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Buskbjerg CR, Amidi A, Munk A, Danielsen JT, Henriksen LT, Lukacova S, Haldbo-Classen L, Evald J, Evald L, Lassen-Ramshad Y, Zachariae R, Høyer M, Hasle H, Wu LM. Engaging carers in neuropsychological rehabilitation for brain cancer survivors: The "I'm aware: Patients And Carers Together" (ImPACT) program. Contemp Clin Trials 2024; 138:107419. [PMID: 38142774 DOI: 10.1016/j.cct.2023.107419] [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: 07/11/2023] [Revised: 12/11/2023] [Accepted: 12/19/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Cognitive impairment is a common late effect in child and adult brain cancer survivors (BCS). Still, there is a dearth of research aimed at therapeutic interventions and no standard treatment options for most BCS. OBJECTIVE To describe 1) a novel neuropsychological rehabilitation program for BCS - the "I'm aware: Patients And Carers Together" (ImPACT) program, and 2) two studies that aim to assess the feasibility of the ImPACT program in child and adult BCS, respectively. The program adapts the holistic neuropsychological approach pioneered by Leonard Diller and Yehuda Ben-Yishay to an outpatient setting. METHODS Two feasibility studies are described: 1) A single-armed study with 15 child BCS (10-17 years) (ImPACT Child); and 2) a randomized waitlist-controlled trial with 26 adult BCS (>17 years) (ImPACT Adult). In both studies, patients will undergo an 8-week program together with a cohabiting carer. Primary outcomes (i.e., cognitive and neurobehavioral symptoms), and secondary outcomes (i.e., behavioral and psychological symptoms, e.g., quality of life, fatigue) will be assessed at four time points: pre-, mid-, and post intervention, and 8 weeks follow-up. Adult waitlist controls will be assessed at equivalent time points and will be included in the intervention group after all study assessments. Semi-structured interviews will be conducted at follow-up. EXPECTED OUTCOMES Results will provide feasibility data in support of future larger scale trials. DISCUSSION The findings could potentially improve the management of cognitive impairment in BCS and transform available services. The program can be delivered in-person or remotely and harnesses existing resources in patients' lives.
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Affiliation(s)
- C R Buskbjerg
- Department of Oncology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark; Unit for Psycho-oncology and Health Psychology, Department of Psychology and Behavioural Sciences, Aarhus University, Bartholins Allé, 8000 Aarhus, Denmark
| | - A Amidi
- Unit for Psycho-oncology and Health Psychology, Department of Psychology and Behavioural Sciences, Aarhus University, Bartholins Allé, 8000 Aarhus, Denmark
| | - A Munk
- Department of Oncology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark; Unit for Psycho-oncology and Health Psychology, Department of Psychology and Behavioural Sciences, Aarhus University, Bartholins Allé, 8000 Aarhus, Denmark
| | - J T Danielsen
- Unit for Psycho-oncology and Health Psychology, Department of Psychology and Behavioural Sciences, Aarhus University, Bartholins Allé, 8000 Aarhus, Denmark
| | - L T Henriksen
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - S Lukacova
- Danish Centre for Particle Therapy, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - L Haldbo-Classen
- Department of Oncology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - J Evald
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - L Evald
- Hammel Neurorehabilitation Centre & University Research Clinic, Voldbyvej 15, 8450, Hammel, Denmark
| | - Y Lassen-Ramshad
- Danish Centre for Particle Therapy, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - R Zachariae
- Department of Oncology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark; Unit for Psycho-oncology and Health Psychology, Department of Psychology and Behavioural Sciences, Aarhus University, Bartholins Allé, 8000 Aarhus, Denmark
| | - M Høyer
- Danish Centre for Particle Therapy, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - H Hasle
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - L M Wu
- Department of Oncology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark; Unit for Psycho-oncology and Health Psychology, Department of Psychology and Behavioural Sciences, Aarhus University, Bartholins Allé, 8000 Aarhus, Denmark; Department of Psychology, Reykjavik University, Iceland.
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2
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Bender CM, Sereika SM, Gentry AL, Cuglewski C, Duquette J, Grove G, Cummings M, Cho MG, Brufsky AM, McAuliffe P, Budway RJ, Diego EJ, Evans S, Rosenzweig MQ, Marsland AL, Conley YP, Erickson K. Effects of aerobic exercise on neurocognitive function in postmenopausal women receiving endocrine therapy for breast cancer: The Exercise Program in Cancer and Cognition randomized controlled trial. Psychooncology 2024; 33:e6298. [PMID: 38911475 PMCID: PMC11189639 DOI: 10.1002/pon.6298] [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: 08/31/2023] [Accepted: 01/14/2024] [Indexed: 06/25/2024]
Abstract
Objective The Exercise Program in Cancer and Cognition (EPICC) Study was a randomized controlled trial (RCT) designed to determine whether six months of moderate-intensity aerobic exercise improves neurocognitive function in women with breast cancer (BC) receiving endocrine therapy (ET). Methods Postmenopausal women with hormone receptor+, early-stage BC, within two years post-primary therapy were randomized to the exercise intervention (six months, ≥150 minutes of moderate-intensity aerobic exercise/week) or usual care control condition. Outcomes were assessed at pre-randomization and after intervention completion. Groups were compared using linear mixed-effects modeling. Results Participants (N=153) wereX ¯ = 62.09 ± 8.27 years old, with stage I BC (64.1%) and a median of 4.7 months post-diagnosis. We found a group-by-time interaction (p=0.041) and a trend for the main effect of time (p=0.11) for processing speed with improved performance in the exercise group and no change in the controls. Similar main effects of time were observed for learning and memory (p=0.024) and working memory (p=0.01). Better intervention adherence was associated with improved processing speed (p=0.017). Conclusions Six months of moderate-intensity aerobic exercise improves processing speed in postmenopausal women with BC receiving ET who initiate exercise within two years of completing primary therapy (surgery +/- chemotherapy). This is the first large-scale study to examine the effects of aerobic exercise on neurocognitive function in women with BC. Additional research is needed to address the long-term effects of aerobic exercise on cognitive function.
