distress in HRQOL sleep and fatigue domains than patients with high tolerance to exercise. METHODS Thirty-eight male and female patients with low- or high-grade glioma treated at a single tertiary care institution participated. Patients completed a validated telephone survey to determine their exercise habits before and following diagnosis. An unpaired t-test was run to measure the interaction between exercise tolerances on HRQOL functional and impairment domains. RESULTS Those with low pre-morbid physical activity levels had more distress in HRQOL sleep and fatigue domains. The effects were independent of plasma brain-derived neurotrophic factor (BDNF) levels and the degree of exercise did not appear to impact plasma BDNF in adult glioma patients. CONCLUSIONS The aim of this study was to examine the significance of exercise habits on perioperative functional outcomes in patients with low-grade or high-grade glioma. We found that glioma patients with low tolerance to exercise had more sleep disturbances and greater fatigue than glioma patients with high tolerance to exercise. Furthermore, exercise tolerance in the adult glioma population does not appear to impact plasma BDNF secretion.
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Affiliation(s)
- Zachary Miklja
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Nicolette Gabel
- Department of Physical Medicine and Rehabilitation, University of Michigan, 325 E Eisenhower Pkwy, Ste 100, Ann Arbor, MI, USA
| | - David Altshuler
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Lin Wang
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | | | - Sean Smith
- Department of Physical Medicine and Rehabilitation, University of Michigan, 325 E Eisenhower Pkwy, Ste 100, Ann Arbor, MI, USA.
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A multidisciplinary perspective on the complex interactions between sleep, circadian, and metabolic disruption in cancer patients. Cancer Metastasis Rev 2021; 40:1055-1071. [PMID: 34958429 PMCID: PMC8825432 DOI: 10.1007/s10555-021-10010-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/08/2021] [Indexed: 01/24/2023]
Abstract
Sleep is a basic need that is frequently set aside in modern societies. This leads to profound but complex physiological maladaptations in the body commonly referred to as circadian disruption, which recently has been characterized as a carcinogenic factor and reason for poor treatment outcomes, shortened survival, and reduced quality of life in cancer patients. As sleep and circadian physiology in cancer patients spans several disciplines including nursing science, neurology, oncology, molecular biology and medical technology, there is a lack of comprehensive and integrated approaches to deal with this serious and growing issue and at best a fractionated understanding of only part of the problem among researchers within each of these segments. Here, we take a multidisciplinary approach to comprehensively review the diagnosis and impact of sleep and circadian disruption in cancer patients. We discuss recent discoveries on molecular regulation of the circadian clock in healthy and malignant cells, the neurological and endocrine pathways controlling sleep and circadian rhythmicity, and their inputs to and outputs from the organism. The benefits and drawbacks of the various technologies, devices, and instruments used to assess sleep and circadian function, as well as the known consequences of sleep disruption and how sleep can be corrected in cancer patients, will be analyzed. We will throughout the review highlight the extensive crosstalk between sleep, circadian rhythms, and metabolic pathways involved in malignancy and identify current knowledge gaps and barriers for addressing the issue of sleep and circadian disruption in cancer patients. By addressing these issues, we hope to provide a foundation for further research as well as better and more effective care for the patients in the future.
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Sheikh IN, Roth M, Stavinoha PL. Prevalence of Sleep Disturbances in Pediatric Cancer Patients and Their Diagnosis and Management. CHILDREN (BASEL, SWITZERLAND) 2021; 8:1100. [PMID: 34943294 PMCID: PMC8700400 DOI: 10.3390/children8121100] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/19/2021] [Accepted: 11/23/2021] [Indexed: 12/27/2022]
Abstract
Sleep disturbances represent an understudied yet common source of distress among pediatric cancer patients and survivors, with deleterious effects on quality of life. Sleep issues stem from multiple risk factors, yet individual contributors are difficult to isolate, consequently impeding the identification of targets for intervention. In many pediatric cancer patients, disrupted sleep and its negative impact on quality of life continue into adulthood and may affect various functional domains. This literature review highlights the types and prevalence of sleep disturbances in pediatric cancer patients during active treatment and through survivorship. Potential etiological and risk factors for disturbed sleep are summarized, including the effects of cancer and its treatment, psychosocial and family factors, as well as individual-patient aspects, such as genetics, mood and coping skills. While existing assessment and management strategies are reviewed, the literature is incomplete, and significant gaps emerge in our understanding of sleep disturbances in pediatric cancer patients and survivors. The review concludes with recommendations of areas where further research is needed. The aims of this review include increasing clinicians' awareness of sleep disturbances as a significant source of poor quality of life in pediatric cancer patients and survivors and directing researchers to gaps in our understanding of sleep disturbances in pediatric cancer patients and survivors.
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Affiliation(s)
- Irtiza N. Sheikh
- Division of Pediatrics and Patient Care, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA;
| | | | - Peter L. Stavinoha
- Division of Pediatrics and Patient Care, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA;
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Zhang D, Wang J, Gu X, Gu Z, Li L, Dong C, Zhao R, Zhang X. Prevalence, correlates, and impact of sleep disturbance in Chinese meningioma patients. Support Care Cancer 2021; 30:1231-1241. [PMID: 34458943 DOI: 10.1007/s00520-021-06504-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 08/09/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Sleep disturbance is common in meningioma patients and may lead to disease aggravation and decreases health-related quality of life (HRQoL). However, the sleep quality of meningioma patients newly diagnosed and ready for surgery has not been well clarified in China. This study aims to evaluate the prevalence, correlates, and impact of sleep disturbance among Chinese meningioma patients. METHODS In this cross-sectional study, meningioma patients were recruited from the Affiliated Hospital of Nantong University from January 2020 to November 2020. A series of questionnaires were applied: the 0-10 Numerical Rating Scale (NRS), the Hospital Anxiety and Depression Scale (HADS), the Multidimensional Fatigue Inventory (MFI-20), the Epworth Sleepiness Scale (ESS), the Short-Form 36 (SF-36), the Pittsburgh Sleep Quality Index (PSQI). Independent samples t test, Mann-Whitney U test, chi-square analysis, Pearson/Spearman correlation, and binary logistic regression were used to analyze the data. RESULTS One hundred meningioma patients completed the questionnaires. Sleep disturbance affected 43% of the meningioma patients and was linked to many concomitant symptoms, such as headache, fatigue, anxiety, and depression. Binary logistic regression indicated that fatigue and headache were independently associated with sleep disturbance of meningioma patients. Meanwhile, severe sleep disturbance led to lower quality of life. CONCLUSIONS These findings demonstrated that a considerable number of meningioma patients newly diagnosed and ready for surgery suffered from sleep disturbance, potentially contributing to impair HRQoL. Medical personnel should pay more attention to meningioma patients with sleep disturbance and take effective measures to improve sleep quality, with the ultimate goal to improve their HRQoL.
