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Kaur S, Ahuja P, Kapil L, Sharma D, Singh C, Singh A. Coenzyme Q10 ameliorates chemotherapy-induced cognitive impairment in mice: a preclinical study. Mol Biol Rep 2024; 51:930. [PMID: 39174728 DOI: 10.1007/s11033-024-09872-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Accepted: 08/19/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND Among the three most used anticancer drugs, cyclophosphamide, Adriamycin, and 5-Fluorouracil (CAF), the most significant outcome is chemobrain, caused by increased oxidative stress, inflammatory insult, and mitochondrial dysfunction. OBJECTIVE In this study, endogenous antioxidant coenzyme Q10 (CoQ10) was evaluated for its neuroprotective effects in CICI. MATERIALS AND METHODS The chemobrain was induced in Swiss albino female mice by administering CAF (40 + 4 + 25 mg/kg) intraperitoneal (i.p.) in three cycles (single injection per week) followed by treatment with CoQ10 (40 mg/kg; p.o.) for up to 3 weeks followed by behavioral, biochemical, molecular and histopathological analysis. RESULTS Treatment with CoQ10 significantly improved cognition by improving exploring time in novel objects recognition test followed by increasing the time spent in the target quadrant in MWM test as compared to CAF-treated animals. Moreover, CoQ10 demonstrated antioxidant properties by reducing the expression of LPO while increasing levels of GSH, SOD, and catalase as compared to CAF-treated animals. While the levels of AChEs were significantly reduced after CoQ10 treatment in CAF-treated animals. In terms of its mechanism, it effectively counteracted the pro-inflammatory substances (TNF-α and IL-1β) triggered by CAF while also enhancing the levels of anti-inflammatory markers (IL-10 and Nrf2). Moreover, CoQ10 showed mitochondrial enhancers and it improved the level of Complex (I, II, and IV). Besides that, mitochondrial morphological analysis was done by TEM, and neuronal morphology along with quantification analysis was performed by H&E staining using Image J software to confirm the neuroprotective effect of CoQ10 over CAF-induced cognitive impairment. CONCLUSION This study suggests CoQ10 can protect the mitochondria by imposing antioxidant, and anti-inflammatory properties, which could be a potential therapy for CICI.
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Affiliation(s)
- Simranjit Kaur
- Department of Pharmacology, ISF College of Pharmacy Affiliated to I.K Gujral Punjab Technical University, Jalandhar, Moga, Punjab, 142001, India
- Department of Pharmaceutical Sciences, School of Health Sciences & Technology, UPES, Dehradun, Uttarakhand, 248007, India
| | - Palak Ahuja
- Department of Pharmacology, ISF College of Pharmacy Affiliated to I.K Gujral Punjab Technical University, Jalandhar, Moga, Punjab, 142001, India
- Department of Pharmaceutical Sciences, School of Health Sciences & Technology, UPES, Dehradun, Uttarakhand, 248007, India
| | - Lakshay Kapil
- Department of Pharmacology, ISF College of Pharmacy Affiliated to I.K Gujral Punjab Technical University, Jalandhar, Moga, Punjab, 142001, India
- Department of Pharmaceutical Sciences, School of Health Sciences & Technology, UPES, Dehradun, Uttarakhand, 248007, India
| | - Deepali Sharma
- Department of Pharmacology, ISF College of Pharmacy Affiliated to I.K Gujral Punjab Technical University, Jalandhar, Moga, Punjab, 142001, India
- Department of Pharmaceutical Sciences, School of Health Sciences & Technology, UPES, Dehradun, Uttarakhand, 248007, India
| | - Charan Singh
- Department of Pharmaceutics (School of Pharmacy), H.N.B. Garhwal University, Garhwal, Srinagar, Uttarakhand, 246174, India
| | - Arti Singh
- Department of Pharmacology, ISF College of Pharmacy Affiliated to I.K Gujral Punjab Technical University, Jalandhar, Moga, Punjab, 142001, India.
- Department of Pharmaceutical Sciences, School of Health Sciences & Technology, UPES, Dehradun, Uttarakhand, 248007, India.
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Chan YN, Cho Y, Hirschey R, Piepmeier A, Bender CM, Anderson RA, Foster MC, Bryant AL. Cancer-related cognitive impairment in older adults with acute myeloid leukemia treated with hypomethylating agents and venetoclax chemotherapy: a longitudinal descriptive study. Support Care Cancer 2024; 32:485. [PMID: 38960966 PMCID: PMC11311204 DOI: 10.1007/s00520-024-08673-2] [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] [Received: 01/18/2024] [Accepted: 06/20/2024] [Indexed: 07/05/2024]
Abstract
PURPOSE To explore cancer-related cognitive impairment (CRCI) in older adults with acute myeloid leukemia (AML) receiving venetoclax in combination with hypomethylating agents or low-dose cytarabine chemotherapy. METHODS This study is a longitudinal, qualitative descriptive study. Participants were recruited using purposive sampling. Semi-structured interviews were conducted among 11 older adults with AML at cycle 2, cycle 4, and cycle 7 of chemotherapy. An early end-of-study interview was conducted for those who changed treatment plans during the study follow-up. RESULTS A total of 22 transcripts were included for thematic analysis. Four themes emerged: (1) CRCI experiences, (2) impact of CRCI, (3) CRCI coping strategies, and (4) perceived CRCI-related factors. Older adults with AML experienced challenges in memory, language, and attention both intermittently and daily. These cognitive changes impacted their emotion, daily activities, social connection, and their caregivers' responsibilities. Hence, these older adults with AML developed problem-solving and emotional coping strategies to cope with CRCI. Older adults with AML also identified demographic, physiology/clinical, psychological, and other factors that might contribute to CRCI. CONCLUSION This study offers important insight for clinicians to understand how older adults with AML experience CRCI and how it impacts their daily routines. It indicates that clinicians should ask patients about their experience with cognitive changes at each encounter to provide support or coping strategies as needed to prevent CRCI from further hindering their quality of life.
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MESH Headings
- Humans
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/psychology
- Leukemia, Myeloid, Acute/complications
- Aged
- Bridged Bicyclo Compounds, Heterocyclic/administration & dosage
- Bridged Bicyclo Compounds, Heterocyclic/therapeutic use
- Male
- Female
- Longitudinal Studies
- Sulfonamides/administration & dosage
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Middle Aged
- Cognitive Dysfunction/etiology
- Qualitative Research
- Adaptation, Psychological
- Cytarabine/administration & dosage
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Affiliation(s)
- Ya-Ning Chan
- Department of Population Health Sciences, Duke University, Durham, NC, USA.
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Youngmin Cho
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rachel Hirschey
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Aaron Piepmeier
- Department of Exercise Science, Elon University, Elon, NC, USA
| | | | - Ruth A Anderson
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- School of Nursing, Duke University, Durham, NC, USA
| | - Matthew C Foster
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ashley Leak Bryant
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Merceur M, Reilly KT, Bonan I, Holé J, Hummel E, Cogné M, Jacquin-Courtois S. A systematic review of rehabilitation programs for cognitive impairment related to breast cancer: Different programs at different times? Ann Phys Rehabil Med 2024; 67:101832. [PMID: 38537525 DOI: 10.1016/j.rehab.2024.101832] [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: 03/02/2023] [Revised: 12/04/2023] [Accepted: 02/10/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND "Cancer Related Cognitive Impairment" (CRCI) defines cognitive disorders related to cancer and its treatments. Many people with breast cancer experience signs of CRCI (incidence between 20 and 30 %) and, although several intervention options exist, there is no established standard of care. Our main objective was to provide a detailed description of the methods and results of randomized controlled trials of interventions for CRCI in breast cancer survivors, paying particular attention to the timing of the interventions within the care pathway. METHODS We conducted a systematic literature review following the PRISMA guidelines from 01 to 01-2019 to 16-07-2023 and included randomized controlled trials of interventions for CRCI after breast cancer with at least one objective cognitive assessment as a primary or secondary outcome. RESULTS Among 228 identified studies, 35 (including 2821 participants) were retained for inclusion. The interventions were classified into 4 categories: cognitive rehabilitation, physical activity, complementary therapy and pharmacological treatment. Our analysis revealed that pharmacological interventions have no effect, whereas physical activity interventions proposed in the months following the initial cancer treatment improve Quality of Life and Speed of Information Processing while interventions proposed later improve Memory and Attention (Cognitive Rehabilitation) and Perceived Cognitive Function and Depression/Anxiety/Mood (Complementary Therapies). CONCLUSION CRCI is multifactorial and affected individuals frequently experience high levels of fatigue, pain, anxiety and depression and are most likely to benefit from holistic approaches that include cognition, physical activity, relaxation, psychoeducation, group support and/or psychological counselling. Thus, rehabilitation programs should be designed on multi-modal approaches, using innovative, cost-effective delivery methods that increase access to treatment, and intervention outcomes should be evaluated using measures of participation. DATABASE REGISTRATION The review was recorded on Prospero (01-03-2020), with the registration number 135,627.
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Affiliation(s)
- Marianne Merceur
- Rehabilitation Medicine Unit, University Hospital of Rennes, 2 rue Henri Le Guilloux, 35000 Rennes, France.
| | - Karen T Reilly
- Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, TRAJECTOIRES, 95 Boulevard Pinel, 69500 Bron, France
| | - Isabelle Bonan
- Rehabilitation Medicine Unit, University Hospital of Rennes, 2 rue Henri Le Guilloux, 35000 Rennes, France
| | - Julie Holé
- Physical Medicine and Rehabilitation Department, Henry Gabrielle Hospital, Hospices Civils de Lyon, 20 route de Vourles, 69230 Saint Genis Laval, France
| | - Emilie Hummel
- Hybrid team, Inria, Campus de Beaulieu, 263 Av. Général Leclerc, 35042 Rennes, France
| | - Mélanie Cogné
- Rehabilitation Medicine Unit, University Hospital of Rennes, 2 rue Henri Le Guilloux, 35000 Rennes, France
| | - Sophie Jacquin-Courtois
- Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, TRAJECTOIRES, 95 Boulevard Pinel, 69500 Bron, France; Hybrid team, Inria, Campus de Beaulieu, 263 Av. Général Leclerc, 35042 Rennes, France
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Lau J, Khoo AMG, Choe L, Hoon A, Tan KK. Quantifying chemotherapy-induced cognitive impairment in gastrointestinal cancer patients: A scoping review of methodological concerns in the literature. Asia Pac J Clin Oncol 2024. [PMID: 38808735 DOI: 10.1111/ajco.14082] [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: 08/22/2023] [Revised: 12/19/2023] [Accepted: 05/13/2024] [Indexed: 05/30/2024]
Abstract
PURPOSE Chemotherapy is one of the common treatments in cancer management. However, chemotherapy-induced cognitive impairment (CICI) is one notable side effect that can greatly impact a patient's quality of life. Literature on CICI in gastrointestinal (GI) cancers are few and inconsistent. This review aims to identify the methodological differences in such studies. METHODS A systematic search was performed in four electronic databases. All peer-reviewed primary literature published in English that evaluated cognitive-related functioning scores related to chemotherapy in GI cancer patients were included. Information about each study such as CICI findings, study limitations, methodology, and sample characteristics was extracted and synthesized. RESULTS A total of 19 studies were included. Evidence of CICI was found in 50.0% (8 of 16) and 62.5% (5 of 8) studies that used objective and subjective measures, respectively. Methodological differences such as groups used for comparison, instruments used, and assessment from the length of time since chemotherapy were highlighted between studies that did and did not find evidence of CICI. CONCLUSIONS This review suggests that the mixed findings can be attributed to the heterogeneous methodologies adopted in the evaluation of CICI in this field. IMPLICATIONS FOR CANCER SURVIVORS Further studies are necessary to establish the presence and chronicity of CICI, and in which groups of patients to facilitate targeted interventions and treatments.
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Affiliation(s)
- Jerrald Lau
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Athena Ming-Gui Khoo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Lina Choe
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Alyssa Hoon
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ker-Kan Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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Rick O, Gerhardt A, Schilling G. Cancer-Related Cognitive Dysfunction: A Narrative Review for Clinical Practice. Oncol Res Treat 2024; 47:218-223. [PMID: 38471462 DOI: 10.1159/000538277] [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: 07/19/2023] [Accepted: 03/06/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Cancer-related cognitive dysfunction (CRCD) is a major functional disorder in patients with cancer. This central nervous dysfunction is found in up to 60% of patients after tumour therapy, often significantly limits the quality of life, and significantly impedes participation in working life. For this reason, diagnosis and treatment of CRCD are of central importance. This narrative review is intended to provide an overview and support for practical clinical care with regard to diagnostics and therapeutic options. SUMMARY In Germany, CRCD has received insufficient attention in clinical practice due to the lack of guidelines for diagnosis and therapy. The pathophysiology is complex and cannot be explained by chemotherapeutic treatment alone. In addition to the tumour disease as such and the tumour therapy, psychological factors such as anxiety and depression as well as sleep disorders also play a significant role. Today, it is known that in addition to age, molecular genetic changes also have an effect on cognitive function. Morphologically, CRCD can be located in the frontal cortex and hippocampus. In addition to easy-to-use screening instruments such as the visual analogue scale, validated questionnaires such as the Questionnaire of Subjectively Experienced Deficits in Attention (FEDA) developed in Germany are also available. These allow the suspected diagnosis to be substantiated and the patient to be referred to further neurological, neuropsychological, or psycho-oncological diagnostics. Within the framework of further neuropsychological diagnostics, the International Cognition and Cancer Task Force (ICCTF) recommends testing learning, memory, processing speed, and executive functions. From the authors' point of view, a step-by-step diagnosis is recommended in order to avoid overdiagnosis. In clinical practice, graduation according to the "Common Terminology Criteria for Adversity Events" (CTCAE Version 5.0) is suitable for assessing the degree of severity. Cognitive training should be behaviourally oriented and include regular practice of cognitive skills to restore attention, psychomotor speed, memory, and executive functions. The best evidence is currently found for web-based training programmes that can be used by the patient at home. There is also evidence for mindfulness training and physical exercises. In particular, the combination of these three therapeutic elements currently seems to be the optimal treatment strategy for CRCD. KEY MESSAGES Cognitive dysfunction should be given much more attention in the clinical care of cancer patients. Diagnostic tools for this purpose and evidence-based therapeutic interventions are available. In the future, networks should be created that allow for better care of patients with CRCD.