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Affiliation(s)
| | - Susan M Sereika
- University of Pittsburgh School of Nursing and Graduate School of Public Health
| | | | | | | | - George Grove
- University of Pittsburgh Dietrich School of Arts and Sciences
| | | | | | | | | | | | | | | | | | - Anna L Marsland
- University of Pittsburgh Dietrich School of Arts and Sciences
| | | | - Kirk Erickson
- AdventHealth Research Institute, Neuroscience, Orlando, FL, University of Pittsburgh Dietrich School of Arts and Sciences
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3
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Davis AG, Dreyer AJ, Albertyn C, Maxebengula M, Stek C, Wasserman S, Marais S, Bateman K, Solms M, Joska J, Wilkinson RJ, Nightingale S. Cognitive Impairment in Tuberculous Meningitis. Clin Infect Dis 2023; 76:842-849. [PMID: 36262054 PMCID: PMC9989126 DOI: 10.1093/cid/ciac831] [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: 07/18/2022] [Revised: 10/03/2022] [Accepted: 10/17/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Cognitive impairment is reported as a common complication in adult tuberculous meningitis (TBM), yet few studies have systematically assessed the frequency and nature of impairment. Moreover, the impact of impairment on functioning and medication adherence has not been described. METHODS A cognitive test battery (10 measures assessing 7 cognitive domains) was administered to 34 participants with human immunodeficiency virus (HIV)-associated TBM 6 months after diagnosis. Cognitive performance was compared with that a comparator group of 66 people with HIV without a history of tuberculosis. A secondary comparison was made between participants with TBM and 26 participants with HIV 6 months after diagnosis of tuberculosis outside the central nervous system (CNS). Impact on functioning was evaluated, including through assessment of medication adherence. RESULTS Of 34 participants with TBM, 16 (47%) had low performance on cognitive testing. Cognition was impaired across all domains. Global cognitive performance was significantly lower in participants with TBM than in people with HIV (mean T score, 41 vs 48, respectively; P < .001). These participants also had lower global cognition scores than those with non-CNS tuberculosis (mean global T score, 41 vs 46; P = .02). Functional outcomes were not significantly correlated with cognitive performance in the subgroup of participants in whom this was assessed (n = 19). CONCLUSIONS Low cognitive performance following HIV-associated TBM is common. This effect is independent of, and additional to, effects of HIV and non-CNS tuberculosis disease. Further studies are needed to understand longer-term outcomes, clarify the association with treatment adherence, a key predictor of outcome in TBM, and develop context-specific tools to identify individuals with cognitive difficulties in order to improve outcomes in TBM.
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Affiliation(s)
- Angharad G Davis
- The Francis Crick Institute, London, United Kingdom.,Faculty of Life Sciences, University College London, London, United Kingdom.,Wellcome Centre for Infectious Diseases Research in Africa and Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, Republic of South Africa
| | - Anna J Dreyer
- Division of Neuropsychiatry, Department of Psychiatry and Mental Health, HIV Mental Health Research Unit, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Christine Albertyn
- Division of Neurology, Department of Medicine, Stellenbosch University, Cape Town, South Africa.,Division of Neurology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Mpumi Maxebengula
- Wellcome Centre for Infectious Diseases Research in Africa and Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, Republic of South Africa
| | - Cari Stek
- Wellcome Centre for Infectious Diseases Research in Africa and Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, Republic of South Africa.,Department of Infectious Diseases, Imperial College London, London, United Kingdom
| | - Sean Wasserman
- Wellcome Centre for Infectious Diseases Research in Africa and Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, Republic of South Africa.,Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Suzaan Marais
- Division of Neurology, Department of Medicine, University of Cape Town, Cape Town, South Africa.,Neurology Research Group, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Kathleen Bateman
- Division of Neurology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Mark Solms
- Division of Psychology, University of Cape Town, Cape Town, South Africa
| | - John Joska
- Division of Neuropsychiatry, Department of Psychiatry and Mental Health, HIV Mental Health Research Unit, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Robert J Wilkinson
- The Francis Crick Institute, London, United Kingdom.,Faculty of Life Sciences, University College London, London, United Kingdom.,Wellcome Centre for Infectious Diseases Research in Africa and Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, Republic of South Africa.,Department of Infectious Diseases, Imperial College London, London, United Kingdom
| | - Sam Nightingale
- Division of Neuropsychiatry, Department of Psychiatry and Mental Health, HIV Mental Health Research Unit, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
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4
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Liu ZX, Whitehead B, Botoseneanu A. Association of Psychological distress and Physical Health with Subjective and Objective Memory in Older Adults. J Aging Health 2022:8982643221143828. [PMID: 36459693 DOI: 10.1177/08982643221143828] [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: 12/04/2022]
Abstract
ObjectivesTo investigate how indicators of psychological stress and physical health differentially influence subjective and objective memory in older adults. Methods: 404 adults aged ≥55 without cognitive impairment participated in remote assessment of physical health (PHY; multimorbidity, body-mass-index), psychological distress (PDS; perceived stress, anxiety, depression), subjective memory complaints (SM), and task-based objective memory performance (OM). Results: Separately, both PHY and PDS significantly predicted SM (p < 0.01), but only PHY was associated with OM (p = 0.05). Combined models showed that PHY and PDS maintained significant association with SM (p < 0.01, R2 = 0.30), while only PHY was associated with OM (p = .07, R2 = 0.03; for associative OM, p = 0.04). Discussion: SM is associated with participants' psychological profile, highlighting the importance of addressing these factors when assessing SM. The results also reveal that remotely-administered OM tasks are more immune to participants' psychological profile, and support previously-established links between physical health and objective and subjective memory function.
