Cognitive Function In Cancer Survivors Research Articles

A scoping review evaluating physical and cognitive functional outcomes in cancer survivors treated with chemotherapy: charting progress since the 2018 NCI think tank on cancer and aging phenotypes.

The primary goal of this scoping review was to summarize the literature published after the 2018 National Cancer Institute think tank, "Measuring Aging and Identifying Aging Phenotypes in Cancer Survivors," on physical and cognitive functional outcomes among cancer survivors treated with chemotherapy. We focused on the influence of chemotherapy on aging-related outcomes (i.e., physical functional outcomes, cognitive functional outcomes, and frailty), given the known associations between chemotherapy and biologic mechanisms that affect aging-related physiologic processes. A search was conducted across electronic databases, including PubMed, Scopus, and Web of Science, for manuscripts published between August 2018 and July 2023. Eligible studies: 1) included physical function, cognitive function, and/or frailty as outcomes; 2) included cancer survivors (as either the whole sample or a subgroup); 3) reported on physical or cognitive functional outcomes and/or frailty related to chemotherapy treatment (as either the whole sample or a subgroup); and 4) were observational in study design. The search yielded 989 potentially relevant articles, of which 65 met the eligibility criteria. Of the 65 studies, 49 were longitudinal, and 16 were cross-sectional; 30 studies (46%) focused on breast cancer, 20 studies (31%) focused on the age group 60 + years, and 17 (26%) focused on childhood cancer survivors. With regards to outcomes, 82% of 23 studies reporting on physical function showed reduced physical function, 74% of 39 studies reporting on cognitive functional outcomes found reduced cognitive function, and 80% of 15 studies reporting on frailty found increasing frailty among cancer survivors treated with chemotherapy over time and/or compared to individuals not treated with chemotherapy. Fourteen studies (22%) evaluated biologic mechanisms and their relationship to aging-related outcomes. Inflammation was consistently associated with worsening physical and cognitive functional outcomes and epigenetic age increases. Further, DNA damage was consistently associated with worse aging-related outcomes. Chemotherapy is associated with reduced physical function, reduced cognitive function, and an increase in frailty in cancer survivors; these associations were demonstrated in longitudinal and cross-sectional studies. Inflammation and epigenetic age acceleration are associated with worse physical and cognitive function; prospective observational studies with multiple time points are needed to confirm these findings. This scoping review highlights the need for interventions to prevent declines in physical and cognitive function in cancer survivors who have received chemotherapy.

Yoga improves self-reported cognitive function among cancer survivors: results from the STAYFit trial

IntroductionVarious physical activity-based interventions have been tested to determine their efficacy in improving cancer related cognitive decline (CRCD), however the role of mind-body practices such as yoga remains to be explored. In this manuscript we present preliminary effects of yoga vs. aerobic and stretching-toning modalities of exercise on CRCD among adult cancer survivors.MethodsParticipants (N = 78) were randomized to one of the three exercise groups for a duration of 12-weeks and engaged in ≥150 min per week of supervised group exercises. At baseline and following the 12-week interventions, participants completed the Functional Assessment of Cancer Therapy–Cognitive Function.ResultsResults demonstrated a significant group*time interaction for FACT-Cog perceived cognitive abilities subscale, with participants in the yoga group demonstrating a significant increase as compared to the aerobic and stretching-toning groups. The FACT-Cog total score showed a significant time effect with all groups demonstrating a significant increase at follow-up. Other subscales did not show any significant improvements.DiscussionThese findings provide promising evidence for the effects of yoga on self-reported cognitive function in cancer survivors. Notably, 12-weeks of yoga showed an increase in the perceived cognitive abilities and demonstrated a clinically meaningful increase in total cognitive function as measured by the FACT-Cog, suggesting that this exercise modality has the potential to impact this important health outcome during cancer survivorship.Trial registrationClinicalTrials.gov, identifier: NCT03650322.

