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Reynolds SA, O'Connor L, McGee A, Kilcoyne AQ, Connolly A, Mockler D, Guinan E, O'Neill L. Recruitment rates and strategies in exercise trials in cancer survivorship: a systematic review. J Cancer Surviv 2024; 18:1233-1242. [PMID: 37022641 PMCID: PMC11324688 DOI: 10.1007/s11764-023-01363-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 03/14/2023] [Indexed: 04/07/2023]
Abstract
PURPOSE Despite clear evidence-based supporting a benefit to exercise on physical and psychological metrics in patients with cancer, recruitment to exercise trials amongst cancer survivors is suboptimal. We explore current recruitment rates, strategies, and common barriers to participation in exercise oncology trials in cancer survivorship. METHODS A systematic review was conducted using a pre-defined search strategy in EMBASE, CINAHL, Medline, Cochrane Library, and Web of Science. The search was performed up to 28/02/2022. Screening of titles and abstracts, full-text review, and data extraction was completed in duplicate. RESULTS Of the 3204 identified studies, 87 papers corresponding to 86 trials were included. Recruitment rates were highly variable with a median rate of 38% (range 0.52-100%). Trials recruiting prostate cancer patients only had the highest median recruitment rate (45.9%) vs trials recruiting colorectal cancer patients only which had the lowest (31.25%). Active recruitment strategies such as direct recruitment via a healthcare professional were associated with higher recruitment rates (rho = 0.201, p = 0.064). Common reasons for non-participation included lack of interest (46.51%, n (number of studies) = 40); distance and transport (45.3%, n = 39); and failure to contact (44.2%, n = 38). CONCLUSIONS Recruitment of cancer survivors to exercise interventions is suboptimal with barriers being predominantly patient-oriented. This paper provides the benchmark for current recruitment rates to exercise oncology trials, providing data for trialists planning future trial design and implementation, optimise future recruitment strategies, and evaluate their own recruitment success against current practice. IMPLICATIONS FOR CANCER SURVIVORS Enhanced recruitment to cancer survivorship exercise trials is necessary in facilitating the publication of definitive exercise guidelines, generalisable to varying cancer cohorts. PROSPERO REGISTRATION NUMBER CRD42020185968.
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Affiliation(s)
- Sophie A Reynolds
- School of Medicine, Trinity College Dublin, University of Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
| | - Louise O'Connor
- Trinity St James's Cancer Institute, Dublin, Ireland
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - Anna McGee
- School of Medicine, Trinity College Dublin, University of Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
| | - Anna Quinn Kilcoyne
- School of Medicine, Trinity College Dublin, University of Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
| | - Archie Connolly
- School of Medicine, Trinity College Dublin, University of Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
| | - David Mockler
- John Stearne Library, Trinity Centre for Health Sciences, St James's Hospital, Dublin, Ireland
| | - Emer Guinan
- School of Medicine, Trinity College Dublin, University of Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
| | - Linda O'Neill
- Trinity St James's Cancer Institute, Dublin, Ireland.
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, University of Dublin, Dublin, Ireland.
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Von Ah D, Rio CJ, Carter A, Perkins SM, Stevens E, Rosko A, Davenport A, Kalady M, Noonan AM, Crouch A, Storey S, Overcash J, Han CJ, Yang Y, Li H, Saligan LN. Association between Cognitive Function and Physical Function, Frailty, and Quality of Life in Older Breast Cancer Survivors. Cancers (Basel) 2024; 16:2718. [PMID: 39123446 PMCID: PMC11311865 DOI: 10.3390/cancers16152718] [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: 07/18/2024] [Accepted: 07/26/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Older cancer survivors in general are at greater risk for cancer-related cognitive impairment (CRCI), yet few studies have explored its association with health outcomes. This study examined the association between subjective and objective measures of cognitive function and physical function, frailty, and quality of life (QoL) among older breast cancer survivors. MATERIALS AND METHODS Older breast cancer survivors who reported cognitive concerns completed surveys on patient-reported cognitive function, physical function, frailty, and QoL as well as objective tests of visuospatial working memory and sustained attention. Data were analyzed using descriptive statistics and separate linear regression models. RESULTS A total of 219 female breast cancer survivors completed the study. Perceived cognitive abilities were associated with better physical function, frailty, and QoL (p ≤ 0.001) while cognitive concerns were negatively related with these metrics (p ≤ 0.001). Poorer visuospatial working memory and sustained attention were linked to increased frailty (p ≤ 0.001-0.01), whereas poorer sustained attention was associated with poorer physical function (p < 0.01). CONCLUSIONS Older breast cancer survivors with perceived cognitive impairment and poorer cognitive performance reported poorer physical functioning, increased frailty, and poorer QoL. These findings underscore the importance of assessing cognitive concerns and their associated outcomes in older breast cancer survivors.
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Affiliation(s)
- Diane Von Ah
- College of Nursing, The Ohio State University, 394 Newton Hall, 1585 Neil Avenue, Columbus, OH 43210, USA (C.J.H.)
| | - Carielle Joy Rio
- Symptoms Biology Unit, Division of Intramural Research, National Institute of Nursing Research, National Institutes of Health, 3 Center Drive, Bethesda, MD 20892, USA
| | - Allie Carter
- Department of Biostatistics and Health Data Science, IU School of Medicine, Richard M. Fairbanks School of Public Health, Indianapolis, IN 46202, USA
| | - Susan M. Perkins
- Department of Biostatistics and Health Data Science, IU School of Medicine, Richard M. Fairbanks School of Public Health, Indianapolis, IN 46202, USA
| | - Erin Stevens
- Division of Palliative Care, Department of Internal Medicine, The Ohio State University, 1581 Dodd Drive, 5th Floor North Columbus, Columbus, OH 43210, USA
| | - Ashley Rosko
- Division of Hematology, James Comprehensive Cancer Center, The Ohio State University, 1150C Lincoln Tower, Columbus, OH 43210, USA
| | - Ashley Davenport
- Division of Medical Oncology, James Comprehensive Cancer Center, The Ohio State University, Columbus, OH 43210, USA
| | - Mathew Kalady
- Division of Colon and Rectal Surgery, Clinical Cancer Genetics Program, The Ohio State University-James: Cancer Treatment and Research Center, Columbus, OH 43210, USA
| | - Anne M. Noonan
- GI Medical Oncology Selection, The Ohio State University-James: Cancer Treatment and Research Center, Columbus, OH 43210, USA
| | - Adele Crouch
- School of Nursing, Indiana University, Indianapolis, IN 46202, USA; (A.C.); (S.S.)
| | - Susan Storey
- School of Nursing, Indiana University, Indianapolis, IN 46202, USA; (A.C.); (S.S.)
| | - Janine Overcash
- College of Nursing, The Ohio State University, 394 Newton Hall, 1585 Neil Avenue, Columbus, OH 43210, USA (C.J.H.)
| | - Claire J. Han
- College of Nursing, The Ohio State University, 394 Newton Hall, 1585 Neil Avenue, Columbus, OH 43210, USA (C.J.H.)
| | - Yesol Yang
- College of Nursing, The Ohio State University, 394 Newton Hall, 1585 Neil Avenue, Columbus, OH 43210, USA (C.J.H.)
| | - Haiying Li
- College of Nursing, The Ohio State University, 394 Newton Hall, 1585 Neil Avenue, Columbus, OH 43210, USA (C.J.H.)
| | - Leorey N. Saligan
- Symptoms Biology Unit, Division of Intramural Research, National Institute of Nursing Research, National Institutes of Health, 3 Center Drive, Bethesda, MD 20892, USA
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Liu L, Lv J, Piao W, Liu X, Li S, Lu X. Research on the influence of yogalates comprehensive rehabilitation training on postoperative recovery of breast cancer patients. Explore (NY) 2024; 20:340-346. [PMID: 37770360 DOI: 10.1016/j.explore.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/26/2023] [Accepted: 09/18/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND In the present study, we analyzed the effects of comprehensive yogalates rehabilitation training on side effects caused by postoperative adjuvant treatment and postoperative physical and mental health in breast cancer patients who had undergone radical mastectomy.The purpose of this investigation was to test the hypothesis that 12 weeks of yogalates training would reduce the peripheral diameter of the upper arm, improve flexibility and posture, and improve sleep quality compared with a non-treated control group. METHODS 36 women with breast cancer who had undergone radical mastectomy in Shanghai were selected and randomly divided into the experimental group (n=20) and the control group (n=16). The patients in the experimental group underwent yogalates comprehensive rehabilitation training, while the control group did not participate in yogalates course. Anthropometric measurements and the "Pittsburgh Sleep Quality Index (PSQI)" questionnaire were administered to both the experimental and control groups before and after the training sessions. RESULTS The experimental group corrected the hunchback posture through yogalates training. Spine extension increased their height and decreased their BMI. The range of motion of upper arm joints in extension, bending and abduction increased. The peripheral diameter of the upper arm decreased, the grip strength increased, and the sleep quality gradually improved. CONCLUSION (1)Prolonging the period of yogalates training stabilized and improve the physical and mental health of patients. (2)In yogalates course, providing proper guidance to patients for diaphragmatic breathing and incorporating yoga relaxation techniques can effectively enhance the sleep quality of patients.(3)Exercise regimens must be designed taking into account individual differences.