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Affiliation(s)
- Zhong-Xu Liu
- Department of Behavioral Sciences, 177870University of Michigan-Dearborn, Dearborn, MI, USA
| | - Brenda Whitehead
- Department of Behavioral Sciences, 177870University of Michigan-Dearborn, Dearborn, MI, USA.,School of Behavioral Science, 492177Grace College, Winona Lake, IN, USA
| | - Anda Botoseneanu
- Department of Health and Human Services, 14711University of Michigan-Dearborn, Dearborn, MI, USA.,Institute of Gerontology, University of Michigan, Ann Arbor, MI, USA
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5
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Wu LM, Valdimarsdottir HB, Amidi A, Reid KJ, Ancoli-Israel S, Bovbjerg K, Fox RS, Walker L, Matharu A, Kaseda ET, Galvin JP, Adekola K, Winkel G, Penedo F, Redd WH. Examining the Efficacy of Bright Light Therapy on Cognitive Function in Hematopoietic Stem Cell Transplant Survivors. J Biol Rhythms 2022; 37:471-483. [PMID: 35904252 DOI: 10.1177/07487304221107833] [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: 11/16/2022]
Abstract
Patients who have undergone hematopoietic stem cell transplant (HSCT) may experience cognitive impairment that can persist after treatment. Several studies have shown that bright light therapy may improve cognition, potentially due to its effects on the circadian system via brain regions that respond preferentially to light. In this double-blind randomized controlled trial, the efficacy of bright light therapy on cognition was examined in HSCT survivors. Forty-seven HSCT survivors at an urban hospital in the United States were screened for mild cognitive impairment, randomized to either bright white light (BWL) or comparison dim red light (DRL) conditions using a block randomization approach, and instructed to use their assigned light box every morning upon awakening for 30 min for 4 weeks. Assessments occurred at baseline, the end of the second week of the intervention, the end of the intervention, and at follow-up (8 weeks later). The primary outcome was objective cognitive function as measured by a global composite score on neuropsychological tests. Secondary outcomes included cognitive performance in individual domains, self-reported cognitive function, fatigue, sleep and sleep quality, and circadian rhythm robustness. Repeated-measures linear mixed models for both objective and self-reported cognitive function indicated significant main effects for time (ps < 0.05) suggesting significant improvements in both conditions over time. Time by light condition interaction effects were not significant. Models focused on secondary outcomes yielded no significant effects. Both BWL and DRL groups demonstrated significant improvements in objective cognitive and self-reported cognitive function over time, but there was no hypothesized effect of BWL over DRL nor associations with circadian rhythm robustness. Therapeutic effects of both light conditions, practice effects, and/or placebo effects may account for the findings.Trial registration: ClinicalTrials.gov Identifier: NCT02677987 (9 February 2016).
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Affiliation(s)
- Lisa M Wu
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Aarhus Institute of Advanced Studies, Aarhus University, Aarhus, Denmark.,Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Heiddis B Valdimarsdottir
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, New York, USA.,Department of Psychology, Reykjavik University, Reykjavik, Iceland
| | - Ali Amidi
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Kathryn J Reid
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sonia Ancoli-Israel
- Department of Psychiatry, School of Medicine, University of California San Diego, San Diego, California, USA
| | - Katrin Bovbjerg
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Rina S Fox
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,College of Nursing, The University of Arizona, Tucson, Arizona, USA
| | - Lauren Walker
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Amreen Matharu
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Erin T Kaseda
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - John P Galvin
- Department of Internal Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Kehinde Adekola
- Division of Hematology and Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Gary Winkel
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Frank Penedo
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida, USA
| | - William H Redd
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
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6
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Abnormal cognitive aging in people with HIV: Evidence from Data Integration between two countries' cohort studies. AIDS 2022; 36:1171-1179. [PMID: 35471252 DOI: 10.1097/qad.0000000000003230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Previous research has shown inconsistent results on whether cognitive aging is abnormal in people with HIV (PWH) because of low sample size, cross-sectional design, and nonstandard neuropsychological methods. To address these issues, we integrated data from two longitudinal studies: Australian HIV and Brain Ageing Research Program (N = 102) and CNS HIV Antiretroviral Therapy Effects Research (CHARTER) study (N = 924) and determined the effect of abnormal aging on neurocognitive impairment (NCI) among PWH. METHODS Both studies used the same neuropsychological test battery. NCI was defined based on demographically corrected global deficit score (≥0.5 = impaired). Both studies also assessed comorbidities, neuropsychiatric conditions and functional status using similar tools. To determine the cross-sectional and longitudinal effects of age on the risk of NCI, a generalized linear mixed-effect model tested main and interaction effects of age group (young, <50 vs. old, ≥50) and time on NCI adjusting the effects of covariates. RESULTS Older PWH had 83% higher chance of NCI compared with younger PWH [odds ratio (OR) = 1.83 (1.15-2.90), P < 0.05]. Older participants also had a greater risk of increases in NCI over the follow-up [OR = 1.66 (1.05-2.64), P < 0.05] than younger participants. Nonwhite ethnicity (P < 0.05), having a contributing (P < 0.05) or confounding (P < 0.001) comorbidity, greater cognitive symptoms (P < 0.001), and abnormal creatinine level (P < 0.05), plasma viral load greater than 200 copies/ml (P < 0.05), being from the Australian cohort (P < 0.05) were also associated with a higher risk of NCI. CONCLUSION Data integration may serve as a strategy to increase sample size and study power to better assess abnormal cognitive aging effect in PWH, which was significant in the current study.
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Cognitive impairment and associations with structural brain networks, endocrine status, and risk genotypes in newly orchiectomized testicular cancer patients. Brain Imaging Behav 2021; 16:199-210. [PMID: 34392471 DOI: 10.1007/s11682-021-00492-x] [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] [Accepted: 06/27/2021] [Indexed: 01/16/2023]
Abstract
A higher incidence of cognitive impairment (CI) has previously been reported among orchiectomized testicular cancer patients (TCPs), but little is known about the underlying pathophysiology. The present study assessed CI in newly orchiectomized TCPs and explored the structural brain networks, endocrine status, and selected genotypes. Forty TCPs and 22 healthy controls (HCs) underwent neuropsychological testing and magnetic resonance imaging, and provided a blood sample. CI was defined as a z-score ≤ -2 on one neuropsychological test or ≤ -1.5 on two neuropsychological tests, and structural brain networks were investigated using graph theory. Associations of cognitive performance with brain networks, endocrine status (including testosterone levels and androgen receptor CAG repeat length), and genotypes (APOE, BDNF, COMT) were explored. Compared with HCs, TCPs performed poorer on 6 out of 15 neuropsychological tests, of which three tests remained statistically significant when adjusted for relevant between-group differences (p < 0.05). TCPs also demonstrated more CI than HCs (65% vs. 36%; p = 0.04). While global brain network analysis revealed no between-group differences, regional analysis indicated differences in node degree and betweenness centrality in several regions (p < 0.05), which was inconsistently associated with cognitive performance. In TCPs, CAG repeat length was positively correlated with delayed memory performance (r = 0.36; p = 0.02). A COMT group × genotype interaction effect was found for overall cognitive performance in TCPs, with risk carriers performing worse (p = 0.01). No effects were found for APOE, BDNF, or testosterone levels. In conclusion, our results support previous findings of a high incidence of CI in newly orchiectomized TCPs and provide novel insights into possible mechanisms.