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Affiliation(s)
- Oliver Rick
- Klinik Reinhardshöhe, Bad Wildungen, Germany
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Altarifi AA, Sawali K, Alzoubi KH, Saleh T, Abu Al-Rub M, Khabour O. Effect of vitamin E on doxorubicin and paclitaxel-induced memory impairments in male rats. Cancer Chemother Pharmacol 2024; 93:215-224. [PMID: 37926754 DOI: 10.1007/s00280-023-04602-y] [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] [Received: 04/25/2023] [Accepted: 10/11/2023] [Indexed: 11/07/2023]
Abstract
PURPOSE In addition to peripheral neuronal dysfunction, conventional chemotherapy can be associated with other neurological treatment-limiting adverse effects, including cognitive dysfunction, memory impairment, and anxiety, which are referred to as "chemobrain". This study aimed to investigate the effects of doxorubicin (DOX) and paclitaxel (PAC) on learning and memory in rats using radial arm water maze (RAWM) and investigated a potential beneficial effect of vitamin E (Vit. E). METHODS Adult male rats were injected with four doses of 2 mg/kg/week DOX, or 2 mg/kg PAC every other day intraperitoneally. Vit. E was co-administered with these drugs in other groups to study its antioxidative effects. Using the RAWM, each rat was assessed for learning and memory performance through two sets of six trials separated by a 5-min rest period evaluating both short- and long-term effects on memory. RESULTS There was no deficit in learning or long-term memory in both drug groups compared to control. However, rats in both drug groups made significantly more errors in all short-term memory trials. This effect was mitigated when Vit. E was co-administered with either drug. Moreover, PAC (but not DOX) induced hippocampal lipid peroxidation by increasing the levels of standard biomarker thiobarbituric acid reactive substances (TBARS). Interestingly, Vit. E prevented PAC-induced hippocampal oxidative stress. Furthermore, both DOX and PAC were correlated with reduction in Brain-Derived Neurotrophic Factor (BDNF) expression levels in the hippocampus, which was overcome by the co-administration of Vit. E. CONCLUSION There is a potential role of Vit. E in alleviating short-term memory impairment in rats exposed to chemotherapy, possibly by reducing hippocampal oxidative stress and neurodegeneration.
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Affiliation(s)
- Ahmad A Altarifi
- Department of Pharmacology, Faculty of Medicine, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan.
| | - Kareem Sawali
- Department of Pharmacology, Faculty of Medicine, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan
| | - Karem H Alzoubi
- Department of Pharmacy Practice and Pharmacotherapeutics, University of Sharjah, Sharjah, United Arab Emirates
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Tareq Saleh
- Department of Pharmacology and Public Health, Faculty of Medicine, The Hashemite University, Zarqa, Jordan
| | - Malik Abu Al-Rub
- Department of Pharmacology, Faculty of Medicine, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan
| | - Omar Khabour
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
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R K, L S, P B, S G, R LP. Psychosocial experiences of breast cancer survivors: a meta-review. J Cancer Surviv 2024; 18:84-123. [PMID: 36854799 PMCID: PMC10866753 DOI: 10.1007/s11764-023-01336-x] [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: 10/12/2022] [Accepted: 01/15/2023] [Indexed: 03/02/2023]
Abstract
PURPOSE Advances in breast cancer care have led to a high rate of survivorship. This meta-review (systematic review of reviews) assesses and synthesises the voluminous qualitative survivorship evidence-base, providing a comprehensive overview of the main themes regarding breast cancer survivorship experiences, and areas requiring further investigation. METHODS Sixteen breast cancer reviews identified by a previous mixed cancer survivorship meta-review were included, with additional reviews published between 1998 and 2020, and primary papers published after the last comprehensive systematic review between 2018 and 2020, identified via database searches (MEDLINE, Embase, CINAHL, PsycINFO). Quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Systematic Reviews and the CASP (Critical Appraisal Skills Programme Qualitative) checklist for primary studies. A meta-ethnographic approach was used to synthesise data. RESULTS Of 1673 review titles retrieved, 9 additional reviews were eligible (25 reviews included in total). Additionally, 76 individual papers were eligible from 2273 unique papers. Reviews and studies commonly focused on specific survivorship groups (including those from ethnic minorities, younger/older, or with metastatic/advanced disease), and topics (including return to work). Eight themes emerged: (1) Ongoing impact and search for normalcy, (2) Uncertainty, (3) Identity: Loss and change, (4) Isolation and being misunderstood, (5) Posttraumatic growth, (6) Return to work, (7) Quality of care, and (8) Support needs and coping strategies. CONCLUSIONS Breast cancer survivors continue to face challenges and require interventions to address these. IMPLICATIONS FOR CANCER SURVIVORS Breast cancer survivors may need to prepare for ongoing psychosocial challenges in survivorship and proactively seek support to overcome these.
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Affiliation(s)
- King R
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Stafford L
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Butow P
- Centre for Medical Psychology and Evidence-Based Decision-Making, School of Psychology, The University of Sydney, Sydney, Australia
| | - Giunta S
- Centre for Medical Psychology and Evidence-Based Decision-Making, School of Psychology, The University of Sydney, Sydney, Australia
| | - Laidsaar-Powell R
- Centre for Medical Psychology and Evidence-Based Decision-Making, School of Psychology, The University of Sydney, Sydney, Australia.
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Roose E, Huysmans E, Leysen L, Mostaqim K, Van Wilgen P, Beckwée D, De Couck M, Timmermans A, Bults R, Nijs J, Lahousse A. Effect of perceived injustice-targeted pain neuroscience education compared with biomedically focused education in breast cancer survivors: a study protocol for a multicentre randomised controlled trial (BCS-PI trial). BMJ Open 2024; 14:e075779. [PMID: 38233049 PMCID: PMC10806532 DOI: 10.1136/bmjopen-2023-075779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 11/08/2023] [Indexed: 01/19/2024] Open
Abstract
INTRODUCTION Current treatments for pain in breast cancer survivors (BCSs) are mostly biomedically focused rather than biopsychosocially driven. However, 22% of BCSs with pain are experiencing perceived injustice, which is a known predictor for adverse pain outcomes and opioid prescription due to increased maladaptive pain behaviour. Educational interventions such as pain neuroscience education (PNE) are suggested to target perceived injustice. In addition, motivational interviewing can be an effective behavioural change technique. This trial aims to examine whether perceived injustice-targeted PNE with the integration of motivational interviewing is superior to biomedically focused pain education in reducing pain after 12 months in BCS with perceived injustice and pain. In addition, improvements in quality of life, perceived injustice and opioid use are evaluated, and a cost-effectiveness analysis will finally result in a recommendation concerning the use of perceived injustice-targeted PNE in BCSs with perceived injustice and pain. METHODS AND ANALYSIS This two-arm multicentre randomised controlled trial will recruit female BCS (n=156) with pain and perceived injustice. Participants will be randomly assigned to perceived injustice-targeted PNE or biomedically focused pain education in each centre. Both interventions include an online session, an information leaflet and three one-to-one sessions. The primary outcome (pain), secondary outcomes (quality of life, perceived injustice and outcomes for cost-effectiveness analysis) and explanatory outcomes (pain phenotyping, sleep, fatigue and cognitive-emotional factors) will be assessed at baseline and at 0, 6, 12 and 24 months postintervention using self-reported questionnaires online. Treatment effects over time will be evaluated using linear mixed model analyses. Additionally, a cost-utility analysis will be done from a healthcare payer and societal perspective. ETHICS AND DISSEMINATION The ethical agreement was obtained from the Main Ethics Committee (B.U.N.1432020000068) at the University Hospital Brussels and all other participating hospitals. Study results will be disseminated through presentations, conferences, social media, press and journals. TRIAL REGISTRATION NUMBER NCT04730154.
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Affiliation(s)
- Eva Roose
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- REVAL Research Group, Universiteit Hasselt, Diepenbeek, Belgium
- Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, Brussels, Belgium
- Rehabilitation Research Group, Vrije Universiteit Brussel, Brussel, Belgium
| | - Eva Huysmans
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Physiotherapy, Vrije Universiteit Brussel, Brussel, Belgium
- Research Foundation-Flanders, (FWO), Brussels, Belgium
| | - Laurence Leysen
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Kenza Mostaqim
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Research Foundation-Flanders, (FWO), Brussels, Belgium
| | - Paul Van Wilgen
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Transcare Pain Transdisciplinary Pain Treatment Center, Groningen, Netherlands
| | - David Beckwée
- Rehabilitation Research Group, Vrije Universiteit Brussel, Brussel, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerpen, Belgium
| | - Marijke De Couck
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Rinske Bults
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jo Nijs
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, Brussels, Belgium
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gotenburg, Sweden
| | - Astrid Lahousse
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, Brussels, Belgium
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Lentoor AG, Motsamai TB. Neurocognitive Dysfunction and predictors in non-CNS cancer patients: Rationale and methods for the neuro-oncology research at a South African academic hospital. Heliyon 2024; 10:e23007. [PMID: 38148796 PMCID: PMC10750072 DOI: 10.1016/j.heliyon.2023.e23007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 08/28/2023] [Accepted: 11/23/2023] [Indexed: 12/28/2023] Open
Abstract
Background The focus on central nervous system (CNS) malignancies has overshadowed scant but substantial research that suggests non-central nervous cancer patients experience cancer-related cognitive impairment (CRCI), which affects higher-order brain function and influences their quality of life. Despite such evidence of the occurrence of CRCI among non-CNS cancer patients, the factors associated with the CRCIs remain a highly debated issue with discrepancies noted. Whether non-CNS cancer itself can affect the brain independent of cancer treatment is an important question to unpack. This necessitates further research, particularly in the sub-Saharan region where the evidence is limited. Methods This study aims to assess the effect of chemotherapy-associated cognitive and affective changes in non-CNS cancer patients. A non-experimental, time-series, correlational design will be used, in which a battery of computerized neuropsychological tests will be administered, including the e-MoCA, the CNS Vital Signs, the Patient Health Questionnaire-4, the Center for Epidemiologic Studies Depression Scale, the Hamilton Anxiety Rating Scale, the Functional Assessment of Cancer Therapy-Fatigue, and the Semi-structured Interview Schedule. Descriptive and inferential statistical analysis will be conducted, as well as NVivo thematic analysis of the qualitative data. The scope of the neurocognitive issues and risk factors that may be present in cancer patients and survivors in a developing environment could be determined by this study. Implications The study is expected to extend research on the extent at which cancer and cancer treatments are associated with neurocognitive changes among non-CNS cancer patients and their impact on their quality of life in the local context. The results are expected to inform treatment providers to develop treatment guidelines tailored for individuals diagnosed with cancer and who have received cancer treatment, as well as individualized psychosocial interventions aimed at addressing psychological challenges associated with quality of life among cancer survivors.
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Affiliation(s)
- Antonio G. Lentoor
- Department of Clinical Psychology, School of Medicine, Sefako Makgatho Health Sciences University, Molotlegi St, Ga-Rankuwa, Pretoria, South Africa
| | - Tiro Bright Motsamai
- Department of Clinical Psychology, School of Medicine, Sefako Makgatho Health Sciences University, Molotlegi St, Ga-Rankuwa, Pretoria, South Africa
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10
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Chan CW, Leung SF, Molassiotis A. Can more be done? - A qualitative study of breast cancer survivors' perspectives on regular walking exercise to improve post-chemotherapy neurotoxicity impairments. Eur J Oncol Nurs 2023; 67:102432. [PMID: 37879196 DOI: 10.1016/j.ejon.2023.102432] [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: 07/21/2023] [Revised: 09/20/2023] [Accepted: 09/29/2023] [Indexed: 10/27/2023]
Abstract
PURPOSE Chemotherapy-induced neurotoxicity in breast cancer survivors requires attention as their population are increasing. Limited qualitative study is known about breast cancer survivors' perspectives on regular walking exercise to improve post-chemotherapy neurotoxicity impairments in their free-living setting. This study explored regular walking exercise to improve post-chemotherapy neurotoxicity impairments from breast cancer survivors' perspectives. METHODS A qualitative descriptive study was conducted. A purposive sample of 15 participants experiencing neurotoxicity impairments was invited to semi-structured interviews. Textual interview data were managed in NVivo. Content analysis was performed. RESULTS Participants were aged 39-68 and had received 4-8 cycles of chemotherapy. Most (86.7%, n = 13) reported engaging in regular walking exercise. Four main categories emerged from the data: (1) perceived effects of regular exercise on neurotoxicity impairments, (2) unmet information needs, (3) regular walking habit being self-sustained, and (4) enablers and constraints of regular walking exercise. CONCLUSIONS Walking exercise, as commonly employed by participants in their free-living setting, was the essence in the management of chemotherapy-induced neurotoxic conditions during survivorship. Participants undertaking walking exercise lacked informed and individualized information about the regular walking exercise regime, and vigilance to evaluate post-exercise neurotoxic conditions. These might be the unmet needs of this research area and in clinical practice. Assessing and addressing individualized endeavors in a walking exercise regime will continue to be a vital component of cancer supportive care to fill the unmet information needs in survivorship.
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Affiliation(s)
- Choi Wan Chan
- School of Nursing, The Hong Kong Polytechnic University, Hung Hum, Kowloon, Hong Kong.
| | - Sau Fong Leung
- School of Nursing, The Hong Kong Polytechnic University, Hung Hum, Kowloon, Hong Kong.
| | - Alex Molassiotis
- College of Arts, Humanities and Education, University of Derby, Derby, United Kingdom.
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11
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Haywood D, Dauer E, Baughman FD, Lawrence BJ, Rossell SL, Hart NH, O’Connor M. "Is My Brain Ever Going to Work Fully Again?": Challenges and Needs of Cancer Survivors with Persistent Cancer-Related Cognitive Impairment. Cancers (Basel) 2023; 15:5331. [PMID: 38001592 PMCID: PMC10669848 DOI: 10.3390/cancers15225331] [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: 09/07/2023] [Revised: 11/01/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
Many cancer survivors experience cognitive impairments that impact memory, concentration, speed of information processing, and decision making. These impairments, collectively known as cancer-related cognitive impairments (CRCIs), are a key domain of unmet needs and can significantly impact a cancer survivor's identity and quality of life. However, there are no purpose-built, multi-domain, needs assessment tools specifically for CRCI. The development of such tools requires an in-depth understanding of cancer survivors' CRCI-specific challenges and associated needs. This study explored the challenges and associated needs of cancer survivors with persistent CRCI. An in-depth qualitative design using semi-structured interviews with (a) cancer survivors with perceived CRCI (n = 32) and (b) oncology health professionals (n = 19) was utilised. A reflexive thematic analysis of the interviews resulted in five overarching themes: (1) executing regular activities, (2) relational difficulties, (3) occupational functioning, (4) psychological distress, and (5) social functioning, as well as an additional informational needs domain. Ultimately, CRCI was found to directly produce a range of challenges that negatively, and persistently, impact cancer survivors' quality of life. Cancer survivors were also found to have a range of needs associated with these challenges. This research should be used to inform future challenges and needs assessment tools as well as treatment and supportive care priority areas directly relating to CRCI.
