Cancer-related Cognitive Impairments Research Articles

Bibliometric Analysis of Research on Exercise Intervention for Cancer-Related Cognitive Impairments

Introduction: Cancer treatments frequently lead to cognitive impairments, affecting a substantial global population. Among various approaches, exercise has emerged as a promising strategy for rehabilitation. However, a comprehensive bibliometric analysis of research in this field is lacking. Methods: We conducted a bibliometric analysis of 10,345 articles sourced from the Web of Science database using the R package “bibliometrix”. Our analysis examined publication trends, leading countries, journals, authors, institutions, keywords, and prevalent themes. Results: Over the past two decades, research on exercise interventions for cancer-related cognitive impairments (CRCI) has advanced significantly. Nonetheless, challenges persist in elucidating underlying mechanisms, developing innovative strategies, and creating effective tools. Conclusions: The number of publications notably increased from 1998 to 2023, although there has been a recent decline in citations. The United States (US) leads in both publications and citations, while China is showing increasing influence. Using Lotka’s Law in our bibliometric analysis, we identified 58 key authors in the field of exercise interventions for CRCI. Leading institutions such as the University of Toronto and Duke University are at the forefront of this research. Although the Journal of Clinical Oncology has fewer publications, it remains influential. Current research focuses on exercise interventions to enhance the quality of life for cancer patients, with particular emphasis on cognitive rehabilitation in breast cancer and the challenges faced by survivors. Future research should delve deeper into intervention mechanisms, behavioral strategies, telemedicine, and precise cognitive assessment tools.

Characterizing cancer-related cognitive impairments and impact on quality of life in women with metastatic breast cancer.

Little is known about cancer-related cognitive impairments (CRCI) in women with metastatic breast cancer (MBC). The purpose of this study is to (1) comprehensively describe CRCI and any associated psychosocial and behavioral symptoms, (2) determine observable sociodemographic and clinical risk factors for CRCI, and (3) explore cognitive and psychosocial predictors of quality of lifeand social functioning in women living with MBC. Using a cross-sectional design, women with MBC completed assessments (objective and subjective measures of CRCI including 3 open-ended questions, measures of psychosocial and behavioral factors, and assessments of quality of life and social function), and data were analyzed using descriptive statistics, qualitative content analysis, correlation analyses, t tests, analysis of variance, and linear regression models. Data from 52 women were analyzed. 69.2% of the sample reported clinically significant CRCI and 46% of the sample scored < 1 standard deviation below the standardized mean on one or more cognitive tests. Those with triple-negative MBC (compared to HER2+), recurrent MBC (compared to de novo), and no history of chemotherapy had worse subjective CRCI, and those without history of surgery and older age had worse objective CRCI. Subjective CRCI, but not objective CRCI, was significantly associated with quality of life and social functioning. Subjective and objective CRCI are likely a common problem for those with MBC. Subjective CRCI is associated with poorer quality of life and lower social functioning. Healthcare providers should acknowledge cognitive symptoms, continually assess cognitive function, and address associated unmet needs across the MBC trajectory.

Occupational Therapy Practice Guidelines for Adults Living With and Beyond Cancer

Abstract Importance: Occupational therapy practitioners play an important role in addressing the impairments, occupational performance, and participation needs of adults living with and beyond cancer. Objective: These Practice Guidelines aim to assist occupational therapy practitioners, educators, and researchers in applying evidence and expert opinion to occupational therapy practice across the cancer continuum of care, including identifying gaps in care. Key focus areas include psychosocial function, fatigue, cognition, pain, sleep, and physical activity. These guidelines can serve as a reference for policymakers, health care professionals, health care managers, regulators, third-party payers, and managed care organizations to manage, reimburse, and set policy. Method: We examined, synthesized, and integrated the results of systematic reviews, supporting literature, and expert opinion to develop and provide clinical recommendations for practice in the care of adults living with and beyond cancer. Results: Sixteen systematic reviews with moderate to strong strength of evidence published between 2019 and 2022 served as the foundation for these Practice Guidelines. Conclusions and Recommendations: To support symptom management for adults living with and beyond cancer, occupational therapy practitioners can consider using psychosocial interventions for anxiety, depression, posttraumatic growth, and overall psychological distress. Practitioners can consider using physical activity interventions for cancer-related fatigue, cognitive performance, and sleep. Practitioners could also consider using interventions for cognition, pain management, and self-management for the improvement of cancer-related symptoms. Plain-Language Summary: These Practice Guidelines provide strong and moderate levels of evidence for occupational therapy practitioners to support adults living with and beyond cancer. They provide specific guidance for addressing pain, cancer-related fatigue, cancer-related cognitive impairments, psychosocial well-being, sleep, and physical activity. The guidelines also include case examples and an infographic to support occupational therapy practitioners in integrating evidence to support interventions in cancer care, and they highlight gaps and expert opinions in practice for continued clinically relevant research.