UNIQUE MICROBIOME SIGNATURES RELATED TO CANCER SURVIVORSHIP AND COGNITIVE DECLINE IN OLDER ADULTS

Abstract Significant scientific advancements have resulted in new and effective therapies for patients with cancer. Although this leads to an increased cancer survivor population, there are several long-term side effects of cancer treatments, including a high risk of developing dementia. Emerging evidence shows that the gut microbiota significantly contributes to brain health and dementia pathology; however, its role in cancer treatment-related side effects, specifically in older adults, is not well known. Here, we used 110 participants from our MiaGB (Microbiome in aging Gut and Brain) consortium aged 60 years and older and analyzed their gut microbiome (using whole genome sequencing) with cognitive function (using Montreal Cognitive Assessment (MoCA) and MiniCog). We observed an 8% increase in cognitive impairment (CI) in cancer survivors compared to non-cancer participants (46% vs 38%, respectively). When only comparing cognitively healthy versus CI, the abundance of Escherichia coli was significantly higher in the CI group, while Streptococcus thermophilus was higher in the cognitively healthy group. Additionally, the abundances of Dorea sp. CAG 317, Ruminococcus gnavus, Roseburia faecis, and Eggerthella lenta were significantly increased in the gut of cancer survivors compared to non-cancer participants. Specifically, the abundance of Dorea sp. CAG 317 was increased in cancer survivors with CI. These findings suggest that unique microbiome signatures induced by cancer treatments may impair cognitive function. Furthermore, understanding the associations between the microbiota and cognitive function in cancer survivors will aid the development of therapeutics to combat cancer treatment-related side effects, which are a growing public health concern.

NCCN Guidelines® Insights: Survivorship, Version 1.2023.

The NCCN Guidelines for Survivorship are intended to help healthcare professionals address the complex and varied needs of cancer survivors. The NCCN Guidelines provide screening, evaluation, and treatment recommendations for psychosocial and physical problems resulting from adult-onset cancer and its treatment; recommendations to help promote healthy behaviors and immunizations in survivors; and a framework for care coordination. These NCCN Guidelines Insights summarize recent guideline updates and panel discussions pertaining to sleep disorders, fatigue, and cognitive function in cancer survivors.

Changes in physical activity, sedentary behavior, and self-reported cognitive function in cancer survivors before and during the COVID-19 pandemic: A cross-sectional study

BackgroundPhysical activity (PA) and reductions in sedentary behavior (SED) may mitigate cancer-related cognitive impairment. The purpose of this study was to examine (a) the associations between changes in PA, SED, and cognitive function in cancer survivors before and during the coronavirus disease 2019 (COVID-19) pandemic; and (b) clinical subgroups that moderate this association. MethodsA cross-sectional survey was administered online to adult cancer survivors globally between July and November of 2020. This was a secondary analysis of a cross-sectional survey examining changes in self-reported PA and quality of life in cancer survivors before and during the COVID-19 pandemic. Self-reported Questionnaires assessed moderate-to-vigorous PA (MVPA) using the modified Godin Leisure Time Exercise Questionnaire, cognitive function using the Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog) scale, and SED using the Domain-specific Sitting Time questionnaire. Cancer survivors were classified into no change in behavior, desirable change (i.e., increase MVPA to meet PA guidelines or decrease SED by ≥60 min/day), and undesirable change (i.e., decrease MVPA to <150 min/week or increase SED by ≥60 min/day). Analysis of covariance examined differences in FACT-Cog scores across the activity change categories. Planned contrasts compared differences in FACT-Cog scores between cancer survivors with (a) no meaningful change vs. any change, and (b) a desirable change vs. an undesirable change. ResultsThere were no significant differences in FACT-Cog scores across activity-change categories in the full sample of cancer survivors (n = 371; age = 48.6 ± 15.3 years (mean ± SD)). However, cancer survivors who were diagnosed ≥5 years ago (t(160) = –2.15, p = 0.03) or who received treatment ≥5 years ago (t(102) = –2.23, p = 0.03) and who had a desirable change in activity reported better perceived cognitive abilities than those who had an undesirable change. ConclusionPA promotion efforts should consider reducing SED in addition to maintaining MVPA in long-term cancer survivors to mitigate cancer-related cognitive impairment during the COVID-19 pandemic.

Sleep Disorders, Fatigue, and Cognitive Function in Cancer Survivors: A Plenary Session

For many patients, sleep disorders (particularly insomnia), cancer-related fatigue, and cancer-related cognitive impairment are common and distressing symptoms of cancer and its treatment. At the NCCN 2023 Annual Conference, a panel of experts began with a personal account of a cancer survivor’s experience and discussed approaches to assess and manage these adverse effects of cancer and its treatment.