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Affiliation(s)
- Darren Haywood
- Human Performance Research Centre, INSIGHT Research Institute, Faculty of Health, University of Technology Sydney (UTS), Moore Park, NSW 2021, Australia;
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC 3800, Australia
- Department of Mental Health, St. Vincent’s Hospital Melbourne, Fitzroy, VIC 3065, Australia; (E.D.); (S.L.R.)
- Department of Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC 3052, Australia
| | - Evan Dauer
- Department of Mental Health, St. Vincent’s Hospital Melbourne, Fitzroy, VIC 3065, Australia; (E.D.); (S.L.R.)
| | - Frank D. Baughman
- School of Population Health, Curtin University, Bentley, WA 6102, Australia; (F.D.B.); (B.J.L.); (M.O.)
| | - Blake J. Lawrence
- School of Population Health, Curtin University, Bentley, WA 6102, Australia; (F.D.B.); (B.J.L.); (M.O.)
| | - Susan L. Rossell
- Department of Mental Health, St. Vincent’s Hospital Melbourne, Fitzroy, VIC 3065, Australia; (E.D.); (S.L.R.)
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Hawthorn, VIC 3122, Australia
| | - Nicolas H. Hart
- Human Performance Research Centre, INSIGHT Research Institute, Faculty of Health, University of Technology Sydney (UTS), Moore Park, NSW 2021, Australia;
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Park, SA 5042, Australia
- Cancer and Palliative Care Outcomes Centre, Faculty of Health, Queensland University of Technology (QUT), Brisbane City, QLD 4000, Australia
- Exercise Medicine Research Institute, School of Medical and Health Science, Edith Cowan University, Joondalup, WA 6027, Australia
- Institute for Health Research, University of Notre Dame Australia, Fremantle, WA 6160, Australia
| | - Moira O’Connor
- School of Population Health, Curtin University, Bentley, WA 6102, Australia; (F.D.B.); (B.J.L.); (M.O.)
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12
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Hummel E, Cogne M, Lange M, Lecuyer A, Joly F, Gouranton V. VR for Vocational and Ecological Rehabilitation of Patients With Cognitive Impairment: A Survey. IEEE Trans Neural Syst Rehabil Eng 2023; 31:4167-4178. [PMID: 37862281 DOI: 10.1109/tnsre.2023.3324131] [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: 10/22/2023]
Abstract
Cognitive impairment arises from various brain injuries or diseases, such as traumatic brain injury, stroke, schizophrenia, or cancer-related cognitive impairment. Cognitive impairment can be an obstacle for patients to the return-to-work. Research suggests various interventions using technology for cognitive and vocational rehabilitation. The present work offers an overview of sixteen vocational or ecological VR-based clinical studies among patients with cognitive impairment. The objective is to analyze these studies from a VR perspective focusing on the VR apparatus and tasks, adaptivity, transferability, and immersion of the interventions. Our results highlight how a higher level of immersion could bring the participants to a deeper level of engagement and transferability, rarely assessed in current literature, and a lack of adaptivity in studies involving patients with cognitive impairments. From these considerations, we discuss the challenges of creating a standardized yet adaptive protocol and the perspectives of using immersive technologies to allow precise monitoring, personalized rehabilitation and increased commitment.
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13
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Haywood D, Wallace IN, Lawrence B, Baughman FD, Dauer E, O'Connor M. Oncology healthcare professionals' perceptions and experiences of 'chemobrain' in cancer survivors and persons undergoing cancer treatment. Gen Hosp Psychiatry 2023; 84:271-272. [PMID: 37407422 DOI: 10.1016/j.genhosppsych.2023.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 07/07/2023]
Affiliation(s)
- Darren Haywood
- Department of Mental Health, St Vincent's Hospital Melbourne, Melbourne, Australia; Turner Institute for Brain and Mental Health, School of Psychological Science, Melbourne, Australia.
| | - India N Wallace
- School of Population Health, Curtin University, Perth, Australia
| | - Blake Lawrence
- School of Population Health, Curtin University, Perth, Australia
| | - Frank D Baughman
- School of Population Health, Curtin University, Perth, Australia
| | - Evan Dauer
- Department of Mental Health, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Moira O'Connor
- School of Population Health, Curtin University, Perth, Australia
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14
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Sharma S, Brunet J. Young Adults' Lived Experiences with Cancer-Related Cognitive Impairment: An Exploratory Qualitative Study. Curr Oncol 2023; 30:5593-5614. [PMID: 37366905 DOI: 10.3390/curroncol30060422] [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: 05/08/2023] [Revised: 06/05/2023] [Accepted: 06/08/2023] [Indexed: 06/28/2023] Open
Abstract
Cancer-related cognitive impairment (CRCI; e.g., disrupted memory, executive functioning, and information processing) affects many young adults, causing significant distress, reducing quality of life (QoL), and thwarting their ability to engage in professional, recreational, and social experiences. The purpose of this exploratory qualitative study was to investigate young adults' lived experiences with CRCI, and any strategies (including physical activity) they use to self-manage this burdensome side effect. Sixteen young adults (Mage = 30.8 ± 6.0 years; 87.5% female; Myears since diagnosis = 3.2 ± 3) who reported clinically meaningful CRCI whilst completing an online survey were interviewed virtually. Four themes comprising 13 sub-themes were identified through an inductive thematic analysis: (1) descriptions and interpretations of the CRCI phenomenon, (2) effects of CRCI on day-to-day and QoL, (3) cognitive-behavioural self-management strategies, and (4) recommendations for improving care. Findings suggest CRCI is detrimental to young adults' QoL and must be addressed more systematically in practice. Results also illuminate the promise of PA in coping with CRCI, but research is needed to confirm this association, test how and why this may occur, and determine optimal PA prescriptions for young adults to self-manage their CRCI.
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Affiliation(s)
- Sitara Sharma
- School of Human Kinetics, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Jennifer Brunet
- School of Human Kinetics, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- Cancer Therapeutic Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada
- Institut du Savoir Montfort, Hôpital Montfort, Ottawa, ON K1N 6N5, Canada
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15
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Corcoran L, Friedenreich CM, McNeely ML, Culos-Reed NS, Bell G, Dickau L, Courneya KS, Vallance JK. A qualitative study examining newly diagnosed breast cancer patients' experiences of participating in the Alberta Moving Beyond Breast Cancer (AMBER) prospective cohort study. BMC Cancer 2023; 23:500. [PMID: 37268901 DOI: 10.1186/s12885-023-10967-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/16/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Decisions to participate in cancer trials are associated with uncertainty, distress, wanting to help find a cure, the hope for benefit, and altruism. There is a gap in the literature regarding research examining participation in prospective cohort studies. The aim of this study was to examine the experiences of newly diagnosed women with breast cancer participating in the AMBER Study to identify potential strategies to support patients' recruitment, retention, and motivation. METHODS Newly diagnosed breast cancer patients were recruited from the Alberta Moving Beyond Breast Cancer (AMBER) cohort study. Data were collected using semi-structured conversational interviews with 21 participants from February to May 2020. Transcripts were imported into NVivo software for management, organization, and coding. Inductive content analysis was undertaken. RESULTS Five main concepts associated with recruitment, retention, and motivation to participate were identified. These main concepts included: (1) personal interest in exercise and nutrition; (2) investment in individual results; (3) personal and professional interest in research; (4) burden of assessments; (5) importance of research staff. CONCLUSIONS Breast cancer survivors participating in this prospective cohort study had numerous reasons for participating and these reasons could be considered in future studies to enhance participant recruitment and retention. Improving recruitment and retention in prospective cancer cohort studies could result in more valid and generalizable study findings that could improve the care of cancer survivors.
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Affiliation(s)
- Lynn Corcoran
- Faculty of Health Disciplines, Athabasca University, 1 University Drive, Athabasca, AB, T9S-3A3, Canada
| | - Christine M Friedenreich
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Margaret L McNeely
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
| | | | - Gordon Bell
- Faculty of Kinesiology, Sport, and Recreation, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Leanne Dickau
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada
| | - Kerry S Courneya
- Faculty of Kinesiology, Sport, and Recreation, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Jeff K Vallance
- Faculty of Health Disciplines, Athabasca University, 1 University Drive, Athabasca, AB, T9S-3A3, Canada.
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Lentoor AG, Motsamai TB, Nxiweni T, Mdletshe B, Mdingi S. Protocol for a systematic review of the effects of gardening physical activity on neuroplasticity and cognitive function. AIMS Neurosci 2023; 10:118-129. [PMID: 37426777 PMCID: PMC10323255 DOI: 10.3934/neuroscience.2023009] [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: 01/30/2023] [Revised: 05/05/2023] [Accepted: 05/09/2023] [Indexed: 07/11/2023] Open
Abstract
Background The beneficial effects of gardening as a form of physical activity have garnered growing interest in recent years. Existing research suggests that physical activity enhances brain function through modifying synaptic plasticity, growth factor synthesis, and neurogenesis. Gardening physical activity is a promising, cost-effective, non-invasive intervention that can easily be augmented in the rehabilitation of neurodegenerative conditions. However, there is still insufficient literature. This protocol describes a systematic review to be conducted of scientific literature on the benefits of gardening as a physical activity that can promote neuroplasticity and improve cognitive function. This information can be useful as an intervention for persons who experience cognitive impairment brought on by cancer and chemotherapy in developing countries such as South Africa where there is real need to access cognitive rehabilitation. Methods and analysis The systematic review strategy will be conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. An electronic literature database search of MEDLINE (PubMed), Embase, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science will be carried out using medical search terms (MeSH), with English as the only permitted language, during the time period of January 2010 to December 2022. We will search for and review studies on how gardening as a physical activity impacts neuroplasticity and cognition. Two reviewers will read the titles, and abstracts and full text of the studies identified during the search to exclude records that do not meet the inclusion criteria. Data will then be extracted from the remaining studies. Any differences in opinion arising between the reviewers during the procedure will be resolved through discussion with a third reviewer. The Joanna Briggs Institute (JBI) Critical Appraisal Tool checklist will be utilized independently by two reviewers to evaluate the possibility of bias. The included articles will be subjected to narrative synthesis, with the results being presented in a thematic manner. Ethics and dissemination There are no need for ethical approval because no patient data will be gathered. The results will be disseminated through an open-access peer-reviewed indexed journal, presented scientific meetings.PROSPERO registration number: CRD42023394493.
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17
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Gao Y, Rosas JC, Fink H, Behrens S, Chang-Claude J, Seibold P. Longitudinal changes of health-related quality of life over 10 years in breast cancer patients treated with radiotherapy following breast-conserving surgery. Qual Life Res 2023:10.1007/s11136-023-03408-y. [PMID: 37093543 PMCID: PMC10393846 DOI: 10.1007/s11136-023-03408-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 04/25/2023]
Abstract
PURPOSES The study intended to (1) assess changes of health-related quality of life (HRQoL) between early treatment-related time points and 10 years post-treatment in a cohort of breast cancer (BC) patients who received radiotherapy (RT), (2) to evaluate differences in HRQoL between long-term BC survivors and unaffected women from the same geographical region and (3) to identify determinants of long-term HRQoL in the survivor cohort. METHODS 292 BC patients were recruited prior to RT after breast-conserving surgery between 1998 and 2001 in Germany and prospectively followed up for a median of 11.4 years (range 10.3-12.8 years). HRQoL was assessed using EORTC QLQ-C30 at pre-RT (baseline), during RT, 6 weeks after RT, and at the 10-year follow-up. Changes in mean HRQoL scores over time were assessed using linear-mixed models. HRQoL in long-term survivors and controls was compared using Wilcoxon rank-sum test, stratified by age groups. Multivariable linear regression models were used to identify determinants for HRQoL in long-term BC survivors. RESULTS Compared to baseline level (mean summary score of 64.9), global health status/quality of life (GHS/QoL) declined during RT (62.4) and improved 6 weeks after RT (69.9) before decreasing to baseline level at the 10-year follow-up (66.7). Most functional domains deteriorated or remained stable at 10 years post-diagnosis compared to post-RT scores, except for role functioning which improved, while dyspnea and diarrhea significantly deteriorated between those two time points. There were no significant differences in long-term GHS/QoL between BC survivors 10 years post-RT and controls for all age groups (p > 0.05). However, deficits in specific HRQoL domains such as emotional burden, sleep problems or fatigue were found to more strongly affect survivors, in particular those younger than 65 years, compared to controls. In the determinant analysis, being overweight was associated with lower GHS/QoL and physical functioning, while living with others was found to be associated with better physical functioning, and decreased dyspnea and pain levels. Certain comorbidities such as depression had a strong association with multiple HRQoL domains, including lower GHS/QoL and functioning as well as a higher level of fatigue, pain, sleep/intestinal problems, and financial difficulties. Side effects such as lymphedema/pain and fibrosis were associated with worse physical and social functioning, respectively. CONCLUSION The long-term GHS/QoL remained comparable when compared with the control population while restrictions in certain functional and symptoms domains in long-term BC survivors persisted over 10 years, in particular among younger survivors. Targeted screening to identify cancer survivors at risk for psychosocial/other impairment accounting also for comorbidities and treatment side effects may be warranted in long-term aftercare to address unmet health needs.
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Affiliation(s)
- Yifeng Gao
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69221, Heidelberg, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-University, Munich, Germany
| | - Juan C Rosas
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69221, Heidelberg, Germany
| | - Hanna Fink
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69221, Heidelberg, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-University, Munich, Germany
| | - Sabine Behrens
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69221, Heidelberg, Germany
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69221, Heidelberg, Germany
- University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Petra Seibold
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69221, Heidelberg, Germany.
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Haller OJ, Semendric I, George RP, Collins-Praino LE, Whittaker AL. The effectiveness of anti-inflammatory agents in reducing chemotherapy-induced cognitive impairment in preclinical models - A systematic review. Neurosci Biobehav Rev 2023; 148:105120. [PMID: 36906244 DOI: 10.1016/j.neubiorev.2023.105120] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 03/03/2023] [Accepted: 03/04/2023] [Indexed: 03/11/2023]
Abstract
Chemotherapy-induced cognitive impairment (CICI) is a debilitating condition resulting from chemotherapy administration for cancer treatment. CICI is characterised by various cognitive impairments, including issues with learning, memory, and concentration, impacting quality of life. Several neural mechanisms are proposed to drive CICI, including inflammation, therefore, anti-inflammatory agents could ameliorate such impairments. Research is still in the preclinical stage; however, the efficacy of anti-inflammatories to reduce CICI in animal models is unknown. Therefore, a systematic review was conducted, with searches performed in PubMed, Scopus, Embase, PsycInfo and Cochrane Library. A total of 64 studies were included, and of the 50 agents identified, 41 (82%) reduced CICI. Interestingly, while non-traditional anti-inflammatory agents and natural compounds reduced impairment, the traditional agents were unsuccessful. Such results must be taken with caution due to the heterogeneity observed in terms of methods employed. Nevertheless, preliminary evidence suggests anti-inflammatory agents could be beneficial for treating CICI, although it may be critical to think beyond the use of traditional anti-inflammatories when considering which specific compounds to prioritise in development.