Online Group Cognitive Rehabilitation Program for Prostate Cancer Survivors: Development Using Codesign and the Theoretical Domains Framework

ObjectivesThis study aimed to describe the adaptation of a group cognitive rehabilitation program for prostate cancer survivors (PCS) via telehealth delivery using a codesign approach with PCS experiencing cancer-related cognitive impairment. The Theoretical Domains Framework (TDF) also informed the intervention development. MethodsIntervention development consisted of three steps: 1) Adapting an existing cancer-related cognitive rehabilitation program for PCS; 2) Conducting a codesign focus group workshop to gather feedback that was analyzed using a template approach; and 3) Incorporation of consumer feedback to refine the program for future piloting in PCS. Components of the finalized intervention were mapped onto the TDF domains. ResultsSix PCS were involved in the codesign focus group workshop, providing feedback on program structure, the topics and its order, and rehabilitation activities. A manualized four-week online group cognitive rehabilitation program titled “Promoting Cognitive Wellbeing in Prostate Cancer Survivors (ProCog)” was developed. Four sessions of 2-hours’ duration were designed exploring: cognitive/brain functions; the impact of cancer treatments and ageing; the relationship between thoughts, feelings and behaviors; values-based goal-setting; and skills/strategies to manage fatigue and improve attention, memory, aspects of executive functioning, and emotional functioning. ConclusionsConsumer input and guidance from the TDF ensures a robust development process for the online ProCog intervention, designed for and with PCS experiencing cognitive difficulties. As an important initial step before piloting, this adaptation and development process ensures that ProCog addresses consumer needs and preferences and targets factors increasing behavior change. Implications for Nursing PracticeThis research raises awareness of possible cancer-related cognitive impairments in prostate cancer survivors and strategies for rehabilitation. ProCog is an accessible online intervention that nurses can use to refer patients needing cognitive rehabilitation.

It’s about time: mitigating cancer-related cognitive impairments through findings from computational models of the Wisconsin Card Sorting Task

BackgroundMany cancer survivors experience cancer-related cognitive impairment (CRCI), often with significant negative consequences across various life domains. Emerging evidence suggests that allowing additional time to process information before acting may be a useful strategy for those with CRCI to mitigate some of its impacts. The Wisconsin Card Sorting Task (WCST), a measure of general cognition, has shown that for some cancer survivors, longer task completion time facilitates similar task performance outcomes to control populations concerning perseveration errors; a key performance metric of the WCST. However, assessing if this strategy may be useful, as well as determining for whom it may be useful, with regard to strengths and weaknesses among select cognitive domains, is challenging due to factors such as the problem of task impurity. Accordingly, this study provides an initial computational and experimental assessment of whether additional time to process information before acting is a useful strategy for those with CRCI.MethodsWe simulated individual cognitive differences observed in humans by varying contributions of executive functioning components (updating, shifting, inhibition) to yield 48 distinct computational models of the WCST. Our main manipulation was then to provide these models with more or less time (at three levels of 20, 40 and 60 cycles) before models executed an action to sort a given card. We compared the number of perseveration errors on the WCST produced by the computational models. Additionally, we determined models that simulated the performance of cancer survivors on the WCST by comparing the number of perseveration errors produced by the models to human data.ResultsAdditional processing time resulted in the models producing significantly fewer perseveration errors, supporting our hypothesis. In addition, 8 unique models simulated the performance of cancer survivors on the WCST. Additional time appeared to have a positive influence on performance primarily by mitigating the impacts of severe inhibition impairments. For more severe global executive function impairments, a substantial amount of additional time was required to mitigate the impacts of the impairments. For the most severe impairments, additional time was unable to adequately mitigate the impact on performance.ConclusionAdditional processing time may be a useful strategy to rectify perseveration errors among cancer survivors with CRCI. Our findings have implications for the development of practical strategies, such as workload and deadline management in occupational settings, which may mitigate the negative effects of CRCI.

