ECOG Scale Research Articles

Racial discrimination predicts subjective cognitive decline: Perceived relationship support buffers the association

ObjectivesRecent studies show that chronic exposure to racial discrimination increases the occurrence of subjective cognitive decline (SCD) among Black Americans. Little research, however, has examined potential for protective factors, such as perceived partner support, to buffer these effects. MethodsThis study utilized longitudinal data over a 10-year period from the Family and Community Health Study (FACHS) to examine the associations between experiences of racial discrimination, marital status, partner support, and SCD, measured by the Everyday Cognition (ECog) Scale, among 286 middle-aged Black American women. Regression analysis and internal moderator analyses were employed to analyze the data. ResultsAbout 31% were in married relationships. Thirty-four percent reported cognitive decline, especially in forgetting object locations and dates. Chronic discrimination predicted SCD, and for those in couple relationships, partner support buffered the adverse effects of discrimination, with those in warm and supportive relationships experiencing less SCD than those in relatively unsupportive relationships or not in a relationship. ConclusionsThe study's findings support the idea that racism influences SCD and underscores the importance of supportive couple relationships in promoting resilience. The results also highlight the potential value of culturally relevant family interventions and support strategies to reduce the impact of discrimination-induced stress on cognitive health.

Descriptive Study on the Relationship between Dyspnea, Physical Performance, and Functionality in Oncology Patients.

Cancer is a leading cause of morbidity and mortality globally. Dyspnea, affecting up to 60% of cancer patients, exacerbates physical and psychological distress, reducing quality of life. This study aims to explore the relationship between dyspnea and factors such as age, sex, clinical diagnosis, and treatment lines in cancer patients, with the goal of improving understanding and management of this debilitating symptom to enhance patient care and quality of life. This study employed an observational, cross-sectional, and descriptive approach to investigate patients with oncological disease at the University Hospital of Salamanca between March 2021 and April 2024. A convenience sample was selected, including patients over 18 years old with a pathological diagnosis of cancer, experiencing any degree of dyspnea, and who consented to participate by signing the informed consent. Exclusion criteria included lack of consent and clinical conditions that prevented an interview. The studied variables encompass sociodemographic (age, gender, diagnosis, tumor stage, number of treatment lines) and clinical aspects (daily activities, degree of dyspnea, functional capacity, physical performance), evaluated using the Barthel Index, the mMRC Dyspnea Scale, the ECOG Scale, and the Short Physical Performance Battery (SPPB). Data were collected through semistructured interviews and medical records, and analyzed using specialized software. This research has ethical approval CEiM Code 2023 12 1472, Reference 2024/01. The mean age was 66.82 years. Lung cancer was predominant (60.2%), with most patients in stage 3 (65.7%) and receiving three treatment lines (68.7%). Higher age, advanced disease stage, and more treatment lines correlated with lower Barthel and SPPB scores, and higher ECOG and mMRC scores, indicating worse functionality, physical performance, and greater dyspnea. No significant correlations were found between gender or pathological diagnosis and the studied variables. Advanced age, higher disease stage, and more treatment lines are associated with decreased functionality, poorer physical performance, and increased dyspnea in cancer patients. Gender and specific cancer diagnosis do not significantly affect these relationships. Addressing dyspnea is crucial to improving the quality of life and physical performance in this population. Future studies should explore additional factors like treatment types and nutritional status.

Second line chemotherapy for advanced biliary cancer: FOLFOX versus FOLFIRI: Analysis of retrospective and prospective data

Aim. To evaluate the efficacy and toxicity of second-line polychemotherapy according to FOLFOX or FOLFIRI regimen in patients with biliary tract tumours after progression during first-line chemotherapy (CT). Materials and methods. The study is based on the analysis of retrospective and prospective data on the examination and treatment of 94 patients with biliary cancer of grades T1-4N0-2M0-1 followed-up and treated at the N.N. Blokhin National Medical Research Center of Oncology from 2015 to 2023. All patients were divided into 2 groups: Group 1 (FOLFOX, n=47) and Group 2 (FOLFIRI, n=47). In Group 1, patients received the recommended FOLFOX second-line CT regimen. Patients in Group 2 received FOLFIRI regimen. The endpoints were overall survival (OS) and incidence of grade 3-4 adverse events. Results. The study included 94 patients. In the FOLFOX group, the median OS was 13.0 months (1-year OS was 57.8±7.4%); for the FOLFIRI group, the median OS was 12.3 months (1-year OS was 54.4±7.3%). The toxicity profiles of FOLFOX and FOLFIRI were acceptable and consistent with those reported for the regimens. According to the grade 3–4 toxicity data, diarrhea was significantly more common in the FOLFIRI group (p=0.014), and neurotoxicity was more common in the FOLFOX group (p=0.006). During the second-line CT, the frequency of grade 1–4 toxicities in the groups did not differ: 18 (38.3%) events in the FOLFOX group and 19 (40.0%) events in the FOLFIRI group. Conclusion. Our results of evaluating the efficacy and toxicity of the second-line polychemotherapy regimens show that the FOLFOX and FOLFIRI CT regimens have equal efficacy in patients with advanced biliary tract cancer with a good performance according to the ECOG scale, who previously received the first-line therapy with a combination of gemcitabine with a platinum agent (cisplatin or oxaliplatin); also, our data demonstrate similar toxicity profiles of these regimens.