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Affiliation(s)
- Olivia J Haller
- School of Biomedicine, The University of Adelaide, Adelaide, South Australia 5005, Australia.
| | - Ines Semendric
- School of Biomedicine, The University of Adelaide, Adelaide, South Australia 5005, Australia
| | - Rebecca P George
- School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy Campus, Roseworthy, South Australia 5371, Australia
| | | | - Alexandra L Whittaker
- School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy Campus, Roseworthy, South Australia 5371, Australia.
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Subramaniam CB, Wardill HR, Davies MR, Heng V, Gladman MA, Bowen JM. 5-Fluorouracil Induces an Acute Reduction in Neurogenesis and Persistent Neuroinflammation in a Mouse Model of the Neuropsychological Complications of Chemotherapy. Mol Neurobiol 2023; 60:1408-1424. [PMID: 36449255 DOI: 10.1007/s12035-022-03136-3] [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: 02/08/2022] [Accepted: 11/12/2022] [Indexed: 12/05/2022]
Abstract
The neuropsychological symptoms associated with chemotherapy treatment remain a major challenge with their prevention hampered by insufficient understanding of pathophysiology. While long-term neuroimmune changes have been identified as a hallmark feature shared by neurological symptoms, the exact timeline of mechanistic events preceding neuroinflammation, and the relationship between the glial cells driving this neuroinflammatory response, remain unclear. We therefore aimed to longitudinally characterize the neuroimmunological changes following systemic 5-fluorouracil (5-FU) treatment to gain insight into the timeline of events preceding the well-documented chronic neuroinflammation seen following chemotherapy. Eighteen female C57Bl/6 mice received a single intraperitoneal dose of 5-FU and groups were killed at days 1 and 2 (acute timepoint), days 4 and 8 (subacute timepoint), and days 16 and 32 (chronic timepoint). A further six mice were administered with vehicle control with tissues collected from three mice on day 1 and day 32 of the study. The expression of key genes of interest, BCL2, BDNF, TIMP1, MMP-9, MMP-2, TNFα, IL-1β, and IL-6R were assessed using real time polymerase chain reaction. Levels of neurogenesis were determined through immunofluorescent staining of doublecortin (DCX). The density of microglia and astrocytes were assessed using immunofluorescence staining of Iba1 and GFAP respectively. 5-FU treatment caused significant decreases to DCX staining at acute timepoints (p = 0.0030) which was positively correlated with BCL2 expression levels. An increase to microglial density was observed in the prefrontal cortex (p = 0.0256), CA3 region (p = 0.0283), and dentate gyrus (p = 0.0052) of the hippocampus at acute timepoints. 5-FU caused increases to astrocyte density, across multiple brains regions, at subacute and chronic timepoints which were positively correlated with TNFα, TIMP-1, MMP-2, and IL-6R expression. This study has identified acute objective neuroinflammatory changes suggesting that the role of early intervention should be explored to prevent the development of neuropsychological deficits in the longer-term following chemotherapy.
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Affiliation(s)
- Courtney B Subramaniam
- School of Biomedicine, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.
- Supportive Oncology Research Group, Precision Medicine (Cancer), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide, Adelaide, South Australia, Australia.
| | - Hannah R Wardill
- Supportive Oncology Research Group, Precision Medicine (Cancer), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide, Adelaide, South Australia, Australia
| | - Maya R Davies
- Supportive Oncology Research Group, Precision Medicine (Cancer), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide, Adelaide, South Australia, Australia
| | - Vivien Heng
- School of Biomedicine, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Marc A Gladman
- School of Biomedicine, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Joanne M Bowen
- School of Biomedicine, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
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20
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Root JC, Gaynor AM, Ahsan A, Jung D, Schofield E, Ryan E, Li Y, Ahles TA. Remote, Computerised Cognitive Assessment for Breast Cancer- and Treatment-Related Cognitive Dysfunction: Psychometric Characteristics of the Cogsuite Neurocognitive Battery. ARCHIVES OF CLINICAL NEUROPSYCHOLOGY : THE OFFICIAL JOURNAL OF THE NATIONAL ACADEMY OF NEUROPSYCHOLOGISTS 2023:6991200. [PMID: 36655820 PMCID: PMC10369363 DOI: 10.1093/arclin/acac111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Cancer-related cognitive dysfunction (CRCD) is a significant concern for breast cancer survivors. The Cogsuite battery was developed to improve sensitivity to CRCD with the use of cognitive experimental measures, clarify specific cognitive processes impacted and to be capable of being administered either in-office or remotely. METHODS In sum, 357 breast cancer survivors and non-cancer controls completed the Cogsuite Battery in-office (n = 76) or remotely (n = 281). Measure validity, sensitivity to demographic factors, correlations with standard neuropsychological measures and intercorrelations of Cogsuite variables were assessed. Test-retest reliability was evaluated in-office (n = 24) and remotely (n = 80). RESULTS Test-retest reliability for most variables assessed was adequate to strong. Internal validity, as indicated by the confirmation of expected condition effects within each measure, was established for all measures. Assessment of external validity found age, but not education, was a significant predictor in the majority of measures. Assessment of criterion validity found that Cogsuite variables were correlated with standard measures in psychomotor speed, working memory and executive function, but not associated with self-reported cognition or mood. CONCLUSIONS Cogsuite is reliable and valid, and is sensitive to the effects of increasing age on cognition. The addition of the Cogsuite battery to standard assessment may improve sensitivity to CRCD and identify underlying processes that may be affected. Remote use of the Cogsuite battery in appropriate settings will lessen the burden for providers, researchers and survivors in research and clinical contexts.
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Affiliation(s)
- James C Root
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Alexandra M Gaynor
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.,Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY 10027, USA.,Cognitive Neuroscience Division, Department of Neurology, Columbia University, New York, NY 10027, USA
| | - Anam Ahsan
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | | | - Elizabeth Schofield
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Elizabeth Ryan
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Yuelin Li
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Tim A Ahles
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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21
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Henneghan AM, Van Dyk KM, Ackerman RA, Paolillo EW, Moore RC. Assessing cancer-related cognitive function in the context of everyday life using ecological mobile cognitive testing: A protocol for a prospective quantitative study. Digit Health 2023; 9:20552076231194944. [PMID: 37588154 PMCID: PMC10426293 DOI: 10.1177/20552076231194944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/28/2023] [Indexed: 08/18/2023] Open
Abstract
Objective Millions of cancer survivors are at risk for cancer-related cognitive impairment (CRCI), yet accurate and accessible assessments of cognitive functioning remain limited. Ecological mobile cognitive testing (EMCT) could offer a solution. This paper presents the protocol for a study that aims to (1) establish the reliability and validity of EMCT to assess CRCI in breast cancer survivors, and (2) prospectively evaluate within-person processes (and interactions) among context, mood, and behavior that explain cognitive variability, everyday functioning, and quality of life of cancer survivors. Methods Participants will include breast cancer survivors (>21 years old) who are within 5 years of completing chemotherapy treatment. Participants will complete two virtual visits (baseline, follow-up) 2 months apart to assess self-reported cognitive symptoms and cognitive performance, sociodemographic characteristics, clinical history, everyday functioning, and quality of life. Between virtual visits, EMCT will be used to sample cognitive functioning every other day (28 times total). We will use linear mixed-effect regressions and single-level multiple regression models to analyze the data. Results We anticipate a minimum of 124 breast cancer survivors enrolling and completing data collection. Study results will be published in peer-reviewed scientific journals. Conclusions Our findings will have broad implications for assessing CRCI in an ecologically valid and person-centered way using EMCT. We aim to provide this protocol to aid researchers who would like to apply this approach to their studies.
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Affiliation(s)
| | - Kathleen M Van Dyk
- Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
- Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA, USA
| | | | | | - Raeanne C Moore
- Department of Psychiatry, University of California San Diego, CA, USA
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22
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Alberti P, Salvalaggio A, Argyriou AA, Bruna J, Visentin A, Cavaletti G, Briani C. Neurological Complications of Conventional and Novel Anticancer Treatments. Cancers (Basel) 2022; 14:cancers14246088. [PMID: 36551575 PMCID: PMC9776739 DOI: 10.3390/cancers14246088] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/05/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
Various neurological complications, affecting both the central and peripheral nervous system, can frequently be experienced by cancer survivors after exposure to conventional chemotherapy, but also to modern immunotherapy. In this review, we provide an overview of the most well-known adverse events related to chemotherapy, with a focus on chemotherapy induced peripheral neurotoxicity, but we also address some emerging novel clinical entities related to cancer treatment, including chemotherapy-related cognitive impairment and immune-mediated adverse events. Unfortunately, efficacious curative or preventive treatment for all these neurological complications is still lacking. We provide a description of the possible mechanisms involved to drive future drug discovery in this field, both for symptomatic treatment and neuroprotection.
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Affiliation(s)
- Paola Alberti
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- NeuroMI (Milan Center for Neuroscience), 20126 Milan, Italy
| | | | - Andreas A. Argyriou
- Neurology Department, Agios Andreas State General Hospital of Patras, 26335 Patras, Greece
| | - Jordi Bruna
- Neuro-Oncology Unit, Hospital Universitari de Bellvitge-ICO Hospitalet, Bellvitge Institute for Biomedical Research (IDIBELL), 08908 Barcelona, Spain
| | - Andrea Visentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, 35131 Padova, Italy
| | - Guido Cavaletti
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Chiara Briani
- Neurology Unit, Department of Neurosciences, University of Padova, 35131 Padova, Italy
- Correspondence:
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23
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Henneghan AM, Kesler SR. Subjective cancer-related cognitive impairments and salience network connectivity in breast cancer survivors. J Cancer Surviv 2022:10.1007/s11764-022-01307-8. [PMID: 36464750 PMCID: PMC10239781 DOI: 10.1007/s11764-022-01307-8] [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: 10/26/2022] [Accepted: 11/26/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE Little is known about the neural basis of subjective cancer-related cognitive changes. The purpose of this study was to explore salience network connectivity in relation to subjective executive and memory dysfunction in breast cancer survivors compared to controls. METHODS A retrospective cross-sectional analysis of neuroimaging, subjective cognitive, clinical, and demographic data in chemotherapy-treated primary breast cancer survivors compared to frequency matched controls was used. Functional connectivity within salience network hubs (anterior cingulate, bilateral insula) was determined using resting state functional MRI. Mann-Whitney U tests were used to evaluate group differences and Spearman's rho correlations were examined among the behavioral measures and salience network connectivity. RESULTS We included 65 breast cancer survivors and 71 controls. Survivors demonstrated greater subjective executive dysfunction and memory complaints (p < .001) and lower salience network connectivity (p < .05) than controls. Executive functioning correlated with bilateral insula and left anterior cingulate connectivity (rho > - 0.29, p < .05). Distress did not correlate with salience network connectivity. CONCLUSION These findings suggest that salience network connectivity may represent a biomarker of subjective cancer-related cognitive changes. IMPLICATIONS FOR CANCER SURVIVORS Subjective cancer-related cognitive changes are common following treatment and associated with objective changes in brain connectivity.
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Affiliation(s)
- Ashley M Henneghan
- School of Nursing, University of Texas at Austin, 1710 Red River St, D0100, Austin, TX, 78712, USA
- Department of Oncology, Dell School of Medicine, University of Texas at Austin, Austin, TX, 78712, USA
| | - Shelli R Kesler
- School of Nursing, University of Texas at Austin, 1710 Red River St, D0100, Austin, TX, 78712, USA.
- Department of Oncology, Dell School of Medicine, University of Texas at Austin, Austin, TX, 78712, USA.
- Department of Diagnostic Medicine, Dell School of Medicine, University of Texas at Austin, Austin, TX, 78712, USA.
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24
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Ormiston K, Gaudier-Diaz MM, TinKai T, Fitzgerald J, Cole RM, Andridge R, Lustberg M, DeVries AC, Orchard T. Effects of plant-based versus marine-based omega-3 fatty acids and sucrose on brain and liver fatty acids in a mouse model of chemotherapy. Nutr Neurosci 2022; 25:2650-2658. [PMID: 34772330 PMCID: PMC9095756 DOI: 10.1080/1028415x.2021.1998296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Chemotherapy can result in toxic side effects in the brain. Intake of marine-based omega-3 polyunsaturated fatty acids (n-3 PUFAs), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), alter brain fatty acids, potentially improving brain function. However, it is unclear if alpha-linolenic acid (ALA), the plant-based n-3, affects brain PUFAs during chemotherapy. The objective of this study was to examine the effects of dietary ALA, EPA and DHA, with high or low sucrose, on brain PUFAs in a mouse model of chemotherapy. Secondarily, the use of liver PUFAs as surrogate measures of brain PUFAs was examined. Lipid peroxidation (4-HNE) and neurotrophic markers (BDNF) were assessed. Female C57Bl/6 mice (n = 90) were randomized to 1 of 5 diets (high EPA + DHA/high or low sucrose, high ALA/high or low sucrose, or control with no EPA + DHA/low ALA/low sucrose) and injected with doxorubicin-based chemotherapy or saline. Brain EPA and DHA were greater (p < 0.0001) with high EPA + DHA diets, regardless of sucrose; there were no significant differences in brain PUFAs between high ALA diets and control. Chemotherapy-treated mice had higher brain and liver DHA (p < 0.05) and lower brain and liver linoleic acid (p < 0.0001). Brain n-3 and n-6 PUFAs were strongly correlated with liver n-3 (r = 0.8214, p < 0.0001) and n-6 PUFAs (r = 0.7568, p < 0.0001). BDNF was correlated with brain total PUFAs (r = 0.36; p < 0.05). In conclusion, dietary ALA in proportions approximately two times greater than consumed by humans did not appreciably increase brain n-3 PUFAs compared to low ALA intake. Liver PUFAs may be a useful surrogate marker of brain PUFAs in this mouse model.