Mindfulness-based interventions and cognitive function in cancer survivors: a systematic review and meta-analysis

Abstract Background: Deterioration in cognitive function is common among cancer survivors undergoing treatment. These problems may persist for several years after completion of treatment and can adversely affect cancer survivors' treatment adherence and quality of life. The cause of cognitive changes in cancer survivors is unclear, although it is likely a complex interaction of disease-related, treatment-related, and psychological factors. Mindfulness-based interventions (MBIs) are one promising intervention for cancer survivors to alleviate unwanted and burdensome side effects, including disruptions in cognitive function. The aim of the current review was to synthesize the literature on MBIs and cognitive function in cancer survivors. Methods: We searched five databases from inception on May 27, 2021 (original search), and May 4, 2022 (updated search): PubMed, MEDLINE Ovid, EMBASE Ovid, PsycInfo Ovid, CINAHL EBSCO, and Web of Science. Articles were screened at the abstract and full-text level by two reviewers. Results: A total of 1916 records were retrieved, and 24 unique studies met the inclusion criteria. There was significant variability across studies regarding type of MBIs investigated, types of cognitive outcome measures used, and study assessment timelines. Eleven studies were included in a meta-analysis of self-reported cognitive function, significantly favoring MBIs over inactive controls (ie, usual care) (standardized mean difference = 0.86; 95% confidence interval = 0.32–1.41). A similar model, including four studies, compared MBIs with active controls (ie, music listening, metacognition treatment, fatigue education and support, walking program); this model also demonstrated a statistically significant pooled effect (standardized mean difference = 0.61; 95% confidence interval = 0.23–0.99). Owing to a small number of studies, meta-analysis could not be completed for objectively assessed cognitive function; a narrative summary for this outcome revealed mixed results. Conclusions: MBIs demonstrated evidence for improving cognitive function among cancer survivors and particularly self-reported cognitive function. However, most studies demonstrated a high risk of bias and significant concerns regarding study quality. Further research is needed to determine the effects of MBIs on both self-reported and objectively assessed cognitive function for cancer survivors, as well as optimal intervention structure and timing.

Effect of Physical Activity During Chemotherapy on Cognitive Function in Cancer Survivors: A Systematic Review and Meta-Analysis.

Purpose: To determine if cancer survivors who perform physical activity (PA) during chemotherapy have improved levels of cognitive function compared to those who do not. Method: E-databases (Ovid MEDLINE, Embase, CINAHL, PsycINFO, AMED) were searched from inception to February 4, 2020. Quantitative studies that assessed cognitive outcomes for adults with any cancer type who received chemotherapy concurrent with PA were selected. Risk of bias was assessed using Cochrane's RoB 2, ROBINS-I, and Newcastle-Ottawa scales. A meta-analysis was performed using standardized mean difference (SMD). Results: Twenty-two studies (15 randomized controlled trials [RCTs] and 7 non-RCTs) met the inclusion criteria. The meta-analysis demonstrated that combined resistance and aerobic training had a small yet statistically significant effect on social cognition compared to usual care (SMD 0.23 [95% CI: 0.04, 0.42], p=0.020). Conclusions: Combined resistance and aerobic exercise may benefit social cognition in cancer survivors undergoing chemotherapy. Due to high risk of bias and low quality of evidence of included studies, we recommend further investigation to support these findings and make specific PA recommendations.

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

Objective: 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, mind-body exercise (MBE), on cognitive function in cancer survivors. Design: 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. Results: 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. Conclusion: 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.

Psycholinguistic Screening for Cognitive Decline in Cancer Survivors: A Feasibility Study.

To test the feasibility of using psycholinguistic speech analysis as a proxy for cognitive function in men undergoing treatment for prostate cancer. Audio-recorded speech samples were collected from 13 men enrolled in a parent study at the University of Kansas Cancer Center in Kansas City. Audio-recorded speech samples, collected from clinical interviews and in response to a prompt question during the parent study at two time points, were evaluated to determine feasibility relationships between neurocognitive and psycholinguistic measures. Correlations between neurocognitive and psycholinguistic measures were identified for prompted speech, but the strength of relationships varied between time points. No relationships were identified in clinical interview speech samples. Feasibility was demonstrated for recording, transcribing, and analyzing speech from clinical interviews, and results suggest relationships between neurocognitive and psycholinguistic measures in prompted speech. If validated, psycholinguistic assessments may be used to assess cognitive function in cancer survivors. Advances in natural language processing may provide opportunities for automated speech analyses for cancer treatment-related cognitive decline.