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Affiliation(s)
- Lu Liu
- Department of Physical Education and Sport, Shanghai Ocean University, Shanghai 201306, China
| | - Jinke Lv
- College of Information Technology, Shanghai Ocean University, Shanghai 201306, China
| | - Wenting Piao
- College of Economics&Management, Shanghai Ocean University, Shanghai 201306,China
| | - Xinran Liu
- College of Foreign Languages, Shanghai Ocean University, Shanghai 201306, China
| | - Shaojing Li
- Department of Gynecology and Obstetrics, Shanghai Fengxian District Central Hospital, Shanghai 201400, China.
| | - Xi Lu
- Department of Public Physical Art Education, Zhejiang University, Hangzhou 310058, China
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Moon C, Wilson RL, Gonzalo-Encabo P, Kang DW, Mithani S, Dieli-Conwright CM, Patel DI. Measurement of Cognitive Function in Exercise Oncology Studies in Patients Treated With Chemotherapy: A Scoping Review. Integr Cancer Ther 2024; 23:15347354241265349. [PMID: 39045709 PMCID: PMC11271141 DOI: 10.1177/15347354241265349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 06/07/2024] [Accepted: 06/14/2024] [Indexed: 07/25/2024] Open
Abstract
Cancer-associated cognitive deficits following chemotherapy have received increased attention in clinical research. Exercise has been shown to preserve cognitive function in cancer patients, though the overall effect is mixed. Here we present a scoping review of the published literature summarizing methods used to assess cognitive function in exercise oncology trials. Methods: PubMed, PsycINFO and CINAHL databases were searched using keywords "cognition," "cancer" OR "neoplasm" OR "tumor," "chemotherapy" and "exercise" OR "physical activity." Studies eligible for inclusion include prospective studies that were published in English in peer-reviewed journals that include a method of assessing cognitive function in adult cancer patients, in which an exercise modality or method of quantifying exercise habits was evident. Studies were excluded if they included a pediatric population, patients that were not diagnosed with cancer, or were systematic/narrative/scoping reviews, protocol papers or dissertation/theses. Results: A total of 29 studies met the inclusion criteria. In total, 29 unique assessments were used to evaluate cognitive function, including patient-reported outcomes (PROs; n = 8) and objective (n = 21) methods. More than half (n = 17) of included studies relied on PROs while 12 studies utilized objective measures of cognitive function Cognitive domains of the PROs were limited in scope, focusing on memory and attention/concentration while the objective measures were broader and inclusive of multiple domains. Conclusion: The results of this review indicate that mixed approaches to evaluating cognitive function in cancer patients pose a major limitation to understanding the role of exercise as an integrative approach. The evidence demonstrates a need for more uniform assessment of cognitive function in exercise oncology trials.
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Affiliation(s)
- Crisann Moon
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Rebekah L. Wilson
- Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Paola Gonzalo-Encabo
- Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Dong-Woo Kang
- Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Sara Mithani
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | | | - Darpan I. Patel
- University of Texas Medical Branch at Galveston, Galveston, TX, USA
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Trinh L, Tabaczynski A, Bastas D, Neville AR, Voss ML, Whitehorn A. Changes in physical activity, sedentary behavior, and self-reported cognitive function in cancer survivors before and during the COVID-19 pandemic: A cross-sectional study. JOURNAL OF SPORT AND HEALTH SCIENCE 2023; 12:653-663. [PMID: 37279854 PMCID: PMC10658308 DOI: 10.1016/j.jshs.2023.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 02/23/2023] [Accepted: 04/10/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Physical activity (PA) and reductions in sedentary behavior (SED) may mitigate cancer-related cognitive impairment. The purpose of this study was to examine (a) the associations between changes in PA, SED, and cognitive function in cancer survivors before and during the coronavirus disease 2019 (COVID-19) pandemic; and (b) clinical subgroups that moderate this association. METHODS A cross-sectional survey was administered online to adult cancer survivors globally between July and November of 2020. This was a secondary analysis of a cross-sectional survey examining changes in self-reported PA and quality of life in cancer survivors before and during the COVID-19 pandemic. Self-reported Questionnaires assessed moderate-to-vigorous PA (MVPA) using the modified Godin Leisure Time Exercise Questionnaire, cognitive function using the Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog) scale, and SED using the Domain-specific Sitting Time questionnaire. Cancer survivors were classified into no change in behavior, desirable change (i.e., increase MVPA to meet PA guidelines or decrease SED by ≥60 min/day), and undesirable change (i.e., decrease MVPA to <150 min/week or increase SED by ≥60 min/day). Analysis of covariance examined differences in FACT-Cog scores across the activity change categories. Planned contrasts compared differences in FACT-Cog scores between cancer survivors with (a) no meaningful change vs. any change, and (b) a desirable change vs. an undesirable change. RESULTS There were no significant differences in FACT-Cog scores across activity-change categories in the full sample of cancer survivors (n = 371; age = 48.6 ± 15.3 years (mean ± SD)). However, cancer survivors who were diagnosed ≥5 years ago (t(160) = -2.15, p = 0.03) or who received treatment ≥5 years ago (t(102) = -2.23, p = 0.03) and who had a desirable change in activity reported better perceived cognitive abilities than those who had an undesirable change. CONCLUSION PA promotion efforts should consider reducing SED in addition to maintaining MVPA in long-term cancer survivors to mitigate cancer-related cognitive impairment during the COVID-19 pandemic.
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Affiliation(s)
- Linda Trinh
- Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, OT M5S 2W6, Canada.
| | - Allyson Tabaczynski
- Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, OT M5S 2W6, Canada
| | - Denise Bastas
- Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, OT M5S 2W6, Canada
| | - Alyssa R Neville
- Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, OT M5S 2W6, Canada
| | - M Lauren Voss
- Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, OT M5S 2W6, Canada
| | - Alexis Whitehorn
- Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, OT M5S 2W6, Canada
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Yang HY, Chou YJ, Shun SC. The Effect of Walking Intervention on Cognitive Function Among Patients With Non-Central Nervous System Cancer: A Systematic Review. Cancer Nurs 2023; 46:375-385. [PMID: 37607373 DOI: 10.1097/ncc.0000000000001106] [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: 11/26/2022]
Abstract
BACKGROUND Cognitive impairment is one of the most frequently reported symptoms in patients with non-central nervous system (non-CNS) cancer. Walking has positive effects on cognitive function. However, the effects of walking interventions on cognitive function outcomes in patients with non-CNS cancer are not well synthesized. OBJECTIVE The aim of this study was to explore the characteristics of walking intervention and its effects on cognitive function in patients with non-CNS cancer. METHODS Ten databases were searched to identify eligible randomized controlled trials from each database's inception to June 7, 2021. The Physiotherapy Evidence Database Scale was used to assess the quality of the included studies. RESULTS Five randomized controlled trials involving 242 adults with non-CNS cancer were included. Two studies involving immediate treadmill walking interventions with moderate intensity at 40% to 60% maximal heart rate reported significantly improved objective cognitive domains of processing speed and spatial working memory with small to moderate effect sizes for cancer survivors. One study delivering home-based, moderate-intensity walking intervention had borderline significantly positive effects on perceived cognitive functioning for patients with non-CNS cancer during chemotherapy. CONCLUSION Walking intervention with moderate intensity is a beneficial approach to improve objective cognitive domains of processing speed and spatial working memory and perceived cognitive function. IMPLICATIONS FOR PRACTICE Nurses may provide moderate-intensity walking with 40% to 60% maximal heart rate monitoring to alleviate cognitive problems during the continuous process of cancer care. The modality and dosage of intervention should be adjusted depending on this population's tolerance to better maintain training.
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Affiliation(s)
- Hui-Ying Yang
- Author Affiliations: School of Nursing, College of Medicine, National Taiwan University (Ms Yang), Taipei; School of Nursing, College of Medicine, Chang Gung University (Dr Chou), Taoyuan; and School of Nursing, National Yang Ming Chiao Tung University (Dr Shun), Taipei, Taiwan
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Yang HY, Chang YL, Lin BR, Chou YJ, Shun SC. Cognitive Function in Patients at Different Stages of Treatment for Colorectal Cancer: A Comparative Cross-Sectional Study. Semin Oncol Nurs 2023; 39:151446. [PMID: 37183103 DOI: 10.1016/j.soncn.2023.151446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 05/16/2023]
Abstract
OBJECTIVES To compare subjective and objective cognitive functions among patients at the following three stages of treatment for colorectal cancer (CRC): new diagnosis (Group A), ≤2 years since chemotherapy completion (Group B), and >2 years since chemotherapy completion (Group C). DATA SOURCES A comparative cross-sectional approach was used in this study. The Functional Assessment of Cancer Therapy-Cognitive Function questionnaire and neuropsychological assessments were used to assess patients' subjective cognitive function, attention, memory, and executive functions. A total of 63 patients with stage I to III CRC were recruited from a medical center in northern Taiwan. We performed one-to-one-to-one propensity score matching to identify 36 individuals as eligible for this study. A generalized estimating equation was used to compare subjective and objective cognitive functions. CONCLUSION We observed no significant between-group differences in subjective cognitive function and objective performance in overall cognition and memory. Group B had significantly longer reaction time in attention and processing speed than did Group A. Adjuvant chemotherapy had significantly deleterious effects on attention and processing speed in patients with CRC. These cognitive symptoms last for approximately 2 years after the completion of chemotherapy. IMPLICATIONS FOR NURSING PRACTICE The early detection of cancer-related cognitive impairment is necessary for managing symptom distress. Future studies with a large sample size and longitudinal design may elucidate the trajectory of specific cognitive functions. Developing nursing interventions aimed at improving attention and executive function in patients with CRC are needed.