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Affiliation(s)
- Kate Ormiston
- Department of Human Sciences, Human Nutrition Program, The Ohio State University
| | | | - Tial TinKai
- Department of Neuroscience, The Ohio State University
| | | | - Rachel M. Cole
- Department of Human Sciences, Human Nutrition Program, The Ohio State University
| | | | | | | | - Tonya Orchard
- Department of Human Sciences, Human Nutrition Program, The Ohio State University
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25
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Stapleton S, Darlington ASE, de Bono JS, Wiseman T. What is the impact of targeted therapies given within phase I trials on the cognitive function of patients with advanced cancer: a mixed-methods exploratory study conducted in an early clinical trials unit. BMJ Open 2022; 12:e050590. [PMID: 36442900 PMCID: PMC9710342 DOI: 10.1136/bmjopen-2021-050590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Novel therapies such as small protein molecule inhibitors and immunotherapies are tested in early phase trials before moving to later phase trials and ultimately standard practice. A key aim of these clinical trials is to define a toxicity profile, however, the emphasis is often on safety with measurements of organ toxicity. Other subjective side effects can be under-reported because they are not measured formally within the trial protocols. The concern from clinical practice is that cognitive toxicity is poorly studied and may be under-reported in this context. This could lead to toxicity profiles of new treatments not being fully described and patients with unmet need in terms of acknowledgement and support of symptoms. This protocol outlines a framework of an exploratory study with feasibility aspects to investigate the impact and experience of cognitive changes for patients on phase I trials. METHODS AND ANALYSIS This is a mixed-methods study, combining quantitative and qualitative approaches. The sample is 30 patients with advanced cancer who are participating in phase I trials of novel therapies in the early clinical trials unit of a specialist cancer centre. A test battery of validated cognitive assessments will be taken alongside patient reported outcome measures at three time points from baseline, day eight and day 28 post start of treatment. At day 28, a semi-structured interview will be conducted and the narrative thematically analysed. Results will be integrated to offer a comprehensive description of cognitive function in this patient group. ETHICS AND DISSEMINATION The study has received full HRA and ethical approval. It is the first study to introduce formal cognitive assessments in a cancer phase I trial context. The study has the potential to highlight previously unreported side effects and more importantly unmet need in terms of care for patients who are participating in the trials.
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Affiliation(s)
- Sarah Stapleton
- Drug Development Unit, Royal Marsden Hospital Sutton, Sutton, UK
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | | | - J S de Bono
- Drug Development Unit, Royal Marsden Hospital Sutton, Sutton, UK
- Institute of Cancer Research Division of Cancer Therapeutics, London, UK
| | - Theresa Wiseman
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- The Royal Marsden NHS Foundation Trust, London, UK
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26
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Vasaghi Gharamaleki M, Mousavi SZ, Owrangi M, Gholamzadeh MJ, Kamali AM, Dehghani M, Chakrabarti P, Nami M. Neural correlates in functional brain mapping among breast cancer survivors receiving different chemotherapy regimens: a qEEG/HEG-based investigation. Jpn J Clin Oncol 2022; 52:1253-1264. [PMID: 35946328 DOI: 10.1093/jjco/hyac121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 07/13/2022] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Post-chemotherapy cognitive impairment commonly known as 'chemobrain' or 'chemofog' is a well-established clinical disorder affecting various cognitive domains including attention, visuospatial working memory, executive function, etc. Although several studies have confirmed the chemobrain in recent years, scant experiments have evaluated the potential neurotoxicity of different chemotherapy regimens and agents. In this study, we aimed to evaluate the extent of attention deficits, one of the commonly affected cognitive domains, among breast cancer patients treated with different chemotherapy regimens through neuroimaging techniques. METHODS Breast cancer patients treated with two commonly prescribed chemotherapy regimens, Adriamycin, Cyclophosphamide and Taxol and Taxotere, Adriamycin and Cyclophosphamide, and healthy volunteers were recruited. Near-infrared hemoencephalography and quantitative electroencephalography assessments were recorded for each participant at rest and during task performance to compare the functional cortical changes associated with each chemotherapy regimen. RESULTS Although no differences were observed in hemoencephalography results across groups, the quantitative electroencephalography analysis revealed increased power of high alpha/low beta in left fronto-centro-parietal regions involved in dorsal and ventral attention networks in the Adriamycin, Cyclophosphamide and Taxol-treated group compared with the Taxotere, Adriamycin and Cyclophosphamide and control group. The Adriamycin, Cyclophosphamide and Taxol-treated cases had the highest current source density values in dorsal attention network and ventral attention network and ventral attention network-related centers in 10 and 15 Hz associated with the lowest Z-scored Fast Fourier Transform coherence in the mentioned regions. CONCLUSIONS The negatively affected neurocognitive profile in breast cancer patients treated with the Adriamycin, Cyclophosphamide and Taxol regimen proposes presumably neurotoxic sequelae of this chemotherapy regimen as compared with the Taxotere, Adriamycin and Cyclophosphamide regimen.
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Affiliation(s)
| | - Seyedeh Zahra Mousavi
- Students' Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Owrangi
- Students' Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Ali-Mohammad Kamali
- Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
- DANA Brain Health Institute, Iranian Neuroscience Society-Fars Chapter, Shiraz, Iran
| | - Mehdi Dehghani
- Hematology Research Center, Department of Hematology and Medical Oncology, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mohammad Nami
- Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
- DANA Brain Health Institute, Iranian Neuroscience Society-Fars Chapter, Shiraz, Iran
- Swiss Alternative Medicine, Geneva, Switzerland
- Neuroscience Center, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT AIP), City of Knowledge, Panama City, Republic of Panama
- Society for Brain Mapping and Therapeutics (SBMT), Los Angeles, CA, USA
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Arshad R, Kiani MH, Rahdar A, Sargazi S, Barani M, Shojaei S, Bilal M, Kumar D, Pandey S. Nano-Based Theranostic Platforms for Breast Cancer: A Review of Latest Advancements. Bioengineering (Basel) 2022; 9:bioengineering9070320. [PMID: 35877371 PMCID: PMC9311542 DOI: 10.3390/bioengineering9070320] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/05/2022] [Accepted: 07/11/2022] [Indexed: 12/24/2022] Open
Abstract
Breast cancer (BC) is a highly metastatic multifactorial disease with various histological and molecular subtypes. Due to recent advancements, the mortality rate in BC has improved over the past five decades. Detection and treatment of many cancers are now possible due to the application of nanomedicine in clinical practice. Nanomedicine products such as Doxil® and Abraxane® have already been extensively used for BC adjuvant therapy with favorable clinical outcomes. However, these products were designed initially for generic anticancer purposes and not specifically for BC treatment. With a better understanding of the molecular biology of BC, several novel and promising nanotherapeutic strategies and devices have been developed in recent years. In this context, multi-functionalized nanostructures are becoming potential carriers for enhanced chemotherapy in BC patients. To design these nanostructures, a wide range of materials, such as proteins, lipids, polymers, and hybrid materials, can be used and tailored for specific purposes against BC. Selective targeting of BC cells results in the activation of programmed cell death in BC cells and can be considered a promising strategy for managing triple-negative BC. Currently, conventional BC screening methods such as mammography, digital breast tomosynthesis (DBT), ultrasonography, and magnetic resonance imaging (MRI) are either costly or expose the user to hazardous radiation that could harm them. Therefore, there is a need for such analytical techniques for detecting BC that are highly selective and sensitive, have a very low detection limit, are durable, biocompatible, and reproducible. In detecting BC biomarkers, nanostructures are used alone or in conjunction with numerous molecules. This review intends to highlight the recent advances in nanomedicine in BC treatment and diagnosis, emphasizing the targeting of BC cells that overexpress receptors of epidermal growth factors. Researchers may gain insight from these strategies to design and develop more tailored nanomedicine for BC to achieve further improvements in cancer specificity, antitumorigenic effects, anti-metastasis effects, and drug resistance reversal effects.
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Affiliation(s)
- Rabia Arshad
- Faculty of Pharmacy, University of Lahore, Lahore 54000, Pakistan;
| | | | - Abbas Rahdar
- Department of Physics, University of Zabol, Zabol 98613-35856, Iran
- Correspondence: (A.R.); or (S.P.)
| | - Saman Sargazi
- Cellular and Molecular Research Center, Research Institute of Cellular and Molecular Sciences in Infectious Diseases, Zahedan University of Medical Sciences, Zahedan 98167-43463, Iran;
| | - Mahmood Barani
- Medical Mycology and Bacteriology Research Center, Kerman University of Medical Sciences, Kerman 76169-13555, Iran;
| | - Shirin Shojaei
- Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah 67158-47141, Iran;
| | - Muhammad Bilal
- School of Life Science and Food Engineering, Huaiyin Institute of Technology, Huaian 223003, China;
| | - Deepak Kumar
- Department of Pharmaceutical Chemistry, School of Pharmaceutical Sciences, Shoolini University, Solan 173229, India;
| | - Sadanand Pandey
- Department of Chemistry, College of Natural Science, Yeungnam University, 280 Daehak-Ro, Gyeongsan 38541, Korea
- Correspondence: (A.R.); or (S.P.)
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Loubani K, Schreuer N, Kizony R. Participation in Daily Activities Among Women 5 Years After Breast Cancer. Am J Occup Ther 2022; 76:7604205050. [PMID: 35767732 DOI: 10.5014/ajot.2022.048736] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Understanding the long-term participation restrictions after breast cancer (BC) is crucial for developing occupation-based interventions. OBJECTIVE To (1) compare women's participation during the BC subacute phase (2 yr postdiagnosis) with the chronic (5 yr postdiagnosis) phase, (2) explore factors associated with participation in the chronic phase, and (3) describe strategies women use to overcome participation restrictions. DESIGN Descriptive longitudinal study. SETTING A community health service in Israel. PARTICIPANTS A convenience sample of 30 women (M age = 53.9 yr, SD = 8.3) diagnosed with BC (Stages 1-3). OUTCOMES AND MEASURES Demographic and BC-related symptom questionnaires; an adapted version of the Activity Card Sort, used to assess retained activity levels (RALs) compared with prediagnosis activity levels in sociocultural, physical, and instrumental domains; the Canadian Occupational Performance Measure; and one open-ended qualitative question, "How were you able to retain your participation in daily activities despite the long-term effects of BC?" RESULTS Significantly higher total RALs were found in most domains for women in the chronic (M = 0.93 RAL, SD = 0.27) compared with the subacute (M = 0.71, SD = 0.22) phase, t(29) = 4.72, p < .001. Almost half the women achieved clinically significant change in their meaningful activities. Lower levels of participation were significantly correlated with higher symptom severity. The qualitative findings indicated that coping strategies, such as positive thinking and changing priorities, helped in managing women's participation. CONCLUSIONS AND RELEVANCE Participation restrictions and residual BC-related symptoms 5 yr postdiagnosis demonstrated the need for a comprehensive evaluation and early occupational therapy intervention to prevent long-term restrictions. What This Article Adds: This study highlights the value of a comprehensive assessment of daily participation (i.e., participation in various activity domains and in specific individual meaningful activities) of women with BC. The combination of quantitative and qualitative analysis provided a subjective perspective and deeper understanding of the associations among long-term symptoms, participation restrictions, and coping strategies.
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Affiliation(s)
- Khawla Loubani
- Khawla Loubani, PhD, OT, is Occupational Therapist, Department of Occupational Therapy, Clalit Health Services, Haifa and Western Galilee, Israel; . At the time of this study, Loubani was Doctoral Candidate, Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Mount Carmel, Haifa, Israel
| | - Naomi Schreuer
- Naomi Schreuer, PhD, OT, is Associate Professor, Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Mount Carmel, Haifa, Israel
| | - Rachel Kizony
- Rachel Kizony, PhD, OT, is Senior Lecturer, Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Mount Carmel, Haifa, Israel, and Occupational Therapist, Department of Occupational Therapy and Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Tel Hashomer, Israel
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29
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Root JC, Zhou X, Ahn J, Small BJ, Zhai W, Bethea T, Carroll JE, Cohen HJ, Dilawari A, Extermann M, Graham D, Isaacs C, Jacobsen PB, Jim H, McDonald BC, Nakamura ZM, Patel SK, Rentscher K, Saykin AJ, Van Dyk K, Mandelblatt JS, Ahles TA. Association of markers of tumor aggressivity and cognition in women with breast cancer before adjuvant treatment: The Thinking and Living with Cancer Study. Breast Cancer Res Treat 2022; 194:413-422. [PMID: 35587324 PMCID: PMC9392482 DOI: 10.1007/s10549-022-06623-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 04/30/2022] [Indexed: 01/13/2023]
Abstract
PURPOSE Tumor features associated with aggressive cancers may affect cognition prior to systemic therapy. We evaluated associations of cognition prior to adjuvant therapy and tumor aggressivity in older breast cancer patients. METHODS Women diagnosed with non-metastatic breast cancer (n = 705) ages 60-98 were enrolled from August 2010-March 2020. Cognition was measured post-surgery, pre-systemic therapy using self-reported (FACT-Cog Perceived Cognitive Impairment [PCI]) and objective tests of attention, processing speed, and executive function (APE domain) and learning and memory [LM domain]. Linear regression tested associations of pre-treatment tumor features and cognition, adjusting for age, race, and study site. HER2 positivity and higher stage (II/III vs. 0/I) were a priori predictors of cognition; in secondary analyses we explored associations of other tumor features and cognitive impairment (i.e., PCI score < 54 or having 2 tests < 1.5 SD or 1 test < 2 SD from the mean APE or LM domain score). RESULTS HER2 positivity and the hormone receptor negative/HER2 + molecular subtype were associated with lower adjusted mean self-reported cognition scores and higher impairment rates (p values < .05). Higher stage of disease was associated with lower objective performance in APE. Other tumor features were associated with cognition in unadjusted and adjusted models, including larger tumor size and lower PCI scores (p = 0.02). Tumor features were not related to LM. CONCLUSIONS Pre-adjuvant therapy cognition was associated with HER2 positivity and higher stage of disease and other features of aggressive tumors. Additional research is needed to confirm these results and assess potential mechanisms and clinical management strategies.
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Affiliation(s)
- James C Root
- Neurocognitive Research Lab, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th Floor, New York, NY, USA.