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Affiliation(s)
- Dandan Zhang
- Department of Nursing, Affiliated Hospital of Nantong University, Nantong University, 20th Xisi Road, Nantong, 226001, China
- Department of Neurosurgery, Affiliated Hospital of Nantong University, Nantong University, 20th Xisi Road, Nantong, 226001, China
| | - Jing Wang
- Department of Medical Image, Affiliated Hospital of Nantong University, 20th Xisi Road, Nantong, 226001, China
| | - Xixi Gu
- Department of Nursing, Affiliated Hospital of Nantong University, Nantong University, 20th Xisi Road, Nantong, 226001, China
| | - Zhifeng Gu
- Department of Rheumatology, Affiliated Hospital of Nantong University, 20th Xisi Road, Nantong, 226001, China
| | - Liren Li
- Department of Gastroenterology, Affiliated Hospital of Nantong University, 20th Xisi Road, Nantong, 226001, China
| | - Chen Dong
- Department of Nursing, Affiliated Hospital of Nantong University, Nantong University, 20th Xisi Road, Nantong, 226001, China
- Department of Rheumatology, Affiliated Hospital of Nantong University, 20th Xisi Road, Nantong, 226001, China
| | - Rui Zhao
- Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, 20th Xisi Road, Nantong, 226001, China.
| | - Xiaomei Zhang
- Department of Neurosurgery, Affiliated Hospital of Nantong University, Nantong University, 20th Xisi Road, Nantong, 226001, China.
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Willis KD, Ravyts SG, Lanoye A, Loughan AR. Sleep disturbance in primary brain tumor: prevalence, risk factors, and patient preferences. Support Care Cancer 2021; 30:741-748. [PMID: 34368887 PMCID: PMC8349701 DOI: 10.1007/s00520-021-06476-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 07/27/2021] [Indexed: 10/31/2022]
Abstract
PURPOSE Primary brain tumor (PBT) patients report sleep disturbance due to their disease and treatment, yet few studies have utilized validated measures to understand the extent of patients' concerns and preferences for treatment. The purpose of this quality improvement project was to determine the prevalence and associated risk factors of sleep disturbance among PBT patients in our clinic and to evaluate interest in treatment for sleep disturbance. METHODS PBT patients completed validated measures of sleep disturbance and health during routine neuro-oncology visits. Patients also reported on sleep-related symptom management and their preferences for pharmacological and/or behavioral treatment. RESULTS Sleep disturbance was common, with 61.5% of PBT patients (N = 119; Mage = 52.60 years; 50% male) reporting poor sleep quality and 21.5% endorsing symptoms of insomnia. Insomnia could be explained by increased fatigue and corticosteroid use; sleep quality could be explained by fatigue. Patients in our clinic with higher grade tumors, significant sleep disturbance, of minority racial/ethnic status, and those not already taking sleep medications were more likely to report their symptoms and were not well-addressed by their medical team. Patients indicated a similar interest in pharmacological and behavioral treatment, warranting the availability of both in our clinic. CONCLUSIONS Findings indicate a high prevalence of sleep disturbance in PBT patients, highlighting the need for increased screening, monitoring, and treatment in our neuro-oncology clinic. Future research would benefit from assessing the efficacy of behavioral treatments for sleep disturbance in this population.
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Affiliation(s)
- Kelcie D Willis
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Scott G Ravyts
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Autumn Lanoye
- Massey Cancer Center, Virginia Commonwealth University, VA, Richmond, USA.,Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Ashlee R Loughan
- Massey Cancer Center, Virginia Commonwealth University, VA, Richmond, USA. .,Department of Neurology, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA.
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IDH Inhibitors and Beyond: The Cornerstone of Targeted Glioma Treatment. Mol Diagn Ther 2021; 25:457-473. [PMID: 34095989 DOI: 10.1007/s40291-021-00537-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2021] [Indexed: 12/12/2022]
Abstract
Diffuse low-grade gliomas account for approximately 20% of all primary brain tumors, they arise from glial cells and show infiltrative growth without histological features of malignancy. Mutations of the IDH1 and IDH2 genes constitute a reliable molecular signature of low-grade gliomas and are the earliest driver mutations occurring during gliomagenesis, representing a relevant biomarker with diagnostic, prognostic, and predictive value. IDH mutations induce a neomorphic enzyme that converts α-ketoglutarate to the oncometabolite D-2-hydroxyglutarate, which leads to widespread effects on cellular epigenetics and metabolism. Currently, there are no approved molecularly targeted therapies and the standard treatment for low-grade gliomas consists of radiation therapy and chemotherapy, with rising concern about treatment-related toxicities. Targeting D-2-hydroxyglutarate is considered a novel attractive therapeutic approach for low-grade gliomas and the insights from clinical trials suggest that mutant-selective IDH inhibitors are the ideal candidates, with a favorable benefit/risk ratio. A pivotal question is whether blocking IDH neomorphic activity may activate alternative oncogenetic pathways, inducing acquired resistance to IDH inhibitors. Based on this rationale, combination therapies to enhance the antitumor activity of IDH inhibitors and approaches aimed at exploiting, rather than inhibiting, the metabolism of IDH-mutant cancer cells, such as poly (adenosine 5'-diphosphate-ribose) polymerase inhibitors, are emerging from preclinical research and clinical trials. In this review, we discuss the pivotal role of IDH mutations in gliomagenesis and the complex interactions between the genomic and epigenetic landscapes, providing an overview of how, in the last decade, therapeutic approaches for low-grade gliomas have evolved.
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Aoun R, Kaul M, Sahni A. Excessive daytime sleepiness due to brain tumor. J Clin Sleep Med 2021; 16:2117-2119. [PMID: 32900427 DOI: 10.5664/jcsm.8788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Raissa Aoun
- Department of Neurology, Lebanese American University Medical Center, Rizk Hospital, Beirut, Lebanon
| | - Malvika Kaul
- Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Ashima Sahni
- Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
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Shuboni-Mulligan DD, Young DL, De La Cruz Minyety J, Vera E, Munasinghe J, Gall AJ, Gilbert MR, Armstrong TS, Smart DK. Impact of age on the circadian visual system and the sleep-wake cycle in mus musculus. NPJ Aging Mech Dis 2021; 7:10. [PMID: 33947857 PMCID: PMC8096965 DOI: 10.1038/s41514-021-00063-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 03/11/2021] [Indexed: 02/06/2023] Open
Abstract
Age plays a critical role in disease development and tolerance to cancer treatment, often leading to an increased risk of developing negative symptoms including sleep disturbances. Circadian rhythms and sleep become disrupted as organisms age. In this study, we explored the behavioral alterations in sleep, circadian rhythms, and masking using a novel video system and interrogate the long-term impact of age-based changes in the non-image forming visual pathway on brain anatomy. We demonstrated the feasibility and utility of the novel system and establish that older mice have disruptions in sleep, circadian rhythms, and masking behaviors that were associated with major negative volume alterations in the non-imaging forming visual system, critical for the induction and rhythmic expression of sleep. These results provide important insights into a mechanism, showing brain atrophy is linked to age in distinct non-image forming visual regions, which may predispose older individuals to developing circadian and sleep dysfunction when further challenged by disease or treatment.
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Affiliation(s)
| | - Demarrius L Young
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Elizabeth Vera
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jeeva Munasinghe
- Mouse Imaging Facility, National Institute of Neurological Disorder and Stroke, NIH, Bethesda, MD, USA
| | - Andrew J Gall
- Department of Psychology and Neuroscience Program, Hope College, Holland, MI, USA
| | - Mark R Gilbert
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Terri S Armstrong
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - DeeDee K Smart
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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24
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Panciroli C, Esteve A, Muñoz-Ferrer A, Abad J, Hernandez JM, Balaña C, Lucente G, Comas S, Villà S. Prospective pilot study to explore the melatonin level in brain tumor patients undergoing radiotherapy. Sleep Breath 2021; 26:469-475. [PMID: 33825098 DOI: 10.1007/s11325-021-02365-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/07/2021] [Accepted: 03/26/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Our aim was to assess if the radiotherapy dose decreased the melatonin levels as well as the quality of life and sleep in brain tumor patients. METHODS We performed a follow-up study on melatonin levels in saliva and its urinary metabolite sulfatoxi-melatonine (STM) samples in patients with brain tumors treated with radiotherapy close to the pineal gland's area. We analyzed the cortisol, cortisone, and excrection of STM normalized by urinary creatinine. In some cases, a polysomnography (PSG) was performed. Quality of life questionnaires, distress scale, and sleepiness inventories were also administered. RESULTS We included twelve patients (experimental arm) and eight healthy controls (control group). No differences were observed between experimental arm and control group at baseline. No differences were detected in the experimental arm before and after delivering the radiotherapy. No clinically significant differences were found according to the radiotherapy dose delivered. CONCLUSION Melatonin levels and PSG outcomes do not change after receiving radiotherapy. The findings of this study do not show a statistically significant association between the treatment and the quality of life and sleep.