Diet and cognitive function in cancer survivors with cancer-related cognitive impairment: A qualitative study.

To identify cancer survivors' perceptions of the role diet plays in their cognitive function, and how their cancer-related cognitive changes influence their diet. Cancer survivors diagnosed with cancer in the past 5years, not on active treatment, and with self-reported cognitive changes since diagnosis were recruited from the general population. Semi-structured interviews were conducted with 15 Australian breast (n=13) and colorectal (n=2) survivors (mean time since diagnosed: 27.0 months±SD=16.8). Questions related to how their diet and cognitive changes influenced each other. Interviews were recorded, and transcripts were analysed using thematic analysis. Four themes related to how diet impacted cognition: (a) directly (e.g. healthy diet improves cognition), (b) indirectly (e.g. diet affects tiredness which affects cognition); (c) no impact; and (d) potentially (e.g. poorer diet quality would worsen cognition). Three themes emerged for how cognitive changes were thought to impact survivors' diets: (a) planning meals is harder; (b) cooking is more difficult and complex; and, (c) choosing healthy is more challenging. Many cancer survivors perceived a bidirectional influence between diet and cognition that has cognitive and behavioural consequences. Diet could be investigated as a modifiable lifestyle behaviour to improve cancer-related cognitive impairment and fatigue. Survivors may benefit from dietary guidance with meal planning and preparing.

Effects of acupuncture versus cognitive behavioral therapy on cognitive function in cancer survivors with insomnia: A secondary analysis of a randomized clinical trial.

Cancer-related cognitive impairment is a prevalent, disruptive condition potentially exacerbated by sleep disturbances. The current study was performed to evaluate the effects of acupuncture versus cognitive behavioral therapy for insomnia (CBT-I) on objective and subjective cognitive function in cancer survivors with insomnia. Using data from a randomized clinical trial (160 survivors) that compared acupuncture versus CBT-I for insomnia occurring in cancer survivors, the authors analyzed cognitive outcomes and their relationship to insomnia symptoms. Analysis was limited to 99 patients who reported baseline cognitive difficulties. Interventions were delivered over 8weeks. Objective attention, learning, and memory were evaluated using the Buschke Selective Reminding Test. Subjective cognitive function was assessed using the Brown Attention-Deficit Disorder Scales. Insomnia symptoms were assessed using the Insomnia Severity Index. All outcomes were collected at baseline, week 8, and week 20. From baseline to week 8, acupuncture produced statistically significant within-group improvements in objective attention (Cohen D, 0.29), learning (Cohen D, 0.31), and memory (Cohen D, 0.33) that persisted to week 20 (all P<.05), whereas CBT-I produced a statistically significant within-group improvement in objective attention from baseline to week 20 (Cohen D, 0.50; P<.05); between-group differences were not statistically significant. Both interventions produced statistically significant within-group improvements in subjective cognitive function at weeks 8 and 20 compared with baseline (all P<.001); between-group differences were not statistically significant. In the acupuncture group, patients with clinically meaningful responses with regard to insomnia symptoms demonstrated a significantly greater improvement in subjective cognitive function compared with those without clinically meaningful insomnia responses (P=.006). Among cancer survivors with insomnia, both acupuncture and CBT-I produced significant improvements in objective and subjective cognitive function. However, the effect sizes varied and only survivors in the acupuncture group demonstrated a significant relationship between cognitive and sleep outcomes. These preliminary findings warrant further investigation to guide the personalized management of patients with cancer-related cognitive impairment.

The relationship between diet and cognitive function in adult cancer survivors: a systematic review.