- Departments of Psychiatry and Anesthesiology, Weill Medical College of Cornell University, New York, NY, USA.
| | - Xingtao Zhou
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown-Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Jaeil Ahn
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown-Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Brent J Small
- School of Aging Studies, University of South Florida, and Senior Member, Health Outcome and Behavior Program and Biostatistics Resource Core, H. Lee Moffitt Cancer Center and Research Institute at the University of South Florida, Tampa, FL, USA
| | - Wanting Zhai
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown-Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Traci Bethea
- Department of Oncology, Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Judith E Carroll
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Jane and Terry Semel Institute for Neuroscience and Human BehaviorJonsson Comprehensive Cancer Center, UCLA, Los Angeles, CA, USA
| | - Harvey Jay Cohen
- Center for the Study of Aging and Human Development and Comprehensive Cancer Center, Duke University School of Medicine, Durham, NC, USA
| | - Asma Dilawari
- MedStar Washington Hospital Center, MedStar Georgetown Lombardi Comprehensive Cancer Center, Washington, USA
| | - Martine Extermann
- Department of Oncology, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA
| | | | - Claudine Isaacs
- Departments of Oncology and Medicine, Breast Cancer Program, Georgetown-Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Paul B Jacobsen
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Heather Jim
- Department of Oncology, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA
- Department of Health Outcomes and Behavior, Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, FL, USA
| | - Brenna C McDonald
- Center for Neuroimaging, Department of Radiology and Imaging Sciences and the Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Zev M Nakamura
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sunita K Patel
- Departments of Population Sciences and Supportive Care Medicine, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Kelly Rentscher
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Jane and Terry Semel Institute for Neuroscience and Human BehaviorJonsson Comprehensive Cancer Center, UCLA, Los Angeles, CA, USA
| | - Andrew J Saykin
- Center for Neuroimaging, Department of Radiology and Imaging Sciences and the Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kathleen Van Dyk
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Jane and Terry Semel Institute for Neuroscience and Human BehaviorJonsson Comprehensive Cancer Center, UCLA, Los Angeles, CA, USA
| | - Jeanne S Mandelblatt
- Department of Oncology, Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Tim A Ahles
- Neurocognitive Research Lab, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th Floor, New York, NY, USA
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30
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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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Mackenzie L, Marshall K. Effective non-pharmacological interventions for cancer related cognitive impairment in adults (excluding central nervous system or head and neck cancer): systematic review and meta-analysis. Eur J Phys Rehabil Med 2022; 58:258-270. [PMID: 34498828 PMCID: PMC9980504 DOI: 10.23736/s1973-9087.21.06898-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Cancer-related cognitive impairment (CRCI) is prevalent in cancer survivors, and impairments affect daily living tasks and overall wellbeing. This review aimed to identify and evaluate published randomized controlled trials (RCTs) of interventions to manage CRCI in adult populations, to analyze their effectiveness and to investigate the quality of the studies. EVIDENCE ACQUISITION Seven databases were searched (Medline, Scopus, CINAHL, AMED, PsychINFO, OTseeker, and the Cochrane Database of Systematic Reviews), including years 2005-2020, for randomized controlled trials (RCTs) investigating interventions to address cognition for adults with cancer. The final search was conducted in February 2021. The quality of studies was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for RCTs. Meta-analysis used comprehensive meta-analysis software. The study protocol was registered with PROSPERO (registration N. CRD42017076868). EVIDENCE SYNTHESIS A total of 45 studies involving 4727 participants examined interventions for CRCI and met selection criteria. Categories of interventions included cognitive training-based intervention (N.=15), cognitive behavior therapy (CBT) (N.=4), physical activity (N.=16) and other supportive therapies (N.=10). Meta-analysis indicated beneficial overall effects for all categories of interventions: cognitive training (standardized mean difference [SMD]=0.41, 95% CI: 0.28-0.53, I2=88.87%); CBT (SMD=0.30, 95% CI: 0.14-0.46, I2=44.86%); physical activity (SMD=0.27, 95% CI: 0.20-0.35, I2=37.67%); and supportive therapies (SMD=0.27, 95% CI: 0.16-0.39, I2=64.94%). Studies used self-report cognitive outcome measures and neurocognitive testing, or a mixture. CONCLUSIONS Findings suggest that effective intervention for CRCI exist, and cognitive training is consistently supported as an effective intervention; however, a high level of heterogeneity was found. CRCI research is currently dominated by breast cancer survivors, and quality research is also needed to address the broader population of cancer survivors who experience CRCI.
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Affiliation(s)
- Lynette Mackenzie
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia -
| | - Kelsey Marshall
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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de la Hoz-Camacho R, Rivera-Lazarín AL, Vázquez-Guillen JM, Caballero-Hernández D, Mendoza-Gamboa E, Martínez-Torres AC, Rodríguez-Padilla C. Cyclophosphamide and epirubicin induce high apoptosis in microglia cells while epirubicin provokes DNA damage and microglial activation at sub-lethal concentrations. EXCLI JOURNAL 2022; 21:197-212. [PMID: 35145370 PMCID: PMC8822306 DOI: 10.17179/excli2021-4160] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/13/2021] [Indexed: 12/12/2022]
Abstract
Chemotherapy Related Cognitive Impairment (CRCI), also called chemobrain, diminishes cancer patient's life quality. Breast cancer (BC) patients have been described to be importantly affected, however, the mechanism leading to CRCI has not been fully elucidated. Recent research proposes microglia as the main architect of CRCI, thus dysregulations in these cells could trigger CRCI. The aim of this research was to evaluate the effects of two drugs commonly used against breast cancer, cyclophosphamide (CTX) and epirubicin (EPI), on the microglia cell line SIM-A9, using the BC cell line, 4T1, as a control. Our results show that CTX and EPI decrease microglia-cell viability and increase cell death on a concentration-dependent manner, being 5 and 2 times more cytotoxic to microglia cell line than to breast cancer 4T1cells, respectively. Both chemotherapies induce cell cycle arrest and a significant increase in p53, p16 and γ-H2AX in breast cancer and microglia cells. Furthermore, mitochondrial membrane potential (ΔΨm) diminishes as cell death increases, and both chemotherapies induce reactive oxygen species (ROS) production on SIM-A9 and 4T1. Moreover, caspase activation increases with treatments and its pharmacological blockade inhibits CTX and EPI induced-cell death. Finally, low concentrations of CTX and EPI induce γ-H2AX, and EPI induces cytokine release, NO production and Iba-1 overexpression. These findings indicate that microglia cells are more sensitive to CTX and EPI than BC cells and undergo DNA damage and cell cycle arrest at very low concentrations, moreover EPI induces microglia activation and a pro-inflammatory profile.
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Affiliation(s)
- Rafael de la Hoz-Camacho
- Universidad Autónoma de Nuevo León, Facultad de Ciencias Biológicas, Laboratorio de Inmunología y Virología, Monterrey 66455, Mexico
| | - Ana Luisa Rivera-Lazarín
- Universidad Autónoma de Nuevo León, Facultad de Ciencias Biológicas, Laboratorio de Inmunología y Virología, Monterrey 66455, Mexico
| | - Jose Manuel Vázquez-Guillen
- Universidad Autónoma de Nuevo León, Facultad de Ciencias Biológicas, Laboratorio de Inmunología y Virología, Monterrey 66455, Mexico
| | - Diana Caballero-Hernández
- Universidad Autónoma de Nuevo León, Facultad de Ciencias Biológicas, Laboratorio de Inmunología y Virología, Monterrey 66455, Mexico
| | - Edgar Mendoza-Gamboa
- Universidad Autónoma de Nuevo León, Facultad de Ciencias Biológicas, Laboratorio de Inmunología y Virología, Monterrey 66455, Mexico
| | - Ana Carolina Martínez-Torres
- Universidad Autónoma de Nuevo León, Facultad de Ciencias Biológicas, Laboratorio de Inmunología y Virología, Monterrey 66455, Mexico
| | - Cristina Rodríguez-Padilla
- Universidad Autónoma de Nuevo León, Facultad de Ciencias Biológicas, Laboratorio de Inmunología y Virología, Monterrey 66455, Mexico.,LONGEVEDEN S.A. de C.V
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Bülbül O, Göksel S, Nak D. Changes in glucose metabolism of the brain after immunochemotherapy in patients with diffuse large B-Cell lymphoma on fluorodeoxyglucose positron emission tomography/computed tomography. JOURNAL OF RADIATION AND CANCER RESEARCH 2022. [DOI: 10.4103/jrcr.jrcr_37_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Rosenberg J, Butow PN, Shaw JM. The untold story of late effects: a qualitative analysis of breast cancer survivors' emotional responses to late effects. Support Care Cancer 2022; 30:177-185. [PMID: 34245359 DOI: 10.1007/s00520-021-06402-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 06/26/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Breast cancer survivors are at increased risk of adverse outcomes, called late effects, years after the completion of active treatment. Late effects can significantly impair physical functioning. The current study aimed to explore breast cancer survivors' experiences of late effects, their emotional responses to existing or potential late effects and their perceived impact. METHODS A total of 36 women treated for breast cancer in the last 10 years participated in semi-structured telephone interviews. Participant views were sought with respect to knowledge, experience, and perceived longer-term risk. A thematic analysis was conducted. RESULTS Four themes emerged from the data: (1) late effects awareness, (2) framing and coping, (3) uncertainty and (4) management. There was a range of emotional responses to late effects; however, many participants reported being unaware of their risk of late effects. Participants conceptualised late effects as any long-term effect of treatment regardless of the time of onset. Women reported living with constant uncertainty and feared cancer recurrence. Many were focused on managing long-term treatment side effects, rather than late effects. CONCLUSION Many women undergo treatment and remain unaware of associated late effect risks. National guidelines recommend patients be informed about late effects; however, the results of this study suggest a gap between policy and practice. Evidence-based interventions are needed to equip women with strategies to physically and emotionally manage late effects.
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Affiliation(s)
- Jodie Rosenberg
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia. .,Psycho-Oncology Co-Operative Research Group, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia.
| | - Phyllis N Butow
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia.,Psycho-Oncology Co-Operative Research Group, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - Joanne M Shaw
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia.,Psycho-Oncology Co-Operative Research Group, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
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Radomski M, Kreiger R, Anheluk M, Berling K, Darger M, Garcia H, Grabe K, Hopkins S, Morrison M, Zola J, Swenson KK. Cognitive Dysfunction: Feasibility of a Brief Intervention to Help Breast Cancer Survivors. Clin J Oncol Nurs 2021; 25:E69-E76. [PMID: 34800105 DOI: 10.1188/21.cjon.e69-e76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Many cancer survivors experience cancer-related cognitive dysfunction (CRCD), which is believed to be the result of multiple contributing biologic, situational, and personal factors. Efficacious, clinically implementable interventions addressing the multifactorial nature of CRCD are needed. OBJECTIVES This study evaluated the feasibility of an intervention to help breast cancer survivors mitigate the effects of modifiable factors that contribute to CRCD and improve cognitive functioning. METHODS A single-group pre-/post-test design was used. Treatment fidelity was tracked to evaluate implementability; attendance rates, experience surveys, and homework engagement were used to characterize acceptability. Pre- and post-test cognitive functioning, stress, fatigue, and mood were measured to evaluate preliminary efficacy. FINDINGS The intervention was implementable and acceptable to participants. Participants made statistically significant improvements.
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Sekeres MJ, Bradley-Garcia M, Martinez-Canabal A, Winocur G. Chemotherapy-Induced Cognitive Impairment and Hippocampal Neurogenesis: A Review of Physiological Mechanisms and Interventions. Int J Mol Sci 2021; 22:12697. [PMID: 34884513 PMCID: PMC8657487 DOI: 10.3390/ijms222312697] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/15/2021] [Accepted: 11/20/2021] [Indexed: 12/16/2022] Open
Abstract
A wide range of cognitive deficits, including memory loss associated with hippocampal dysfunction, have been widely reported in cancer survivors who received chemotherapy. Changes in both white matter and gray matter volume have been observed following chemotherapy treatment, with reduced volume in the medial temporal lobe thought to be due in part to reductions in hippocampal neurogenesis. Pre-clinical rodent models confirm that common chemotherapeutic agents used to treat various forms of non-CNS cancers reduce rates of hippocampal neurogenesis and impair performance on hippocampally-mediated learning and memory tasks. We review the pre-clinical rodent literature to identify how various chemotherapeutic drugs affect hippocampal neurogenesis and induce cognitive impairment. We also review factors such as physical exercise and environmental stimulation that may protect against chemotherapy-induced neurogenic suppression and hippocampal neurotoxicity. Finally, we review pharmacological interventions that target the hippocampus and are designed to prevent or reduce the cognitive and neurotoxic side effects of chemotherapy.
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Affiliation(s)
| | | | - Alonso Martinez-Canabal
- Cell Biology Department, National Autonomous University of Mexico, Mexico City 04510, Mexico;
| | - Gordon Winocur
- Rotman Research Institute, Baycrest Center, Toronto, ON M6A 2E1, Canada;
- Department of Psychology, Department of Psychiatry, University of Toronto, Toronto, ON M5S 3G3, Canada
- Department of Psychology, Trent University, Peterborough, ON K9J 7B8, Canada
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Kesler SR, Henneghan AM, Thurman W, Rao V. Identifying themes for assessing cancer-related cognitive impairment identified by topic modeling and qualitative content analysis of public online comments (Preprint). JMIR Cancer 2021; 8:e34828. [PMID: 35612878 PMCID: PMC9178450 DOI: 10.2196/34828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 04/28/2022] [Accepted: 05/01/2022] [Indexed: 11/28/2022] Open
Abstract
Background Cancer-related cognitive impairment (CRCI) is a common and significant adverse effect of cancer and its therapies. However, its definition and assessment remain difficult due to limitations of currently available measurement tools. Objective This study aims to evaluate qualitative themes related to the cognitive effects of cancer to help guide development of assessments that are more specific than what is currently available. Methods We applied topic modeling and inductive qualitative content analysis to 145 public online comments related to cognitive effects of cancer. Results Topic modeling revealed 2 latent topics that we interpreted as representing internal and external factors related to cognitive effects. These findings lead us to hypothesize regarding the potential contribution of locus of control to CRCI. Content analysis suggested several major themes including symptoms, emotional/psychological impacts, coping, “chemobrain” is real, change over time, and function. There was some conceptual overlap between the 2 methods regarding internal and external factors related to patient experiences of cognitive effects. Conclusions Our findings indicate that coping mechanisms and locus of control may be important themes to include in assessments of CRCI. Future directions in this field include prospective acquisition of free-text responses to guide development of assessments that are more sensitive and specific to cognitive function in patients with cancer.
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Affiliation(s)
- Shelli R Kesler
- School of Nursing, University of Texas at Austin, Austin, TX, United States
| | - Ashley M Henneghan
- School of Nursing, University of Texas at Austin, Austin, TX, United States
| | - Whitney Thurman
- School of Nursing, University of Texas at Austin, Austin, TX, United States
| | - Vikram Rao
- School of Nursing, University of Texas at Austin, Austin, TX, United States
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Chan YN, Leak Bryant A, Conklin JL, Girdwood T, Piepmeier A, Hirschey R. Systematic Review of Cognitive Impairment in Colorectal Cancer Survivors Who Received Chemotherapy. Oncol Nurs Forum 2021; 48:634-647. [PMID: 34673756 PMCID: PMC8666003 DOI: 10.1188/21.onf.634-647] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PROBLEM IDENTIFICATION Cognitive impairment is a common and troublesome side effect experienced by many cancer survivors. It can have a significant impact on survivors' ability to function and enjoy a high quality of life. However, most cognitive impairment research has focused on breast cancer survivors, despite the high rates of colorectal cancer and the toxicity of treatment agents in some colorectal cancer chemotherapeutic regimens, which have been linked to cognitive impairment. This review provides a novel synthesis of what is known about cognitive impairment in colorectal cancer survivors. LITERATURE SEARCH CINAHL®, Cochrane Library, Embase®, PsycINFO®, and PubMed® were systematically searched by a health sciences librarian. DATA EVALUATION Data were extracted across studies; findings about the prevalence, severity, and correlates of cognitive impairment were synthesized. SYNTHESIS Across findings from 26 articles representing 24 independent studies, 13%-57% of participants had cognitive impairment. Potential demographic, physiologic, and psychological correlates of cognitive impairment were identified. IMPLICATIONS FOR PRACTICE Findings indicate a need to focus research and patient assessments on early identification of risk factors, assessing for existing cognitive deficits and testing interventions to decrease cognitive impairment in colorectal cancer survivors.
