Assessment Of Cancer Therapy-Cognitive Function Research Articles

Physical Activity and Cognition: Longitudinal findings from the Thinking and Living with Cancer Study.

Physical activity can improve cognition; however, little is known regarding the relationships between longitudinal objectively-measured physical activity, cognition, and inflammation in older breast cancer survivors. Older (≥60 yrs) breast cancer survivors (n = 216) and frequency-matched non-cancer controls (n = 216) were assessed at baseline (pre-systemic therapy for survivors) and annually for up to five years. Assessments included hip-worn ActiGraphs worn for seven days, neuropsychological tests, the Functional Assessment of Cancer Therapy-Cognitive Function Perceived Cognitive Impairment (FACT-Cog PCI) subscale, and circulating levels of C-reactive protein (CRP) and interleukin-6 (IL-6). Data were analyzed using linear mixed-effect, random-effect contemporaneous fluctuation, and multi-level mediation models, considering covariates; p < .05 (two-sided) was considered significant. Survivors had fewer minutes of moderate-to-vigorous physical activity (MVPA) than controls at 36-, 48-, and 60-month time points (p < .03). Fewer survivors met Aerobic Physical Activity Guidelines at 36 months than controls (17.7% vs 33.0%, p = .030). When Guidelines were met (vs not), FACT-Cog PCI scores were 2.1 ± 1.0 (p = .034) points higher. Higher MVPA and meeting Aerobic Guidelines were not related to objective neuropsychological performance. MVPA was inversely associated with CRP and IL-6 (p < .001), but inflammation did not mediate physical activity effects on perceived cognition. Older breast cancer survivors were less physically active than older non-cancer controls, especially farther from baseline. Meeting Aerobic Guidelines was associated with better perceived cognition in survivors. Survivorship care should consider physical activity monitoring and referral to rehabilitation and supervised exercise programs to promote physical activity and improve recovery in older survivors.

Cognitive symptoms in patients with cancer receiving PD-1/PD-L1 checkpoint inhibitors: Insights from a cross-sectional pilot study.

12094 Background: Cancer-related cognitive impairment is common with traditional therapeutic modalities, affecting memory, psychomotor speed, attention, and executive function of up to 75% of adults with cancer. Over the past decade, immune checkpoint inhibitors (ICIs) have emerged as novel and efficacious treatments due to their ability to penetrate the blood-brain barrier and improve survival rates. However, they come with significant short- and long-term complications, including neurological toxicities. Despite their benefits, the impact of ICIs on cognitive function is not well understood. This study aims to examine the frequency and severity of cognitive impairment and the factors correlated among adults with cancer receiving ICIs. Methods: We collected questionnaire data on cognitive function using the Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog) and other concurrent symptoms, as well as saliva samples of a subset of inflammatory cytokines from patients treated with PD-1/PD-L1 checkpoint inhibitors between 2022 and 2023. Sample characteristics were described using mean, frequency, and percentage. To analyze the relationship among symptoms and demographics, we used Pearson’s correlation and the Mann-Whitney U test. Saliva cytokines were analyzed using ELISA assays. This study is IRB approved. Results: Twenty-three patients (male: n=11, female: n=12) have received ICIs for an average of eight months, with a mean age of 70.87±11.63 years. 78.3% had melanoma/skin cancer, 8.7% had head and neck cancer, and 13% had other malignancies. Pembrolizumab was administered to 47.8%, and Nivolumab to 26.1%. The mean scores of FACT-Cog for perceived cognitive impairment (PCI) and perceived cognitive abilities (PCA) were 60.87±13.06 (maximum: 72) and 22.30±6.70 (maximum: 28), respectively. 26.1% of participants (n=6) reported lower scores than the cut-off in both PCI (cut-off: ≤55.1) and PCA (cut-off: ≤19.5). Lower FACT-Cog PCI scores were significantly correlated with older age ( r=-.511, p&lt;.05), greater fatigue ( r=-.483, p&lt;.05) and pain ( r=-.558, p&lt;.01). Participants with PCA and PCI scores below the cut-off showed higher mean concentrations of IL-1β (mean±SE: 188.22±133.72 vs. 80.99±14.73pg/mL), CRP (6659.47±3027.58 vs. 3910.71±1022.41pg/mL), and IL-6 (109.24±56.07 vs. 30.22±6.26pg/mL) compared to those with scores above the cut-off, although the results were not significant. This suggests that increased inflammatory cytokines may be associated with cognitive impairment. Conclusions: This preliminary study suggests that some patients may experience cognitive impairment during ICI treatment. As cancer patients are more at risk for cognitive impairment before treatment, a longitudinal study is warranted to confirm cognitive function both pre- and post-immunotherapy, along with objective measures of cognitive performance.