Development of a machine learning algorithm to predict the residual cognitive reserve index.

Elucidating the mechanisms by which late-life neurodegeneration causes cognitive decline requires understanding why some individuals are more resilient than others to the effects of brain change on cognition (cognitive reserve). Currently, there is no way of measuring cognitive reserve that is valid (e.g. capable of moderating brain-cognition associations), widely accessible (e.g. does not require neuroimaging and large sample sizes), and able to provide insight into resilience-promoting mechanisms. To address these limitations, this study sought to determine whether a machine learning approach to combining standard clinical variables could (i) predict a residual-based cognitive reserve criterion standard and (ii) prospectively moderate brain-cognition associations. In a training sample combining data from the University of California (UC) Davis and the Alzheimer's Disease Neuroimaging Initiative-2 (ADNI-2) cohort (N = 1665), we operationalized cognitive reserve using an MRI-based residual approach. An eXtreme Gradient Boosting machine learning algorithm was trained to predict this residual reserve index (RRI) using three models: Minimal (basic clinical data, such as age, education, anthropometrics, and blood pressure), Extended (Minimal model plus cognitive screening, word reading, and depression measures), and Full [Extended model plus Clinical Dementia Rating (CDR) and Everyday Cognition (ECog) scale]. External validation was performed in an independent sample of ADNI 1/3/GO participants (N = 1640), which examined whether the effects of brain change on cognitive change were moderated by the machine learning models' cognitive reserve estimates. The three machine learning models differed in their accuracy and validity. The Minimal model did not correlate strongly with the criterion standard (r = 0.23) and did not moderate the effects of brain change on cognitive change. In contrast, the Extended and Full models were modestly correlated with the criterion standard (r = 0.49 and 0.54, respectively) and prospectively moderated longitudinal brain-cognition associations, outperforming other cognitive reserve proxies (education, word reading). The primary difference between the Minimal model-which did not perform well as a measure of cognitive reserve-and the Extended and Full models-which demonstrated good accuracy and validity-is the lack of cognitive performance and informant-report data in the Minimal model. This suggests that basic clinical variables like anthropometrics, vital signs, and demographics are not sufficient for estimating cognitive reserve. Rather, the most accurate and valid estimates of cognitive reserve were obtained when cognitive performance data-ideally augmented by informant-reported functioning-was used. These results indicate that a dynamic and accessible proxy for cognitive reserve can be generated for individuals without neuroimaging data and gives some insight into factors that may promote resilience.

Predictive and Prognostic Factors Related to Chemoradioresistance in Neoadjuvant Treatment of Locally Advanced Rectal Cancer at Panama

<i>Background:</i> In Panama, and the rest of Latin America, there are few publications on chemoradioresistance, it leads to poor prognosis and represents the main reason for failure of therapy, ultimately it can lead to tumor recurrence and metastasis. <i>Objective:</i> Identify factors associated with chemoradioresistance in the neoadjuvant treatment of locally advanced rectal cancer at the Instituto Oncológico Nacional de Panamá, period 2016-2020. Methodology: This retrospective study included 71 patients with LARC who received neoadjuvant chemoradiotherapy and surgery. Chemoradioresistant patients were those who did not reach a higher pathological stage of ypT2NO and the results were compared. <i>Results:</i> Of the 71 patients, pathological complete response (pCR) was achieved in 34 patients (48%). 49% of patients met chemoradioresistance criteria. In this group, the median CEA was 136 ng/ml, the median hemoglobin was 12 g/dl, and the median BMI was 26 kg/m2. The median radiation dose was 5000Gy. The time between completion of chemoradiotherapy and surgery was 110 days (16 weeks). Depending on the type of surgery, 65% who underwent low anterior resection were chemoradioresistant. The variables with statistical significance were the CEA value >5 ng/mL (OR=1.81, p=0.026) prior to the start of neoadjuvant treatment, with a lower pCR rate. Likewise, the ECOG scale (OR=2.51, p=0.015) was a risk factor related to chemoradioresistance, the lower the ECOG, the lower the risk of chemoradioresistance. The median overall survival and median recurrence-free survival was not reached in both groups and there was no statistically significant difference. <i>Conclusions:</i> Significant interactions were identified between CEA levels prior to the start of neoadjuvant treatment with the pathological complete response rate and the ECOG score with chemoradioresistance. Therefore, these factors can be used to predict patient outcomes, will help optimize personalized treatment strategies and improve patient outcomes.

УЧЕТ ИНДЕКСА КОМОРБИДНОСТИ ПРИ ПРОВЕДЕНИИ ПРОТИВООПУХОЛЕВОЙ ЛЕКАРСТВЕННОЙ ТЕРАПИИ У ПАЦИЕНТОВ ПОЖИЛОГО И СТАРЧЕСКОГО ВОЗРАСТА С КОЛОРЕКТАЛЬНЫМ РАКОМ (ОБЗОР ЛИТЕРАТУРЫ)