To perform a systematic review identifying how dietary factors are related to cognitive function in cancer survivors who are not currently undergoing primary treatment. Using the PRISMA framework, a search was conducted for studies published before February 2019 across multiple databases, identifying 2304 unique articles. Twelve met final inclusion criteria and were evaluated through narrative synthesis. This review was registered with the International Prospective Register Of Systematic Reviews (CRD42018111941). Included studies were heterogeneous in methodology and in dietary and cognitive variables investigated making direct comparisons difficult. Evidence of a relationship between diet and cognition was mixed; the most consistent evidence was identified in relation to a positive relationship between fruit and vegetable intake and cognitive function (both self-reported and objectively tested) in five out of six studies, but was not concordant across all studies. Preliminary evidence exists that a greater fruit and vegetable intake is associated with better cognitive functioning in cancer survivors, as has been reported in healthy populations; however, these data are correlational and include relatively small samples. Most evidence related to breast cancer survivors, with individual studies extending to colorectal and stomach cancer survivors. Experimental trials are needed to identify causal attribution of dietary factors on cognitive function in cancer survivors. At this time, there is not sufficient evidence to make dietary or nutritional recommendations specifically for improving cognitive function in cancer survivors. This should be considered in light of the general paucity of research on this subject, necessitating further investigations.

Pretreatment Psychoneurological Symptoms and Their Association With Longitudinal Cognitive Function and Quality of Life in Older Breast Cancer Survivors

ContextSymptoms affect quality of life (QOL), functional status, and cognitive function in cancer survivors, but older survivors are understudied. ObjectivesThe objectives of this study were to identify prototypical presystemic therapy psychoneurological symptom clusters among older breast cancer survivors and determine whether these symptom clusters predicted cognition and QOL over time. MethodsWomen with newly diagnosed nonmetastatic breast cancer (n = 319) and matched noncancer controls (n = 347) aged 60+ years completed questionnaires and neuropsychological tests before systemic therapy and 12 and 24 months later. Latent class analysis identified clusters of survivors based on their pretherapy depression, anxiety, fatigue, sleep disturbance, and pain. Linear mixed-effects models examined changes in objective cognition, perceived cognition, and functional status (Instrumental Activities of Daily Living disability, functional well-being, and breast cancer–specific QOL) by group, controlling for covariates. ResultsNearly one-fifth of older survivors were classified as having high pretherapy symptoms (n = 51; 16%); the remainder had low symptoms (n = 268; 84%); both groups improved over time on all outcomes. However, compared to the low symptom group and controls, survivors with high symptoms had lower baseline objective cognition and lower perceived cognition at baseline and 24 months, lower functional well-being at baseline and 12 months, greater Instrumental Activities of Daily Living disability at baseline, and lower breast cancer–specific QOL at all time points (all P < 0.05). ConclusionNearly one-fifth of older breast cancer survivors had high psychoneurological symptoms at diagnosis, which predicted clinically meaningful decrements in perceived cognition and function in the first 24 months after diagnosis. Pretreatment psychoneurological symptom clusters could identify survivors for monitoring or intervention.

Abstract 4256: Handgrip strength and cognitive function in elderly cancer survivors

