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van de Kamp HJ, Molder MT, Schulkes KJG, Stellingwerf M, van Elden LJR, van Lindert ASR, Hamaker ME. Impact of Lung Cancer Treatment on Cognitive Functioning. Clin Lung Cancer 2019; 21:114-126.e3. [PMID: 31839534 DOI: 10.1016/j.cllc.2019.06.006] [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: 01/31/2019] [Revised: 05/18/2019] [Accepted: 06/05/2019] [Indexed: 12/30/2022]
Abstract
The impact of oncologic treatment for (non)-small-cell lung cancer (NSCLC and SCLC, respectively) on cognition is relevant when deciding which treatment is the most preferable option, especially when curation is not possible. A systematic search of Medline and EMBASE for studies on the effect of treatment on cognition in patients with lung cancer was performed. A total of 39 longitudinal articles were included. Study populations were heterogeneous with regards to stage and treatment type. In the 7 studies concerning SCLC, the median age of patients was between 59 and 68 years. Eighty-six percent of these studies had a loss to follow-up > 10%. Six studies used objective tests to assess cognition. Objective measurements showed a negative effect on attention, memory, and fluency after treatment. Thirty-three studies concerning NSCLC were included. The mean age of patients was between 53 and 77 years. Seventy percent of these studies included patients with stage III and IV NSCLC. Over one-half of the studies had a high rate of loss to follow-up. Eighty-eight percent used objective scales to assess cognitive functioning. Subjective decline of cognitive functioning up to 11.1% was experienced, with recovery at 4 to 6 months. Objective measurement of attention showed improvement over the course of chemotherapy. In SCLC, there is a significant negative effect on attention, memory, and fluency. In NSCLC, the longer term impact of treatment on both subjective and objective cognitive functioning appears limited. Thus, there is no evidence directing treatment choice for NSCLC based on longer term cognitive deficits. Further research is needed to precisely assess the impact of lung cancer treatment on cognition.
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Affiliation(s)
| | - Marthe Te Molder
- Department of Internal Medicine, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - Karlijn J G Schulkes
- Department of Pulmonology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Margriet Stellingwerf
- Department of Pulmonology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Anne S R van Lindert
- Department of Pulmonology, University Medical Center Utrecht, Utrecht, The Netherlands
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Hamel JF, Saulnier P, Pe M, Zikos E, Musoro J, Coens C, Bottomley A. A systematic review of the quality of statistical methods employed for analysing quality of life data in cancer randomised controlled trials. Eur J Cancer 2017; 83:166-176. [DOI: 10.1016/j.ejca.2017.06.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 06/21/2017] [Indexed: 11/27/2022]
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Zikos E, Ghislain I, Coens C, Ediebah DE, Sloan E, Quinten C, Koller M, van Meerbeeck JP, Flechtner HH, Stupp R, Pallis A, Czimbalmos A, Sprangers MAG, Bottomley A. Health-related quality of life in small-cell lung cancer: a systematic review on reporting of methods and clinical issues in randomised controlled trials. Lancet Oncol 2014; 15:e78-89. [PMID: 24480558 DOI: 10.1016/s1470-2045(13)70493-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Small-cell lung cancer represents about 15% of all lung cancers; increasingly, randomised controlled trials of this disease measure the health-related quality of life of patients. In this Systematic Review we assess the adequacy of reporting of health-related quality-of-life methods in randomised controlled trials of small-cell lung cancer, and the potential effect of this reporting on clinical decision making. Although overall reporting of health-related quality of life was acceptable, improvements are needed to optimise the use of health-related quality of life in randomised controlled trials.
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Affiliation(s)
- Efstathios Zikos
- Quality of Life Department, EORTC Headquarters, Brussels, Belgium.