The problem of treating elderly patients is one of the most pressing in modern clinical medicine. Colorectal cancer is one of the main causes of mortality from malignant neoplasms in Russia and other developed countries. At the same time, the incidence of tumors of the colon and rectum steadily increases with age. Before starting treatment for elderly patients, it is necessary to carefully weigh the potential risks and the possibility of achieving positive results of antitumor therapy. Objective: To summarize the literature on the use of a comprehensive geriatric assessment, including the Cancer and Aging Research Group (CARG) toxicity assessment, to predict the risk of adverse events during anticancer drug treatment in elderly patients diagnosed with colorectal cancer. Materials and methods: The search for scientific sources was carried out in PubMed / Medline / UpToDate using the following keywords: “malignant tumors”, “metastatic colorectal cancer”, “senile age”, “antitumor drug therapy”. The time horizon covered 2016–2023. Using a time filter, the most relevant and innovative research papers on the issues of chemotherapy treatment of elderly and senile patients were selected. Results: Most current evidence demonstrates the importance of performing a comprehensive geriatric assessment (CGA), Cancer and Aging Research Group (CARG) toxicity assessment in elderly and geriatric patients. Information obtained from geriatric assessment should be used to predict and manage treatment toxicity. And also for assessing and predicting overall survival. Activities based on CGA can reduce the toxicity of chemotherapy, improve the quality of life of patients, and increase compliance with medical recommendations. Undoubtedly, a comprehensive geriatric assessment (CGA) can help achieve the necessary balance between the potential effectiveness and adverse events of chemotherapy. The choice of treatment tactics for an elderly and senile cancer patient should be based on the patient’s functional status (PS), general somatic status according to the ECOG scale, and the risk of toxicity according to the CARG scale. In the presence of colorectal cancer, patients with good functional status who need antitumor systemic effects can be prescribed polychemotherapy with FOLFOX, XELOX, FOLFIRI doublets with the addition of targeted drugs: bevacizumab or cetuximab (depending on the results of gene profiling of the tumor). Patients who are not candidates for polychemotherapy in standard doses, who have a general somatic status on the ECOG scale of 1-2 and an average risk of developing toxicity of grade 3 on the CARG scale, can undergo PCT with FOLFOX, XELOX, FOLFIRI doublets with a reduction in the starting dose by 20%, or monochemotherapy with antimetabolites: capecitabine, 5-fluorouracil; topoisomerase I inhibitor irinotecan. Patients with poor functional status, general somatic status on the ECOG scale 3-4, and a high risk of developing toxicity on the CARG scale are not candidates for systemic combination chemotherapy. Particular attention should be paid to maintenance therapy in this subgroup of patients. However, if the decrease in PS level is directly related to malignancy and PS ≥2, the possibility of monochemotherapy by infusion of a combination of 5-fluorouracil and leucovorin FU/LV can be evaluated.

Complexity and 1/f slope jointly reflect brain states

Characterization of brain states is essential for understanding its functioning in the absence of external stimuli. Brain states differ on their balance between excitation and inhibition, and on the diversity of their activity patterns. These can be respectively indexed by 1/f slope and Lempel–Ziv complexity (LZc). However, whether and how these two brain state properties relate remain elusive. Here we analyzed the relation between 1/f slope and LZc with two in-silico approaches and in both rat EEG and monkey ECoG data. We contrasted resting state with propofol anesthesia, which directly modulates the excitation-inhibition balance. We found convergent results among simulated and empirical data, showing a strong, inverse and non trivial monotonic relation between 1/f slope and complexity, consistent at both ECoG and EEG scales. We hypothesize that differentially entropic regimes could underlie the link between the excitation-inhibition balance and the vastness of the repertoire of brain systems.

Cross‐cultural adaptation, validity and reliability of the Everyday Cognition Scale in Mexico M‐ECog in Older Adults with Subjective Cognitive Decline, Mild Cognitive Impairment and Alzheimer’s Dementia

AbstractBackgroundThe Everyday Cognition (ECog) scale was created to assess the functional abilities of older adults across a wide range of abilities between normal aging and dementia. The original ECog was shown to have convergent and divergent external validity. Developed in 2008 by Farias et al and updated in 2021. This scale screens early cognitive alterations such as Subjective Cognitive Decline (SCD), Mild Cognitive Impairment (MCI) and Alzheimer’s dementia (AD) through the decline of basic activities and instruments of daily life (DLA)To establish validity, reliability, and cross‐cultural adaptation of the ECog in Spanish (M‐ECog) to identify: SCD, MCI, and Alzheimer’s‐type dementia in older Mexican adults.Method200 patients and 200 informants in a memory clinic of a third level hospital in Mexico City. Four groups were formed: 50 cognitively healthy (CH), 50 SQD, 50 MCI and 50 AD. The clinical evaluation included: sociodemographic aspects, cognitive status by the Mini‐Mental State Evaluation (MMSE) and Montreal Cognitive Evaluation Spanish version (MoCA‐E). The informants rated the functional status measured through the KATZ and Lawton & Brody scales, as well as the ECog Spanish version (M‐ECog).ResultThe internal consistency of the overall function of the M‐ECog (Cronbach’s alpha) was 0.881. The intraclass correlation coefficient was 0.877 (95% CI, 0.850‐0.902; p<0.001). M‐ECog was significantly correlated with DLA 0.40 (95% CI, 0.320‐0.471; p<0.001), MMSE 0.68; (95% CI, 0.650‐0.710; p<0.001) and MoCA‐E 0.70 (95% CI, 0.620‐0.892; p<0.001). And it differentiated patients with SCD, MCI and AD from CH (p < 0.002). The area under the curve (AUC) for SQD was 0.70 (95% CI, 0.58‐0.82), p < 0.005 with a cut‐off value of 46 points, (Sensitivity (S) 99%, and Specificity (E) of 96%; the AUC for MCI was 0.94 (95% CI, 0.89‐0.99), p < 0.001 with a cut‐off point of 52 points, (S: 97%, E: 27%); and for the dementia group, the AUC was 0.86 (95% CI, 0.79‐0.92), p <0.001 with a cut‐off value of 85 points, with (S: 97%, E: 51%).ConclusionM‐ECog is a valid, reliable, useful instrument that measures daily skills mediated by cognition in older Mexican adults, self‐applicable (patients and informants) with SCD, MCI and Alzheimer’s Dementia