Abstract Aim: Cancer and cancer treatment-related cognitive impairments are frequently reported in cancer survivors, presenting as lack of attention, impaired executive function and short-term money loss. The aetiology of these impairments is largely unknown. Recently, serum level of brain-derived neurotrophic factor (BDNF) has been associated with cancer related cognitive impairments. BDNF is a neurotrophin, secreted in responses to muscle contraction. Meanwhile, muscle dysfunction, characterized by muscle strength and muscle composition, is common in cancer survivors. Yet its impact on cancer survivors' cognitive function is unknown. To address this gap we evaluated for the first time the associations of muscle strength determined by handgrip with two cognitive function outcomes in cancer survivors using data from the National Health and Nutrition Examination Survey (NHANES). Method: Data in two waves of NHANES (2011-2014) were aggregated. Handgrip strength in kilogram (kg) was measured with the Takei Digital Grip Strength Dynamometer, defined as the maximum value achieved using either hand. Data on two cognitive function tests were extracted, both were conducted among adults 60 years and older: the Animal Fluency Test (AFT) which examines categorical verbal fluency (a component of executive function), and the Digital Symbol Substitution test (DSST) which assesses processing speed, sustained attention and working memory. Survey analysis procedures were used to account for the complex sampling design of the NHANES. Gender-specific multivariable linear regression models were used to estimate associations of handgrip strength with cognitive test scores, adjusting for confounders (age, gender, race/ethnicity, education, marital status, smoking status, depression and leisure time physical activity). For explorative purpose, we further adjusted for handgrip strength squared. Results: There were 383 cancer survivors (mean age=70.9 years, mean BMI=29.3 kg/m2) with detailed data for analyses. Prevalent cancer types were breast (22.9%), prostate (16.4%), colon (6.9%) and cervix (6.2%). The prevalence of handgrip strength defined sarcopenia was 10.9% in men (&amp;lt;30kg) and 20.4 % in women (&amp;lt;20kg). Scores on AFT and DSST were 18.0 (s.e. 0.4) and 51.7 (s.e. 1.0), respectively. We observed significant linear associations of handgrip strength with both test scores in women. Each increase kg of handgrip strength was associated with 0.20 (95% CI: 0.08 to 0.33) higher score on AFT and 0.83 (95% CI: 0.30 to 1.35) higher score on DSST. In men, we observed inverted U-shape association between handgrip strength and DSST score, which peaked at handgrip strength of 40-42 kg. Conclusion: Handgrip determined muscle strength appears to be associated with aspects of cognitive functions in cancer survivors. Prospective studies are needed to identify the role of muscle on cancer related-cognitive impairments in men and women cancer survivors. Citation Format: Lin Yang, Lee Smith, Liang Hu, Graham A. Colditz, Adetunji T. Toriola, Davy Vancampfort, Mark Hamer, Brendon Stubbs, Thomas Waldhör. Handgrip strength and cognitive function in elderly cancer survivors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4256.

Hand grip strength and cognitive function among elderly cancer survivors.

BackgroundWe evaluated the associations of handgrip strength and cognitive function in cancer survivors ≥ 60 years old using data from the National Health and Nutrition Examination Survey (NHANES).MethodsData in two waves of NHANES (2011–2014) were aggregated. Handgrip strength in kilogram (kg) was defined as the maximum value achieved using either hand. Two cognitive function tests were conducted among adults 60 years and older. The Animal Fluency Test (AFT) examines categorical verbal fluency (a component of executive function), and the Digital Symbol Substitution test (DSST) assesses processing speed, sustained attention, and working memory. Survey analysis procedures were used to account for the complex sampling design of the NHANES. Multiple linear regression models were used to estimate associations of handgrip strength with cognitive test scores, adjusting for confounders (age, gender, race/ethnicity, education, marital status, smoking status, depressive symptoms and leisure time physical activity).ResultsAmong 383 cancer survivors (58.5% women, mean age = 70.9 years, mean BMI = 29.3 kg/m2), prevalent cancer types were breast (22.9%), prostate (16.4%), colon (6.9%) and cervix (6.2%). In women, each increase in kg of handgrip strength was associated with 0.20 (95% CI: 0.08 to 0.33) higher score on AFT and 0.83 (95% CI: 0.30 to 1.35) higher score on DSST. In men, we observed an inverted U-shape association where cognitive function peaked at handgrip strength of 40–42 kg.ConclusionsHandgrip strength, a modifiable factor, appears to be associated with aspects of cognitive functions in cancer survivors. Prospective studies are needed to address their causal relationship.

Mindfulness to Improve Cognitive Function in Cancer Survivors

Mindfulness to Improve Cognitive Function in Cancer Survivors

Feasibility of a combined aerobic and cognitive training intervention on cognitive function in cancer survivors: a pilot investigation