"Is My Brain Ever Going to Work Fully Again?": Challenges and Needs of Cancer Survivors with Persistent Cancer-Related Cognitive Impairment.

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.

Subjective cancer-related cognitive impairments and salience network connectivity in breast cancer survivors.

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. 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. 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. These findings suggest that salience network connectivity may represent a biomarker of subjective cancer-related cognitive changes. Subjective cancer-related cognitive changes are common following treatment and associated with objective changes in brain connectivity.

Establishing construct validity of neuropsychological tests in cancer survivors.

Cancer-related cognitive impairments (CRCI) are frequently reported among cancer survivors, and attention is the most frequently assessed cognitive domain in CRCI. However, there is no consensus as to whether attention is impaired. We suggest that a major reason for this lack of agreement is a lack of construct validity for neuropsychological attention tests. We propose to assess the construct validity of neuropsychological attention tests with respect to experimental paradigms from cognitive psychology. Self-reported cancer survivors (N=314) completed an online battery comprising six experimental attention paradigms and eight neuropsychological tests. Confirmatory factor analysis was used to evaluate the fit of five models derived from a general population sample (N=636) in a previous study (M. Treviño, Cogn Res Princ Implic, in press). We then subjected the best-fitting model to a measurement invariance analysis. The best-fitting model was a six intercorrelated factor structure, comprising Capacity, Search, Digit Span, Arithmetic, Sustained Attention, and Flanker Interference factors. Configural and weak invariance held, indicating that the factor loadings were invariant across groups. Strong invariance, indicating that intercepts were also invariant, held except for the Approximate Number Sense test. According to our factor model, Spatial Span and Digit Symbol Coding measure attentional capacity, while the Trail Making Test (A&B) and Letter Cancellation tests measure visual search ability. However, Digit Span and Arithmetic tests do not measure attention. We hope that these results will lead to better scientific models, better patient education, and, ultimately, improved outcomes for survivors.

Cancer‐related cognitive impairment in survivors of adolescent and young adult non‐central nervous system cancer: A scoping review

Cancer-related cognitive impairments (CRCI) are common after treatment and can have important impacts on the lives of adolescent and young adult (AYA) cancer survivors-those cancer survivors diagnosed between ages 15 and 39. However, most research focuses on survivors diagnosed under age 15 or over age 39 so we know relatively little about CRCI among AYA survivors of non-central nervous system (CNS) cancers. Here we review the research on CRCI among AYA survivors of non-CNS cancers to determine prevalence, associated factors, and impact on survivors' lives as well as implications for future research. In November 2021 we performed a systematic search of the literature in MEDLINE, Web of Science, PsycInfo, CINAHL, EMBASE, and Cochrane Central Register of Controlled Trials to identify peer-reviewed English language articles describing original research with at least one cognitive outcome and conducted with AYA survivors of non-CNS cancer diagnosed as AYAs. We screened 6003 articles and 21 met eligibility criteria. Guided by the PRISMA-ScR Checklist, we extracted study information to meet review objectives. Most studies employed cross-sectional surveys or interviews, though some employed longitudinal methods, neurocognitive assessments, or brain imaging. From the subset of articles that reported a prevalence we calculated a weighted mean prevalence of 25.75% and weighted median prevalence of 27.8%. The factors associated with CRCI included female gender, higher dose chemotherapy, and comorbidities. CRCI impacted the lives of AYA survivors through impaired role functioning, financial toxicity, and unmet needs. CRCI is highly prevalent among non-CNS cancer survivors diagnosed as AYAs and impacts quality of life and role functioning. This review suggests a need for further longitudinal, imaging, and mixed methods research and provision of resources to help achieve better quality of life and educational and occupational attainment during what is potentially a decades-long survivorship period. However, although interventions might improve cognition and functioning, the review identified only one pilot study. Digital interventions may be a practical and effective option for this age group, but they have yet to be adequately investigated.

The effect of mind-body exercise on cognitive function in cancer survivors: A systematic review.