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Affiliation(s)
- Hui-Ying Yang
- PhD Candidate, School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Ling Chang
- Professor, Department of Psychology, National Taiwan University, Taipei, Taiwan
| | - Been-Ren Lin
- Attending Physician, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan; Attending Physician, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yun-Jen Chou
- Assistant Professor, School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shiow-Ching Shun
- Professor, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Cheung YT, To KKW, Hua R, Lee CP, Chan ASY, Li CK. Association of markers of inflammation on attention and neurobehavioral outcomes in survivors of childhood acute lymphoblastic leukemia. Front Oncol 2023; 13:1117096. [PMID: 37416531 PMCID: PMC10320851 DOI: 10.3389/fonc.2023.1117096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/30/2023] [Indexed: 07/08/2023] Open
Abstract
Background Survivors of childhood acute lymphoblastic leukemia (ALL) are at-risk of developing cognitive impairment and neurobehavioral symptoms. Inflammation induced by a compromised health status during cancer survivorship is proposed as a pathophysiological mechanism underlying cognitive impairment in cancer survivors. Objectives To evaluate the associations of biomarkers of inflammation with attention and neurobehavioral outcomes in survivors of childhood ALL, and to identify clinical factors associated with biomarkers of inflammation in this cohort. Methods We recruited patients who were diagnosed with ALL at ≤ 18 years old and were currently ≥5 years post-cancer diagnosis. The study outcomes were attention (Conners Continuous Performance Test) and self-reported behavioral symptoms (Adult Self-Report [ASR] checklist). Using a commercial screening kit, survivors' plasma (5ml) was assayed for 17 cytokines/chemokine cell-signaling molecules that are associated with neurodegenerative diseases. The final panel of the targeted markers included interleukin (IL)-8, IL-13, interferon-gamma (IFN-γ), monocyte chemoattractant protein-1 (MCP-1), macrophage inflammatory protein-1β, and tumor necrosis factor-α. Biomarker levels were rank-ordered into tertiles based on the sample distribution. Multivariable general linear modeling was used to test for associations between biomarkers and study outcomes in the overall cohort and stratified by gender. Results This study included 102 survivors (55.9% males, mean[SD] age 26.2[5.9] years; 19.3[7.1] years post-diagnosis). Survivors within top tertiles of IFN-γ (Estimate =6.74, SE=2.26; P=0.0037) and IL-13 (Estimate =5.10, SE=2.27; P=0.027) demonstrated more inattentiveness. Adjusting for age, gender and treatment, more self-reported thought (Estimate=3.53, SE=1.78; P=0.050) and internalizing problems (Estimate =6.52, SE=2.91; P=0.027) correlated with higher IL-8. Higher levels of IL-13 (RR = 4.58, 95% CI: 1.01-11.10) and TNF-α (RR = 1.44, 95% CI: 1.03-4.07) were observed in survivors had developed chronic health conditions (n=26, 25.5%). The stratified analysis showed that association of IFN-γ with attention was stronger in male survivors than in female survivors. Conclusion Inflammation due to cancer-related late effects may potentially be mechanistic mediators of neurobehavioral problems in pediatric ALL survivors. Markers of inflammation can potentially be applied to assess or monitor the effectiveness of interventions, particularly behavioral interventions, in improving cognitive outcomes in survivors. Future work includes understanding the underlying gender-specific pathophysiology behind functional outcomes in the population.
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Affiliation(s)
- Yin Ting Cheung
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Kenneth Kin-Wah To
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Rong Hua
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Chui Ping Lee
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Agnes Sui-Ying Chan
- Neuropsychology Laboratory, Department of Psychology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Chi Kong Li
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children’s Hospital, Hong Kong, Hong Kong SAR, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
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Von Ah D, Crouch A, Arthur E, Yang Y, Nolan T. Association Between Cardiovascular Disease and Cognitive Dysfunction in Breast Cancer Survivors. Cancer Nurs 2023; 46:E122-E128. [PMID: 35353757 PMCID: PMC9519810 DOI: 10.1097/ncc.0000000000001083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Breast cancer survivors (BCSs) may have a greater risk for cardiovascular disease (congestive heart failure and hypertension), which in turn, can affect cognitive dysfunction, a frequent, bothersome, and potentially debilitating symptom. OBJECTIVE The purpose of this study was to examine the relationship of cardiovascular disease on cognitive function in BCSs. METHODS Baseline data from a double-blind randomized controlled trial for cognitive training of BCSs were examined. Early-stage BCS (stages I-IIIA) who were 21 years or older, completed adjuvant therapy (≥6 months), and reported cognitive concerns completed questionnaires and a brief neuropsychological assessment, including tests of memory, attention and working memory, speed of processing, and verbal fluency. Descriptive statistics, Pearson correlation coefficient, and separate linear regression models for each cognitive domain were conducted. RESULTS Forty-seven BCSs, who were on average 57.3 (SD, 8.1) years old, were 58% White, and had some college education (75%), completed the study. Furthermore, 44.7% of the BCS had cardiovascular disease (congestive heart failure or hypertension). In linear regression models, cardiovascular disease was significantly related to immediate and delayed memory and attention and working memory ( P < .01-.05). CONCLUSION Breast cancer survivors who have cardiovascular disease may also be at a greater risk for cognitive dysfunction post treatment. Results from this study inform both clinical practice and future research, specifically by examining the intersection between cancer, cardiovascular disease (cardiotoxicity), and cognition. IMPLICATIONS FOR PRACTICE Nurses should be aware that BCSs with co-occurring cardiovascular disease are at a higher risk for cognitive dysfunction and work within the multidisciplinary team to optimize BCS health and function.
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Affiliation(s)
- Diane Von Ah
- Author Affiliations: College of Nursing, The Ohio State University, Columbus (Drs Von Ah and Nolan); NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia (Dr Crouch); and The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute, Columbus (Drs Arthur and Yang)
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Takemura N, Ho MH, Cheung DST, Lin CC. Factors associated with perceived cognitive impairment in patients with advanced lung cancer: a cross-sectional analysis. Support Care Cancer 2022; 30:9607-9614. [PMID: 36178636 DOI: 10.1007/s00520-022-07377-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 09/25/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Perceived cognitive impairment refers to cognitive dysfunction that particularly involves impairment in working or short-term memory, and inattention. This study aimed to identify factors associated with perceived cognitive impairment in patients with advanced lung cancer. METHODS This cross-sectional analysis used pooled data from a prospective, ongoing randomized controlled trial examining the effectiveness of exercise in patients with advanced lung cancer (Trial Registration: NCT04119778). Patients diagnosed with stage IIIB or IV non-small cell lung cancer were recruited from three public hospitals in Hong Kong between December 2018 and December 2021. Demographics, daily step count, sleep quality, fatigue, depression, anxiety, and perceived cognitive impairment were included in the analyses. Multivariate logistic regression analysis was used to determine the most critical risk factors associated with perceived cognitive impairments in attention and memory. RESULTS A total of 226 patients were included and analyzed, 35.4% of patients had perceived attention impairment and 58.4% had perceived memory impairment. The daily step count (adjusted odds ratio [aOR] = 0.496; confidence interval [CI] = 0.258-0.954), fatigue (aOR = 1.342; CI = 1.903-1.648), and anxiety (aOR = 1.179; CI = 1.042-1.335) were associated with a significantly increased risk of perceived attention impairment, while anxiety (aOR = 1.126; CI = 1.008-1.257) was identified as the most significant factor for perceived memory impairment. CONCLUSION The findings of this study can inform the design of effective interventions to reduce perceived cognitive impairment and promote the quality of life and well-being of patients with advanced lung cancer.
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Affiliation(s)
- Naomi Takemura
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 5/F, Academic Building, 3 Sassoon Road, Pokfulam, Hong Kong
| | - Mu-Hsing Ho
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 5/F, Academic Building, 3 Sassoon Road, Pokfulam, Hong Kong
| | - Denise Shuk Ting Cheung
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 5/F, Academic Building, 3 Sassoon Road, Pokfulam, Hong Kong
| | - Chia-Chin Lin
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 5/F, Academic Building, 3 Sassoon Road, Pokfulam, Hong Kong.