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Binarelli G, Joly F, Tron L, Lefevre Arbogast S, Lange M. Management of Cancer-Related Cognitive Impairment: A Systematic Review of Computerized Cognitive Stimulation and Computerized Physical Activity. Cancers (Basel) 2021; 13:5161. [PMID: 34680310 PMCID: PMC8534081 DOI: 10.3390/cancers13205161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/05/2021] [Accepted: 10/11/2021] [Indexed: 01/27/2023] Open
Abstract
Cancer-related cognitive impairment (CRCI) occurs frequently in patients living with cancer, with consequences on quality of life. Recently, research on the management of these difficulties has focused on computerized cognitive stimulation and computerized physical activity programs. This systematic review presents the state of knowledge about interventions based on computerized-cognitive stimulation and/or physical activity to reduce CRCI. The review followed the PRISMA guidelines. A search was conducted in PUBMED and Web of Science databases. Risk of bias analysis was conducted using the Rob2 tool and the quality of evidence was conducted following the GRADE approach. A total of 3776 articles were initially identified and 20 of them met the inclusion criteria. Among them, sixteen investigated computerized-cognitive stimulation and four computerized-physical activity. Most of the studies were randomized controlled trials and assessed the efficacy of a home-based intervention on objective cognition in adults with cancer. Overall, cognitive improvement was found in 11/16 computerized-cognitive stimulation studies and 2/4 computerized-physical activity studies. Cognitive stimulation or physical activity improved especially cognitive complaints, memory, and attention. These results suggest the efficacy of both computerized-cognitive stimulation and physical activity. However, we report a high risk of bias for the majority of studies and a low level of quality of evidence. Therefore, further investigations are needed to confirm the efficacy of these interventions and to investigate the possible added benefit on cognition of a combined computerized-cognitive/physical intervention.
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Affiliation(s)
- Giulia Binarelli
- Clinical Research Department, Centre François Baclesse, 14000 Caen, France; (G.B.); (F.J.)
- ANTICIPE, INSERM, UNICAEN, Normandie University, 14000 Caen, France; (L.T.); (S.L.A.)
| | - Florence Joly
- Clinical Research Department, Centre François Baclesse, 14000 Caen, France; (G.B.); (F.J.)
- ANTICIPE, INSERM, UNICAEN, Normandie University, 14000 Caen, France; (L.T.); (S.L.A.)
- Cancer and Cognition Platform, Ligue Nationale Contre le Cancer, 14000 Caen, France
| | - Laure Tron
- ANTICIPE, INSERM, UNICAEN, Normandie University, 14000 Caen, France; (L.T.); (S.L.A.)
- Cancer and Cognition Platform, Ligue Nationale Contre le Cancer, 14000 Caen, France
| | - Sophie Lefevre Arbogast
- ANTICIPE, INSERM, UNICAEN, Normandie University, 14000 Caen, France; (L.T.); (S.L.A.)
- Cancer and Cognition Platform, Ligue Nationale Contre le Cancer, 14000 Caen, France
| | - Marie Lange
- Clinical Research Department, Centre François Baclesse, 14000 Caen, France; (G.B.); (F.J.)
- ANTICIPE, INSERM, UNICAEN, Normandie University, 14000 Caen, France; (L.T.); (S.L.A.)
- Cancer and Cognition Platform, Ligue Nationale Contre le Cancer, 14000 Caen, France
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Binarelli G, Lange M, Dos Santos M, Grellard JM, Lelaidier A, Tron L, Lefevre Arbogast S, Clarisse B, Joly F. Multimodal Web-Based Intervention for Cancer-Related Cognitive Impairment in Breast Cancer Patients: Cog-Stim Feasibility Study Protocol. Cancers (Basel) 2021; 13:cancers13194868. [PMID: 34638354 PMCID: PMC8508392 DOI: 10.3390/cancers13194868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/02/2021] [Accepted: 09/23/2021] [Indexed: 12/02/2022] Open
Abstract
Simple Summary Cognitive difficulties and their impact on patients’ quality of life are frequently reported by patients treated for breast cancer, who ask for support to improve these difficulties. Cognitive stimulation and physical activity resulted as beneficial for cognitive difficulties, but they are challenging to generalize in hospitals. To overcome this limitation, home-based computerized interventions have been proposed. In this study, the feasibility of a combined intervention of web-based cognitive stimulation and physical activity among breast cancer patients undergoing radiotherapy will be investigated. The overall goal is to develop interventions for cognitive difficulties adapted to supportive care units. Abstract Cancer-related cognitive impairment (CRCI) is a frequent side-effect of cancer treatment, with important consequences on patients’ quality of life. Cognitive stimulation and physical activity are the most efficient in improving cognitive impairment, but they are challenging to generalize in hospitals’ routine and to patients’ needs and schedules. Moreover, the added value of a combination of these interventions needs to be more investigated. The Cog-Stim study is an interventional study investigating the feasibility of a web-based multimodal intervention (combining cognitive stimulation and physical activity for the improvement of cognitive complaints among breast-cancer patients currently treated with radiotherapy (n = 20). Patients will take part in a 12-week program, proposing two sessions per week of web-based cognitive stimulation (20 min/session with HappyNeuron®) and two sessions per week of web-based physical activity (30 min/session with Mooven® platform). Cognitive complaints (FACT-Cog) and objective cognitive functioning (CNS Vital Signs®), anxiety, depression (HADS), sleep disorders (ISI) and fatigue (FACIT-Fatigue) will be assessed before and after the intervention. The primary endpoint is the adherence rate to the intervention program. Patients’ satisfaction, reasons for non-attrition and non-adherence to the program will also be assessed. The overall goal of this study is to collect information to develop web-based interventions for cognitive difficulties in supportive care units.
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Affiliation(s)
- Giulia Binarelli
- Clinical Research Department, Centre François Baclesse, 14000 Caen, France; (M.L.); (M.D.S.); (J.-M.G.); (S.L.A.); (B.C.); (F.J.)
- Interdisciplinary Research Unit for the Prevention and Treatment of Cancers (ANTICIPE), National Institute of Health and Medical Research (INSERM), University of Caen Normandie (UNICAEN), Normandie University, 14000 Caen, France;
- Correspondence: ; Tel.: +33-2-31-45-86-09; Fax: +33-2-31-45-50-97
| | - Marie Lange
- Clinical Research Department, Centre François Baclesse, 14000 Caen, France; (M.L.); (M.D.S.); (J.-M.G.); (S.L.A.); (B.C.); (F.J.)
- Interdisciplinary Research Unit for the Prevention and Treatment of Cancers (ANTICIPE), National Institute of Health and Medical Research (INSERM), University of Caen Normandie (UNICAEN), Normandie University, 14000 Caen, France;
- Cancer and Cognition Platform, Ligue Nationale Contre le Cancer, 14000 Caen, France
| | - Mélanie Dos Santos
- Clinical Research Department, Centre François Baclesse, 14000 Caen, France; (M.L.); (M.D.S.); (J.-M.G.); (S.L.A.); (B.C.); (F.J.)
- Interdisciplinary Research Unit for the Prevention and Treatment of Cancers (ANTICIPE), National Institute of Health and Medical Research (INSERM), University of Caen Normandie (UNICAEN), Normandie University, 14000 Caen, France;
| | - Jean-Michel Grellard
- Clinical Research Department, Centre François Baclesse, 14000 Caen, France; (M.L.); (M.D.S.); (J.-M.G.); (S.L.A.); (B.C.); (F.J.)
| | - Anaïs Lelaidier
- Northwest Data Center (CTD-CNO), Ligue Nationale Contre le Cancer and French National Cancer Institute (INCa), 14000 Caen, France;
| | - Laure Tron
- Interdisciplinary Research Unit for the Prevention and Treatment of Cancers (ANTICIPE), National Institute of Health and Medical Research (INSERM), University of Caen Normandie (UNICAEN), Normandie University, 14000 Caen, France;
- Cancer and Cognition Platform, Ligue Nationale Contre le Cancer, 14000 Caen, France
| | - Sophie Lefevre Arbogast
- Clinical Research Department, Centre François Baclesse, 14000 Caen, France; (M.L.); (M.D.S.); (J.-M.G.); (S.L.A.); (B.C.); (F.J.)
- Interdisciplinary Research Unit for the Prevention and Treatment of Cancers (ANTICIPE), National Institute of Health and Medical Research (INSERM), University of Caen Normandie (UNICAEN), Normandie University, 14000 Caen, France;
- Cancer and Cognition Platform, Ligue Nationale Contre le Cancer, 14000 Caen, France
| | - Benedicte Clarisse
- Clinical Research Department, Centre François Baclesse, 14000 Caen, France; (M.L.); (M.D.S.); (J.-M.G.); (S.L.A.); (B.C.); (F.J.)
| | - Florence Joly
- Clinical Research Department, Centre François Baclesse, 14000 Caen, France; (M.L.); (M.D.S.); (J.-M.G.); (S.L.A.); (B.C.); (F.J.)
- Interdisciplinary Research Unit for the Prevention and Treatment of Cancers (ANTICIPE), National Institute of Health and Medical Research (INSERM), University of Caen Normandie (UNICAEN), Normandie University, 14000 Caen, France;
- Cancer and Cognition Platform, Ligue Nationale Contre le Cancer, 14000 Caen, France
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Bernstein LJ, Edelstein K, Sharma A, Alain C. Chemo-brain: An activation likelihood estimation meta-analysis of functional magnetic resonance imaging studies. Neurosci Biobehav Rev 2021; 130:314-325. [PMID: 34454915 DOI: 10.1016/j.neubiorev.2021.08.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 07/24/2021] [Accepted: 08/23/2021] [Indexed: 11/17/2022]
Abstract
Adults with non-central nervous system (CNS) cancers frequently report problems in attention, memory and executive function during or after chemotherapy, referred to as cancer-related cognitive dysfunction (CRCD). Despite numerous studies investigating CRCD, there is no consensus regarding the brain areas implicated. We sought to determine if there are brain areas that consistently show either hyper- or hypo-activation in people treated with chemotherapy for non-CNS cancer (Chemo+). Using activation likelihood estimation on brain coordinates from 14 fMRI studies yielding 25 contrasts from 375 Chemo+ and 429 chemotherapy-naive controls while they performed cognitive tasks, the meta-analysis yielded two significant clusters which are part of the frontoparietal attention network, both showing lower activation in Chemo+. One cluster peaked in the left superior parietal cortex, extending into precuneus, inferior parietal lobule, and angular gyrus. The other peaked in the right superior prefrontal areas, extending into inferior prefrontal cortex. We propose that these observed lower activations reflect a dysfunction in mobilizing and/or sustaining attention due to depletion of cognitive resources. This could explain higher level of mental fatigue reported by Chemo+ and why cancer survivors report problems in a wide variety of cognitive domains.
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Affiliation(s)
- Lori J Bernstein
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Canada.
| | - Kim Edelstein
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Canada
| | - Alisha Sharma
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Claude Alain
- Rotman Research Institute, Baycrest Health Centre, Canada; Department of Psychology, University of Toronto, Canada
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Keetile NM, Osuch E, Lentoor AG. Chemotherapy-related subjective cognitive impairment in breast cancer patients in semi-rural South Africa. Health SA 2021; 26:1605. [PMID: 34394969 PMCID: PMC8335783 DOI: 10.4102/hsag.v26i0.1605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 05/26/2021] [Indexed: 12/09/2022] Open
Abstract
Background Breast cancer is the most commonly diagnosed cancer amongst women worldwide. Whilst current evidence indicates the therapeutic benefits from the use of chemotherapy, self-perceived cognitive difficulties emerged as a frequent occurrence during and after chemotherapy treatment in breast cancer patients. Aim The current study sought to investigate self-perceived cognitive impairment in a group of breast cancer patients in semi-rural South Africa. Setting The patients were recruited from an outpatient oncology clinic at a semi-rural, tertiary academic hospital in Gauteng, South Africa. Methods In a randomised, quantitative, time-based series study, 30 female patients aged 21–60 years (mean age = 50 years) diagnosed with stages II and III breast cancer on CMF (cyclophosphamide, methotrexate, fluorouracil) (n = 10) and FAC (fluorouracil, adriamycin, cyclophosphamide) (n = 20) chemotherapy regimens, completed the self-reported Functional Assessment of Cancer Therapy-Cognition (Fact-Cog) test as a measure of subjective cognitive functioning at three points during the course of treatment (T0, T1, T2). Results The results of the paired sample t-tests showed the scores on the Fact-Cog test confirmed significant cognitive decline for both treatment groups from baseline (T0) to completion (T2) of chemotherapy; CMF group, t (9) = 2.91, p = 0.017 and the FAC group t (19) = 4.66, p < 0.001. Conclusion This study confirms that self-reported subjective cognitive impairment is common in breast cancer patients who received chemotherapy in a sample of South African patients. The results have implications for the overall care of cancer patients. Contribution The context-based knowledge engendered by the current study is expected to augment the continuum of care for breast cancer patients.
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Affiliation(s)
- Nicholas M Keetile
- Department of Pharmacology, School of Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Elzbieta Osuch
- Department of Pharmacology, School of Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Antonio G Lentoor
- Department of Clinical Psychology, School of Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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Swainston J, Louis C, Moser J, Derakshan N. Neurocognitive efficiency in breast cancer survivorship: A performance monitoring ERP study. Int J Psychophysiol 2021; 168:9-20. [PMID: 34242661 DOI: 10.1016/j.ijpsycho.2021.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/26/2021] [Accepted: 06/28/2021] [Indexed: 12/24/2022]
Abstract
Breast cancer diagnosis and treatment can lead to longer term cognitive and emotional vulnerability, making the ability to efficiently adapt to setbacks critical. Whilst cancer-related cognitive impairments (CRCI) are often reported amongst breast cancer survivors, investigation into the capacity to efficiently process errors is limited. The present study investigated the neurocognitive correlates of cognitive-control related performance monitoring, an important function influencing behavioural adjustment to mistakes. 62 participants (30 Breast Cancer Survivors, 32 Non-Cancer) completed a modified flanker task designed to challenge response inhibition as we measured neurocognitive indices of performance monitoring (ERN, the error-related negativity; CRN, the correct-response negativity; Pe, the error positivity). Findings indicated a blunted CRN and larger ∆ERN in the breast cancer survivors compared to the non-cancer group, in the absence of performance effects. This was followed by a larger Pe in the breast cancer survivors' group, indicating an exaggerated performance monitoring response. For women affected by breast cancer, findings suggest an early disrupted neural response to monitoring cognitive performance, followed by the requirement for more effortful processing in the conscious response to errors, indicating deficits in neurocognitive efficiency. These findings have important implications for developing cognitive rehabilitation programmes for breast cancer survivors affected by cognitive dysfunction to assist in the monitoring and adjustment of performance required to meet established goals in the face of adversity.