Stratification Using ECOG, ADL and HCT-CI Scales, but Not CGA Enables Identifying Elderly AML Patients Fit for Intensive Chemotherapy - a Multicenter Study from Polish Adult Leukemia Group

Introduction: A key part of decision-making in older AML patients is an insightful clinical assessment before qualification for treatment with intensive chemotherapy (IC). It was demonstrated that among the patients initially deemed “fit” for IC, there are vulnerable patients who experience greater treatment toxicity and have poorer outcomes. Comprehensive geriatric assessment (CGA) is a well-recognized tool for identifying such patients. However, due to its time-consuming nature, it is not commonly used. A number of other prognostic models exist, but none of them enable fast and optimal identification of patients eligible for IC. Aim: In this prospective observational study our group aimed to I) assess clinical outcomes of elderly AML patients who were stratified by Eastern Cooperative Oncology Group Performance Status (ECOG PS), Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI), Activity of Daily Living (ADL) scales and received IC and II) evaluate the predictive and prognostic value of CGA components. Material and methods: AML patients aged between 60 and 75 were considered fit for IC if they met all 3 stratification criteria: ECOG PS<2 and HCT-CI<3 and ADL=6. IC regimens included daunorubicin and cytarabine (DA) or daunorubicin, cytarabine and cladribine (DAC) followed by 2 consolidation cycles according to local references. CGA was performed by a qualified medical professional before treatment initiation. CGA included Instrumental Activities of Daily Living Score (iADL), timed up and go test (TUG), geriatric depression scale (GDS), Mini-mental scale Examination (MMSE) and Mini Nutritional Assessment (MNA). The correlations between CGA and complete response (CR) rate were determined by Chi-square test or Fisher's exact test. The Kaplan-Meier analysis and log-rank test were used to compare relapse-free survival (RFS) and overall survival (OS) Results: In total, 85 patients with a median age of 65 years [IQR:63.5-69.0] and slight male predominance (53%) were included in the study. Most patients had HCT-CI score <2 (71.8%). Secondary AML was diagnosed in 23.5% of patients, and most patients had intermediate (32.9%) or adverse (37.6%) ELN cytogenetic risk. Fifty-five (58.8%) patients achieved CR after induction. Median OS reached 16.0 months [95% CI: 11.0-21.00] with median RFS 15.3 months [95% CI: 12.1-18.4]. No significant difference in CR rate (p=0.451), OS (p=0.484) or RFS (p=0.529) was demonstrated between DA or DAC groups. Regardless of induction regimen, patients with CR presented significantly improved OS (p=0.015 for DA, p=0.029 for DAC) compared with non-CR patients. None of the CGA components was shown to influence the CR rate, OS or RFS. Conclusions: In patients aged 60-70 years with AML, stratification by ECOG, ADL, and HCT-CI is an effective tool for qualifying patients for intensive chemotherapy. Comprehensive geriatric assessment does not improve identification of vulnerable patients in this group.

54 The Relationship between Error-Monitoring and Measures of Real-World Awareness and Everyday Function

Objective:Aging older adults and individuals with mild cognitive impairment (MCI) experience changes in ability to self-monitor errors. Difficulties with accurate self-monitoring of errors can negatively impact everyday functioning. Without proper error recognition, individuals will continue to make mistakes and not implement compensatory strategies to prevent future errors. A modified Sustained Attention to Response Task (SART; Robertson et al., 1997) has previously been used to assess self-monitoring by the number of errors individuals were able to recognize. The current study sought to examine the relationship of this laboratory-based error-awareness task with everyday functional abilities as assessed by informants and with real-world error-monitoring. We hypothesized that self-monitoring would be significantly related to real-world error-monitoring and everyday functional abilities.Participants and Methods:135 community-dwelling participants (110 healthy older adults (HOA) and 25 individuals with MCI) were included from a larger parent study (mean age = 67.73, SD = 8.89). A modified SART was used to measure error-monitoring and create a self-monitoring variable by dividing accurately recognized errors by the total number of errors. Participants also completed simple and complex everyday tasks of daily living (e.g., making lemonade, cooking oatmeal, cleaning, filling medication pillbox) in a university campus apartment. Examiners coded both number of errors committed and self-corrections that were made during task completion. To examine real world error awareness, total self-correct errors were divided by the total number of errors. Knowledgeable informants (KI) completed the Everyday Cognition (ECog) scale, where they rated the participant on domains of memory, language, spatial abilities, planning, organization, and divided attention, to capture changes in everyday function. Pearson correlations were used to examine the relationship between SART self-monitoring and real-world error-monitoring, and changes in everyday functions as rated by their informants.Results:As self-monitoring scores on the SART increased, so too did real-world error awareness scores, r(133) = .18, p = .04. Higher self-monitoring scores on the SART were also significantly positively associated with functional performance abilities on the Ecog total (r(96) = -.24, p = .02). Further, higher self-monitoring on the SART was related to better functional performance within the Ecog domains of everyday memory (r(96) = -.23, p = .02), everyday language (r(96) = -.24, p = .02), everyday spatial abilities (r(96) = -.23, p = .02), and everyday planning (r(96) = -.21, p = .04). SART self-monitoring was not significantly related to everyday organization or divided attention domains.Conclusions:The findings revealed that better error-monitoring performance on a laboratory-based task was related to better error-monitoring when completing real-world activities, and less overall impairment in everyday function as reported by informants. Results support the ecological validity of the SART error-monitoring score and suggest that error-monitoring performance on the modified SART may have important clinical implications in predicting real-world error-monitoring and everyday function. Future research should consider how SART error-monitoring may predict everyday functioning, over and above other clinical measures.