BackgroundCancer-related cognitive impairment (CRCI) may negatively affect upwards of 75% of cancer patients. Exercise and cognitive training, independently, may increase functional capacity and aspects of cognitive function. Yet, combined training protocols have not been evaluated in cancer survivor populations. Therefore, the aim of this study was to explore the feasibility of a quasi-randomized, controlled, exploratory, repeated-measures aerobic and cognitive training intervention on cognitive function in participants undergoing treatment for cancer (N = 28).MethodsPre- and post-physical and cognitive assessments were administered. A 36-session (approximately 12 weeks) computer-based cognitive (COG), aerobic (AER), cognitive and aerobic (AER + COG), and flexibility (CON) training intervention was completed. Dependent measures t tests and pre- to post percentages were then calculated to address within-group changes for each dependent variable.ResultsWithin-group measures revealed that the AER logical memory scores (pre- to post mean difference [2.3], 95.0% CI [0.9, 3.7], percentage change [32.7%]), delayed recall scores (pre- to post mean difference [2.1], 95.0% CI [0.3, 3.9], percentage change [27.2%]), block design scores (pre- to post mean difference [1.7], 95.0% CI [0.2, 3.2], percentage change [19.0%]), and letter-number sequencing scores (pre- to post mean difference [1.0], 95.0% CI [0.2, 1.8], percentage change [12.3%]) all increased. Aspects of verbal fluidity scores increased in the CON group. However, all cognitive scores (AER + COG and COG groups) failed to increase.ConclusionsAerobic training for CRCI may positively impact cognitive function. Individually, these methods may appropriately address CRCI, but combined training of this nature may be too demanding for patients undergoing treatment for cancer. However, larger randomized trials are needed to substantiate this protocol in large-scale cancer rehabilitation centers.

Effects of a Combined Aerobic and Cognitive Training Intervention on Cognitive Function in Cancer Survivors

INTRODUCTION: Cancer-related cognitive impairment (CRCI) has been reported to negatively affect upwards of 75% of cancer patients undergoing treatment. Treatment and management of CRCI has proven to be a difficult task due to the fact that it has yet to be fully characterized. Some studies have shown that cognitive training or aerobic exercise may mitigate aspects of CRCI. Yet, it is unclear whether simultaneously combining these two interventions could provide additive or synergistic benefits on cognitive function in cancer survivors. PURPOSE: To determine the effects of a quasi-randomized, controlled aerobic and cognitive training intervention on cognitive function in cancer survivors (N = 28). METHODS: Pre and post physical and cognitive assessments were administered. A 36-session computer-based cognitive, aerobic, and flexibility training intervention was completed. Participants were assigned to one of the following groups: aerobic exercise only (AER), cognitive training only (COG), simultaneous aerobic exercise plus cognitive training (AER+COG), or a control flexibility only group (CON). RESULTS: No significant (p > 0.05) main effects between groups and variables were observed. Within groups measures revealed that the AER logical memory scaled scores (+33%), delayed recall scaled scores (+27%), block design scaled scores (+19%), and letter-number sequencing scaled scores (+12%) significantly increased (p < 0.05, respectively) pre-to-post. The CON group significantly (p < 0.05) increased from pre-to-post in controlled oral word association gender, age, and education verbal fluidity subtests (Z-scores). All cognitive scores (AER+COG and COG groups) failed to significantly (p > 0.05) increase pre-to-post. CONCLUSIONS: Aerobic training alone had the greatest impact on cognitive function. Individually, these methods may be appropriate for addressing CRCI in this population, but combined training of this nature may be too demanding for cancer survivors suffering from CRCI.

Neurocognitive function of lymphoma patients after treatment with chemotherapy

Background: Chemotherapy has been shown to cause brain changes and to compromise cognitive function in cancer survivors. Knowledge about this matter is of vital importance for good clinical practice and insights into neurological aging. However, most studies have been conducted among breast cancer patients. Less is known about the effects of chemotherapy on the cognitive function of lymphoma patients.Material and method: We studied patients with non-Hodgkin or Hodgkin lymphoma who had been treated with standard dose chemotherapy or with supplementary high dose chemotherapy when standard dose chemotherapy had been unsuccessful. Age- and sex-matched relatives and friends were invited to participate as control participants. All participants underwent a cognitive examination with a battery of validated neuropsychological tests.Results: Matching of patients with control participants was found to be successful. Regression analysis did not reveal worse cognitive functioning of patients (N = 106) compared to matched controls (N = 53) on the overall group level (All Bonferroni-Holm corrected p-values >0.05). However, a subgroup of 16% of patients had deviant performance according to a chance-corrected criterion based on Ingraham and Aiken's probability curves, i.e. 1.5 standard deviations below the norm on three of 14 tests. Exploratory analyses showed that this subgroup of patients was lower educated and had lower estimated premorbid intelligence.Conclusion: Chemotherapy may compromise the function of the brain in a subgroup of lymphoma patients. We hypothesize protection of the brain by ‘cognitive or brain reserve’ as a possible explanation.