| | - Irina Ghislain
- Quality of Life Department, EORTC Headquarters, Brussels, Belgium
| | - Corneel Coens
- Quality of Life Department, EORTC Headquarters, Brussels, Belgium
| | - Divine E Ediebah
- Quality of Life Department, EORTC Headquarters, Brussels, Belgium
| | - Elizabeth Sloan
- New England Center for Children, Southborough, Massachusetts, MA, USA
| | - Chantal Quinten
- European Centre for Disease Prevention and Control, Surveillance and Response Support Unit, Stockholm, Sweden
| | - Michael Koller
- University Hospital Regensburg, Center for Clinical Studies, Regensburg, Germany
| | - Jan P van Meerbeeck
- Multidisciplinary Oncology Centre Antwerp (MOCA)/Thoracic Oncology, Antwerp University Hospital, Edegem, Belgium
| | - Hans-Henning Flechtner
- University of Magdeburg, Child and Adolescent Psychiatry and Psychotherapy, Magdeburg, Germany
| | - Roger Stupp
- Department of Oncology and Cancer Center, University Hospital Zurich, Zurich, Switzerland
| | - Athanasios Pallis
- Clinical Research Physicians Unit, EORTC Headquarters, Brussels, Belgium
| | | | - Mirjam A G Sprangers
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Andrew Bottomley
- Quality of Life Department, EORTC Headquarters, Brussels, Belgium
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Du XL, Cai Y, Symanski E. Association between chemotherapy and cognitive impairments in a large cohort of patients with colorectal cancer. Int J Oncol 2013; 42:2123-33. [PMID: 23563930 DOI: 10.3892/ijo.2013.1882] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 02/08/2013] [Indexed: 11/06/2022] Open
Abstract
No population-based study has been conducted on the relationship between chemotherapy and the risk of cognitive impairments in patients with colorectal cancer. This study aimed to determine this association in a large population-based cohort of patients. We studied 72,374 men and women who were diagnosed with stages I-III colorectal cancer at age ≥ 65 years from 1991 through 2002 from 16 regions in the Surveillance, Epidemiology and End Results program who were free of cognitive impairments at baseline with up to 17 years of follow-up and also studied 15,921 matched cohorts based on the propensity of receiving chemotherapy. The cumulative incidence of drug-induced dementia at 5 years was 16.2 cases per 1,000 persons for the chemotherapy group and 12.4 cases per 1,000 persons for the no chemotherapy group. Overall, patients who received chemotherapy were 24% significantly more likely to develop drug-induced dementia compared to those without chemotherapy after adjusting for patient and tumor characteristics (hazard ratio 1.24, 95% confidence interval 1.05-1.47). The significantly increased risk was only observed in those without mood disorder who received chemotherapy in the entire cohort (1.26, 1.06-1.50) and in the matched cohort (1.29, 1.04-1.59). The risk of developing Alzheimer's disease, vascular dementia or other dementias was significantly lower in patients receiving chemotherapy compared to those without chemotherapy regardless of mood disorder status. In conclusion, there was a significant association between chemotherapy and the risk of developing drug-induced dementia in patients with colorectal cancer without mood disorder, but chemotherapy was associated with a decreased risk of other dementias.
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Affiliation(s)
- Xianglin L Du
- School of Public Health, Division of Epidemiology, Human Genetics and Environmental Sciences, University of Texas Health Science Center, Houston, TΧ 77030, USA.
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Relationship Between Chemotherapy Use and Cognitive Impairments in Older Women With Breast Cancer. Am J Clin Oncol 2010; 33:533-43. [DOI: 10.1097/coc.0b013e3181b9cf1b] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Samson DJ, Seidenfeld J, Simon GR, Turrisi AT, Bonnell C, Ziegler KM, Aronson N. Evidence for management of small cell lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest 2007; 132:314S-323S. [PMID: 17873177 DOI: 10.1378/chest.07-1384] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
PURPOSES This systematic review addressed the following key questions on managing small cell lung cancer (SCLC): the sequence, timing, and dosing characteristics of primary thoracic radiotherapy (TRTx) for limited-stage disease; primary TRTx for extensive-stage disease; effect of prophylactic cranial irradiation (PCI); positron emission tomography (PET) for staging; treatment of mixed histology tumors; surgery; and second-line and subsequent-line treatment for relapsed/progressive disease. METHODS The review methods were defined prospectively in a written protocol. We primarily sought randomized controlled trials that compared the interventions of interest. RESULTS Robust evidence was lacking for all questions except PCI, for which a patient-level metaanalysis showed that PCI improves survival of SCLC patients who achieved complete response after primary therapy from 15.3 to 20.7% (p = 0.01). The case for concurrent over sequential radiation delivery rests largely on a single multicenter trial. Support for early concurrent therapy comes from one multicenter trial, but two other multicenter trials found no advantage. Metaanalysis did not find significant reductions in 2-year and 3-year mortality rates for early TRTx. Favorable results from a single-center trial on TRTx for extensive stage disease need replication in a multicenter setting. Relevant comparative studies were nonexistent for management of mixed histology disease and surgery for early limited SCLC. PET may be more sensitive in detecting extracranial disease than conventional staging modalities, but studies were of poor quality. CONCLUSIONS PCI improves survival among those with a complete remission to primary therapy. A research agenda is needed to optimize the effectiveness of TRTx and its components.
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Affiliation(s)
- David J Samson
- Technology Evaluation Center, Blue Cross Blue Shield Association, 1310 G St, NW, Washington, DC 20005, USA.
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Vokes EE, Perry MC, Kindler HL, Green MR. The cancer and leukemia group B respiratory committee. Clin Cancer Res 2006; 12:3581s-8s. [PMID: 16740789 DOI: 10.1158/1078-0432.ccr-06-9015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Cancer and Leukemia Group B Respiratory Committee has a 30-year track record of clinical investigation in patients with small-cell lung cancer and non-small-cell lung cancer (NSCLC) and mesothelioma. The most widely recognized contributions of the Committee include the early confirmation of the role of concurrent chemoradiotherapy in LD-SCLC, the effect of combination chemotherapy followed by radiation in stage III NSCLC, the introduction of third-generation agents into concurrent chemoradiation for stage III disease, the prospective demonstration of the benefit of treating older (70 years old) and poorer performance status (performance status = 2) patients with first-line combinations for stage IV disease, and the development of the "Herndon prognostic index" to normalize patient characteristics and outcomes in sequential phase II trials of new agents in patients with mesothelioma. Many other contributions have also emerged from the Committee's clinical trials and correlative science programs. We look forward to making additional critical contributions during future decades of Cancer and Leukemia Group B Respiratory Committee research.