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11
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Effect of physical exercise on cognitive function after chemotherapy in patients with breast cancer: a randomized controlled trial (PAM study). Breast Cancer Res 2022; 24:36. [PMID: 35619188 PMCID: PMC9135390 DOI: 10.1186/s13058-022-01530-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 05/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Up to 60% of breast cancer patients treated with chemotherapy is confronted with cognitive problems, which can have a significant impact on daily activities and quality of life (QoL). We investigated whether exercise training improves cognition in chemotherapy-exposed breast cancer patients 2-4 years after diagnosis. METHODS Chemotherapy-exposed breast cancer patients, with both self-reported cognitive problems and lower than expected performance on neuropsychological tests, were randomized to an exercise or control group. The 6-month exercise intervention consisted of supervised aerobic and strength training (2 h/week), and Nordic/power walking (2 h/week). Our primary outcome was memory functioning (Hopkins Verbal Learning Test-Revised; HVLT-R). Secondary outcomes included online neuropsychological tests (Amsterdam Cognition Scan; ACS), self-reported cognition (MD Anderson Symptom Inventory for multiple myeloma; MDASI-MM), physical fitness (relative maximum oxygen uptake; VO2peak), fatigue (Multidimensional Fatigue Inventory), QoL (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire; EORTC QLQ C-30), depression (Patient Health Questionnaire-9, Hospital Anxiety and Depression Scale; HADS), and anxiety (HADS). HVLT-R total recall was analyzed with a Fisher exact test for clinically relevant improvement (≥ 5 words). Other outcomes were analyzed using multiple regression analyses adjusted for baseline and stratification factors. RESULTS We randomized 181 patients to the exercise (n = 91) or control group (n = 90). Two-third of the patients attended ≥ 80% of the exercise sessions, and physical fitness significantly improved compared to control patients (B VO2peak 1.4 ml/min/kg, 95%CI:0.6;2.2). No difference in favor of the intervention group was seen on the primary outcome. Significant beneficial intervention effects were found for self-reported cognitive functioning [MDASI-MM severity (B-0.7, 95% CI - 1.2; - 0.1)], fatigue, QoL, and depression. A hypothesis-driven analysis in highly fatigued patients showed positive exercise effects on tested cognitive functioning [ACS Reaction Time (B-26.8, 95% CI - 52.9; - 0.6) and ACS Wordlist Learning (B4.4, 95% CI 0.5; 8.3)]. CONCLUSIONS A 6-month exercise intervention improved self-reported cognitive functioning, physical fitness, fatigue, QoL, and depression in chemotherapy-exposed breast cancer patients with cognitive problems. Tested cognitive functioning was not affected. However, subgroup analysis indicated a positive effect of exercise on tested cognitive functioning in highly fatigued patients. Trial Registration Netherlands Trial Registry: Trial NL5924 (NTR6104). Registered 24 October 2016, https://www.trialregister.nl/trial/5924 .
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12
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Wilson R, Kang DW, Tahbaz M, Norris M, Uno H, Ligibel J, Guenette J, Christopher C, Dieli-Conwright C. Improving cognitive function through high-intensity interval training in breast cancer patients undergoing chemotherapy – the CLARITY Trial: Protocol for a randomized study. (Preprint). JMIR Res Protoc 2022; 12:e39740. [PMID: 37027186 PMCID: PMC10132015 DOI: 10.2196/39740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 12/23/2022] [Accepted: 12/25/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND More than 75% of patients with breast cancer treated with chemotherapy experience cognitive impairments (eg, memory and attention problems), commonly known as chemo-brain. Exercise, especially aerobic high-intensity interval training (HIIT), is associated with better cognitive function in healthy populations. However, clinical trials testing the impact of exercise interventions on chemotherapy-induced cognitive decline in patients with cancer are lacking, and the mechanisms through which exercise could improve cognitive function are unclear. OBJECTIVE The objective of the Improving Cognitive Function Through High-Intensity Interval Training in Breast Cancer Patients Undergoing Chemotherapy trial is to examine the effects of HIIT on cognitive function in patients with breast cancer undergoing chemotherapy. METHODS This 2-arm, single-center, pilot randomized controlled trial will randomize 50 patients with breast cancer undergoing chemotherapy to HIIT or attention control. The HIIT group will perform a supervised 16-week, thrice-weekly intervention, with each session including a 5-minute warm-up at 10% maximal power output (POmax), 10 sets of alternating 1-minute high-intensity (90% POmax) and 1-minute recovery (10% POmax) intervals, and a 5-minute cooldown (10% POmax). The attention control group will receive a stretching program with no exercise components and be asked to maintain their exercise levels for 16 weeks. The primary outcomes of the study are executive function and memory measured using the National Institutes of Health toolbox and resting-state connectivity and diffusion tensor imaging microstructure evaluated using magnetic resonance imaging. The secondary and tertiary outcomes include cardiorespiratory fitness, body composition, physical fitness, and psychosocial health. The study has been approved by the institutional review board of the Dana-Farber Cancer Institute (20-222). RESULTS The trial was funded in January 2019, with recruitment started in June 2021. As of May 2022, a total of 4 patients have consented and been randomized (n=2, 50% to exercise; n=1, 25% to control; and n=1, 25% nonrandomized). Trial completion is expected in January 2024. CONCLUSIONS This first-of-its-kind study incorporates a novel exercise intervention (ie, HIIT) and comprehensive cognitive measures. If positive, our findings will establish the pilot efficacy of HIIT on chemotherapy-induced cognitive function in patients with breast cancer, providing the foundation for future larger phase-II and phase-III trials to confirm the findings and potentially establish HIIT as a standard of care for women undergoing chemotherapy for breast cancer. TRIAL REGISTRATION ClinicalTrials.gov NCT04724499; https://clinicaltrials.gov/ct2/show/NCT04724499. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/39740.
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Affiliation(s)
- Rebekah Wilson
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Dong-Woo Kang
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Meghan Tahbaz
- Department of Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Mary Norris
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Hajime Uno
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Jennifer Ligibel
- Harvard Medical School, Boston, MA, United States
- Division of Breast Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Jeffrey Guenette
- Division of Neuroradiology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Cameron Christopher
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Christina Dieli-Conwright
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
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Kiesl D, Kuzdas-Sallaberger M, Fuchs D, Brunner S, Kommenda R, Tischler C, Hornich H, Akbari K, Kellermair J, Blessberger H, Ocenasek H, Hofmann P, Zimmer P, Vosko MR. Protocol for the Exercise, Cancer and Cognition - The ECCO-Study: A Randomized Controlled Trial of Simultaneous Exercise During Neo-/Adjuvant Chemotherapy in Breast Cancer Patients and Its Effects on Neurocognition. Front Neurol 2022; 13:777808. [PMID: 35401389 PMCID: PMC8990905 DOI: 10.3389/fneur.2022.777808] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 02/10/2022] [Indexed: 12/21/2022] Open
Abstract
Introduction Epidemiological studies show that increased physical activity is linked to a lower risk of breast cancer and mortality. As a result, physical activity can significantly improve patients' quality of life (QOL) both during and after therapy.Many breast cancer patients demonstrate a decrease in cognitive capacity, referred to as the symptom-complex cancer related cognitive impairment (CRCI). Most frequently reported impairments are mild to moderate deficits in processing speed, attention, memory, and executive functions. Cognitive symptoms persist for months or even years, following medical treatment in roughly 35% of afflicted people, impairing everyday functioning, limiting the ability to return to work, and lowering the overall QOL. Recent studies point toward a key role of inflammatory pathways in the CRCI genesis. Attention to physical activity as a potential supportive care option is therefore increasing. However, evidence for the positive effects of exercise on preventing CRCI is still lacking. Patients and Methods Against this background, the prospective, two-arm, 1:1 randomized, controlled trial investigates the influence of first line chemotherapy accompanied by exercise training on preventing CRCI in 126 patients with breast cancer at the local University Hospital. The study will evaluate biomarkers and secondary assessments suspected to be involved in the pathogenesis of CRCI in addition to objective (primary outcome) and subjective cognitive function. CRCI is believed to be connected to either functional and/or morphological hippocampal damage due to chemotherapy. Thus, cerebral magnetic resonance imaging (MRI) and hippocampal volume measurements are performed. Furthermore, a specific neuropsychological test battery for breast cancer patients has been developed to detect early signs of cognitive impairments in patients and to be integrated into practice. Discussion This study will explore how a long-term supervised exercise intervention program might prevent CRCI, enables optimization of supportive care and objectifies limits of psychological and physical resilience in breast cancer patients during and after chemotherapy treatment. Trial Registration ClinicalTrials.gov: Identifier: NCT04789187. Registered on 09 March 2021.