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8
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Henneghan AM, Van Dyk K, Kaufmann T, Harrison R, Gibbons C, Heijnen C, Kesler SR. Measuring Self-Reported Cancer-Related Cognitive Impairment: Recommendations From the Cancer Neuroscience Initiative Working Group. J Natl Cancer Inst 2021; 113:1625-1633. [PMID: 33638633 PMCID: PMC8849125 DOI: 10.1093/jnci/djab027] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/07/2021] [Accepted: 02/22/2021] [Indexed: 12/15/2022] Open
Abstract
Cancer and its treatments are associated with increased risk for cancer-related cognitive impairment (CRCI). Methods and measures used to study and assess self-reported CRCI (sr-CRCI), however, remain diverse, resulting in heterogeneity across studies. The Patient-Reported Outcomes Working Group has been formed to promote homogeneity in the methods used to study sr-CRCI. In this report, using a psychometric taxonomy, we inventory and appraise instruments used in research to measure sr-CRCI, and we consider advances in patient-reported outcome methodology. Given its psychometric properties, we recommend the Patient-Reported Outcome Measurement Information System Cognitive Function Short Form 8a for measurement of sr-CRCI in cancer patients and survivors, at a minimum, to increase scientific rigor and progress in addressing CRCI.
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Affiliation(s)
- Ashley M Henneghan
- School of Nursing, University of Texas at Austin, Austin, TX, USA,Department of Oncology, Dell Medical School, University of Texas at Austin, Austin, TX, USA,Correspondence to: Ashley M. Henneghan, PhD, RN, FAAN, School of Nursing, University of Texas at Austin, 1710 Red River St, Austin TX, 78712, USA (e-mail: )
| | - Kathleen Van Dyk
- Semel Institute, Department of Psychiatry and Biobehavioral Sciences David Geffen School of Medicine, Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, CA, USA
| | - Tara Kaufmann
- Department of Oncology , Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Rebecca Harrison
- Department of Neuro Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Christopher Gibbons
- Department of Symptom Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Cobi Heijnen
- Department of Symptom Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shelli R Kesler
- School of Nursing, Department of Diagnostic Medicine, Dell Medical School, University of Texas at Austin, Austin, TX, USA
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9
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Mayo SJ, Rourke SB, Atenafu EG, Vitorino R, Chen C, Kuruvilla J. Computerized cognitive training in post-treatment hematological cancer survivors: a feasibility study. Pilot Feasibility Stud 2021; 7:36. [PMID: 33514444 PMCID: PMC7847007 DOI: 10.1186/s40814-021-00778-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 01/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Computerized cognitive training (CCT) programs have shown some effectiveness in alleviating cognitive symptoms in long-term cancer survivors. For patients presenting with cognitive symptoms in the early post-treatment phase, the benefit of CCT is unclear. To assess the possibility of testing the effectiveness of CCT in the early post-treatment period, our aim was to investigate the feasibility of an 8-week home-based, online CCT intervention among patients who have recently completed treatment for hematological malignancy. METHODS This study was a single-arm, non-blinded, feasibility study. All participants were provided with the CCT intervention for an 8-week period. Feasibility was evaluated based on participant adherence and patient perceptions of the intervention, assessed through responses to an acceptability questionnaire and semi-structured interviews at the end of the intervention period. RESULTS The feasibility study included 19 patients who had completed treatment for hematological malignancy at a Canadian tertiary cancer center. Adherence to the CCT intervention was limited, with only one participant meeting the criteria for intervention adherence. At the end of the intervention period, participants characterized the program as easy to follow (92%) and felt well-prepared for how to complete the exercises (100%). In semi-structured interviews, participants highlighted post-treatment barriers to intervention adherence that included symptom burden and competing time demands. Participants also suggested improvements to the intervention that could help maintain adherence despite these barriers, such as fostering a sense of accountability, providing personalized feedback and coaching, and enabling opportunities for peer support. CONCLUSIONS Participation in CCT can be challenging in the post-treatment period for hematological cancers. Further research on the effectiveness of CCT in this setting may require the implementation of strategies that support participants' engagement with the intervention in the context of symptoms and competing demands, such as establishing a minimum dose requirement and integrating approaches to help promote and sustain motivation.