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Anderson-Hanley C, Sherman ML, Riggs R, Agocha VB, Compas BE. Neuropsychological effects of treatments for adults with cancer: a meta-analysis and review of the literature. J Int Neuropsychol Soc 2003; 9:967-82. [PMID: 14738279 DOI: 10.1017/s1355617703970019] [Citation(s) in RCA: 223] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 01/16/2003] [Indexed: 11/05/2022]
Abstract
A meta-analysis was conducted to evaluate possible neuropsychological effects of treatments for cancer in adults. A search revealed 30 studies, encompassing 29 eligible samples, and leading to inclusion of a total of 838 patients and control participants. A total of 173 effect sizes (Cohen's d) were extracted across 7 cognitive domains and as assessed in the literature via 3 methods of comparison (post-treatment compared with normative data, controls, or baseline performance). Statistically significant negative effect sizes were found consistently across both normative and control methods of comparison for executive function, verbal memory, and motor function. The largest effects were for executive function and verbal memory normative comparisons (-.93 and -.91, respectively). When limiting the sample of studies in the analyses to only those with relatively "less severe" diagnoses and treatments, the effects remained. While these results point toward some specific cognitive effects of systemic cancer therapies in general, no clear clinical implications can yet be drawn from these results. More research is needed to clarify which treatments may produce cognitive decrements, the size of those effects, and their duration, while ruling out a wide variety of possible mediating or moderating variables.
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Affiliation(s)
- Cay Anderson-Hanley
- Department of Psychology, Skidmore College, Saratoga Springs, New York 12866, USA.
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Abstract
This article has attempted to provide an overview of the clinical literature regarding the psychological issues facing patients with pulmonary disease, depending on when the illness begins in the life span, because different developmental tasks are disrupted. Patients must contend with side effects of medication that may mimic or exacerbate psychiatric disorders. The main drug interactions for psychiatrists to be aware of in this patient population occur between rifampin, or theophylline and psychotropic medications. In lung transplant recipients on cyclosporine therapy, the antidepressant drug nefazadone may cause increased cyclosporine levels. Psychiatrists must be aware of the risks, benefits, and survival statistics; educate patients; and ascertain whether the patient is competent to make medical decisions regarding treatment procedures.
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Affiliation(s)
- Kathy Coffman
- Department of Psychiatry, Comprehensive Liver Disease Center, St. Vincent Medical Center, Los Angeles, California, USA.
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Repetto L, Comandini D, Mammoliti S. Life expectancy, comorbidity and quality of life: the treatment equation in the older cancer patients. Crit Rev Oncol Hematol 2001; 37:147-52. [PMID: 11166588 DOI: 10.1016/s1040-8428(00)00104-9] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
With ageing, function preservation and maintenance of quality of life represent a major goal in an increasing proportion of patients. Life expectancy is a function of age, comorbidity, disability and cancer type and stage. Decision-making involves a delicate balance among all these factors, evaluation of treatment related complications of the overall effects of cancer and cancer treatment on the patients' quality of life. Despite several instruments for the assessment of quality of life being validated, none have been calibrated to the special requirements of the older patients. The structured interview administered by a trained clinician represents a standard approach for geriatric research and even for clinical practice because of the frailty of the older population. The combination of this approach with the self-administered questionnaire appears the most effective way to minimise missing data in collecting information for patients unable to complete the form.
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Affiliation(s)
- L Repetto
- Divisione di Oncologia Medica 1, Istituto Nazionale per la Ricerca sul Cancro, Largo Rosanna Benzi 10, 16132 Genova, Italy.
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Abstract
This longitudinal study examined relations among mood, coping, perceived stress, and side effects from chemotherapy in 50 individuals with stages III and IV adenocarcinoma of the lung over four consecutive combination chemotherapy courses. Results indicated that perceived stress was moderately high only at the time of pretreatment, and four coping strategies were used: seeking social support, planful problem solving, self-control, and positive reappraisal. No relations existed between coping strategies and side effects from chemotherapy, coping and perceived stress, mood and side effects, and perceived stress and side effects. Seven side effects occurred: leukopenia, decreased activity, nausea, loss of appetite, fatigue, constipation, and taste changes. In summary, receiving chemotherapy is stressful at the time of pretreatment, so nursing interventions need to be concentrated at that point.
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Affiliation(s)
- C Chernecky
- School of Nursing, Medical College of Georgia, Augusta 30912, USA
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Ganz PA. Cognitive dysfunction following adjuvant treatment of breast cancer: a new dose-limiting toxic effect? J Natl Cancer Inst 1998; 90:182-3. [PMID: 9462670 DOI: 10.1093/jnci/90.3.182] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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