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Affiliation(s)
- David Kiesl
- Department for Internal Medicine III, Kepler University Hospital, Linz, Austria
| | | | - David Fuchs
- Department for Palliative Care, Ordensklinikum Linz, Sisters of Mercy Hospital, Linz, Austria
| | - Silvana Brunner
- Department for Clinical Psychology, Kepler University Hospital, Linz, Austria
| | - Romana Kommenda
- Department for Clinical Psychology, Kepler University Hospital, Linz, Austria
| | - Clemens Tischler
- Department for Clinical Psychology, Kepler University Hospital, Linz, Austria
| | | | - Kaveh Akbari
- Central Radiology Institute, Kepler University Hospital, Johannes Kepler University, Linz, Austria
| | - Jörg Kellermair
- Department of Cardiology, Medical Faculty of the Johannes Kepler University, Kepler University Hospital, Linz, Austria
| | - Hermann Blessberger
- Department of Cardiology, Medical Faculty of the Johannes Kepler University, Kepler University Hospital, Linz, Austria
| | | | - Peter Hofmann
- Institute of Human Movement Science, Sport & Health, Exercise Physiology, Training & Training Therapy Research Group, University of Graz, Graz, Austria
| | - Philipp Zimmer
- Divison of Performance and Health (Sports Medicine), Institute for Sport and Sport Science, TU Dortmund University, Dortmund, Germany
| | - Milan R Vosko
- Department of Neurology, Kepler University Hospital, Linz, Austria
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Bender CM, Sereika SM, Gentry AL, Duquette JE, Casillo FE, Marsland A, Brufsky AM, Evans S, Gorantla VC, Grahovac TL, McAuliffe PF, Steiman JG, Zhu Y, Erickson KI. Physical activity, cardiorespiratory fitness, and cognitive function in postmenopausal women with breast cancer. Support Care Cancer 2021; 29:3743-3752. [PMID: 33210238 PMCID: PMC8131400 DOI: 10.1007/s00520-020-05865-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 10/28/2020] [Indexed: 01/25/2023]
Abstract
Physical activity may improve cognitive function in women with breast cancer. In a cross-sectional study, we explored the relationship between cognitive function and physical activity (actigraph) and cardiorespiratory fitness (sub-maximal graded exercise test) in 73 postmenopausal women with early stage breast cancer prior to the initiation of systemic adjuvant therapy. Cognitive function was assessed with a standardized battery of neurocognitive measures assessing eight domains. Data were analyzed using partial correlations, controlling for age and total hours of actigraph wear-time. Women were, on average, 63.71 (± 5.3) years of age with 15.47 (± 2.48) years of education. For physical activity, greater average number of steps per day were associated with better attention (r = .262, p = .032) and psychomotor speed (r = .301, p = .011); greater average hours of moderate and moderate/vigorous intensity physical activity were associated with better visual memory (r = .241, p = .049; r = .241, p = .049, respectively); and greater average daily energy expenditure was associated with better visual memory (r = .270, p = .027) and psychomotor speed (r = .292, p = .017). For fitness, higher peak maximum VO2 was associated with better concentration (r = .330, p = .006), verbal memory (r = .241, p = .048), and working memory (r = .281, p = .019). These results suggest that higher levels of physical activity and cardiorespiratory fitness are associated with better cognitive function in postmenopausal women with breast cancer. Randomized controlled trials (RCT) to examine whether physical activity improves cognitive function in women with breast cancer are warranted. These RCTs should also determine the mechanisms of the influence of physical activity on cognitive function. CLINICAL TRIALS REGISTRATION NUMBER: NCT02793921; Date: May 20, 2016.
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Affiliation(s)
| | - Susan M Sereika
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Amanda L Gentry
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | | | | | - Anna Marsland
- School of Arts and Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Adam M Brufsky
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Steven Evans
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Tara L Grahovac
- Department of Surgery, St. Clair Hospital, Pittsburgh, PA, USA
| | | | | | - Yehui Zhu
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kirk I Erickson
- School of Arts and Sciences, University of Pittsburgh, Pittsburgh, PA, USA
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15
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Harrison RA, Sharafeldin N, Rexer JL, Streck B, Petersen M, Henneghan AM, Kesler SR. Neurocognitive Impairment After Hematopoietic Stem Cell Transplant for Hematologic Malignancies: Phenotype and Mechanisms. Oncologist 2021; 26:e2021-e2033. [PMID: 34156729 DOI: 10.1002/onco.13867] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 06/14/2021] [Indexed: 12/16/2022] Open
Abstract
Hematopoietic stem cell transplant (HSCT) plays a central role in the treatment of hematologic cancers. With the increasing survival of patients after HSCT, survivorship issues experienced by this population have become an important outcome. Cognitive impairment is an established sequela of HSCT, with studies to date establishing its presence, associated risk factors, and clinical phenotype. There are multiple potential contributors to cognitive impairment after HSCT. Efforts are ongoing to further characterize its clinical phenotype, associated biomarkers, and biologic underpinnings. A fundamental knowledge of post-HSCT cognitive impairment is of value for all clinicians who interface with this population, and further academic efforts are needed to more fully understand the impact of this cancer treatment on brain health. IMPLICATIONS FOR PRACTICE: As survival outcomes after hematopoietic stem cell transplant (HSCT) improve, an awareness of the post-treatment challenges faced by this population has become central to its care. HSCT can have a sustained and broad impact on brain health, causing cognitive dysfunction, fatigue, disturbed mood, and sleep. In affected patients, autonomy, return to work, relationships, and quality of life may all be affected. A fundamental fluency in this area is important for clinicians interfacing with HSCT survivors, facilitating the identification and management of cognitive dysfunction and concurrent symptom clusters, and stimulating interest in these sequelae as areas for future clinical research.
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Affiliation(s)
- Rebecca A Harrison
- Department of Neuro-Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Noha Sharafeldin
- Department of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jennie L Rexer
- Department of Neuro-Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Brennan Streck
- Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Melissa Petersen
- Department of Family Medicine, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Ashley M Henneghan
- School of Nursing, Dell School of Medicine, University of Texas at Austin, Austin, Texas, USA.,Department of Oncology, Dell School of Medicine, University of Texas at Austin, Austin, Texas, USA
| | - Shelli R Kesler
- School of Nursing, Dell School of Medicine, University of Texas at Austin, Austin, Texas, USA.,Department of Diagnostic Medicine, Dell School of Medicine, University of Texas at Austin, Austin, Texas, USA
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Nusca SM, Parisi A, Mercantini P, Gasparrini M, Pitasi FA, Lacopo A, Colonna V, Stella G, Cerulli C, Grazioli E, Tranchita E, Santoboni F, Latini E, Trischitta D, Vetrano M, Visco V, Pavan A, Vulpiani MC. Evaluation of a Post-Operative Rehabilitation Program in Patients Undergoing Laparoscopic Colorectal Cancer Surgery: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115632. [PMID: 34070340 PMCID: PMC8197504 DOI: 10.3390/ijerph18115632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/21/2021] [Accepted: 05/21/2021] [Indexed: 01/07/2023]
Abstract
This pilot study explores the effects of a post-operative physical exercise program on the quality of life (QoL) and functional and nutritional parameters of patients that underwent laparoscopic colorectal cancer surgery, compared to usual care alone. The intervention group (IG) attended a 2-month-long supervised and combined exercise–training program during the post-operative period. Both IG and control group (CG) participated in the QoL, functional, and nutritional assessments before exercise training (T0), 2 months after the beginning of the exercise (end of treatment) (T1), and 2 (T2) and 4 (T3) months from the end of treatment. Eleven patients with colorectal cancer that underwent laparoscopic surgery were enrolled (six intervention; five control). The IG showed significant improvements compared to the CG in “Physical functioning” (PF2) (p = 0.030), “Cognitive functioning” (CF) (p = 0.018), and “Fatigue” (FA) (p = 0.017) of the European Organization for Research and Treatment of Cancer Quality of Life-C30 Questionnaire (EORTC QLQ-C30) at T1; in SMWT (p = 0.022) at T1; in PF2 (p = 0.018) and FA (p = 0.045) of EORTC QLQ-C30 at T2, in phase angle (PhA) of bioelectrical impedance analysis (p = 0.022) at T3. This pilot study shows that a post-operative, combined, and supervised physical exercise program may have positive effects in improving the QoL, functional capacity, and nutritional status in patients that undergo laparoscopic colorectal cancer surgery.
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Affiliation(s)
- Sveva Maria Nusca
- PhD Course in “Translational Medicine and Oncology”, Department of Medical and Surgical Sciences and Translational Medicine, Sant’Andrea University Hospital, “Sapienza” University of Rome, 00189 Rome, Italy
- Correspondence:
| | - Attilio Parisi
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (A.P.); (C.C.); (E.G.); (E.T.)
| | - Paolo Mercantini
- Department of Medical and Surgical Sciences and Translational Medicine, Sant’Andrea University Hospital, “Sapienza” University of Rome, 00189 Rome, Italy;
| | - Marcello Gasparrini
- Department of General Surgery, Sant’Andrea University Hospital, “Sapienza” University of Rome, 00189 Rome, Italy;
| | - Francesco Antonio Pitasi
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences and Translational Medicine, Sant’Andrea University Hospital, “Sapienza” University of Rome, 00189 Rome, Italy; (F.A.P.); (A.L.); (V.C.); (G.S.); (F.S.); (E.L.); (D.T.); (M.V.); (M.C.V.)
| | - Alessandra Lacopo
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences and Translational Medicine, Sant’Andrea University Hospital, “Sapienza” University of Rome, 00189 Rome, Italy; (F.A.P.); (A.L.); (V.C.); (G.S.); (F.S.); (E.L.); (D.T.); (M.V.); (M.C.V.)
| | - Vincenzo Colonna
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences and Translational Medicine, Sant’Andrea University Hospital, “Sapienza” University of Rome, 00189 Rome, Italy; (F.A.P.); (A.L.); (V.C.); (G.S.); (F.S.); (E.L.); (D.T.); (M.V.); (M.C.V.)
| | - Giulia Stella
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences and Translational Medicine, Sant’Andrea University Hospital, “Sapienza” University of Rome, 00189 Rome, Italy; (F.A.P.); (A.L.); (V.C.); (G.S.); (F.S.); (E.L.); (D.T.); (M.V.); (M.C.V.)
| | - Claudia Cerulli
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (A.P.); (C.C.); (E.G.); (E.T.)
| | - Elisa Grazioli
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (A.P.); (C.C.); (E.G.); (E.T.)
| | - Eliana Tranchita
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (A.P.); (C.C.); (E.G.); (E.T.)