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Affiliation(s)
- Jessica Swainston
- Department of Psychological Sciences, Birkbeck, University of London, UK.
| | - Courtney Louis
- Department of Psychology, Michigan State University, USA
| | - Jason Moser
- Department of Psychology, Michigan State University, USA
| | - Nazanin Derakshan
- Department of Psychological Sciences, Birkbeck, University of London, UK
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Magnuson A, Ahles T, Chen BT, Mandelblatt J, Janelsins MC. Cognitive Function in Older Adults With Cancer: Assessment, Management, and Research Opportunities. J Clin Oncol 2021; 39:2138-2149. [PMID: 34043437 PMCID: PMC8260910 DOI: 10.1200/jco.21.00239] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/11/2021] [Accepted: 03/25/2021] [Indexed: 12/12/2022] Open
Affiliation(s)
- Allison Magnuson
- Department of Medicine, University of Rochester Medical Center, Wilmot Cancer Institute, Rochester, NY
| | - Tim Ahles
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Bihong T. Chen
- Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, CA
| | - Jeanne Mandelblatt
- Georgetown-Lombardi Comprehensive Cancer Center, Cancer Control Program, Georgetown University Medical Center, Washington, DC
| | - Michelle C. Janelsins
- Department of Surgery, Cancer Control, University of Rochester Medical Center, Wilmot Cancer Institute, Rochester, NY
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45
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George RP, Semendric I, Bowley-Schubert ER, Chivonivoni CT, Warrender AP, Whittaker AL. Reporting in rodent models of 'chemobrain': a systematic review assessing compliance with the ARRIVE guidelines. Support Care Cancer 2021; 29:7073-7084. [PMID: 34080055 DOI: 10.1007/s00520-021-06312-8] [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: 02/08/2021] [Accepted: 05/20/2021] [Indexed: 12/09/2022]
Abstract
Patients diagnosed with cancer are often plagued with debilitating side effects post-chemotherapy treatment. One such side effect is chemotherapy-induced cognitive impairment or 'chemobrain'. Rodent models are commonly used to investigate pathogenesis and potential therapeutic strategies. However, concerns have been raised regarding inadequacies in reporting of animal studies rendering them unreliable and irreproducible. The aim of this systematic review was to assess compliance with the ARRIVE reporting guidelines in peer-reviewed publications evaluating chemotherapy-induced cognitive changes in rodent models, and to determine if the introduction of the ARRIVE guidelines has improved quality of reporting. A comprehensive search was conducted to identify relevant peer-reviewed publications. Ninety-seven studies met the eligibility criteria, and publication compliance with the ARRIVE guideline reporting was assessed. No studies achieved full adherence with the ARRIVE guidelines. Furthermore, no significant improvement was demonstrated in the overall compliance score post-ARRIVE. Given the lack of standardisation of animal models in this research area, these results pose particular threat to future progress and translation of findings in this area of research. These results highlight the need for stricter adherence to the ARRIVE guidelines by journal editors and reviewers. Animal Ethics Committees also have an important educative role in improving knowledge and awareness of the guidelines amongst researchers.
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Affiliation(s)
- Rebecca P George
- School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy Campus, Roseworthy, South Australia, 5371, Australia.
| | - Ines Semendric
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, 5005, Australia
| | | | - Christine T Chivonivoni
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, 5005, Australia
| | - Alexandra P Warrender
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, 5005, Australia
| | - Alexandra L Whittaker
- School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy Campus, Roseworthy, South Australia, 5371, Australia.
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Loubani K, Kizony R, Milman U, Schreuer N. Hybrid Tele and In-Clinic Occupation Based Intervention to Improve Women's Daily Participation after Breast Cancer: A Pilot Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5966. [PMID: 34199448 PMCID: PMC8199623 DOI: 10.3390/ijerph18115966] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 05/30/2021] [Accepted: 05/31/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Women after breast cancer (BC) cope with decreased daily participation and quality of life (QOL) due to physical, cognitive, and emotional symptoms. This study examined a hybrid occupation-based intervention, Managing Participation with Breast Cancer (MaP-BC), to improve daily participation in their meaningful activities. METHODS Thirty-five women after BC phase were randomly allocated to the MaP-BC intervention (n = 18) or control (n = 17) group (standard care only). Assessments were administered at baseline (T1), 6-week (T2), and 12-week (T3) post-T1. MAIN OUTCOME perceived performance and performance-satisfaction with meaningful activities according to the Canadian Occupational Performance Measure. SECONDARY OUTCOMES retained activity levels (Activity Card Sort), QOL (Functional Assessment of Cancer Therapy-Breast), cognitive abilities (Montreal Cognitive Assessment and Behavior Rating Inventory of Executive Function), and upper-extremity functioning (Disability of Arm, Shoulder, Hand). Results showed significant interaction (group x time) effects for the primary outcome in performance, F(2,66) = 29.54, p = 0.001, ɳP2 = 0.472, and satisfaction, F(2,66) = 37.15, p = 0.000, ɳP2 = 0.530. The intervention group improved more in performance, t = 5.51, p = 0.0001, d = 1.298, and satisfaction, t = -5.32, p = 0.0001, d = 1.254, than the control group between T1 and T2. Secondary outcomes demonstrated within-group improvements. CONCLUSION MaP-BC, a comprehensive occupation-based hybrid intervention tailored to women's functional daily needs after BC, improved participation in meaningful activities within a short period.
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Affiliation(s)
- Khawla Loubani
- Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Mount Carmel, Haifa 31905, Israel; (R.K.); (N.S.)
- Clalit Health Services, Haifa and Western Galilee, Tel Aviv 62098, Israel;
| | - Rachel Kizony
- Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Mount Carmel, Haifa 31905, Israel; (R.K.); (N.S.)
- Sheba Medical Center, Department of Occupational Therapy, Tel Hashomer, Ramat Gan 52621, Israel
| | - Uzi Milman
- Clalit Health Services, Haifa and Western Galilee, Tel Aviv 62098, Israel;
| | - Naomi Schreuer
- Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Mount Carmel, Haifa 31905, Israel; (R.K.); (N.S.)
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Syarif H, Waluyo A, Afiyanti Y. Cognitive Perception among Post-Chemotherapy, Non-Chemotherapy Breast Cancer Survivors and Non-Cancer. Asian Pac J Cancer Prev 2021; 22:1775-1780. [PMID: 34181333 PMCID: PMC8418839 DOI: 10.31557/apjcp.2021.22.6.1775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Indexed: 11/25/2022] Open
Abstract
Objective: This study aims to compare the cognitive function perceived by post-chemotherapy breast cancer survivors, breast cancer survivors without chemotherapy, and non-cancer woman patients. Methods: This study was conducted by a descriptive comparative method. The respondents consisted of 82 survivors of post-chemotherapy breast cancer, 81 non-chemotherapy breast cancer survivors, and 80 non-cancer woman patients who were recruited using consecutive sampling. The data were collected from October until December 2017 by using a FACT-Cog version 3 questionnaire. Data analysis was performed by using a comparative test of Kruskal-Wallis followed by a Mann-Whitney posthoc analysis. Results: The results showed that the median of cognitive function perception in breast cancer survivors post-chemotherapy, non-chemotherapy, and non-cancerous women are 94 (52-122), 113 (53-130), and 121 (69-132), respectively. Mann-Whitney’s post-hoc analysis showed a significantly different perception of cognitive function between post-chemotherapy survivors and non-chemotherapy survivors; also between post-chemotherapy survivors and non-cancer women, and between non-chemotherapy survivors with non-cancer women. Conclusion: Perceived cognitive impairment, comments from others, perceived cognitive abilities, and effects on quality of life in breast cancer survivors who received chemotherapy are significantly different as compared to the survivor group without chemotherapy and non-cancerous healthy women.
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Affiliation(s)
- Hilman Syarif
- Department of Medical Surgical Nursing, Faculty of Nursing, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Agung Waluyo
- Medical Surgical Nursing Department, Faculty of Nursing, Universitas Indonesia, Depok, East Java, Indonesia
| | - Yati Afiyanti
- Maternity Department, Faculty of Nursing, Universitas Indonesia, Depok, East Java. Indonesia
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Ibrahim EY, Domenicano I, Nyhan K, Elfil M, Mougalian SS, Cartmel B, Ehrlich BE. Cognitive Effects and Depression Associated With Taxane-Based Chemotherapy in Breast Cancer Survivors: A Meta-Analysis. Front Oncol 2021; 11:642382. [PMID: 33996556 PMCID: PMC8121254 DOI: 10.3389/fonc.2021.642382] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/23/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose: This meta-analysis provides a longitudinal assessment of depression and cognitive impairment induced by taxane-based chemotherapy in women with breast cancer after 6 months of treatment. We highlighted the incidence and prevalence, the cognitive pattern in neuropsychological studies, and the relationship between chemotherapy-induced cognitive impairment and different risk factors. We estimated the effect sizes on each cognitive domain and differentiated effect sizes by each method of comparison of effects (i.e., baseline data, or control groups). Methods: The databases MEDLINE and Embase were searched for publications about taxane-related cognitive changes in patients with breast cancer published from 1980 to 2019. Cross-sectional and self-reported outcomes studies were excluded except for the depression item. Included studies were assessed for risk of bias with the Newcastle-Ottawa Scale. We estimated effect sizes for each cognitive domain and differentiated effect sizes by each method of comparison of effects. The review is reported in compliance with the PRISMA Statement; it was registered prospectively in PROSPERO as CRD42020163255. Results: Eleven studies meeting the criteria were analyzed, which resulted in a sample of 1,057 patients with breast cancer who received chemotherapy including 820 patients (77%) who received taxane-based chemotherapy. Attention and concentration, depression, and executive function domains had significant chemotherapy-induced impairment across all comparison types. Statistically significant improvement was found in language and verbal memory when comparing chemotherapy patients' test scores with baseline or matched controls. Taxane-based chemotherapy had a non-significant effect on processing speed, visual memory, visuospatial, and motor function domains. Conclusions: The occurrence of chemotherapy-induced cognitive impairment 6 months or more after the course of treatment in people with breast cancer is frequent in the domains of attention, executive function, and depression. Other domains appear stable or improve with time after treatment cessation.
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Affiliation(s)
- Eiman Y. Ibrahim
- Department of Pharmacology, Yale University, New Haven, CT, United States
| | - Ilaria Domenicano
- Department of Biostatistics, Yale School of Public Health Yale University, New Haven, CT, United States
| | - Kate Nyhan
- Harvey Cushing/John Hay Whitney Medical Library and Environmental Health Sciences, Yale School of Public Health, Yale University, New Haven, CT, United States
| | - Mohamed Elfil
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, United States
| | - Sarah S. Mougalian
- Department of Medicine (Medical Oncology), Yale School of Medicine, New Haven, CT, United States
| | - Brenda Cartmel
- Department of Chronic Disease Epidemiology Yale School of Public Health and the Yale Cancer Center, Yale School of Public Health, New Haven, CT, United States
| | - Barbara E. Ehrlich
- Department of Pharmacology, Yale University, New Haven, CT, United States
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Armin JS, Marshall CA, Kroeger S. Exploring the Experiences of University Students with a History of Cancer: A Pilot Study. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:294-298. [PMID: 31776893 DOI: 10.1007/s13187-019-01627-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
This exploratory pilot study aims to provide preliminary data describing the experiences of university student cancer survivors, quantify their connection to the campus Disability Resource Center, and assess the feasibility of conducting research with this population. In this descriptive study of cancer survivor students at one large university in the southwestern U.S., online survey respondents with a history of cancer (N = 19) reported cognitive, emotional, and physical limitations that affected their educational experience. The majority (78.9%) of our participants were children, adolescents, or young adults (up to age 39) when diagnosed with cancer; all others were diagnosed between 40 and 60 years old. We found that students living with cancer have short- and long-term impairments, including memory issues that made academic performance difficult. These effects led some students to cope individually while others sought support from institutional entities or instructors. Here we document survivor experiences and propose next steps in research, which includes an intervention that builds on our preliminary findings and uses the positive deviance model.
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Affiliation(s)
- Julie S Armin
- Department of Family & Community Medicine and Sonoran University Center for Excellence in Disabilities, College of Medicine, University of Arizona, 655 N. Alvernon Way, Ste. 228, Tucson, AZ, 85711, USA.
| | - Catherine A Marshall
- Department of Disability and Psychoeducational Studies, College of Education, University of Arizona, Tucson, AZ, USA
| | - Sue Kroeger
- Department of Disability and Psychoeducational Studies, College of Education, University of Arizona, Tucson, AZ, USA
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50
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Theoharides TC, Cholevas C, Polyzoidis K, Politis A. Long-COVID syndrome-associated brain fog and chemofog: Luteolin to the rescue. Biofactors 2021; 47:232-241. [PMID: 33847020 PMCID: PMC8250989 DOI: 10.1002/biof.1726] [Citation(s) in RCA: 109] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/01/2021] [Indexed: 01/08/2023]
Abstract
COVID-19 leads to severe respiratory problems, but also to long-COVID syndrome associated primarily with cognitive dysfunction and fatigue. Long-COVID syndrome symptoms, especially brain fog, are similar to those experienced by patients undertaking or following chemotherapy for cancer (chemofog or chemobrain), as well in patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) or mast cell activation syndrome (MCAS). The pathogenesis of brain fog in these illnesses is presently unknown but may involve neuroinflammation via mast cells stimulated by pathogenic and stress stimuli to release mediators that activate microglia and lead to inflammation in the hypothalamus. These processes could be mitigated by phytosomal formulation (in olive pomace oil) of the natural flavonoid luteolin.
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Affiliation(s)
- Theoharis C. Theoharides
- Laboratory of Molecular Immunopharmacology and Drug Discovery, Department of ImmunologyTufts University School of MedicineBostonMassachusettsUSA
- School of Graduate Biomedical SciencesTufts University School of MedicineBostonMassachusettsUSA
- Department of Internal MedicineTufts University School of Medicine and Tufts Medical CenterBostonMassachusettsUSA
- Department of PsychiatryTufts University School of Medicine and Tufts Medical CenterBostonMassachusettsUSA
- BrainGateThessalonikiGreece
| | | | | | - Antonios Politis
- First Department of PsychiatryEginition Hospital, National and Kapodistrian UniversityAthensGreece
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