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Affiliation(s)
- Samantha J Mayo
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College St., Suite 130, Toronto, ON, M5T 1P8, Canada. .,Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
| | - Sean B Rourke
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Eshetu G Atenafu
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Rita Vitorino
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Christine Chen
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - John Kuruvilla
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
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10
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R Buskbjerg C, Zachariae R, Buus S, H Gravholt C, Haldbo-Classen L, Hosseini SMH, Amidi A. Cognitive impairment and associations with structural brain networks, endocrine status, and risk genotypes in patients with newly diagnosed prostate cancer referred to androgen-deprivation therapy. Cancer 2020; 127:1495-1506. [PMID: 33351221 DOI: 10.1002/cncr.33387] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/03/2020] [Accepted: 11/03/2020] [Indexed: 11/12/2022]
Abstract
BACKGROUND Evidence suggests that patients with prostate cancer (PCPs) receiving androgen-deprivation therapy (ADT) are at risk for cognitive impairment. Research with other populations with cancer indicates that cognitive impairment may also occur before systemic treatment. The authors assessed cognitive impairment in untreated PCPs referred to ADT and explored associations with structural brain networks, endocrine status, and selected genotypes. METHODS Forty untreated PCPs and 27 healthy controls (HCs) who completed a questionnaire package underwent neuropsychological testing, magnetic resonance imaging, and blood sampling. Cognitive impairment was defined as a z score ≤-2 on 1 neuropsychological test or ≤-1.5 on 2 neuropsychological tests. Structural brain networks were investigated using diffusion-weighted imaging and graph theory. Associations of cognitive performance with patient-reported outcome measures (PROMs), brain networks, testosterone levels, and genotypes (apolipoprotein ε [APOE], catechol-O-methyltransferase [COMT], and brain-derived neurotrophic factor [BDNF]) were explored. RESULTS PCPs performed poorer than HCs on 7 of 15 neuropsychological tests and exhibited a higher frequency of cognitive impairment (57.5% vs 22.2%; P ≤ .01 to .03). All neuropsychological outcomes were associated with ≥1 PROM (P ≤ .01 to .04). Compared with the HC group, the PCP group exhibited altered global network organization as well as disrupted regional network characteristics in frontal and temporal regions (P < .01). PCPs had lower testosterone levels (P < .01) than HCs, which correlated with better visuospatial performance (r = -0.33; P = .04). No effects were found of APOE, COMT, or BDNF. CONCLUSIONS The current results suggest that untreated PCPs may demonstrate cognitive impairment and that psychological and behavioral symptoms (PROMs), as well as impairment in structural brain networks, might be the underlying mechanisms.
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Affiliation(s)
- Cecilie R Buskbjerg
- Unit for Psychooncology and Health Psychology, Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
| | - Robert Zachariae
- Unit for Psychooncology and Health Psychology, Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark.,Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Simon Buus
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Claus H Gravholt
- Department of Endocrinology, Aarhus University Hospital, Aarhus, Denmark.,Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - S M Hadi Hosseini
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, California
| | - Ali Amidi
- Unit for Psychooncology and Health Psychology, Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
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11
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Psychometric Properties of the Patient Assessment of Own Functioning Inventory Following Aneurysmal Subarachnoid Hemorrhage. J Nurs Meas 2020; 28:205-228. [PMID: 32341171 DOI: 10.1891/jnm-d-18-00117] [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: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to examine the psychometric properties of the Patient Assessment of Own Functioning Inventory (PAOFI) following aneurysmal subarachnoid hemorrhage (aSAH). METHODS The PAOFI was completed by 182 participants 3 months after verified aSAH. Exploratory factor analysis was used to evaluate the underlying factor structure of the PAOFI and reliability and concurrent validity were evaluated for each subscale. RESULTS A three-factor structure accounted for 58.9% of the extracted variance. Cronbach's alpha coefficients for extracted factors ranged from .867 to .924. The PAOFI subscales demonstrated concurrent validity with neuropsychological tests measuring similar constructs. CONCLUSION There is evidence of reliability and validity of the PAOFI following aSAH. Further studies are needed to confirm these results.
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12
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Abstract
BACKGROUND Practical brief measures are needed for clinicians and researchers to identify and effectively manage cognitive impairment in cancer patients. OBJECTIVE This study evaluated the reliability (ie, internal consistency reliability) and validity (ie, construct, convergent, concurrent, and known-group validity) of the Brief Perceived Cognitive Impairment Scale-Korean (BPCIS-K). METHODS From a university hospital, 249 cancer patients participated. The BPCIS-K was constructed with 6 items evaluating key aspects of cognitive impairment in cancer patients. For internal consistency reliability, Cronbach's α and item-total correlations were evaluated. For construct validity, confirmatory factor analysis was performed. For convergent validity, Pearson correlations were tested with the Functional Assessment of Cancer Therapy-Cognitive Function. For concurrent validity, Pearson correlations were tested with the Functional Assessment of Chronic Illness Therapy-Fatigue. For known-group validity, t tests were performed. RESULTS The BPCIS-K showed high internal consistency reliability (Cronbach's α = .92; item-total correlations ranged from 0.76 to 0.81). Factor analysis confirmed the scale is unidimensional. It is highly associated with another validated cognitive impairment measure (r = -0.91, P < .001) and moderately correlated with a fatigue measure (r = -0.52, P < .001). In known-group validity, female and patients undergoing treatment experienced more severe impairment than did male patients and patient awaiting treatment (P = .05, P = .08, respectively). CONCLUSION The BPCIS-K is valid and reliable for assessing cancer patients' perceived cognitive impairment, particularly in concentration, memory, and executive functions. IMPLICATION FOR PRACTICE This study introduces a practical brief measure to clinicians and researchers.
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13
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Li H, Sereika SM, Marsland AL, Conley YP, Bender CM. Symptom Clusters in Women With Breast Cancer During the First 18 Months of Adjuvant Therapy. J Pain Symptom Manage 2020; 59:233-241. [PMID: 31610271 DOI: 10.1016/j.jpainsymman.2019.10.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/30/2019] [Accepted: 10/01/2019] [Indexed: 02/09/2023]
Abstract
CONTEXT Women with breast cancer treated with aromatase inhibitor (AI) therapy experience multiple concurrent symptoms or symptom clusters. Understanding of the symptom experience and identifying symptom clusters before and during AI therapy are important for the development of interventions to improve clinical outcomes. OBJECTIVES The aim of this study was to identify symptom clusters experienced by women with breast cancer treated with AI therapy from pre-adjuvant therapy up to 18 months of adjuvant therapy using a broad scope of symptoms assessment. METHODS Forty-seven symptoms were evaluated in postmenopausal women with breast cancer (N = 354) who received AI therapy or chemotherapy followed by AI therapy. Symptoms were assessed at four semiannual time points with the Breast Cancer Prevention Trial Symptom Checklist, Patient's Assessment of Own Functioning Inventory, Beck Depression Inventory-II, and Profile of Mood States Tension/Anxiety and Fatigue/Inertia subscales. Exploratory factor analyses were conducted at each time point to identify symptom clusters. RESULTS Four stable symptom clusters (i.e., musculoskeletal, vasomotor, urinary, sexual) and three relatively stable symptom clusters (i.e., psychological, neurocognitive, weight) were identified across the 18-month follow-up period. The gastrointestinal symptom cluster only appeared at after six months of adjuvant therapy (postchemotherapy). CONCLUSION This study helps us to better understand the most common symptom clusters over the first 18 months of adjuvant therapy among postmenopausal women with early-stage breast cancer. It is critical for health care providers to know the symptom clusters commonly experienced by women receiving AI therapy with or without chemotherapy and manage them properly over time.