| | - Flavia Santoboni
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences and Translational Medicine, Sant’Andrea University Hospital, “Sapienza” University of Rome, 00189 Rome, Italy; (F.A.P.); (A.L.); (V.C.); (G.S.); (F.S.); (E.L.); (D.T.); (M.V.); (M.C.V.)
| | - Eleonora Latini
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences and Translational Medicine, Sant’Andrea University Hospital, “Sapienza” University of Rome, 00189 Rome, Italy; (F.A.P.); (A.L.); (V.C.); (G.S.); (F.S.); (E.L.); (D.T.); (M.V.); (M.C.V.)
| | - Donatella Trischitta
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences and Translational Medicine, Sant’Andrea University Hospital, “Sapienza” University of Rome, 00189 Rome, Italy; (F.A.P.); (A.L.); (V.C.); (G.S.); (F.S.); (E.L.); (D.T.); (M.V.); (M.C.V.)
| | - Mario Vetrano
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences and Translational Medicine, Sant’Andrea University Hospital, “Sapienza” University of Rome, 00189 Rome, Italy; (F.A.P.); (A.L.); (V.C.); (G.S.); (F.S.); (E.L.); (D.T.); (M.V.); (M.C.V.)
| | - Vincenzo Visco
- Department of Clinical and Molecular Medicine, Sant’Andrea University Hospital, “Sapienza” University of Rome, 00189 Rome, Italy; (V.V.); (A.P.)
| | - Antonio Pavan
- Department of Clinical and Molecular Medicine, Sant’Andrea University Hospital, “Sapienza” University of Rome, 00189 Rome, Italy; (V.V.); (A.P.)
| | - Maria Chiara Vulpiani
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences and Translational Medicine, Sant’Andrea University Hospital, “Sapienza” University of Rome, 00189 Rome, Italy; (F.A.P.); (A.L.); (V.C.); (G.S.); (F.S.); (E.L.); (D.T.); (M.V.); (M.C.V.)
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Relationship of perceived everyday cognitive function and work engagement in breast cancer survivors. Support Care Cancer 2021; 29:4303-4309. [PMID: 33415361 DOI: 10.1007/s00520-020-05950-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 12/15/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Breast cancer survivors (BCS) who represent approximately 3.5 million survivors in the USA frequently report ongoing cognitive dysfunction that may impact work outcomes. However, little is known about how perceived everyday cognitive function may affect work engagement (a measure of work efficacy and work well-being) in BCS who have completed treatment. OBJECTIVES The purpose of this study was to examine the relationship between perceived everyday cognitive function and work engagement in BCS. METHODS A convenience sample of 68 employed BCS seen at a Midwest NCI-Cancer Center who were at least 1-year post-treatment, completed a cross-sectional questionnaire assessing demographic and medical characteristics, and perceived everyday cognitive function (Everyday Cognition Scale) and work engagement (Utrecht Work Engagement Scale). Descriptive statistics, Pearson's r, and separate regression models controlling for age and education were used to analyze the data. RESULTS BCS who were on average 52 (SD = 8.6) years old, 5 (SD = 3.8) years post-treatment, and primarily employed full-time (79%) participated. A subset of BCS (12%) identified poorer everyday cognitive function after BC diagnosis and treatment. Everyday cognition, including subscales vigor and dedication, were correlated with work engagement (p˂0.01), controlling for age and education. CONCLUSIONS Findings indicate the important role of perceived everyday cognitive function in work engagement well into survivorship. Reducing cognitive dysfunction may be an important area for future intervention research to support BCS who return to work. IMPLICATIONS TO PRACTICE Healthcare providers need to assess and address perceived cognitive dysfunction to promote work-related outcomes in BCS well into survivorship.
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Okechukwu C, Okechukwu C, Agag A, Naushad N, Abbas S, Deb A. Hypothesized biological mechanisms by which exercise-induced irisin mitigates tumor proliferation and improves cancer treatment outcomes. MGM JOURNAL OF MEDICAL SCIENCES 2021. [DOI: 10.4103/mgmj.mgmj_67_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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A pilot feasibility randomized controlled trial adding behavioral counseling to supervised physical activity in prostate cancer survivors: behavior change in prostate cancer survivors trial (BOOST). J Behav Med 2020; 44:172-186. [DOI: 10.1007/s10865-020-00185-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 09/16/2020] [Indexed: 01/19/2023]
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Morris R, Lewis A. Falls and Cancer. Clin Oncol (R Coll Radiol) 2020; 32:569-578. [PMID: 32291190 DOI: 10.1016/j.clon.2020.03.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 03/04/2020] [Accepted: 03/26/2020] [Indexed: 11/26/2022]
Abstract
Falls among older people are common and are associated with substantial morbidity, mortality and healthcare costs. Increasingly cancer is becoming a disease of older people and fall rates are higher in elders living with cancer. Cancer and its treatments potentiate important risk factors for falls, including muscle weakness, poor balance, proprioception, cognitive impairment and functional disability. Sarcopenia refers to the progressive deterioration in muscle strength, mass and quality with ageing. Chronic conditions and cancer amplify this decline and are associated with a greater negative effect on function. Age-related impairments of lower limb neurological function are commonly exacerbated by neurotoxic chemotherapy, resulting in gait and balance deficits. Postural instability and falls erode confidence and result in a negative cycle of diminishing activity levels, further deconditioning and a higher risk of further falls. Cancer-related fatigue, sleep and mood disturbances compound this progressive frailty, further worsening treatment tolerance and outcomes. Cognitive impairment is a potent risk factor for falling and is frequently associated with gait abnormalities. The well-recognised effects of cancer treatment on working memory, attention, processing speed and executive function are often apparent (when their presence is sought) before treatment and may be as much the result of the cancer itself as they are 'chemo brain'. Structured exercise programmes focusing on progressively challenging strength and balance training are of proven benefit in falls prevention. Regular aerobic exercise accrues additional benefits in improved cardiorespiratory resilience and concomitant positive effects on treatment tolerance. Increased activity levels positively influence cognition, mood and foster an improved sense of well-being. Simple, practicable clinic-based tests of physical functioning, cognition and neurological function can help to identify those at high risk of falls and functional decline. The use of such instruments can aid judicious treatment planning and identify those most likely to benefit from more detailed specialist comprehensive geriatric assessment.
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Affiliation(s)
- R Morris
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK.
| | - A Lewis
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK
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21
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Effects of partly supervised and home-based exercise program in patients undergoing hematopoietic stem cell transplantation: a case-control study. Support Care Cancer 2020; 28:5851-5860. [DOI: 10.1007/s00520-020-05432-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 03/27/2020] [Indexed: 12/18/2022]
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22
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Ehlers DK, Fanning J, Sunderlage A, Severson J, Kramer AF, McAuley E. Influence of sitting behaviors on sleep disturbance and memory impairment in breast cancer survivors. Cancer Med 2020; 9:3417-3424. [PMID: 32202706 PMCID: PMC7221435 DOI: 10.1002/cam4.3008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 02/25/2020] [Indexed: 01/09/2023] Open
Abstract
Background The purpose was to prospectively examine the effects of sedentary behaviors on subjective memory impairment in breast cancer survivors (BCS) and the extent to which sleep disturbances mediated this pathway. Methods BCS (N = 380; Mage = 57.38 ± 9.25 years) completed questionnaires assessing demographics, health history, sitting behaviors, sleep disturbance, subjective memory impairment, and moderate‐to‐vigorous physical activity (MVPA) at baseline and 6‐month follow‐up. A subsample (N = 300) wore an accelerometer to objectively estimate sedentary time and MVPA. Structural equation modeling was used to test direct and indirect effects of self‐reported and objectively estimated sedentary behaviors on memory impairment (through sleep disturbance) across time. Models were adjusted for demographic, clinical, and MVPA covariates. Results At baseline, more total daily sitting (γ = 0.23), occupational sitting (γ = 0.11), television viewing (γ = 0.15), and computer use (γ = 0.22) were associated with greater sleep disturbance, which was associated with greater memory impairment (γ = −0.22). Indirect effects of self‐reported sitting on memory were significant. At follow‐up, increased total daily sitting (γ = 0.08) and computer use (γ = 0.14) predicted increased sleep disturbance, which predicted increased memory impairment (γ = −0.09). The indirect path from increased computer use to memory impairment was significant (β = −0.01). In the accelerometer subsample, greater daily sedentary time at baseline was associated with less sleep disturbance (γ = −0.14) and memory impairment (indirect effect: β = 0.03). Conclusions Findings provide early evidence that sedentary contexts may differentially influence sleep disturbance and memory impairment in BCS. Computer use and television viewing may pose the strongest risks to cognitive health. Disparate findings between objective and subjective sedentary measures warrant further research.