Cancer-related cognitive impairments experienced by cancer survivors cause many to seek non-pharmacological intereventions to manage these symptoms. The aim of this systematic review was to evaluate the effects of one such intervention, mindbody exercise (MBE), on cognitive function in cancer survivors. Searches for relevant studies were conducted in four electronic databases, including PubMed, Embase, Scopus, and Web of Science. The Joanna Briggs Institute and Jadad scales were utilized to evaluate the quality of the selected studies. Eleven studies including 1,032 participants, published between 2006 and 2019, were selected for review based on specific inclusion criteria. Our results indicated that interventions including, yoga, tai chi, and qigong may improve objective and subjective cognitive function in cancer survivors. Cancer survivors experiencing cognitive symptoms may benefit from participation in MBE. Adequately powered randomized controlled trials are required to establish the short- and long-term effects of MBE on cognitive functioning.

Subjective Cancer-Related Cognitive Impairments and Salience Network Connectivity in Breast Cancer Survivors

Subjective Cancer-Related Cognitive Impairments and Salience Network Connectivity in Breast Cancer Survivors

Impact of taxane-based chemotherapy among older women with breast cancer on cognition and quality of life: a longitudinal pooled analysis.

Older cancer patients are susceptible to long-term effects of chemotherapy, including cancer-related cognitive decline and impairments to quality of life. Taxane-based chemotherapies are associated with physical declines among older women and may negatively impact cognitive performance. We sought to examine whether changes in objective and subjective measures of cognitive performance and well-being differ among older breast cancer survivors as a function of taxane-based chemotherapy treatment regimens. Individual-level data were pooled and harmonized from two large prospective studies of older (greater than 60years) breast cancer survivors. Assessments were conducted prior to systemic therapy and up to 36 months after. Cognitive performance was assessed with objective (working memory, processing speed, and executive functions) and subjective tests and physical, emotional, and functional well-being were also assessed. One hundred and sixty-seven (M age = 67.3years) women with 116 receiving chemotherapy with taxanes and 51 without taxanes contributed data. Declines in subjective cognition for both groups were significant between pre-treatment and 12-month follow-up. Significant improvements were seen on a measure of objective cognition (working memory) from 12 to 36 months. Measures of well-being improved from prior to systemic therapy to 12 months. Longitudinal changes across all measures did not vary as a function of receipt of taxane-based treatment. Older women who received treatment with taxanes did not have greater declines in cognitive performance or well-being than women receiving other chemotherapy regimens. Despite older cancer survivors being at greater risk for negative outcomes, treatment with taxane-based chemotherapies does not appear to exacerbate these health consequences.

Sustained effects of mantra meditation compared to music listening on neurocognitive outcomes of breast cancer survivors: A brief report of a randomized control trial

ObjectiveCancer-related cognitive impairment is common following the end of adjuvant treatment and there are limited treatment options for it. We compared the sustained cognitive (primary) and psychological (secondary) effects of mantra meditation to classical music listening 8 weeks after interventions ended (Time 3) compared to baseline (Time 1). MethodsA two-group parallel random assignment experimental design was used in a community setting. Thirty one breast cancer survivors (ages 21 to 75, received chemotherapy, and reported cognitive complaints) were randomly assigned to practice mantra meditation (n = 16) or listen to classical music (n = 15) 12 min a day for 8 weeks. No blinding was used. Repeated measures analysis of variance models were used to compare Time 1 and Time 3 data for the 26 survivors (13 per group) who completed the interventions and Time 3 data collection. ResultsVerbal fluency (p < .001, ηp2 = 0.58), attention (p = .002, ηp2 = 0.33), immediate memory recall (p < .001, ηp2 = 0.38), perceived cognitive impairment (p < .001, ηp2 = 0.39), and quality of life (p = .001, ηp2 = 0.35) improved significantly across time for both groups. The two conditions did not differ significantly in changes across time. There were no adverse effects. ConclusionDaily mantra meditation or classical music listening may be beneficial for cognitive outcomes and quality of life of breast cancer survivors with cancer-related cognitive impairment. The cognitive benefits appear to be sustained beyond the initial intervention period.Clinical Trials Registration number: NCT03696056, recruitment status completed.The study details can be accessed at: https://clinicaltrials.gov/ct2/show/NCT03696056 Key messageThere are limited treatment options for managing cancer-related cognitive impairments. Daily mantra meditation or classical music listening for 12 min a day may improve cognitive outcomes and quality of life for cancer survivors, with no negative side effects.

Changes in Brain Functional and Effective Connectivity After Treatment for Breast Cancer and Implications for Intervention Targets.