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Affiliation(s)
- Hongjin Li
- Department of Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
| | - Susan M Sereika
- Department of Health and Community Systems, Center for Research and Evaluation, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Anna L Marsland
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Yvette P Conley
- Department of Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Department of Health Promotion and Development, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Catherine M Bender
- Department of Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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14
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Merriman JD, Sereika SM, Conley YP, Koleck TA, Zhu Y, Phillips ML, Bertocci MA, Brufsky AM, Bender CM. Exploratory Study of Associations Between DNA Repair and Oxidative Stress Gene Polymorphisms and Cognitive Problems Reported by Postmenopausal Women With and Without Breast Cancer. Biol Res Nurs 2018; 21:50-60. [PMID: 30213196 DOI: 10.1177/1099800418799964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Women with breast cancer report varying frequencies of cognitive problems during adjuvant systemic therapy. This variability suggests latent subgroups. Therefore, we identified latent subgroups of self-reported cognitive problems among postmenopausal women with and without breast cancer. We explored associations between membership in these subgroups and (a) demographic, clinical, and symptom characteristics and (b) variations in candidate gene polymorphisms. METHODS We evaluated frequency of cognitive problems using the Patient Assessment of Own Functioning Inventory. Growth mixture modeling identified latent subgroups over 18 months of adjuvant systemic therapy and at matched time points for women without cancer ( N = 331). We evaluated for differences among subgroups in demographic, clinical, and symptom characteristics and in 41 single nucleotide polymorphisms in 10 candidate genes involved in DNA repair and oxidative stress pathways ( n = 199). We modeled associations between genotypes and subgroup membership using multinomial logistic regression. RESULTS We identified three latent subgroups: more frequent, persistent, and almost never. Receipt of chemotherapy plus anastrozole, depressive symptoms, and baseline neuropathic symptoms increased the odds of belonging to the more frequent subgroup. Anxiety and depressive symptoms increased the odds of belonging to the persistent subgroup. With covariates controlled for, carrying the ERCC5 rs873601 G minor allele increased the odds of reporting more frequent cognitive problems. CONCLUSIONS Chemotherapy plus anastrozole, depressive symptoms, and presence of neuropathic symptoms may predict more frequent cognitive problems during systemic therapy that later resolve. Mood dysregulation before therapy may predict persistent cognitive problems during therapy. ERCC5 genotype may influence frequency of cognitive problems after controlling for these risk factors.
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Affiliation(s)
- John D Merriman
- 1 New York University Meyers College of Nursing, New York, NY, USA
| | - Susan M Sereika
- 2 School of Nursing, University of Pittsburgh, Pittsburgh, USA.,3 Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yvette P Conley
- 2 School of Nursing, University of Pittsburgh, Pittsburgh, USA.,3 Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Yehui Zhu
- 2 School of Nursing, University of Pittsburgh, Pittsburgh, USA
| | - Mary L Phillips
- 5 School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Adam M Brufsky
- 5 School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,6 University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - Catherine M Bender
- 2 School of Nursing, University of Pittsburgh, Pittsburgh, USA.,6 University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
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15
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Gentry AL, Erickson KI, Sereika SM, Casillo FE, Crisafio ME, Donahue PT, Grove GA, Marsland AL, Watt JC, Bender CM. Protocol for Exercise Program in Cancer and Cognition (EPICC): A randomized controlled trial of the effects of aerobic exercise on cognitive function in postmenopausal women with breast cancer receiving aromatase inhibitor therapy. Contemp Clin Trials 2018; 67:109-115. [PMID: 29501739 PMCID: PMC5877817 DOI: 10.1016/j.cct.2018.02.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 02/26/2018] [Accepted: 02/27/2018] [Indexed: 12/19/2022]
Abstract
The Exercise Program in Cancer and Cognition (EPICC) Study is a randomized controlled trial designed to test the effects of moderate-intensity aerobic exercise on cognitive function in postmenopausal women with early-stage breast cancer during the first six months of aromatase inhibitor therapy. It is estimated that up to 75% of survivors of breast cancer experience cognitive impairment related to disease and treatment. At present, there are no known interventions to improve or manage cognitive function for women with breast cancer. Here, we describe a single-blinded, randomized controlled trial with allocation of 254 postmenopausal women with early-stage breast cancer to a supervised six-month aerobic exercise intervention or usual care. Prior to beginning aromatase inhibitor (AI) therapy, participants complete baseline assessments of cognitive function, cardiorespiratory fitness, blood-based biomarkers, physical activity and sleep, and symptoms (fatigue, sleep problems, depressive symptoms, anxiety). A random subset of participants (n = 150) undergoes neuroimaging procedures that include structural and functional magnetic resonance imaging assessments. All participants maintain an activity diary; physical activity and sleep monitoring is repeated three and seven months post-randomization. The remaining baseline assessments are repeated seven months post-randomization. If successful, exercise could be a low-cost method to improve cognitive function in women with breast cancer that is easily adaptable to the home or community. TRIAL REGISTRATION Clinicaltrials.govNCT02793921. Registered 20 May 2016.