25 Update to: The Predictive Utility of Various Subjective Cognitive Complaints Using Item Level Data from the Everyday Cognition (ECog) Scales

Objective:Early identification of individuals at risk for dementia provides an opportunity for risk reduction strategies. Many older adults (30-60%) report specific subjective cognitive complaints, which has also been shown to increase risk for dementia. The purpose of this study is to identify whether there are particular types of complaints that are associated with future: 1) progression from a clinical diagnosis of normal to impairment (either Mild Cognitive impairment or dementia) and 2) longitudinal cognitive decline.Participants and Methods:415 cognitively normal older adults were monitored annually for an average of 5 years. Subjective cognitive complaints were measured using the Everyday Cognition Scales (ECog) across multiple cognitive domains (memory, language, visuospatial abilities, planning, organization and divided attention). Cox proportional hazards models were used to assess associations between self-reported ECog items at baseline and progression to impairment. A total of 114 individuals progressed to impairment over an average of 4.9 years (SD=3.4 years, range=0.8-13.8). A subset of individuals (n=352) underwent repeat cognitive assessments for an average of 5.3 years. Mixed effects models with random intercepts and slopes were used to assess associations between baseline ECog items and change in episodic memory or executive function on the Spanish and English Neuropsychological Assessment Scales. Time in years since baseline, the ECog items, and the interaction were key terms of interest in the models. Separate models for both the progression analyses and mixed effects models were fit for each ECog item that included age at the baseline visit, gender, and years of education as covariates.Results:More complaints on five of the eight memory items, three of the nine language items, one of the seven visuospatial items, two of the five planning items, and one of the six organization items were associated with progression to impairment (HR=1.25 to 1.59, ps=0.003 to 0.03). No items from the divided attention domain were significantly associated with progression to impairment. In individuals reporting no difficulty on ECog items at the baseline visit there was no significant change over time in episodic memory(p>0.4). More complaints on seven of the eight memory items, two of the nine language items, and three of the seven visuospatial items were associated with more decline in episodic memory (ps=0.003 to 0.04). No items from the planning, organization, or divided attention domains were significantly associated with episodic memory decline. Among those reporting no difficulty on ECog items at the baseline visit there was slight decline in executive function (ps=<0.001 to 0.06). More complaints on three of the eight memory items and three of the nine language items were associated with decline in executive function (ps=0.002 to 0.047). No items from the visuospatial, planning, organization, or divided attention domains were significantly associated with decline in executive function.Conclusions:These findings suggest that, among cognitively normal older adults at baseline, specific complaints across several cognitive domains are associated with progression to impairment. Complaints in the domains of memory and language are associated with decline in both episodic memory and executive function.

A - 61 The Impact of Metacognition on Everyday Functioning in Mild Cognitive Impairment and Dementia.

The purpose of this study was to evaluate the role of metacognition on everyday functioning in mild cognitive impairment and dementia. Participants included 44 healthy older controls, 57 individuals with mild cognitive impairment (MCI), and 26 individuals with Alzheimer's disease (ad). Participants were administered verbal and nonverbal memory tests and a visuospatial test. They made predictions about their performances before taking each test and then made postdictions about their performances after each test. Prediction and postdiction accuracy scores were calculated. Additionally, all participants took the Everyday Cognition (ECog) Scale. Regression analyses were conducted, separately for each diagnostic group, to determine the roles of prediction and postdiction accuracy on everyday functioning. For healthy older controls, prediction and postdiction accuracy on a visuospatial test significantly impacted overall everyday functioning. In MCI, prediction accuracy on a nonverbal memory test significantly impacted everyday functioning. Finally, in ad, postdiction accuracy on a nonverbal memory test significantly predicted everyday memory. Overall, metacognition predicts everyday functioning in healthy aging, MCI, and ad. For healthy aging and MCI, the ability to both accurately predict and retrospectively evaluate their own cognition impacts overall everyday functioning. With the increased cognitive impairment of ad, only the ability to retrospectively evaluate performances impacts everyday memory.

Bronchial Microbiota and the Stress Associated with Invasive Diagnostic Tests in Lung Cancer vs. Benign Pulmonary Diseases: A Cross-Sectional Study.