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Affiliation(s)
| | | | | | | | - Arthur F Kramer
- University of Illinois at Urbana-Champaign, Urbana, IL, USA.,Northeastern University, Boston, MA, USA
| | - Edward McAuley
- University of Illinois at Urbana-Champaign, Urbana, IL, USA
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23
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Pergolotti M, Battisti NML, Padgett L, Sleight AG, Abdallah M, Newman R, Van Dyk K, Covington KR, Williams GR, van den Bos F, Pollock Y, Salerno EA, Magnuson A, Gattás-Vernaglia IF, Ahles TA. Embracing the complexity: Older adults with cancer-related cognitive decline-A Young International Society of Geriatric Oncology position paper. J Geriatr Oncol 2020; 11:237-243. [PMID: 31619372 PMCID: PMC7054166 DOI: 10.1016/j.jgo.2019.09.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 08/01/2019] [Accepted: 09/04/2019] [Indexed: 01/16/2023]
Abstract
Cancer-related cognitive decline (CRCD) may have particularly significant consequences for older adults, impacting their functional and physical abilities, level of independence, ability to make decisions, treatment adherence, overall quality of life, and ultimately survival. In honor of Dr. Hurria's work we explore and examine multiple types of screening, assessment and non-pharmacologic treatments for CRCD. We then suggest future research and clinical practice questions to holistically appreciate the complexity of older adults with cancer's experiences and fully integrate the team-based approach to best serve this population.
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Affiliation(s)
- Mackenzi Pergolotti
- ReVital Cancer Rehabilitation, Select Medical, 4174 Gettysburg Rd, Mechanicsburg, PA 17055, USA; Department of Occupational Therapy - College of Health and Human Sciences, Colorado State University, 200 Occupational Therapy Building, Fort Collins, CO 80523-1573, USA.
| | - Nicolò Matteo Luca Battisti
- Department of Medicine - Breast Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton Surrey SM2 5PT, United Kingdom.
| | - Lynne Padgett
- Veterans Affairs Medical Center, Washington, DC, USA
| | - Alix G Sleight
- Outcomes Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, USA.
| | - Maya Abdallah
- Department of Internal Medicine, University of Massachusetts Medical School - Baystate Medical Center, 759 Chestnut St., Springfield, MA, 01199, USA.
| | - Robin Newman
- Department of Occupational Therapy, Boston University Sargent College of Health and Rehabilitation Sciences, 635 Commonwealth Avenue, Boston, MA 02215, USA.
| | - Kathleen Van Dyk
- Jonsson Comprehensive Cancer Center, Cancer Prevention and Control Research, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA 90095, USA.
| | - Kelley R Covington
- ReVital Cancer Rehabilitation, Select Medical, 4174 Gettysburg Rd, Mechanicsburg, PA 17055, USA; Department of Occupational Therapy - College of Health and Human Sciences, Colorado State University, 200 Occupational Therapy Building, Fort Collins, CO 80523-1573, USA.
| | - Grant R Williams
- Divisions of Hematology/Oncology & Gerontology, Geriatrics, and Palliative Care, Institute for Cancer Outcomes and Survivorship, The University of Alabama at Birmingham, 1670 University Blvd, Birmingham, AL 35233, USA.
| | - Frederiek van den Bos
- Departement of Geriatric Medicine, University Medical Centre Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, Netherlands.
| | - YaoYao Pollock
- Geriatric Oncology Fellowship Program, University of California, San Francisco, 1600 Divisadero St, San Francisco, CA 94115, USA.
| | - Elizabeth A Salerno
- Division of Cancer Epidemiology & Genetics, Metabolic Epidemiology Branch, National Cancer Institute, 9609 Medical Center Dr, Rockville, MD 20850, USA.
| | - Allison Magnuson
- Department of Medicine, Hematology/Oncology, University of Rochester Medical Center, 601 Elmwood Ave, Box 704, Rochester, NY 14642, USA.
| | - Isabella F Gattás-Vernaglia
- Division of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, Hospital Sírio-Libanês- Geriatric Oncology Team, Av. Dr. Enéas de Carvalho Aguiar, 155, 8° Andar, Bloco 3, São Paulo, SP CEP 05403-900, Brazil
| | - Tim A Ahles
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, New York, NY 10022, USA.
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24
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Erickson KI, Hillman C, Stillman CM, Ballard RM, Bloodgood B, Conroy DE, Macko R, Marquez DX, Petruzzello SJ, Powell KE. Physical Activity, Cognition, and Brain Outcomes: A Review of the 2018 Physical Activity Guidelines. Med Sci Sports Exerc 2019; 51:1242-1251. [PMID: 31095081 DOI: 10.1249/mss.0000000000001936] [Citation(s) in RCA: 503] [Impact Index Per Article: 100.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE Physical activity (PA) is known to improve cognitive and brain function, but debate continues regarding the consistency and magnitude of its effects, populations and cognitive domains most affected, and parameters necessary to achieve the greatest improvements (e.g., dose). METHODS In this umbrella review conducted in part for the 2018 Health and Human Services Physical Activity Guidelines for Americans Advisory Committee, we examined whether PA interventions enhance cognitive and brain outcomes across the life span, as well as in populations experiencing cognitive dysfunction (e.g., schizophrenia). Systematic reviews, meta-analyses, and pooled analyses were used. We further examined whether engaging in greater amounts of PA is associated with a reduced risk of developing cognitive impairment and dementia in late adulthood. RESULTS Moderate evidence from randomized controlled trials indicates an association between moderate- to vigorous-intensity PA and improvements in cognition, including performance on academic achievement and neuropsychological tests, such as those measuring processing speed, memory, and executive function. Strong evidence demonstrates that acute bouts of moderate- to vigorous-intensity PA have transient benefits for cognition during the postrecovery period after exercise. Strong evidence demonstrates that greater amounts of PA are associated with a reduced risk of developing cognitive impairment, including Alzheimer's disease. The strength of the findings varies across the life span and in individuals with medical conditions influencing cognition. CONCLUSIONS There is moderate-to-strong support that PA benefits cognitive functioning during early and late periods of the life span and in certain populations characterized by cognitive deficits.
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Affiliation(s)
- Kirk I Erickson
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA
| | - Charles Hillman
- Department of Psychology and Department of Physical Therapy, Movement, and Rehabilitation Sciences, Northeastern University, Boston, MA
| | | | - Rachel M Ballard
- Office of Disease Prevention, Office of the Director, National Institutes of Health, Bethesda, MD
| | | | - David E Conroy
- Department of Kinesiology, The Pennsylvania State University, University Park, PA
| | - Richard Macko
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD
| | - David X Marquez
- Department of Kinesiology and Nutrition, Center for Research on Health and Aging, University of Illinois at Chicago, Chicago, IL
| | - Steven J Petruzzello
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL
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25
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Hartman SJ, Weiner LS, Nelson SH, Natarajan L, Patterson RE, Palmer BW, Parker BA, Sears DD. Mediators of a Physical Activity Intervention on Cognition in Breast Cancer Survivors: Evidence From a Randomized Controlled Trial. JMIR Cancer 2019; 5:e13150. [PMID: 31605514 PMCID: PMC6914286 DOI: 10.2196/13150] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 04/11/2019] [Accepted: 08/14/2019] [Indexed: 12/13/2022] Open
Abstract
Background Emerging research suggests that increasing physical activity can help improve cognition among breast cancer survivors. However, little is known about the mechanism through which physical activity impacts cancer survivors’ cognition. Objective The objective of this secondary analysis examined physical and psychological function potentially linking physical activity with changes in cognition among breast cancer survivors in a randomized controlled trial where the exercise arm had greater improvements in cognition than the control arm. Methods A total of 87 sedentary breast cancer survivors were randomized to a 12-week physical activity intervention (n=43) or control condition (n=44). Objectively measured processing speed (National Institutes of Health Toolbox Oral Symbol Digit), self-reported cognition (patient-reported outcomes measurement information system [PROMIS] cognitive abilities), PROMIS measures of physical and psychological function (depression, anxiety, fatigue, and physical functioning), and plasma biomarkers (brain-derived neurotrophic factor, homeostatic model assessment 2 of insulin resistance, and C-reactive protein [CRP]) were collected at baseline and 12 weeks. Linear mixed-effects models tested intervention effects on changes in physical and psychological function variables and biomarkers. Bootstrapping was used to assess mediation. Exploratory analyses examined self-reported cognitive abilities and processing speed as mediators of the intervention effect on physical functioning. Results Participants in the exercise arm had significantly greater improvements in physical functioning (beta=1.23; 95% CI 2.42 to 0.03; P=.049) and reductions in anxiety (beta=−1.50; 95% CI −0.07 to −2.94; P=.04) than those in the control arm. Anxiety significantly mediated the intervention effect on cognitive abilities (bootstrap 95% CI −1.96 to −0.06), whereas physical functioning did not (bootstrap 95% CI −1.12 to 0.10). Neither anxiety (bootstrap 95% CI −1.18 to 0.74) nor physical functioning (bootstrap 95% CI −2.34 to 0.15) mediated the intervention effect on processing speed. Of the biomarkers, only CRP had greater changes in the exercise arm than the control arm (beta=.253; 95% CI −0.04 to 0.57; P=.09), but CRP was not associated with cognition; therefore, none of the biomarker measures mediated the intervention effect on cognition. Neither cognitive abilities (bootstrap 95% CI −0.06 to 0.68) nor processing speed (bootstrap 95% CI −0.15 to 0.63) mediated the intervention effect on physical function. Conclusions Physical activity interventions may improve self-reported cognition by decreasing anxiety. If supported by larger studies, reducing anxiety may be an important target for improving self-reported cognition among cancer survivors. Trial Registration ClinicalTrials.gov NCT02332876; https://clinicaltrials.gov/ct2/show/NCT02332876
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Affiliation(s)
- Sheri J Hartman
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, United States.,UC San Diego Moores Cancer Center, University of California, San Diego, La Jolla, CA, United States
| | - Lauren S Weiner
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, United States.,UC San Diego Moores Cancer Center, University of California, San Diego, La Jolla, CA, United States
| | - Sandahl H Nelson
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, United States.,UC San Diego Moores Cancer Center, University of California, San Diego, La Jolla, CA, United States
| | - Loki Natarajan
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, United States.,UC San Diego Moores Cancer Center, University of California, San Diego, La Jolla, CA, United States
| | - Ruth E Patterson
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, United States.,UC San Diego Moores Cancer Center, University of California, San Diego, La Jolla, CA, United States
| | - Barton W Palmer
- Veterans Affairs San Diego Healthcare System, San Diego, CA, United States.,Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Barbara A Parker
- UC San Diego Moores Cancer Center, University of California, San Diego, La Jolla, CA, United States.,Department of Medicine, University of California, San Diego, La Jolla, CA, United States
| | - Dorothy D Sears
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, United States.,UC San Diego Moores Cancer Center, University of California, San Diego, La Jolla, CA, United States.,Department of Medicine, University of California, San Diego, La Jolla, CA, United States.,College of Health Solutions, Arizona State University, Phoenix, AZ, United States
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26
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The relationship between diet and cognitive function in adult cancer survivors: a systematic review. J Cancer Surviv 2019; 13:773-791. [PMID: 31399855 DOI: 10.1007/s11764-019-00796-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 08/01/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE To perform a systematic review identifying how dietary factors are related to cognitive function in cancer survivors who are not currently undergoing primary treatment. METHODS Using the PRISMA framework, a search was conducted for studies published before February 2019 across multiple databases, identifying 2304 unique articles. Twelve met final inclusion criteria and were evaluated through narrative synthesis. This review was registered with the International Prospective Register Of Systematic Reviews (CRD42018111941). RESULTS Included studies were heterogeneous in methodology and in dietary and cognitive variables investigated making direct comparisons difficult. Evidence of a relationship between diet and cognition was mixed; the most consistent evidence was identified in relation to a positive relationship between fruit and vegetable intake and cognitive function (both self-reported and objectively tested) in five out of six studies, but was not concordant across all studies. CONCLUSION Preliminary evidence exists that a greater fruit and vegetable intake is associated with better cognitive functioning in cancer survivors, as has been reported in healthy populations; however, these data are correlational and include relatively small samples. Most evidence related to breast cancer survivors, with individual studies extending to colorectal and stomach cancer survivors. Experimental trials are needed to identify causal attribution of dietary factors on cognitive function in cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS At this time, there is not sufficient evidence to make dietary or nutritional recommendations specifically for improving cognitive function in cancer survivors. This should be considered in light of the general paucity of research on this subject, necessitating further investigations.