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Affiliation(s)
| | - Kirk I Erickson
- University of Pittsburgh, Department of Psychology, United States
| | - Susan M Sereika
- University of Pittsburgh, School of Nursing, Graduate School of Public Health, United States
| | | | - Mary E Crisafio
- University of Pittsburgh, Department of Psychology, United States
| | | | - George A Grove
- University of Pittsburgh, Department of Psychology, United States
| | - Anna L Marsland
- University of Pittsburgh, Department of Psychology, United States
| | - Jennifer C Watt
- University of Pittsburgh, Department of Psychology, United States
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16
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Allen DH, Myers JS, Jansen CE, Merriman JD, Von Ah D. Assessment and Management of Cancer- and Cancer Treatment-Related Cognitive Impairment. J Nurse Pract 2018; 14:217-224.e5. [PMID: 30906237 DOI: 10.1016/j.nurpra.2017.11.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Deborah H Allen
- Duke University Health System, DUMC Box 3543, Durham NC 27710
| | - Jamie S Myers
- Research Assistant Professor, Kansas Univeristy School of Nursing, Mail Stop 2029, Kansas City, KS 66160,
| | - Catherine E Jansen
- Oncology Clinical Nurse Specialist, Kaiser Permanente, 4141 Geary Blvd., San Francisco, CA 94118,
| | - John D Merriman
- Assistant Professor, New York University Meyers College of Nursing, 433 1st Avenue, New York, NY 10010,
| | - Diane Von Ah
- Associate Professor & Chair, Dept. of Community Health Systems, Indiana University School of Nursing, 749 Chestnut St, Terre Haute, IN 47809,
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17
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Nugent BD, Bender CM, Sereika SM, Tersak JM, Rosenzweig M. Cognitive and Occupational Function in Survivors of Adolescent Cancer. J Adolesc Young Adult Oncol 2017; 7:79-87. [PMID: 28783480 DOI: 10.1089/jayao.2017.0043] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Adolescents with cancer have unique developmental considerations. These include brain development, particularly in the frontal lobe, and a focus on completing education and entering the workforce. Cancer and treatment at this stage may prove to uniquely affect survivors' experience of cognitive and occupational function. METHODS An exploratory, cross-sectional, descriptive comparative study was employed to describe cognitive and occupational function in adult survivors of adolescent cancer (diagnosed between the ages of 15 and 21 years) and explore differences in age- and gender-matched controls. RESULTS In total, 23 survivors and 14 controls participated in the study. While significant differences were not found between the groups on measures of cognitive and occupational function, several small and medium effect sizes were found suggesting that survivors may have greater difficulty than controls. Two small effect sizes were found in measures of neuropsychological performance (the Digit Vigilance test [d = 0.396] and Stroop test [d = 0.226]). Small and medium effect sizes ranging from 0.269 to 0.605 were found for aspects of perceived and total cognitive function. A small effect size was also found in work output (d = 0.367). CONCLUSIONS While we did not find significant differences in cognitive or occupational function between survivors and controls, the effect sizes observed point to the need for future research. Future work using a larger sample size and longitudinal design are needed to further explore cognitive and occupational function in this vulnerable and understudied population and assist in the understanding of patterns of change over time.
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Affiliation(s)
- Bethany D Nugent
- 1 University of Pittsburgh School of Nursing , Pittsburgh, Pennsylvania.,2 University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania
| | | | - Susan M Sereika
- 1 University of Pittsburgh School of Nursing , Pittsburgh, Pennsylvania
| | - Jean M Tersak
- 2 University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania.,3 Children's Hospital of Pittsburgh of UPMC , Pittsburgh, Pennsylvania
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18
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Concordance Between Self-Report and Performance-Based Measures of Everyday Functioning in HIV-Associated Neurocognitive Disorders. AIDS Behav 2017; 21:2124-2134. [PMID: 28108876 DOI: 10.1007/s10461-017-1689-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Self-report is typically used to differentiate between asymptomatic neurocognitive impairment (ANI) and mild neurocognitive disorder (MND) in the assessment of HIV-associated neurocognitive disorders (HAND). Yet, it is unclear whether the lack of self-reported functional impairments in individuals with ANI is indicative of a genuine absence of functional impairment, or of inaccurate self-reports. In the present study, we examined the relationship between previously validated self-report (patient's assessment of own functioning inventory; instrumental activities of daily living inventory) and performance-based (the Texas Functional Living Scale) measures of functional abilities in 112 virologically-controlled HIV-infected, and 40 well-matched, HIV-uninfected participants. Participants with symptomatic cognitive impairment (CI) had significantly lower overall scores and higher rates of impairment on a performance-based measure of everyday functioning as compared to participants with either asymptomatic CI or normal cognitive performance (WNL [within normal limits]; all p < 0.05), while asymptomatic CI and WNL participants had comparable rates of impairment and performance within the average range on the performance-based measure. The concordance between self-report and performance-based measures of everyday functioning in asymptomatic and symptomatic CI provide support for ANI and MND as clinically distinct diagnostic entities, and support the use of self-reports as appropriate measures of everyday functioning in the diagnosis of HAND.
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19
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Kabuba N, Anitha Menon J, Franklin DR, Heaton RK, Hestad KA. Use of Western Neuropsychological Test Battery in Detecting HIV-Associated Neurocognitive Disorders (HAND) in Zambia. AIDS Behav 2017; 21:1717-1727. [PMID: 27278547 PMCID: PMC5145764 DOI: 10.1007/s10461-016-1443-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This is a study of neuroAIDS in sub-Saharan Africa, involving 266 Zambian adults infected with the human immunodeficiency virus (HIV), clade C. All HIV+ participants were receiving combination antiretroviral therapy (CART), and were administered a comprehensive neuropsychological (NP) test battery covering seven ability domains that are frequently affected by neuroAIDS. The battery was developed in the U.S. but has been validated in other international settings and has demographically-corrected normative standards based upon 324 healthy Zambian adults. Compared to the healthy Zambian controls, the HIV+ sample performed worse on the NP battery with a medium effect size (Cohen's d = 0.64). 34.6 % of the HIV+ individuals had global NP impairment and met criteria for HIV associated neurocognitive disorder (HAND). The results indicate that the Western-developed NP test battery is appropriate for use in Zambia and can serve as a viable HIV and AIDS management tool.
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Affiliation(s)
- Norma Kabuba
- Department of Psychology, The University of Zambia, Great East Road Campus, P.O BOX 32379, Lusaka, Zambia.