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Affiliation(s)
- Claudia Panciroli
- Medical Oncology Department, Catalan Institute of Oncology (ICO), Badalona (Barcelona), Catalonia, Spain.
| | - Anna Esteve
- Medical Oncology Department, Catalan Institute of Oncology (ICO), Badalona (Barcelona), Catalonia, Spain
| | - Aida Muñoz-Ferrer
- Sleep Disturbance Unit, Pulmonary Department, Germans Trias i Pujol University Hospital, Badalona (Barcelona), Catalonia, Spain
| | - Jorge Abad
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES); Pulmonary Department, Germans Trias i Pujol University Hospital, Badalona (Barcelona), Catalonia, Spain
| | - Jose Maria Hernandez
- Proteomic and Metabolomics Unit, Germans Trias i Pujol Institute (IGTP), Badalona (Barcelona), Catalonia, Spain
| | - Carmen Balaña
- Medical Oncology Department, Catalan Institute of Oncology (ICO), Badalona (Barcelona), Catalonia, Spain
| | - Giuseppe Lucente
- Neurology Service, Neuroscience Department, Germans Trias i Pujol University Hospital, Badalona (Barcelona), Catalonia, Spain
| | - Silvia Comas
- Radiation Oncology Department, Catalan Institute of Oncology (ICO), Badalona (Barcelona), Catalonia, Spain
| | - Salvador Villà
- Radiation Oncology Department, Catalan Institute of Oncology (ICO), Badalona (Barcelona), Catalonia, Spain
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25
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Ghandour F, Squassina A, Karaky R, Diab-Assaf M, Fadda P, Pisanu C. Presenting Psychiatric and Neurological Symptoms and Signs of Brain Tumors before Diagnosis: A Systematic Review. Brain Sci 2021; 11:301. [PMID: 33673559 PMCID: PMC7997443 DOI: 10.3390/brainsci11030301] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 02/24/2021] [Indexed: 12/20/2022] Open
Abstract
Brain tumors can present with various psychiatric symptoms, with or without neurological symptoms, an aspect that complicates the clinical picture. However, no systematic description of symptoms that should prompt a neurological investigation has been provided. This review aims to summarize available case reports describing patients with brain tumors showing psychiatric symptoms before brain tumor diagnosis, in order to provide a comprehensive description of these symptoms as well as their potential relationship with delay in the diagnosis. A systematic literature review on case reports of brain tumors and psychiatric symptoms from 1970 to 2020 was conducted on PubMed, Ovid, Psych Info, and MEDLINE. Exclusion criteria comprised tumors not included in the World Health Organization (WHO) Classification 4th edition and cases in which psychiatric symptoms were absent or followed the diagnosis. A total of 165 case reports were analyzed. In a subset of patients with brain tumors, psychiatric symptoms can be the only manifestation or precede focal neurological signs by months or even years. The appearance of focal or generalized neurological symptoms after, rather than along with, psychiatric symptoms was associated with a significant delay in the diagnosis in adults. A timely assessment of psychiatric symptoms might help to improve early diagnosis of brain tumors.
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Affiliation(s)
- Fatima Ghandour
- Department of Biomedical Sciences, Division of Neuroscience and Clinical Pharmacology, University of Cagliari, 09042 Monserrato, Italy; (F.G.); (A.S.); (C.P.)
- EDST, Pharmacology and Cancerology Laboratory, Faculty of Sciences, Lebanese University, Beirut 1500, Lebanon;
| | - Alessio Squassina
- Department of Biomedical Sciences, Division of Neuroscience and Clinical Pharmacology, University of Cagliari, 09042 Monserrato, Italy; (F.G.); (A.S.); (C.P.)
| | - Racha Karaky
- Drug-Related Sciences Department, Faculty of Pharmacy, Lebanese University, Hadath 1500, Lebanon;
| | - Mona Diab-Assaf
- EDST, Pharmacology and Cancerology Laboratory, Faculty of Sciences, Lebanese University, Beirut 1500, Lebanon;
| | - Paola Fadda
- Department of Biomedical Sciences, Division of Neuroscience and Clinical Pharmacology, University of Cagliari, 09042 Monserrato, Italy; (F.G.); (A.S.); (C.P.)
- Centre of Excellence “Neurobiology of Addiction”, University of Cagliari, 09042 Monserrato, Italy
- CNR Institute of Neuroscience-Cagliari, National Research Council, 09042 Monserrato, Italy
- National Institute of Neuroscience (INN), 10126 Turin, Italy
| | - Claudia Pisanu
- Department of Biomedical Sciences, Division of Neuroscience and Clinical Pharmacology, University of Cagliari, 09042 Monserrato, Italy; (F.G.); (A.S.); (C.P.)
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26
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Worrell SL, Kirschner ML, Shatz RS, Sengupta S, Erickson MG. Interdisciplinary Approaches to Survivorship with a Focus on the Low-grade and Benign Brain Tumor Populations. Curr Oncol Rep 2021; 23:19. [PMID: 33471214 PMCID: PMC7817573 DOI: 10.1007/s11912-020-01004-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW "Brain tumor is a bump in the road." Sheryl Crow a famous singer was quoted talking about her meningioma, a benign brain tumor that caused her to forget her lyrics. In this review, we focus on low-grade gliomas in adults and benign brain tumors, such as meningiomas, vestibular schwannomas, and pituitary tumors, since these individuals survive a long time and morbidity is a major issue. RECENT FINDINGS As per the NCI dictionary definition, cancer survivorship focuses on the health and well-being of a person with cancer from the time of diagnosis until the end of life. This includes the physical, mental, emotional, social, and financial effects of cancer that begin at diagnosis and continue through treatment and beyond. The survivorship experience also includes issues related to follow-up care (including regular health and wellness checkups), late effects of treatment, cancer recurrence, second cancers, and quality of life. Family members, friends, and caregivers are also considered part of the survivorship experience (NCI Dictionary: https://www.cancer.gov/publications/dictionaries/cancer-terms ).