Lung cancer is the leading cause of cancer-related deaths worldwide. This study aimed to compare the bronchial microbiota of patients with lung cancer and patients with benign pulmonary diseases undergoing bronchoscopy, and to assess the stress levels associated with invasive diagnostic lung tests. A cross-sectional study was conducted at the "Victor Babes" Hospital for Infectious Diseases and Pulmonology in Timisoara, Romania. A total of 33 patients with histologically diagnosed bronchopulmonary cancer and 33 control patients with benign lung pathologies underwent bronchoscopy. Bronchial microbiota was analyzed by multiplex PCR, culture media, and cytology. Anxiety and depression levels were assessed using the ECOG performance status scale, Karnofsky scale, GAD-7, PHQ-9, and HADS questionnaires. There were no significant differences in the presence of common microbial species between the two groups, except for Acinetobacter spp. Which was identified in 15.2% of patients with lung cancer and 0.0% in the control group, Candida spp. Was more prevalent in the benign group (24.2% vs. 6.1%), and the Parainfluenza virus was detected only in the malignant group (21.1% vs. 0.0%). Cytology results showed a higher prevalence of atypical and tumoral cells in the malignant group (39.4% and 30.0%, respectively), as well as higher lymphocyte levels in the benign group (69.7% vs. 24.2%). Patients with lung cancer had significantly lower performance status on the ECOG scale (2.34 vs. 1.92), lower Karnofsky scores (71.36 vs. 79.43), and higher GAD-7 and PHQ-9 scores at the initial evaluation compared to the benign group. At the 90-day follow-up, ECOG and Karnofsky scores remained significantly different from the initial evaluation, but only GAD-7 scores showed a significant difference between the two groups. There were differences in the bronchial microbiota between patients with lung cancer and benign pulmonary diseases, with a higher prevalence of Candida spp. in the benign group and exclusive detection of Acinetobacter spp. and Parainfluenza virus in the malignant group. Patients with lung cancer exhibited higher stress levels, more severe anxiety, and depression symptoms, which persisted during follow-up. Further research is needed to understand the role of bronchial microbiota in lung cancer and the impact of stress on patient outcomes.

Оценка качества жизни пациентов с распространенной/рецидивирующей меланомой кожи на фоне лечения ингибиторами контрольных точек иммунного ответа

Objective. To evaluate the quality of life in patients with advanced/recurrent melanoma receiving immunotherapy with checkpoint inhibitors. Material and methods. The study enrolled 30 patients with advanced/recurrent melanoma treated with checkpoint inhibitors in the City Clinical Oncology Center, Saint Petersburg from 2020 to 2023. Quality of life was measured by SF-36 questionnaire and ESAS-R scale thrice: before treatment, after one and three months. Results. The age of the included patients ranged from 30 to 87 years (mean age is 64 ± 11 years, 95% CI 57.20–71.11). Cutaneous melanoma was present in 90% of the patients, while melanoma of mucosal origin was found in 10% of the patients. The functional status of 40% of the patients on the ECOG scale was 2–3 points. 40% (n = 12) of patients received Prolgolimab, 26.7% (n = 8) received the combination of Nivolumab 1 mg/kg + Ipilimumab 3 mg/kg, 23.3% (n = 7) received Nivolumab in mono regimen, 6.7% (n = 2) received Ipilimumab, and 3.3% (n = 1) received the combination Nivolumab 3 mg/kg + Ipilimumab 1 mg/kg. There was a significant decrease in pain (before treatment 2.29 ± 1.979, after 3 months 1.29 ± 1.922 (p = 0.021)), an improvement in the overall symptom profile (before treatment 15.79 ± 11.127, after 1 month – 12.00 ± 8.899, after 3 months – 12.82 ± 12.157 (p = 0.006)) on ESAS-R questionnaire was registered. Improvement was noted in most scales of the SF-36 questionnaire compared with baseline, with statistically significant changes obtained for physical functioning (p = 0.05), pain (p = 0.01), social functioning (p = 0.013), mental health (p = 0.01), overall index of physical health component (p = 0.001), overall index of mental health component (p = 0.042). Conclusion. The results demonstrate a positive effect of treatment with checkpoint inhibitors on the quality of life and symptom profile of patients diagnosed with advanced/recurrent melanoma.

Assessment of employability in patients with breast cancer with a completely unfavorable clinical-labor prognosis

Objective. To develop objective criteria applicable in the practice of medical and social expertise when assessing the employability of patients suffering from breast cancer with absolutely life-threatening clinical and labor prognosis.Materials and methods. In order to realize our aims we conducted a retrospective study of 37 female patients of employable age with malignant neoplasms of the breast, who at examination (primary or repeated) in medical and rehabilitation expert commissions (MREC) were assigned the first disability group due to absolutely unfavorable clinical and labor prognosis in respect of life in the nearest future. Inclusion criteria were morphologically confirmed breast cancer, absolutely unfavorable clinical and clinical and labor prognosis. Exclusion criteria were synchronous and metachronous cancer, presence of significant concomitant pathology.Results. The results of the study showed that it is reasonable to use quantitative values of the Karnovsky index and ECOG scale as the simplest and the most universal criteria for evaluation of the general somatic status of a patient when examining patients with breast cancer with absolutely unfavorable prognosis at MREC. During the study, the quantitative values of the given indicators correlating with the degree of severity of disability to labor activity are determined: at the values of the Karnovsky index 60 points and more, the ECOG status 2-3, a reliable correlation (τ = 0,51, p < 0,001) with severely limited ability to work (АС 4) is revealed. As a result of the study, it was demonstrated that disabled individuals of the first group can be recognized as able-bodied with limitations only with higher values of these scales, taking into account harmful and dangerous production factors, as well as class of working conditions.Conclusion. We found that when assessing the degree of severity of limitations to the ability to work in the disabled people of the first group with absolutely unfavorable clinical and labor prognosis, it is reasonable to be guided by the generally accepted scales of assessment of the general condition of a cancer patient (Karnovsky index, ECOG scale), taking into account the existing harmful and/or dangerous production factors, as well as the working conditions class.