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Myers JS, Mitchell M, Krigel S, Steinhoff A, Boyce-White A, Van Goethem K, Valla M, Dai J, He J, Liu W, Sereika SM, Bender CM. Qigong intervention for breast cancer survivors with complaints of decreased cognitive function. Support Care Cancer 2018; 27:1395-1403. [PMID: 30128855 DOI: 10.1007/s00520-018-4430-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 08/15/2018] [Indexed: 01/13/2023]
Abstract
PURPOSE The purpose of this pilot study was to evaluate the feasibility of an 8-week Qigong intervention to improve objectively and subjectively assessed cognitive function in breast cancer survivors who were 2 months to 8 years post completion of chemotherapy and radiation therapy. METHODS A randomized, single-blind, three-arm intervention pilot was conducted to compare Qigong to gentle exercise and survivorship support. Feasibility was measured by recruitment, group session attendance, and adherence to home practice for the two exercise groups. Changes in self-report and objectively measured cognitive function were compared between the three groups from baseline (T1) to completion of the intervention (T2) and 4 weeks post intervention (T3). RESULTS Fifty participants consented (83% of desired sample) with an overall attrition rate of 28%. Attrition was highest for the gentle exercise group (50%). Group attendance adherence ranged from 44 to 67%. The a priori established rate of 75% weekly attendance was not achieved, nor was the goal of 75% adherence to home practice for the two exercise groups (7 to 41%). Self-report of cognitive function improved most for the Qigong group (p = .01). Improvement was demonstrated for the Trail Making A (gentle exercise, p = .007) and F-A-S verbal fluency (support group, p = .02) tests. Qigong participants reported the most reduction of distress (p = .02). CONCLUSIONS The study results suggest that mindfulness-based exercise may be superior to gentle exercise alone or survivorship support for improving self-report of cognitive function and distress after treatment for breast cancer. The mindfulness component may enhance the positive impact of exercise on cognitive function.
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Affiliation(s)
- Jamie S Myers
- Office of Grants and Research, University of Kansas School of Nursing, MS 4043, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA.
| | - Melissa Mitchell
- Department of Radiation Oncology, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - Susan Krigel
- Midwest Cancer Alliance, University of Kansas Medical Center, 4350 Shawnee Mission Parkway, Fairway, KS, 66205, USA
| | - Andreanna Steinhoff
- Office of Grants and Research, University of Kansas School of Nursing, MS 4043, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - Alyssa Boyce-White
- University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - Karla Van Goethem
- Midwest Cancer Alliance, University of Kansas Medical Center, 4350 Shawnee Mission Parkway, Fairway, KS, 66205, USA
| | - Mary Valla
- North Kansas City Hospital, 2750 Clay Edwards Drive, North Kansas City, MO, 64116, USA
| | - Junqiang Dai
- Department of Biostatistics, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - Jianghua He
- Department of Biostatistics, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - Wen Liu
- Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - Susan M Sereika
- Center for Research and Evaluation, University of Pittsburgh School of Nursing, 3500 Victoria St, Pittsburgh, PA, 15213, USA
| | - Catherine M Bender
- Nancy Glunt Hoffman Endowed Chair of Oncology Nursing, University of Pittsburgh School of Nursing, 3500 Victoria St, Pittsburgh, PA, 15213, USA
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Ehlers DK, Fanning J, Salerno EA, Aguiñaga S, Cosman J, Severson J, Kramer AF, McAuley E. Replacing sedentary time with physical activity or sleep: effects on cancer-related cognitive impairment in breast cancer survivors. BMC Cancer 2018; 18:685. [PMID: 29940894 PMCID: PMC6019533 DOI: 10.1186/s12885-018-4603-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 06/18/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Evidence suggests reallocating daily sedentary time to physical activity or sleep confers important health benefits in cancer survivors. Despite emerging research suggesting physical activity as a treatment for cancer-related cognitive impairment (CRCI), little is known about the interactive effects of behaviors across the 24-h period. The present purpose was to examine the cognitive effects of reallocating sedentary time to light-intensity physical activity, moderate-to-vigorous physical activity (MVPA), or sleep in breast cancer survivors. METHODS Breast cancer survivors (N = 271, Mage = 57.81 ± 9.50 years) completed iPad-based questionnaires and cognitive tasks assessing demographics, health history, executive function, and processing speed (Task-Switch, Trail Making). Participants wore an accelerometer for seven consecutive days to measure their sedentary, physical activity, and sleep behaviors. Single effects (each behavior individually) and partition (controlling for other behaviors) models were used to examine associations among behaviors and cognitive performance. Isotemporal substitution models were used to test the cognitive effects of substituting 30 min of sedentary time with 30 min of light-intensity activity, MVPA, and sleep. RESULTS MVPA was associated with faster Task-switch reaction time in the partition models (stay: B = - 35.31, p = 0.02; switch: B = - 48.24, p = 0.004). Replacing 30 min of sedentary time with 30 min of MVPA yielded faster reaction times on Task-Switch stay (B = - 29.37, p = 0.04) and switch (B = - 39.49, p = 0.02) trials. In Trails A single effects models, sedentary behavior was associated with faster completion (B = - 0.97, p = 0.03) and light-intensity activity with slower completion (B = 1.25, p = 0.006). No single effects were observed relative to Trails B completion (all p > 0.05). Only the effect of MVPA was significant in the partition models (Trails A: B = - 3.55, p = 0.03; Trails B: B = - 4.46, p = 0.049). Replacing sedentary time with light-intensity activity was associated with slower Trails A (B = 1.55 p = 0.002) and Trails B (B = 1.69, p = 0.02) completion. Replacing light activity with MVPA yielded faster Trails A (B = - 4.35, p = 0.02) and Trails B (B = - 5.23, p = 0.03) completion. CONCLUSIONS Findings support previous research suggesting MVPA may be needed to improve cognitive function in breast cancer survivors. Trails findings underscore the need to dissect sedentary contexts to better understand the impact of daily behavioral patterns on CRCI. Additional research investigating the cognitive impacts of behaviors across the 24-h period is warranted. TRIAL REGISTRATION This study is registered with United States ClinicalTrials.gov ( NCT02523677 ; 8/14/2015).
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Affiliation(s)
| | - Jason Fanning
- Wake Forest School of Medicine, Winston-Salem, NC USA
| | | | - Susan Aguiñaga
- University of Illinois at Urbana-Champaign, Urbana, IL USA
| | | | | | - Arthur F. Kramer
- University of Illinois at Urbana-Champaign, Urbana, IL USA
- Northeastern University, Boston, MA USA
| | - Edward McAuley
- University of Illinois at Urbana-Champaign, Urbana, IL USA
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