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Affiliation(s)
- Stacey L Worrell
- Department of Neurology & Rehabilitation Medicine, University of Cincinnati, 234 Goodman St, Cincinnati, OH, 45219, USA
| | | | - Rhonna S Shatz
- Department of Neurology & Rehabilitation Medicine, University of Cincinnati, 234 Goodman St, Cincinnati, OH, 45219, USA
| | - Soma Sengupta
- Department of Neurology & Rehabilitation Medicine, University of Cincinnati, 234 Goodman St, Cincinnati, OH, 45219, USA.
| | - Melissa G Erickson
- Department of Family Medicine, University of Cincinnati, Cincinnati, OH, USA
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27
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Jeon MS, Agar MR, Koh ES, Nowak AK, Hovey EJ, Dhillon HM. Barriers to managing sleep disturbance in people with malignant brain tumours and their caregivers: a qualitative analysis of healthcare professionals' perception. Support Care Cancer 2021; 29:3865-3876. [PMID: 33386987 DOI: 10.1007/s00520-020-05970-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 12/22/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE This study explores healthcare professionals (HCPs)' perception and current management of sleep disturbance (SD) in people with malignant brain tumours and their caregivers. We aimed to identify barriers to effective management of SD in neuro-oncology care. METHODS We conducted semi-structured interviews with 11 HCPs involved in neuro-oncology care. The study was underpinned by the Capability Opportunity Motivation-Behaviour (COM-B) model within the Behavioural Change Wheel (BCW) guiding topic selection for the exploration of underlying processes of HCPs' behaviours and care decisions for SD management. Data were analysed thematically using a framework synthesis, and subsequently mapped onto the BCW to identify barriers for effective management and recommend potential interventions. RESULTS We identified four themes: HCPs' clinical opinions about SD, the current practice of SD management in neuro-oncology clinics, gaps in the current practice, and suggested areas for improvements. HCPs perceived SD as a prevalent yet secondary issue of low priority in neuro-oncology care. SD was unrecognised, and inadequately managed in usual clinical settings. Interventional options included modifying the use of corticosteroids or prescribing sedatives. When mapped onto the BCW, themes identified main barriers as a lack of awareness among HCPs about SD warranting care, due to the absence of screening tools and limited knowledge and resources for therapeutic interventions. CONCLUSIONS Multidisciplinary HCPs need training in the routine use of appropriate sleep assessment tools, and access to clear management pathways. More professional resources are needed to educate staff in implementing appropriate interventions for people with malignant brain tumours who are experiencing SD.
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Affiliation(s)
- Megan S Jeon
- South Western Sydney Clinical School, University of New South Wales, Liverpool, Australia.
| | - Meera R Agar
- South Western Sydney Clinical School, University of New South Wales, Liverpool, Australia
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, Sydney, Australia
- Ingham Institute for Applied Medical Research, Sydney, Australia
| | - Eng-Siew Koh
- South Western Sydney Clinical School, University of New South Wales, Liverpool, Australia
- Ingham Institute for Applied Medical Research, Sydney, Australia
- Department of Radiation Oncology, Liverpool Hospital, Liverpool, NSW, Australia
| | - Anna K Nowak
- Medical School, QEII Medical Centre Unit, University of Western Australia, Crawley, Australia
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA, Australia
| | - Elizabeth J Hovey
- University of New South Wales, Sydney, Australia
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, Australia
| | - Haryana M Dhillon
- Centre for Medical Psychology & Evidence-Based Decision-Making, University of Sydney, Sydney, Australia
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28
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Jeon MS, Agar MR, Koh ES, Nowak AK, Hovey EJ, Dhillon HM. Understanding sleep disturbance in the context of malignant brain tumors: a qualitative analysis. Neurooncol Pract 2020; 8:179-189. [PMID: 33898051 DOI: 10.1093/nop/npaa081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background Sleep is an important element in health-related quality of life of cancer patients and caregivers. This study aimed to explore the experience of sleep disturbance in people with malignant brain tumors (BT) and their family caregivers. Methods Participants were recruited from ambulatory neuro-oncology clinics. Semi-structured interviews were conducted with 24 patients (67% with high-grade gliomas) and 14 caregivers. Data were analyzed thematically using a framework synthesis. Results We identified six themes relating to perceptions of the nature, impact, causal factors, and interventions for sleep disturbance, beliefs about sleep and impact, and personal coping strategies. Participants described their sleep disturbance in terms of insomnia symptoms; most commonly difficulties initiating and maintaining sleep. Participants had varied views on causal factors including the BT diagnosis and treatment and caregiver burden. However, excessive thinking and BT-related anxiety were evident in both patients and caregivers. The described impact on daytime functioning due to non-restful sleep and fatigue appeared to be significant and many participants needed daytime naps, although they understated the impact on individual functioning. Some participants were reluctant to seek help from clinicians for sleep disturbance due to previous experiences where sleep disturbance was overlooked, or because they held negative views toward pharmacological interventions. Participants reported various coping strategies, ranging from relaxation-promoting techniques to behaviors to distract thinking at night that may instead disturb sleep. Conclusions Psychological factors contribute to sleep disturbance in patients with BT and caregivers. This population may benefit from information about sleep disturbance and interventions targeting anxiety.
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Affiliation(s)
- Megan S Jeon
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Meera R Agar
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia.,IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.,Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Eng-Siew Koh
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia.,Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.,Department of Radiation Oncology, Liverpool Hospital, Liverpool, NSW, Australia
| | - Anna K Nowak
- Medical School, QEII Medical Centre Unit, University of Western Australia, Crawley, WA, Australia.,Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Elizabeth J Hovey
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia
| | - Haryana M Dhillon
- Centre for Medical Psychology & Evidence-Based Decision-Making, University of Sydney, Sydney, NSW, Australia
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29
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Jaumally BA, Das A, Cassell NC, Pachecho GN, Majid R, Bashoura L, Balachandran DD, Faiz SA. Excessive daytime sleepiness in cancer patients. Sleep Breath 2020; 25:1063-1067. [PMID: 32939599 DOI: 10.1007/s11325-020-02151-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/15/2020] [Accepted: 07/17/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Excessive daytime sleepiness (EDS) is commonly reported in patients with cancer, and it is also a cardinal feature of central disorders of hypersomnolence. Multiple sleep latency testing (MSLT) is used for objective assessment. METHODS A retrospective review of patients with cancer history who underwent formal sleep evaluation and MSLT from 2006 to 2019 was performed. Clinical characteristics, sleep-related history, and polysomnographic data were reviewed. RESULTS Of 16 patients with cancer history, 9 were women (56%) and median age was 49. Cancer diagnoses included 4 central nervous system, 3 breast, 1 lymphoma, and 9 other solid malignancies, and 31% were undergoing active treatment. Comorbid conditions included depression, obstructive sleep apnea, and cancer-related fatigue. Daytime fatigue (94%), daily naps (81%), and EDS (69%) were the most common symptoms. Hypnopompic and hypnogogic hallucinations, sleep paralysis, sleep attacks, and cataplexy were present in a few. Epworth Sleepiness Scale scores were consistent with EDS in 88%, and mean sleep latency was less than 8 min in 69%. Only 31% had more than 2 sleep-onset REM periods. MSLT supported diagnoses of central disorders of hypersomnolence in 5 patients (4 narcolepsy, 1 idiopathic hypersomnia); 5 hypersomnia due to a medical disorder, psychiatric condition, or medication; and 6 with normal results. Pharmacotherapy was prescribed in 5 patients. CONCLUSIONS EDS in patients with cancer may be multifactorial, but persistent symptoms may indicate an underlying disorder of hypersomnolence. Sleep referral and polysomnography to exclude other sleep disorders may be indicated. MSLT can help confirm the diagnosis. In those with normal MSLT, further evaluation for mood disorder should be considered.