- Department of Psychology, The Norwegian University of Science and Technology, Trondheim, Norway.
| | - J Anitha Menon
- Department of Psychology, The University of Zambia, Great East Road Campus, P.O BOX 32379, Lusaka, Zambia
| | - Donald R Franklin
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| | - Robert K Heaton
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| | - Knut A Hestad
- Department of Psychology, The Norwegian University of Science and Technology, Trondheim, Norway
- Department of Research, Innlandet Hospital Trust, Hamar, Norway
- Hedmark University College, 2418, Elverum, Norway
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20
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Bakoyiannis I, Tsigka EA, Perrea D, Pergialiotis V. The Impact of Endocrine Therapy on Cognitive Functions of Breast Cancer Patients: A Systematic Review. Clin Drug Investig 2016; 36:109-18. [PMID: 26619839 DOI: 10.1007/s40261-015-0364-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE The purpose of the present review was to study the impact of endocrine therapy (ET) on the cognitive outcomes of breast cancer patients. MATERIALS AND METHODS We systematically searched the literature using the MEDLINE (1966-2015), Scopus (2004-2015), ClinicalTrials.gov (2008-2015) and Cochrane Central Register (CENTRAL) databases, as well as the references of the electronically retrieved articles. RESULTS Twelve studies were included in the present systematic review, which assessed the cognitive function of 2756 patients. Among these patients, 2381 received ET, whereas the remaining 375 served as controls (placebo or no therapy). The majority of patients were postmenopausal, and the minimum follow-up period was 3 months and the maximum 2 years. Treatment with ET seems to be accompanied by altered cognitive abilities, including verbal memory, verbal fluency, motor speed, attention and working memory. Tamoxifen seems to be related to decreased cognitive performances compared with treatment with an aromatase inhibitor. CONCLUSIONS ET among breast cancer patients seems to negatively alter the cognitive outcomes of breast cancer patients. However, the methodological heterogeneity of the included studies, as well as the relatively small follow-up period, render imperative the conduct of further studies in the field.
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Affiliation(s)
- Ioannis Bakoyiannis
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, University of Athens, Athens, Greece
| | - Eleousa-Alexandra Tsigka
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, University of Athens, Athens, Greece
| | - Despina Perrea
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, University of Athens, Athens, Greece
| | - Vasilios Pergialiotis
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, University of Athens, Athens, Greece. .,, 6, Danaidon Str., 15232, Halandri, Greece.
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21
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Measuring cognitive complaints in breast cancer survivors: psychometric properties of the patient's assessment of own functioning inventory. Support Care Cancer 2016; 24:4939-4949. [PMID: 27432402 DOI: 10.1007/s00520-016-3352-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 07/10/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Cognitive complaints are a concern for breast cancer survivors. Among various published measures for cognitive complaints, the Patient's Assessment of Own Functioning Inventory (PAOFI) is one of the few assessing a spectrum of cognitive abilities, including those most commonly reported by breast cancer survivors. This study aimed to examine the psychometric properties of the PAOFI in breast cancer survivors. METHODS An exploratory factor analysis was conducted with a sample of breast cancer survivors (n = 189) who had completed all primary cancer treatments. Construct validity was examined by correlating factor scores with valid measures of cognitive complaints, fatigue, and quality of life. Reliability was measured by internal consistency of the items in each factor within this sample, a separate sample of breast cancer survivors with high persistent cognitive complaints (n = 72), and healthy controls (n = 63). Factor scores were compared across the three samples. RESULTS A five-factor structure similar to the PAOFI standardization study was found, with factors related to executive functioning (accounting for most of the variance), two aspects of memory functioning, language, and motor/sensory-perceptual abilities. Factor scores highly correlated with measures of cognitive complaints, fatigue, and quality of life. Executive functioning and memory-related factors achieved adequate reliability across samples. Scores were significantly different across the three samples as expected. CONCLUSIONS The PAOFI is a reliable and valid tool for measuring cognitive complaints in breast cancer survivors.
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22
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Merriman JD, Sereika SM, Brufsky AM, McAuliffe PF, McGuire KP, Myers JS, Phillips ML, Ryan CM, Gentry AL, Jones LD, Bender CM. Trajectories of self-reported cognitive function in postmenopausal women during adjuvant systemic therapy for breast cancer. Psychooncology 2015; 26:44-52. [PMID: 26486371 DOI: 10.1002/pon.4009] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 08/10/2015] [Accepted: 09/25/2015] [Indexed: 01/29/2023]
Abstract
OBJECTIVE In a sample of 368 postmenopausal women, we (1) determined within-cohort and between-cohort relationships between adjuvant systemic therapy for breast cancer and self-reported cognitive function during the first 18 months of therapy and (2) evaluated the influence of co-occurring symptoms, neuropsychological function, and other covariates on relationships. METHODS We evaluated self-reported cognitive function, using the Patient Assessment of Own Functioning Inventory (PAOFI), and potential covariates (e.g., co-occurring symptom scores and neuropsychological function z-scores) in 158 women receiving aromatase inhibitor (AI) therapy alone, 104 women receiving chemotherapy followed by AI therapy, and 106 non-cancer controls. Patients were assessed before systemic therapy and then every 6 months, for a total of four assessments over 18 months. Controls were assessed at matched time points. Mixed-effects modeling was used to determine longitudinal relationships. RESULTS Controlling for covariates, patients enrolled before chemotherapy reported poorer global cognitive function (p < 0.001), memory (p < 0.001), language and communication (p < 0.001), and sensorimotor function (p = 0.002) after chemotherapy. These patients reported poorer higher-level cognitive and intellectual functions from before chemotherapy to 12 months after initiation of AI therapy (p < 0.001). Higher levels of depressive symptoms (p < 0.001), anxiety (p < 0.001), and fatigue (p = 0.040) at enrollment were predictors of poorer cognitive function over time. PAOFI total score was a predictor of executive function (p = 0.048) and visual working memory (p = 0.005) z-scores, controlling for covariates. CONCLUSIONS Findings provide further evidence of poorer self-reported cognitive function after chemotherapy and of relationships between co-occurring symptoms and cognitive changes. AI therapy alone does not have an impact on self-reported cognitive function. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- John D Merriman
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Susan M Sereika
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Adam M Brufsky
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - Priscilla F McAuliffe
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - Kandace P McGuire
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jamie S Myers
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mary L Phillips
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Amanda L Gentry
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lindsay D Jones
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
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