A prospective study to evaluate the prevelance of chemobrain (CB) in patients (pts) receiving adjuvant treatment.

e23174 Background: Although adjuvant chemotherapy (CT) significantly improves the clinical outcome of pts with early-stage (ES) cancer, it is also known to cause side-effects. CT-induced cognitive impairment or CB refers to a clinical condition characterized by lack of mental sharpness, memory and concentration impairment and difficulty in processing information and executing simple tasks. Prospective data regarding the emergence of CB are limited. We aimed to explore the prevalence and predictors for CB among pts receiving adjuvant CT and to evaluate its impact on their quality of life (QoL). Methods: This was a prospective cohort study conducted at the University Hospital of Larissa. Pts who were recently diagnosed with ES breast (BC) or colorectal (CRC) cancer and were about to receive adjuvant CT containing doxorubicin (D) or oxaliplatin (O), respectively, were eligible for this study (C1). The first control group (C2) consisted of ES cancer pts that were not eligible for adjuvant CT and the second group (C3) was recruited from a pool of healthy controls (HCs). All participants (pcs) met the following inclusion criteria: age &gt; 50 years old, ability to speak and write in Greek. Pts with pre-existing dementia/anxiety disorder and severe anemia were excluded from the study. Pts in C1 were assessed before receiving CT and 3 months after CT initiation. All subjects in C2 and C3 were assessed in 3 months intervals as well. After completion of the informed consent process, all pts and age-matched noncancer controls completed the Greek Version of Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog) to specifically assess CB. QoL was measured using the EORTC QLQ-C30. Results: Overall, 82 pts (53 with BC and 29 with CRC) were included in C1, 36 pts (24 with BC and 12 with CRC) in C2 and 15 pcs in C3. At baseline, pts in C1 and C2 had significantly lower FACT-Cog scores than healthy controls in C3 (p: 0.028 and p:0.038, respectively), indicating a higher prevalence of self-reported cognitive impairment among pts with cancer after a curative surgery compared to age-matched HCs. However, after 3 months of CT the majority of pts in C1 (59/82, 72%) demonstrated a decline in their cognitive performance (35/53, 66% in BC pts receiving D and 24/29, 82% in CRC pts receiving O). Pts with CRC receiving O experienced more severe cognitive deficits. On the contrary, 55% of the pts in C2 (20/36, 16 with BC and 4 with CRC) demonstrated an improvement. The presence of CB (decline in cognitive functioning in the absence of severe anemia) was associated with decreased QoL (p = 0.004). Pts were mostly frustrated by the difficulty in executing simple tasks. Conclusions: As demonstrated in one of the largest cohorts of pts with ES cancer, CB is a common problem among pts receiving adjuvant CT and is associated with detrimental impact on daily life. Creating awareness is crucial to offer cancer survivors the best care directed at improving QoL.

Abstract PO3-11-03: A Randomized Controlled Trial to Assess the Benefit of Art &amp; Music Therapy on Quality of Life in Patient with Breast Cancer