Background: Patients with breast cancer frequently report cognitive impairment both during and after completion of therapy. Evidence suggests that cancer-related cognitive impairments are related to widespread neural network dysfunction. The default mode network (DMN) is a large conserved network that plays a critical role in integrating the functions of various neural systems. Disruption of the network may play a key role in the development of cognitive impairment. Methods: We compared neuroimaging and neurocognitive data from 43 newly diagnosed primary breast cancer patients (mean age = 48, standard deviation [SD] = 8.9 years) and 50 frequency-matched healthy female controls (mean age = 50, SD = 10 years) before treatment and 1 year after treatment completion. Functional and effective connectivity measures of the DMN were obtained using graph theory and Bayesian network analysis methods, respectively. Results: Compared with healthy females, the breast cancer group displayed higher global efficiency and path length post-treatment (p < 0.03, corrected). Breast cancer survivors showed significantly lower performance on measures of verbal memory, attention, and verbal fluency (p < 0.05) at both time points. Within the DMN, local brain network organization, as measured by edge-betweenness centralities, was significantly altered in the breast cancer group compared with controls at both time points (p < 0.0001, corrected), with several connections showing a significant group-by-time effect (p < 0.003, corrected). Effective connectivity demonstrated significantly altered patterns of neuronal coupling in patients with breast cancer (p < 0.05). Significant correlations were seen between hormone blockade therapy, radiation therapy, chemotherapy cycles, memory, and verbal fluency test and edge-betweenness centralities. Discussion: This pattern of altered network organization in the default mode is believed to result in reduced network efficiency and disrupted communication. Subregions of the DMN, the orbital prefrontal cortex and posterior memory network, appear to be at the center of this disruption and this could inform future interventions. Impact statement This prospective study is the first to investigate how post-treatment changes in functional and effective connectivity in the regions of default mode network are related to cancer therapy and measures of memory and verbal learning in breast cancer patients. We demonstrate that the interactions between treatment, brain connectivity, and neurocognitive outcomes coalesce around a subgroup of brain structures in the orbital frontal and parietal lobe. This would suggest that interventions that target these regions may improve neurocognitive outcomes in breast cancer survivors.

Neurocognitive efficiency in breast cancer survivorship: A performance monitoring ERP study

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.

Initial validation of the German version of the Attentional Function Index in a sample of haematological cancer survivors.

To date, no German instrument exists to assess subjective levels of cancer-related cognitive impairments (CRCI) in cancer survivors. We translated the validated Attentional Function Index (AFI) into German and explored its psychometric properties. The validation sample consisted of 1,111 haematological cancer survivors mainly recruited from two cancer registries. Factorial structure was explored using principal component analysis, internal consistency via Cronbach's α, construct validity through correlational analyses (Pearson's r) and associations of patient characteristics with the AFI score via regression analyses. In line with the original version, we revealed three factors, that is "effective action" (seven items), "attentional lapses" (three items) and "interpersonal effectiveness" (three items). The overall reliability α was .91. Verifying construct validity, the AFI score correlated positively with cognitive functioning (r=.64, p≤.01) and global QoL (r=.44, p≤.01), but negatively with fatigue (r=-.60, p≤.01) and depressive symptomatology (r=-.6, p≤.01). Older age (β=.12, p<.001), higher comorbidity (β=-.07, p=.02) and being male patient (β=.07, p=.01) were significantly associated with the AFI scores, but effect sizes were small. The German translation of the AFI shows good psychometric properties and thus may be reasonably applied to measure the subjective level of CRCI in German-speaking oncological populations.

Neurocognitive changes in cancer patients as a current challenge in psycho-oncology

Introduction. Along with a high intensity emotional distress, cancer patients often face neurocognitive changes that are particularly pronounced after chemotherapy. Clinical features of neurocognitive deficits in non-central nervous system cancer patients. So far, studies have demonstrated that neurocognitive changes most often occur in domains of executive functions, attention and concentration, working memory, information processing speed and visuospatial abilities, but there is still no definite protocol for the diagnosis and management of this condition. Potential causal mechanisms and risk factors. Apart from chemotherapy, there are other factors associated with the development and manifestation of neurocognitive deficits in cancer patients: genetic, biological, psychological and socio-demographic. Assessment of cancer-related cognitive impairments. When assessing potential cognitive impairments, it is beneficial to combine neuropsychological test battery and self-report questionnaires for the assessment of cognitive and affective status, as well as modern neuroimaging methods that will indicate neural (structural and functional) changes underlying neurocognitive deficit. The role of psychosocial factors: implications for future research. In addition to cognitive reserve and emotional status, the patient?s personal characteristics may very likely play an important role in explaining neurocognitive functioning and neurocognitive adaptation of cancer patients upon completion of treatment. Conclusion. Further studies are needed to elucidate the mechanisms underlying neurocognitive changes in cancer patients, with special emphasis on the contribution of psychosocial factors. Based on the novel findings, adequate and timely cognitive rehabilitation treatment will be provided for patients suffering from malignant diseases.