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Affiliation(s)
- Bibi Aneesah Jaumally
- Divisions of Pulmonary, Critical Care Medicine and Sleep Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Aneesa Das
- Division of Pulmonary, Critical Care and Sleep, The Ohio State University, Columbus, OH, USA
| | - Nathaniel C Cassell
- Divisions of Pulmonary, Critical Care Medicine and Sleep Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - G Nancy Pachecho
- Department of Pulmonary Medicine, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, P.O. Box 301402, Houston, TX, 77030-1402, USA
| | - Ruckshanda Majid
- Divisions of Pulmonary, Critical Care Medicine and Sleep Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Lara Bashoura
- Department of Pulmonary Medicine, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, P.O. Box 301402, Houston, TX, 77030-1402, USA
| | - Diwakar D Balachandran
- Department of Pulmonary Medicine, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, P.O. Box 301402, Houston, TX, 77030-1402, USA
| | - Saadia A Faiz
- Department of Pulmonary Medicine, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, P.O. Box 301402, Houston, TX, 77030-1402, USA.
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30
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Jeon MS, Dhillon HM, Koh ES, Nowak AK, Hovey E, Descallar J, Miller L, Marshall NS, Agar MR. Exploring sleep disturbance among adults with primary or secondary malignant brain tumors and their caregivers. Neurooncol Pract 2020; 8:48-59. [PMID: 33664969 DOI: 10.1093/nop/npaa057] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Emerging evidence supports the clinical impact of sleep disturbance (SD) on cancer patients. This study aimed to determine the prevalence and predictors of SD in people with malignant brain tumors and caregivers, and explore any relationship between the patient-caregiver dyad's sleep. Methods Eighty-one adults with primary malignant (91%) or metastatic (9%) brain tumors and their family caregivers (n = 44) completed a series of self-report questionnaires, including the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index, and the drowsiness item of The MD Anderson Symptom Inventory-Brain Tumor in an Australian ambulatory neuro-oncology setting. Participants were grouped by the PSQI cutoff (SD > 5), and binary logistic regression analyses were performed to identify risk factors. Results Of patients, 53% reported SD and 15% of those clinically significant insomnia, and 27% reported moderate to severe daytime drowsiness. Whereas anxiety, depression, fatigue, pain, neurocognitive symptoms, and antiemetic use were higher in patients with SD, fatigue and KPS were strong predictors of SD. In caregivers, 55% reported poor sleep and 13% clinical insomnia. Anxiety, caregiver burden, and comorbid illness were significantly associated with caregivers' SD. The individual's SD did not affect the chance of the other member of the patient-caregiver dyad experiencing SD. Conclusions More than half the sample had sleep disturbance, which was linked to many concomitant symptoms, such as fatigue in patients and anxiety in caregivers, potentially contributing to distress and functional impairment. Understanding underlying mechanisms of SD, the potential use of these clinical predictors in care settings, and options for management is warranted.
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Affiliation(s)
- Megan S Jeon
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Haryana M Dhillon
- Centre for Medical Psychology & Evidence-based Decision-making, University of Sydney, Sydney, Australia
| | - Eng-Siew Koh
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia.,Ingham Institute for Applied Medical Research, Liverpool, Australia.,Department of Radiation Oncology, Liverpool Hospital, Liverpool, NSW, Australia
| | - Anna K Nowak
- Medical School, QEII Medical Centre Unit, University of Western Australia, Crawley, Australia.,Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands WA, Australia
| | - Elizabeth Hovey
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, Australia.,University of New South Wales, Sydney, Australia
| | - Joseph Descallar
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia.,Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - Lisa Miller
- Sir Charles Gairdner Hospital, Perth, Australia
| | - Nathaniel S Marshall
- Woolcock Institute for Medical Research & Sydney Nursing School, University of Sydney, Sydney, Australia
| | - Meera R Agar
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia.,Ingham Institute for Applied Medical Research, Liverpool, Australia.,IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, Sydney, Australia
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31
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Wen PY, Weller M, Lee EQ, Alexander BM, Barnholtz-Sloan JS, Barthel FP, Batchelor TT, Bindra RS, Chang SM, Chiocca EA, Cloughesy TF, DeGroot JF, Galanis E, Gilbert MR, Hegi ME, Horbinski C, Huang RY, Lassman AB, Le Rhun E, Lim M, Mehta MP, Mellinghoff IK, Minniti G, Nathanson D, Platten M, Preusser M, Roth P, Sanson M, Schiff D, Short SC, Taphoorn MJB, Tonn JC, Tsang J, Verhaak RGW, von Deimling A, Wick W, Zadeh G, Reardon DA, Aldape KD, van den Bent MJ. Glioblastoma in adults: a Society for Neuro-Oncology (SNO) and European Society of Neuro-Oncology (EANO) consensus review on current management and future directions. Neuro Oncol 2020; 22:1073-1113. [PMID: 32328653 PMCID: PMC7594557 DOI: 10.1093/neuonc/noaa106] [Citation(s) in RCA: 575] [Impact Index Per Article: 143.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Glioblastomas are the most common form of malignant primary brain tumor and an important cause of morbidity and mortality. In recent years there have been important advances in understanding the molecular pathogenesis and biology of these tumors, but this has not translated into significantly improved outcomes for patients. In this consensus review from the Society for Neuro-Oncology (SNO) and the European Association of Neuro-Oncology (EANO), the current management of isocitrate dehydrogenase wildtype (IDHwt) glioblastomas will be discussed. In addition, novel therapies such as targeted molecular therapies, agents targeting DNA damage response and metabolism, immunotherapies, and viral therapies will be reviewed, as well as the current challenges and future directions for research.
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Affiliation(s)
- Patrick Y Wen
- Dana-Farber Cancer Institute, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Michael Weller
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Eudocia Quant Lee
- Dana-Farber Cancer Institute, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Brian M Alexander
- Dana-Farber Cancer Institute, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jill S Barnholtz-Sloan
- Case Western Reserve University School of Medicine and University Hospitals of Cleveland, Cleveland, Ohio, USA
| | - Floris P Barthel
- The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut, USA
| | - Tracy T Batchelor
- Department of Neurology, Brigham and Women’s Hospital, Dana-Farber Cancer Institute and Harvard Medical School
| | - Ranjit S Bindra
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Susan M Chang
- University of California San Francisco, San Francisco, California, USA
| | - E Antonio Chiocca
- Department of Neurosurgery, Brigham and Women’s Hospital, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - Timothy F Cloughesy
- David Geffen School of Medicine, Department of Neurology, University of California Los Angeles, Los Angeles, California, USA
| | - John F DeGroot
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Mark R Gilbert
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Monika E Hegi
- Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Craig Horbinski
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Raymond Y Huang
- Division of Neuroradiology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew B Lassman
- Department of Neurology and Herbert Irving Comprehensive Cancer Center, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Emilie Le Rhun
- University of Lille, Inserm, Neuro-oncology, General and Stereotaxic Neurosurgery service, University Hospital of Lille, Lille, France; Breast Cancer Department, Oscar Lambret Center, Lille, France and Department of Neurology & Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Michael Lim
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Ingo K Mellinghoff
- Department of Neurology and Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Giuseppe Minniti
- Radiation Oncology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - David Nathanson
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, California, USA
| | - Michael Platten
- Department of Neurology, Medical Faculty Mannheim, MCTN, Heidelberg University, Heidelberg, Germany
| | - Matthias Preusser
- Division of Oncology, Department of Medicine, Medical University of Vienna, Vienna, Austria
| | - Patrick Roth
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Marc Sanson
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière – Charles Foix, Service de Neurologie 2-Mazarin, Paris, France
| | - David Schiff
- University of Virginia School of Medicine, Division of Neuro-Oncology, Department of Neurology, University of Virginia, Charlottesville, Virginia, USA
| | - Susan C Short
- Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, UK
| | - Martin J B Taphoorn
- Department of Neurology, Medical Center Haaglanden, The Hague and Department of Neurology, Leiden University Medical Center, the Netherlands