Abstract Introduction: Quality of life (QoL) in oncology captures the well-being of a patient and is considered a significant outcome criterion. Breast cancer (BC) is the most diagnosed cancer in women, however, standardizing integrative therapies to alleviate the burden of cancer and improve QoL is still an unmet need. Art and music therapy might mitigate psychological and emotional distress. We sought to evaluate their efficacy compared to control among patients with BC during or after active therapy. Methods: Seventy-six treated patients with Stages I-III BC were randomly assigned to art, music therapy, or routine oncology care standard of care arm (SOC) for 3 months and received two sessions per month by a licensed therapist (including in-person/virtual and group sessions). The primary outcome was an improvement in QoL measured by the Functional Assessment of Cancer Therapy–Breast (FACT-B) questionnaire and secondary outcomes included: cognitive function measured by Functional Assessment of Cancer Therapy–Cognition (FACT-Cog), response to a 4-component Cleveland Clinic Visual Analog Scale (CCVAS), indicators of anxiety and depression assessed by the Generalized Anxiety Disorder-7 item (GAD-7) and Patient Health Questionnaire-9 item (PHQ-9). All questionnaires were assessed at baseline, 30, 90, and 180 days. Statistical considerations included stratified randomization, and a mean difference in 15 points between either of the interventions. SOC arm was considered relevant at the 3-month mark. Mean improvement within groups was performed using paired t-tests whereas independent t-tests were used to evaluate mean improvement between interventions (1 or 2 vs. SOC arm). All analyses were performed using SPSS version 26 (IBM, Armonk, NY). Results: Forty-five participants completed the study to date and were included in the interim analysis. Median age was 58 (57-59), white race (51.1%), patients on active treatment (45%), art therapy group (n=16), music therapy (n=15) and standard of care (n=14). Significant improvement was noted in the art therapy arm at 3 months in FACT-B physical well-being (p=0.04), functional well-being (p=0.008) domains as well as GAD-7 (p=0.003), PHQ-9 (p=0.04) and FACT-Cog section “impact on quality of life” (p=0.03). At 6 months, the art therapy arm demonstrated lower scores in the CCVAS questionnaire total score, emotional distress (p=0.01) and anxiety (p=0.004) scales. Music therapy participants reported a significant improvement only in GAD-7 index(p=0.04) at 3 and 6 months compared to SOC. No significant difference was found between art and music therapy arms. Conclusion: Art therapy patients exhibited significant improvement in overall QoL (including anxiety, depression, improvement in cognitive function) and 4-scale CCVAS (emotional distress, anxiety, depression, and pain). Music therapy improved anxiety scores (GAD-7). Art and music therapy should be considered in the care of patients to manage cancer associated distress and improve their quality of life. Table 1. Comparison of test changes from 3 months to baseline within groups Table 2. Comparison of test changes from 6 months to baseline within groups Citation Format: Maria Herran, Mohamed Mohanna, Saad Sabbagh, Barbara Dominguez, Kaylee Sarna, Rachel Upton-Rice, Angie Burdine, Zeina Nahleh. A Randomized Controlled Trial to Assess the Benefit of Art &amp; Music Therapy on Quality of Life in Patient with Breast Cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-11-03.

Abstract 7454: Cognitive function in older breast cancer survivors after chemotherapy

Abstract Background: In the United States, over 60% of breast cancer survivors are 65 years and older; however, little is known about patient-reported symptoms and the effect that cancer treatments could have on survivors years after their primary treatment and diagnosis. This study evaluated perceived cognitive function in older breast cancer survivors and whether prior chemotherapy was associated with cognitive outcomes. Methods: Breast cancer patients aged 65 years and older, diagnosed 2012-2013, with local and regional stage disease, were identified through the linked Texas Cancer Registry-Medicare dataset (TCR). Survivors were mailed a survey to assess their cognitive function through the Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog V3) instrument (section G of the survey). The survey also collected demographic and clinical data and was collected between April 2018 and October 2019. Utilizing the data from the self-administered questionnaires, TCR, and Medicare claims, the cognitive function and quality of life among elderly patients were evaluated to assess whether prior chemotherapy and/or endocrine therapy impacts long-term health. A linear regression model was used to examine the significance of receiving chemotherapy to FACT-Cog V3 primary score while controlling for respondent sociodemographic and clinical variables. Results: Of 4,448 eligible patients, 1,954 (43.9% response rate) responded to section G. Of these, 1,065 respondents completed all 4 sections, 37 questions. Eighty of those 1065 respondents self-reported disease recurrence which excluded them from the analyses in order to avoid biases, leaving a total of 985 cases for this study. Median time from diagnosis to survey completion was 68 months (IQR 62-73). Receipt of chemotherapy was associated with a slightly lower FACT-Cog score. In total, those with chemotherapy scored, on average, 105.6 (SD 21.2) while those without scored 107.1 (SD 22.3). The largest difference in mean scores is attributed to the Perceived Cognitive Impairment subsection (scored from 0-72) where those with chemotherapy scored, on average, 57.2 (SD 13.8) and those without scored 58.7 (SD 14.0). Responsible Conduct Of Research: We need to ensure that the privacy of our patients will be protected when using their information from the surveys. Conclusion: Adjuvant chemotherapy was associated with more self-reported cognitive impairment in older breast cancer survivors, even 5-6 years after diagnosis. However, the difference between patients who received chemotherapy versus those who did not was modest, suggesting limited clinical significance. Further research is needed to determine the long-term impact of cancer treatments, particularly in older cancer survivors. Citation Format: Rachel Kim, Kai-Ping Liao, Susan Peterson, Daria Zorzi, Liang Li, Mariana Chavez MacGregor, Sharon Giordano. Cognitive function in older breast cancer survivors after chemotherapy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 7454.

Construction and validation of a risk-prediction model for chemotherapy-related cognitive impairment in patients with breast cancer.