Temporal evolution of quality of life in patients endoscopically treated for sinonasal malignant tumors.

The aim of our study is to assess which factors may affect the quality of life (QoL) and its fluctuation over time in adult patients who received endonasal endoscopic oncologic sinus surgery (EOSS) for sinonasal malignancies (SNM) in our center. We analyzed EOSS cases for primary SNM from January 2015 to June 2020. For each patient, we have recorded the age at treatment, gender, smoking habits, use of psychotropic drugs for mood disorders, stage, histotype, type of surgical resection, need for skull-base reconstruction, development of postoperative major complications, and the use of adjuvant intensity-modulated radiotherapy (IMRT). We evaluated the patient's performance status pre-treatment using the ECOG scale. Quality of life was measured using three questionnaires (SNOT-22; ASK-9; EORTC QLQ-C30 version 3). Fifty-five patients were enrolled in our study, of whom thirty-two (58.18%) received adjuvant IMRT. Overall, a significant improvement in all QoL outcomes was observed at eighteen months, while, female sex, higher ECOG scores, advanced stage of disease, and adjuvant IMRT were associated with worse QoL. After 18 months the delta in QoL between women and men worsened (in SNOT-22 and EORTC QLQ-GLOBAL) while if only the most fragile patients according to ECOG are considered, this difference was reduced for both tools. Our analysis revealed that IMRT is the element that has the greatest impact on patient's quality of life, in association with the female sex, ECOG >2, and advanced stage of the disease.

Quality of Life, Psychological Distress, and Nutritional Status of Polish Patients with Head and Neck Cancer Treated with Radiotherapy.

Head and neck cancer (HNC) is a global epidemiological and clinical problem. In 2020, it was the seventh most common type of cancer worldwide. In 2019, HNC was the fourth most common cause of cancer death among men in Poland. Radiotherapy plays an important role in the treatment of patients with HNC at all clinical stages. However, it is associated with a significant rate of early and late adverse effects. As head and neck cancers are located close to vital anatomical structures, both the local progression of the disease and the treatments used can cause serious problems for patients with HNC, reducing their health-related quality of life (HRQoL) as well as increasing the risk of depressive disorders. Despite this, the current literature lacks research on these aspects of the therapeutic process in the Polish population. The aim of this study was to assess the early impact of radiotherapy on HRQoL outcomes, psychological distress, nutritional status, and overall performance of patients with HNC. The study was carried out among 85 patients with HNC treated in the Inpatient Radiotherapy Unit of the Radiotherapy Department of the Lower Silesian Oncology Center in Wrocław. The patients were asked to complete a set of questionnaires, including the EORTC QLQ-H&N35, the BDI, the NRS-2002, and the ECOG scale, at two time points: before the initiation of radiotherapy treatment and after a course of radiotherapy. The period between the assessments was 7 to 8 weeks. Our findings demonstrated a negative impact of radiotherapy on scores in all the cancer-specific symptom and functioning scales used in the study. As regards functioning scales, the largest differences were observed for senses and swallowing, whereas with symptoms scales, the largest differences were noted for "sticky saliva" and "dry mouth". Over half of the patients included in the study required nutritional support after radiotherapy treatment. We found statistically significant differences in the levels of depressive symptom severity before and after radiotherapy treatment. The present study showed significant changes in the physical and psychological functioning and nutritional status of the patients with HNC studied after radiotherapy treatment, which may have an impact on the effectiveness of cancer treatment.

Personalized Management of Chronic Myeloid Leukemia Presenting with Ovarian Apoplexy and Review of Health Emergency Cases

Introduction: Chronic myeloid leukemia (CML) may significantly affect quality of life and life expectancy in the accelerated and acute phases, especially if presented with health emergencies. Objective: The purpose of the study was the evaluation of the personalized management milestones in CML cases presented with ovarian apoplexy and the analysis of the international experience on health emergencies in this leukemia. Materials and Methods: An original, case-report study was performed. The diagnosis was confirmed by cytological, cytogenetic and molecular examinations of the peripheral blood and bone marrow at the comprehensive research cancer center— Institute of Oncology from Moldova. The real-time PCR was performed for quantitative detection of BCR-ABL gene p210 and p190 transcripts. The ECOG Scale and complete hematologic response (CR) estimated the short-term results. The ECOG performance status served as a measure of functional status. Its scores range from 0 to 5 and correlate with the level of patient functioning. CR is the disappearance of all detectable clinical and hematological signs of malignant neoplasm in response to treatment. CR span was assessed in months. The overall and relapse-free survivals asserted the long-term results of treatment, and were evaluated in months as a case. Results: CML may be manifested by life-threatening conditions, including infections and thrombotic events, splenic infarcts and ruptures, bleedings, etc. CML with the uncommon onset under the form of the ovarian apoplexy is described. The hematological CR was obtained under the treatment with imatinib mesylate. The molecular CR and the long-lasting overall survival (197.5 months) were achieved after the treatment with nilotinib. Under the treatment with tyrosine kinase inhibitors, the patient did not experience the disease burden and side effects, and resumed her work, with a good life quality (ECOG score is 0). Discussion: CML may be manifested by life-threatening health emergencies, especially thrombotic events, splenic infarcts and ruptures, bleedings, etc. The CML patients with high leukocyte and platelet counts may experience also different symptoms of hyperviscosity: tinnitus, priapism, stupor, visual abnormalities and cerebrovascular accidents. However, the management of CML with the life-threatening conditions, especially in the accelerated and acute phases, should be realized with participation of the multidisciplinary teams. Conclusions: The ovarian apoplexy may serve as a presenting feature of CML in young females with a highly elevated leukocyte count. The reported CML case underwent successful personalized management with 2 generations of tyrosine kinase inhibitors, even if designated with Socal intermediate-risk score and complicated by a health emergency.