| | | | - Jonathan Tsang
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, California, USA
| | - Roel G W Verhaak
- The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut, USA
| | - Andreas von Deimling
- Neuropathology and Clinical Cooperation Unit Neuropathology, University Heidelberg and German Cancer Center, Heidelberg, Germany
| | - Wolfgang Wick
- Department of Neurology and Neuro-oncology Program, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Gelareh Zadeh
- MacFeeters Hamilton Centre for Neuro-Oncology Research, Princess Margaret Cancer Centre, Toronto, Canada
| | - David A Reardon
- Dana-Farber Cancer Institute, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Kenneth D Aldape
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
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Nasal Drug Delivery of Anticancer Drugs for the Treatment of Glioblastoma: Preclinical and Clinical Trials. Molecules 2019; 24:molecules24234312. [PMID: 31779126 PMCID: PMC6930669 DOI: 10.3390/molecules24234312] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 11/22/2019] [Accepted: 11/24/2019] [Indexed: 12/18/2022] Open
Abstract
Glioblastoma (GBM) is the most lethal form of brain tumor, being characterized by the rapid growth and invasion of the surrounding tissue. The current standard treatment for glioblastoma is surgery, followed by radiotherapy and concurrent chemotherapy, typically with temozolomide. Although extensive research has been carried out over the past years to develop a more effective therapeutic strategy for the treatment of GBM, efforts have not provided major improvements in terms of the overall survival of patients. Consequently, new therapeutic approaches are urgently needed. Overcoming the blood–brain barrier (BBB) is a major challenge in the development of therapies for central nervous system (CNS) disorders. In this context, the intranasal route of drug administration has been proposed as a non-invasive alternative route for directly targeting the CNS. This route of drug administration bypasses the BBB and reduces the systemic side effects. Recently, several formulations have been developed for further enhancing nose-to-brain transport, mainly with the use of nano-sized and nanostructured drug delivery systems. The focus of this review is to provide an overview of the strategies that have been developed for delivering anticancer compounds for the treatment of GBM while using nasal administration. In particular, the specific properties of nanomedicines proposed for nose-to-brain delivery will be critically evaluated. The preclinical and clinical data considered supporting the idea that nasal delivery of anticancer drugs may represent a breakthrough advancement in the fight against GBM.
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Lawrie TA, Gillespie D, Dowswell T, Evans J, Erridge S, Vale L, Kernohan A, Grant R. Long-term neurocognitive and other side effects of radiotherapy, with or without chemotherapy, for glioma. Cochrane Database Syst Rev 2019; 8:CD013047. [PMID: 31425631 PMCID: PMC6699681 DOI: 10.1002/14651858.cd013047.pub2] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Gliomas are brain tumours arising from glial cells with an annual incidence of 4 to 11 people per 100,000. In this review we focus on gliomas with low aggressive potential in the short term, i.e. low-grade gliomas. Most people with low-grade gliomas are treated with surgery and may receive radiotherapy thereafter. However, there is concern about the possible long-term effects of radiotherapy, especially on neurocognitive functioning. OBJECTIVES To evaluate the long-term neurocognitive and other side effects of radiotherapy (with or without chemotherapy) compared with no radiotherapy, or different types of radiotherapy, among people with glioma (where 'long-term' is defined as at least two years after diagnosis); and to write a brief economic commentary. SEARCH METHODS We searched the following databases on 16 February 2018 and updated the search on 14 November 2018: Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 11) in the Cochrane Library; MEDLINE via Ovid; and Embase via Ovid. We also searched clinical trial registries and relevant conference proceedings from 2014 to 2018 to identify ongoing and unpublished studies. SELECTION CRITERIA Randomised and non-randomised trials, and controlled before-and-after studies (CBAS). Participants were aged 16 years and older with cerebral glioma other than glioblastoma. We included studies where patients in at least one treatment arm received radiotherapy, with or without chemotherapy, and where neurocognitive outcomes were assessed two or more years after treatment. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed risk of bias. We assessed the certainty of findings using the GRADE approach. MAIN RESULTS The review includes nine studies: seven studies were of low-grade glioma and two were of grade 3 glioma. Altogether 2406 participants were involved but there was high sample attrition and outcome data were available for a minority of people at final study assessments. In seven of the nine studies, participants were recruited to randomised controlled trials (RCTs) in which longer-term follow-up was undertaken in a subset of people that had survived without disease progression. There was moderate to high risk of bias in studies due to lack of blinding and high attrition, and in two observational studies there was high risk of selection bias. Paucity of data and risk of bias meant that evidence was of low to very low certainty. We were unable to combine results in meta-analysis due to diversity in interventions and outcomes.The studies examined the following five comparisons.Radiotherapy versus no adjuvant treatmentTwo observational studies contributed data. At the 12-year follow-up in one study, the risk of cognitive impairment (defined as cognitive disability deficits in at least five of 18 neuropsychological tests) was greater in the radiotherapy group (risk ratio (RR) 1.95, 95% confidence interval (CI) 1.02 to 3.71; n = 65); at five to six years the difference between groups did not reach statistical significance (RR 1.38, 95% CI 0.92 to 2.06; n = 195). In the other study, one subject in the radiotherapy group had cognitive impairment (defined as significant deterioration in eight of 12 neuropsychological tests) at two years compared with none in the control group (very low certainty evidence).With regard to neurocognitive scores, in one study the radiotherapy group was reported to have had significantly worse mean scores on some tests compared with no radiotherapy; however, the raw data were only given for significant findings. In the second study, there were no clear differences in any of the various cognitive outcomes at two years (n = 31) and four years (n = 15) (very low certainty evidence).Radiotherapy versus chemotherapyOne RCT contributed data on cognitive impairment at up to three years with no clear difference between arms (RR 1.43, 95% CI 0.36 to 5.70, n = 117) (low-certainty evidence).High-dose radiotherapy versus low-dose radiotherapyOnly one of two studies reporting this comparison contributed data, and at two and five years there were no clear differences between high- and low-dose radiotherapy arms (very low certainty evidence).Conventional radiotherapy versus stereotactic conformal radiotherapyOne study involving younger people contributed limited data from the subgroup aged 16 to 25 years. The numbers of participants with neurocognitive impairment at five years after treatment were two out of 12 in the conventional arm versus none out of 11 in the stereotactic conformal radiotherapy arm (RR 4.62, 95% CI 0.25 to 86.72; n = 23; low-certainty evidence).Chemoradiotherapy versus radiotherapyTwo RCTs tested for cognitive impairment. One defined cognitive impairment as a decline of more than 3 points in MMSE score compared with baseline and reported data from 2-year (110 participants), 3-year (91 participants), and 5-year (57 participants) follow-up with no clear difference between the two arms at any time point. A second study did not report raw data but measured MMSE scores over five years in 126 participants at two years, 110 at three years, 69 at four years and 53 at five years. Authors concluded that there was no difference in MMSE scores between the two study arms (P = 0.4752) (low-certainty evidence).Two RCTs reported quality of life (QoL) outcomes for this comparison. One reported no differences in Brain-QoL scores between study arms over a 5-year follow-up period (P = 0.2767; no raw data were given and denominators were not stated). The other trial reported that the long-term results of health-related QoL showed no difference between the arms but did not give the raw data for overall HRQoL scores (low-certainty evidence).We found no comparative data on endocrine dysfunction; we planned to develop a brief economic commentary but found no relevant economic studies for inclusion. AUTHORS' CONCLUSIONS Radiotherapy for gliomas with a good prognosis may increase the risk of neurocognitive side effects in the long term; however the magnitude of the risk is uncertain. Evidence on long-term neurocognitive side effects associated with chemoradiotherapy is also uncertain. Neurocognitive assessment should be an integral part of long-term follow-up in trials involving radiotherapy for lower-grade gliomas to improve the certainty of evidence regarding long-term neurocognitive effects. Such trials should also assess other potential long-term effects, including endocrine dysfunction, and evaluate costs and cost effectiveness.