To identify risk factors of chemotherapy-related cognitive impairment (CRCI) and construct and validate a visual prediction model of such for patients with breast cancer. A multicenter, descriptive, and cross-sectional design was adopted. Data were collected from ten public tertiary hospitals in China. Cognitive function was assessed by using Functional Assessment of Cancer Therapy-cognitive function. Socio-demographic, clinical, psychological, and physical indicators were also assessed. The logistic prediction model was constructed by fivefold cross-validation. Then, a nomogram was utilized to visualize the prediction model, which was also evaluated via discrimination, calibration, and decision curve analysis. A total of 71 breast cancer patients had CRCI with a prevalence of 9.58%. This visual prediction model was constructed based on education background, exercise frequency, chemotherapy times, and fatigue and demonstrated good discrimination, with an area under the receiver operating characteristic curve of 0.882. The calibration curve indicated good agreement between experimental and projected values, and the decision curve proved good clinical applicability. Education background, exercise frequency, chemotherapy times, and fatigue were associated with high incidence of CRCI. The prediction model exhibits superior performance and has promise as a useful instrument for assessing the likelihood of CRCI in breast cancer patients. Our findings could provide breast cancer survivors with risk screening based on CRCI predictors to implement prevention and early intervention, and help patients integrate into society and achieve comprehensive recovery.

Repeated surgical resections for management of high-grade glioma and its impact on quality of life.

High-grade gliomas (HGG) are aggressive cancers, and their recurrence is inevitable, despite advances in treatment options. While repeated tumor resection has been shown to increase survival rate, its impact on quality of life is not clearly defined. To address this gap, we compared quality of life (QoL) changes in HGG patients who underwent first-time (FTR) versus repeat surgical resections (RSR) for management of recurrence. Forty-four adults with HGG who underwent tumor resection were included in this study and classified into either the FTR group (n = 23) or the RSR group (n = 21). All patients completed comprehensive neuropsychological evaluations that included the Functional Assessment of Cancer Therapy-General (FACT-G) and Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog) scales, pre-operatively and at two weeks post-operatively. There was no difference between the FTR and RSR groups in any of the QoL indices (all p > .05), except for improved emotional well-being and worsened social well-being, suggesting minimal detrimental effects of repeat surgeries on QoL in comparison to first time surgery. These results suggest that repeated resection is a viable strategy in certain cases for management of HGG recurrence, with similar impact on QoL as observed in patients undergoing first time surgery. These encouraging outcomes provide useful insight to guide treatment strategies and patient and clinician decision making to optimize surgical and functional outcomes.

Cognitive function and its associated factors among patients with cancer pain: a multicentre cross-sectional study in China

ObjectiveThis research aimed to assess the levels of cognitive function and its contributing factors among individuals experiencing cancer pain (CP) in mainland China.DesignA descriptive, cross-sectional study.SettingThe investigation was undertaken within...

The association between inflammation-related biomarkers and the subtypes of cancer-related cognitive impairment in colorectal cancer patients: A latent profile analysis

PurposeCancer-related cognitive impairment (CRCI) has garnered considerable attention, yet limited research has delved into nuanced distinctions among varying degrees of CRCI in colorectal cancer survivors. This study aimed to identify distinct subgroups based on the patterns of CRCI, assess the heterogeneity among different subgroups, and investigate the potential correlations between the subgroups of CRCI and inflammation-related biomarkers. Methods268 colorectal cancer patients were enrolled in this cross-sectional study, followed by the Functional Assessment of Cancer Therapy-Cognitive Function. The determination of CRCI subgroups was accomplished by the latent profile analysis (LPA). The effects of inflammation-related biomarkers on CRCI were examined using the binary logistic regression analysis. The receiver operating characteristic (ROC) curves assessed the diagnostic efficacy of inflammation-related biomarkers. ResultsTwo latent profiles were identified: CRCI (n = 64, 23.88%) and non-CRCI (n = 204, 76.12%). Independent factors for CRCI in colorectal cancer patients were SIRI (OR = 3.248, 95%CI [1.197–8.807], P = 0.021) and ALI (OR = 0.962, 95%CI [0.937–0.989], P = 0.005). The areas under the curve (AUCs) for SIRI and ALI in predicting CRCI were 0.781 and 0.774, with the optimal cut-off values being 0.70 and 37.04, respectively. ConclusionsColorectal cancer patients exhibited divergent cognitive performance profiles, categorized into two subgroups based on LPA. SIRI and ALI were identified as independent factors for CRCI, demonstrating strong diagnostic accuracy. These two inflammation-related biomarkers may potentially be novel indicators to identify and manage the development of CRCI among colorectal cancer patients.

Effects of D-CAG chemotherapy regimen on cognitive function in patients with acute myeloid leukaemia: A resting-state functional magnetic resonance imaging study.