Understanding the Profile of Cancer-Related Cognitive Impairments: A Critique of Meta-Analyses.

A large body of evidence indicates that cancer survivors who have undergone chemotherapy have cognitive impairments. Substantial disagreement exists regarding which cognitive domains are impaired in this population. We suggest that is in part due to inconsistency in how neuropsychological tests are assigned to cognitive domains. The purpose of this paper is to critically analyze the meta-analytic literature on cancer-related cognitive impairments (CRCI) to quantify this inconsistency. We identified all neuropsychological tests reported in seven meta-analyses of the CRCI literature. Although effect sizes were generally negative (indicating impairment), every domain was declared to be impaired in at least one meta-analysis and unimpaired in at least one other meta-analysis. We plotted summary effect sizes from all the meta-analyses and quantified disagreement by computing the observed and ideal distributions of the one-way χ2 statistic. The actual χ2 distributions were noticeably more peaked and shifted to the left than the ideal distributions, indicating substantial disagreement among the meta-analyses in how neuropsychological tests were categorized to domains. A better understanding of the profile of impairments in CRCI is essential for developing effective remediation methods. To accomplish this goal, the research field needs to promote better agreement on how to measure specific cognitive functions.

The Development of a Cancer-Related Cognitive Impairments Seminar for Occupational Therapy Practitioners

The Development of a Cancer-Related Cognitive Impairments Seminar for Occupational Therapy Practitioners

Protocol for the \u201cChemobrain in Motion \u2013 study\u201d (CIM \u2013 study): a randomized placebo-controlled trial of the impact of a high-intensity interval endurance training on cancer related cognitive impairments in women with breast cancer receiving first-line chemotherapy

BackgroundUp to 80% of breast cancer patients suffer from Cancer Related Cognitive Impairments (CRCI). Exercise is suggested as a potential supportive care option to reduce cognitive decline in cancer patients. This study will investigate the effects of a high-intensity interval endurance training (HIIT) on CRCI in breast cancer patients. Potentially underlying immunological and neurobiological mechanisms, as well as effects on patients’ self-perceived cognitive functioning and common cancer related side-effects, will be explored.MethodsA single-blinded randomized controlled trial will be carried out. The impact of HIIT on CRCI will be compared to that of a placebo-intervention (supervised myofascial release training). Both interventions will be conducted simultaneously with the patients’ first-line chemotherapy treatment typically lasting 12–18 weeks. Fifty-nine women with breast cancer will be included in each of the two groups. The study is powered to detect (α = .05, β = .2) a medium effect size difference between the two groups (d = .5) in terms of patients’ change in cognitive testing performances, from baseline until the end of the exercise-intervention. The cognitive test battery, recommended by the International Cancer and Cognition Task Force to assess CRCI, will be used as primary measure. This includes the Hopkins Verbal Learning Test (learning/verbal memory), the Controlled Oral Word Association Test (verbal fluency) and the Trail-Making-Test A/B (attention/set-switching). The following endpoints will be assessed as secondary measures: Go-/No-Go test performance (response inhibition), self-perceived cognitive functioning, serum levels of pro- and antiinflammatory markers (tumor necrosis factor alpha, Interleukin-6, Interleukin-1 alpha, Interleukin-1 beta, C-reactive protein, Interleukin-1 receptor antagonist and Interleukin-10), serum levels of neurotrophic and growth factors (brain-derived neurotrophic factor, insulin-like growth factor 1 and vascular endothelial growth factor), as well as common cancer-related side effects (decrease in physical capacity, fatigue, anxiety and depression, sleep disturbances, quality of life and chemotherapy compliance).DiscussionThis study will provide data on the question whether HIIT is an effective supportive therapy that alleviates CRCI in breast cancer patients. Moreover, the present study will help shed light on the underlying mechanisms of potential CRCI improving effects of exercise in breast cancer patients.Trial registrationDRKS.de, German Clinical Trials Register (DRKS), ID: DRKS00011390, Registered on 17 January 2018.