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Affiliation(s)
- Theresa A Lawrie
- 1st Floor Education Centre, Royal United HospitalCochrane Gynaecological, Neuro‐oncology and Orphan Cancer GroupCombe ParkBathUKBA1 3NG
| | - David Gillespie
- Western General HospitalDepartment of Neuropsychology133 Grange LoanEdinburghUKEH9 2HL
| | - Therese Dowswell
- The University of LiverpoolC/o Cochrane Pregnancy and Childbirth Group, Department of Women's and Children's HealthFirst Floor, Liverpool Women's NHS Foundation TrustCrown StreetLiverpoolUKL8 7SS
| | - Jonathan Evans
- University of GlasgowSchool of Psychological MedicineGartnavel Royal Hospital1055 Great Western RoadGlasgowUKG12 0XH
| | - Sara Erridge
- NHS LothianEdinburgh Cancer CentreWestern General HospitalCrewe RoadEdinburghUKEH4 2XU
| | - Luke Vale
- Newcastle UniversityInstitute of Health & SocietyBaddiley‐Clarke Building, Richardson RoadNewcastle upon TyneUKNE2 4AX
| | - Ashleigh Kernohan
- Newcastle UniversityInstitute of Health & SocietyBaddiley‐Clarke Building, Richardson RoadNewcastle upon TyneUKNE2 4AX
| | - Robin Grant
- Western General HospitalEdinburgh Centre for Neuro‐Oncology (ECNO)Crewe RoadEdinburghUKEH4 2XU
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van der Linden SD, Gehring K, Rutten GJM, Kop WJ, Sitskoorn MM. Prevalence and correlates of fatigue in patients with meningioma before and after surgery. Neurooncol Pract 2019; 7:77-85. [PMID: 32257286 PMCID: PMC7104880 DOI: 10.1093/nop/npz023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Fatigue is a common symptom in patients with brain tumors, but comprehensive studies on fatigue in patients with meningioma specifically are lacking. This study examined the prevalence and correlates of fatigue in meningioma patients. Methods Patients with grade I meningioma completed the Multidimensional Fatigue Inventory (MFI-20) before and 1 year after neurosurgery. The MFI consists of 5 subscales: General Fatigue, Physical Fatigue, Mental Fatigue, Reduced Motivation, and Reduced Activity. Patients’ scores were compared with normative data. Preoperative fatigue was compared with postoperative fatigue. Correlations with sex, age, education, tumor hemisphere, preoperative tumor volume, antiepileptic drugs (AEDs), symptoms of anxiety/depression, and self-reported cognitive complaints were explored. Results Questionnaires were completed by 65 patients preoperatively, and 53 patients postoperatively. Of 34 patients, data from both time points were available. Patients had significantly higher fatigue levels on all subscales compared to normative values at both time points. Mean scores on General Fatigue, Physical Fatigue, and Mental Fatigue remained stable over time and improvements were observed on Reduced Motivation and Reduced Activity. Preoperatively, the prevalence of high fatigue (Z-score ≥ 1.3) varied between 34% for Reduced Motivation and 43% for General Fatigue/Mental Fatigue. The postoperative prevalence ranged from 19% for Reduced Activity to 49% on Mental Fatigue. Fatigue was associated with cognitive complaints, anxiety and depression, but not with education, tumor lateralization, tumor volume, or AEDs. Conclusion Fatigue is a common and persistent symptom in patients with meningioma undergoing neurosurgery. Findings emphasize the need for more research and appropriate care targeting fatigue for meningioma patients.
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Affiliation(s)
- Sophie D van der Linden
- Department of Neurosurgery, Elisabeth-TweeSteden Hospital, The Netherlands.,Department of Cognitive Neuropsychology, Tilburg University, The Netherlands
| | - Karin Gehring
- Department of Neurosurgery, Elisabeth-TweeSteden Hospital, The Netherlands.,Department of Cognitive Neuropsychology, Tilburg University, The Netherlands
| | - Geert-Jan M Rutten
- Department of Neurosurgery, Elisabeth-TweeSteden Hospital, The Netherlands
| | - Willem J Kop
- Department of Medical and Clinical Psychology, Tilburg University, Center of Research on Psychology in Somatic diseases (CoRPS), The Netherlands
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Jeon MS, Dhillon HM, Descallar J, Lam L, Allingham S, Koh ES, Currow DC, Agar MR. Prevalence and severity of sleep difficulty in patients with a CNS cancer receiving palliative care in Australia. Neurooncol Pract 2019; 6:499-507. [PMID: 31832221 DOI: 10.1093/nop/npz005] [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: 11/13/2022] Open
Abstract
Background The literature describing the incidence of sleep difficulty in CNS cancers is very limited, with exploration of a sleep difficulty symptom trajectory particularly sparse in people with advanced disease. We aimed to establish the prevalence and longitudinal trajectory of sleep difficulty in populations with CNS cancers receiving palliative care nationally, and to identify clinically modifiable predictors of sleep difficulty. Methods A consecutive cohort of 2406 patients with CNS cancers receiving palliative care from sites participating in the Australian national Palliative Care Outcomes Collaboration were evaluated longitudinally on patient-reported sleep difficulty from point-of-care data collection, comorbid symptoms, and clinician-rated problems. Multilevel models were used to analyze patient-reported sleep difficulty. Results Reporting of mild to severe sleep difficulties ranged from 10% to 43%. Sleep scores fluctuated greatly over the course of palliative care. While improvement in patients' clinical status was associated with less sleep difficulty, the relationship was not clear when patients deteriorated. Worsening of sleep difficulty was associated with higher psychological distress (P < .0001), greater breathing problems (P < .05) and pain (P < .05), and higher functional status (P < .001) at the beginning of care. Conclusions Sleep difficulty is prevalent but fluctuates widely in patients with CNS cancers receiving palliative care. A better-tailored sleep symptom assessment may be needed for this patient population. Early interventions targeting psychological distress, breathing symptoms, and pain for more functional patients should be explored to see whether it reduces sleep difficulties late in life.
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Affiliation(s)
- Megan S Jeon
- South Western Sydney Clinical School, University of New South Wales, Australia
| | - Haryana M Dhillon
- Centre for Medical Psychology & Evidence-based Decision-making, University of Sydney, Australia
| | - Joseph Descallar
- South Western Sydney Clinical School, University of New South Wales, Australia.,Ingham Institute for Applied Medical Research, Sydney, Australia
| | - Lawrence Lam
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, Australia
| | - Samuel Allingham
- Palliative Care Outcomes Collaboration, University of Wollongong, Australia
| | - Eng-Siew Koh
- South Western Sydney Clinical School, University of New South Wales, Australia.,Ingham Institute for Applied Medical Research, Sydney, Australia
| | - David C Currow
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, Australia
| | - Meera R Agar
- South Western Sydney Clinical School, University of New South Wales, Australia.,IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, Australia.,Ingham Institute for Applied Medical Research, Sydney, Australia
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Abstract
Survival alone is no longer an adequate outcome for persons with brain tumors; the quality of the survivorship experience should be viewed with equal importance. Symptom management is a significant component of quality survivorship care. Regardless of their histology, brain tumors and therapies used to treat them produce symptoms that affect an individual's ability to function in everyday life. Common symptoms include fatigue, cognitive impairment, distress, and sleep disturbance. Symptom-based interventions for persons with brain tumors focus on prevention, self-management, and prescriptive interventions targeted to these problems. Unfortunately, little evidence exists to support many interventions, making it challenging for clinicians to provide concrete recommendations. Research is needed to provide evidence in support of symptom-based interventions while novel approaches to these challenging problems are developed.