Validation and reliability study of the Turkish version of the everyday cognition - 12 (T- ECog) scale.

Assessing the activities of daily living (ADL) is important in cognitive impairment. The everyday cognition scale includes 12 items (ECog-12). It evaluates complex ADLs and executive functions. This scale can differentiate healthy elderly people from patients with mild cognitive impairment (MCI) as well as MCI from dementia patients. Our aim is to validate a Turkish version of ECog-12. The study group consisted of 40 healthy elders, 40 patients with Alzheimer's disease (AD), and 40 patients with MCI. In addition to T-ECog-12, test - your memory- Turkish version (TYM-TR), Geriatric Dementia Scale (GDS), the Blessed orientation-memory-concentration (BOMC), and Katz ADL tests were administered to all participants for concurrent validity. Cronbach's alpha test showed excellent internal consistency (0.93). When T-ECog-12 was compared to the other tests, strong positive correlations were found between the GDS and BOMC; in addition, strong negative correlations were found between Katz ADL and TYM-TR scale. ECog-12 was found to be sensitive in differentiating healthy individuals from individuals with dementia (AD and MCI) (Area under the curve [AUC]=0.82, Cl=0.74-0.89). It was found to have low sensitivity in discriminating between MCI and healthy individuals (AUC=0.52, Cl=0.42-0.63). T-ECog-12 was found to be reliable and valid for Turkish population. This scale is reliable and effective in diagnostic distinguishing healthy individuals from dementia.

Management of primary CNS lymphomas including vitreoretinal lymphomas

AbstractPrimary CNS lymphomas (PCNSL) are represented in almost all cases by diffuse large B‐cell lymphomas (DLBCL). WHO 2017 defines “Primary DLBCL of CNS as DLBCL arising within the brain, spinal cord, leptomeninges or eye”. Those sites together with testes are characterized as “immune sanctuaries”. CNS DLBCL accounts <1% of all lymphomas and 2–3% of brain tumours. Approximately 15% of patients (pts) have ocular involvement and approximately 75% of pts with vitreoretinal lymphomas (VRL) develop contralateral and/or parenchymal CNS lesions. The aetiology in immunocompetent patients is unknown. The majority of DLBCL cases shows nongerminal center immunophenotype. The significant proportion reveals MYD88 and CD79b mutations. Copy number gains at chromosome 9p24.1 lead to PD‐L1/2 overexpression are frequently found. Cognitive dysfunction, psychomotor slowing, different neurological symptoms including seizures are among the leading symptoms. The median age at diagnosis is around 60 years and significant proportion of patients have worse performance status based on ECOG scale. The diagnosis is established on immunohistochemical examination of biopsy. Corticosteroid administration leads to the lymphoma regression and biopsy is therefore recommended before it. MRI, eye and cerebrospinal fluid (CSF) examination is recommended as essential for the staging. The neurosurgical tumour removal is generally not recommended. The CNS DLBCL is usually chemosensitive and combined immunochemotherapy consisted of rituximab and high dose methotrexate (HD MTX) up to 8 g/m2 (usually 3.5 g/m2) based chemotherapy is recommended. Several combinations are used, especially for younger patients, combine HD MTX with HD cytarabine and thiotepa, or procarbazine, lomustine. Intrathecal administration of methotrexate is omitted if the CSF is negative. The therapy goal is to achieve complete remission. The relapse rate is, however, high and consolidation therapy is necessary. The radiation therapy is a standard with the dose of 40Gy, but it seems to cause long‐term cognitive impairment especially in elderly patients with the age above 60 years. The dose reduction and even radiotherapy omitting has been tested in patient with complete remission at the end of induction. The high dose therapy with autologous stem cell transplantation is increasingly used in younger population. The prognosis has been significantly improved during last 10–15 years. At the time of relapse immunochemotherapy with radiotherapy (if it was not part of 1st line treatment) could be used. The targeted therapy or immunotherapy based on molecular biological findings is tested. Brutone tyrosine kinase inhibitor ibrutinib (active in lymphoproliferations dependent on BCR signalling and presence of MYD88 mutations) is tested. Immune checkpoint inhibitors nivolumab and pembrolizumab (active in lymphoproliferations with PD1/PDL‐1,2 axis activation) are tested in prospective trials and results awaited. Imids (lenalidomide, pomalidomide), mTOR inhibitors (temsirolimus) among others are tested. VRL is considered to be CNS DLBCL subtype as mentioned above. The diagnosis is challenging because the tumour tissue is usually not available and it is established on morphology, flow cytometry and currently on mutations of MYD88 and other genes. The same systemic therapy is recommended as in classical CNS DLBCL, intraocular methotrexate administration is used in some centers. A new drugs are tested in the relapse setting.