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Affiliation(s)
- Christina Amidei
- Northwestern Medicine, Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Arapova YY, Kuznetsova NS, Rostorguev EE, Protasova TP, Shikhliarova AI. [Night sleep organization in patients with primary brain tumor]. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 118:124-128. [PMID: 30059062 DOI: 10.17116/jnevro201811842124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIM To study cycle organization of night sleep and analyze brain electrical activity during sleep in patients with primary brain tumor before and after surgical intervention. MATERIAL AND METHODS Ten patients, mean age 48.6±4.2 years, with primary tumors participated in the study. Polysomnography study was performed before and on the 7th day after surgical intervention. RESULTS Shot delta-sleep latency, shorter 2nd stage, disturbances of rhythmogenesis in the 2nd stage and higher delta-sleep activity were observed before and after surgical intervention. There were changes in the brain electrical activity during delta-sleep and REM. The changes in the first sleep cycles were noted before surgical intervention. The greater amount of stage 2 was found after surgery. CONCLUSION The results can be used to correct the accompanying therapy in the early postoperative period to improve its efficacy.
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Affiliation(s)
- Yu Yu Arapova
- Rostov Research Institute of Oncology, Rostov-on-Don, Russia
| | - N S Kuznetsova
- Rostov Research Institute of Oncology, Rostov-on-Don, Russia
| | - Ed E Rostorguev
- Rostov Research Institute of Oncology, Rostov-on-Don, Russia
| | - T P Protasova
- Rostov Research Institute of Oncology, Rostov-on-Don, Russia
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Duhart JM, Brocardo L, Caldart CS, Marpegan L, Golombek DA. Circadian Alterations in a Murine Model of Hypothalamic Glioma. Front Physiol 2017; 8:864. [PMID: 29163208 PMCID: PMC5670357 DOI: 10.3389/fphys.2017.00864] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 10/16/2017] [Indexed: 01/09/2023] Open
Abstract
The mammalian circadian system is controlled by a central oscillator located in the suprachiasmatic nuclei (SCN) of the hypothalamus, in which glia appears to play a prominent role. Gliomas originate from glial cells and are the primary brain tumors with the highest incidence and mortality. Optic pathway/hypothalamic gliomas account for 4–7% of all pediatric intracranial tumors. Given the anatomical location, which compromises both the circadian pacemaker and its photic input pathway, we decided to study whether the presence of gliomas in the hypothalamic region could alter circadian behavioral outputs. Athymic nude mice implanted with LN229 human glioma cells showed an increase in the endogenous period of the circadian clock, which was also less robust in terms of sustaining the free running period throughout 2 weeks of screening. We also found that implanted mice showed a slower resynchronization rate after an abrupt 6 h advance of the light-dark (LD) cycle, advanced phase angle, and a decreased direct effect of light in general activity (masking), indicating that hypothalamic tumors could also affect photic sensitivity of the circadian clock. Our work suggests that hypothalamic gliomas have a clear impact both on the endogenous pacemaking of the circadian system, as well as on the photic synchronization of the clock. These findings strongly suggest that the observation of altered circadian parameters in patients might be of relevance for glioma diagnosis.
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Affiliation(s)
- José M Duhart
- Laboratorio de Cronobiología, Departamento de Ciencia y Tecnología, Universidad Nacional de Quilmes, Buenos Aires, Argentina
| | - Lucila Brocardo
- Laboratorio de Cronobiología, Departamento de Ciencia y Tecnología, Universidad Nacional de Quilmes, Buenos Aires, Argentina
| | - Carlos S Caldart
- Laboratorio de Cronobiología, Departamento de Ciencia y Tecnología, Universidad Nacional de Quilmes, Buenos Aires, Argentina
| | - Luciano Marpegan
- Laboratorio de Cronobiología, Departamento de Ciencia y Tecnología, Universidad Nacional de Quilmes, Buenos Aires, Argentina
| | - Diego A Golombek
- Laboratorio de Cronobiología, Departamento de Ciencia y Tecnología, Universidad Nacional de Quilmes, Buenos Aires, Argentina
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Measurements and status of sleep quality in patients with cancers. Support Care Cancer 2017; 26:405-414. [DOI: 10.1007/s00520-017-3927-x] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 10/09/2017] [Indexed: 01/04/2023]
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Armstrong TS, Vera E, Zhou R, Acquaye AA, Sullaway CM, Berger AM, Breton G, Mahajan A, Wefel JS, Gilbert MR, Bondy M, Scheurer ME. Association of genetic variants with fatigue in patients with malignant glioma. Neurooncol Pract 2017; 5:122-128. [PMID: 31386001 DOI: 10.1093/nop/npx020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Fatigue is a consistently reported, severe symptom among patients with gliomas throughout the disease trajectory. Genomic pathways associated with fatigue in glioma patients have yet to be identified. Methods Clinical factors (performance status, tumor details, age, gender) were collected by chart review on glioma patients with fatigue ("I have lack of energy" on Functional Assessment of Cancer Therapy-Brain), as well as available genotyping data. Candidate genes in clock and inflammatory pathways were identified from a literature review, of which 50 single nucleotide polymorphisms (SNPs) in 7 genes were available. Clinical factors and SNPs identified by univariate analyses were included in a multivariate model for moderate-severe fatigue. Results The study included 176 patients (median age = 47 years, 67% males). Moderate-severe fatigue was reported by 43%. Results from multivariate analysis revealed poor performance status and 2 SNPs were associated with fatigue severity. Moderate-severe fatigue was more common in patients with poor performance status (OR = 3.52, P < .01). For each additional copy of the minor allele in rs934945 (PER2) the odds of fatigue decreased (OR = 0.51, P < .05). For each additional copy of the minor allele in rs922270 (ARTNL2) the odds of fatigue increased (OR = 2.38, P < .01). Both of these genes are important in the circadian clock pathway, which has been implicated in diurnal preference, and duration and quality of sleep. No genes in the inflammatory pathway were associated with fatigue in the current study. Conclusions Identifying patients at highest risk for fatigue during treatment allows for improved clinical monitoring and enrichment of patient selection for clinical trials.
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Affiliation(s)
- Terri S Armstrong
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Elizabeth Vera
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Renke Zhou
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas.,Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Alvina A Acquaye
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Catherine M Sullaway
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ann M Berger
- University of Nebraska Medical Center, Omaha, Nebraska
| | | | | | - Jeffrey S Wefel
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mark R Gilbert
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Melissa Bondy
- Department of Medicine, Baylor College of Medicine, Houston, Texas.,Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Michael E Scheurer
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas.,Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
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Balachandran DD, Bashoura L, Faiz SA. Sleep-Related Breathing Disorders and Cancer. CURRENT PULMONOLOGY REPORTS 2017. [DOI: 10.1007/s13665-017-0182-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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