Post-chemotherapy cognitive impairment, also known as 'chemobrain', is a common neurotoxic complication induced by chemotherapy, which has been reported in many cancer survivors who have undergone chemotherapy. In this study, we aimed to explore the effects of D-neneneba dicitabine, C-nenenebb cytarabine, A-aclamycin, G-granulocyte colony-stimulating factor (D-CAG) chemotherapy on cognitive function in patients with acute myeloid leukaemia (AML) and its possible central mechanisms. Twenty patients with AML and 25 matched healthy controls (HC) were enrolled in this study. The cognitive function of patients before and after D-CAG chemotherapy was evaluated by the Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog). The resting-state functional magnetic resonance imaging data were collected from all patients before and after chemotherapy intervention, as well as HC. Then, resting-state functional magnetic resonance imaging data were preprocessed using DPABI software package and regional homogeneity (ReHo) values of brain regions were calculated. Finally, ReHo values between groups were compared by Resting-State fMRI Data Analysis software package with t-tests and Alphasim method was performed for multiple comparison correction. Moreover, associations between ReHo values of altered brain regions and the scores of FACT-Cog were analysed by Pearson correlation. The total FACT-Cog scores and four factor scores of AML patients increased significantly after treatment. ReHo values showed no significant changes in patients before treatment when compared with HC. Compared with HC, ReHo values of the right middle frontal gyrus, inferior frontal gyrus (opercular part), middle occipital gyrus, and left praecuneus decreased significantly, while ReHo values of the left inferior temporal gyrus, right middle temporal gyrus, and hippocampus increased significantly in patients after treatment. Compared with patients before treatment, ReHo values decreased significantly in the right middle frontal gyrus, inferior frontal gyrus (opercular part), and middle and inferior occipital gyri of patients after treatment. In addition, ReHo values of the right inferior frontal gyrus (opercular part) were negatively correlated with the total scores of FACT-Cog and factor scores of perceived cognitive impairment in patients after treatment. There were also negative correlations between ReHo values of the right middle frontal gyrus and perceived cognitive impairment scores. The present study confirmed that D-CAG chemotherapy might cause impaired subjective self-reported cognitive functioning in AML patients, which might be related to the decreased function of certain regions in the right prefrontal lobe. These findings provided further understanding of the mechanisms involved in post-chemotherapy cognitive impairment and would help develop new therapeutic strategies for 'chemobrain' in AML patients.

Feasibility of a remotely-delivered yoga intervention on cognitive function in breast cancer survivors: a mixed-methods study

BackgroundCancer-related cognitive impairment (CRCI) is a common, persistent quality of life complaint among breast cancer survivors (BCS), however there remain no proven treatments. There is emerging evidence that aerobic exercise and yoga may improve CRCI. There remains limited research on the safety and feasibility of virtually-supervised, remotely-delivered yoga interventions among cancer survivors, and no yoga studies to date have assessed cognitive function as a primary outcome in BCS. The purpose of this study was to explore the feasibility of an 8-week, remotely-delivered yoga intervention and examine its impact on cognitive function, fatigue, and exercise levels in BCS using a concurrent mixed-methods design.MethodsParticipants completed objective and self-report cognitive function measures (NIH Toolbox remote cognitive battery, PsyToolkit Task Switch test, Functional Assessment of Cancer Therapy-Cognitive Function [FACT-Cog3]); fatigue (Revised-Piper Fatigue Scale); and exercise activity level (modified Godin Leisure Time Exercise Questionnaire) before and after the yoga intervention. Semi-structured qualitative interviews were conducted post-intervention to understand participants' experiences with the yoga intervention, CRCI, and fatigue.ResultsThe intervention surpassed a priori feasibility indicators (adherence rate = 83.7%, attrition rate = 5.4%, no adverse events). Participants (n = 18, Mage= 52.2 ± 10.1) had significant improvements in objective memory, fatigue, and weekly minutes of moderate-to-vigorous exercise post-intervention. Qualitative themes indicated that participants found the remote intervention to be enjoyable and beneficial.ConclusionsIn this small proof-of-concept study, remotely-delivered yoga appears safe and effective at improving CRCI. Future randomized controlled trials examining the impact of remotely-delivered yoga interventions on cognitive function in BCS are warranted.

Validating the PROMIS cognitive function short form in cancer survivors.

The Patient-Reported Outcome Measurement Information System Cognitive Function Short Form 8a (PROMIS Cog) could provide a shorter, useful alternative to the often used Functional Assessment of Cancer Therapy - Cognition (FACT-Cog) in researchand clinical care. This study aimed to determine the convergent validity and internal reliability of the PROMIS Cog in 3 separate samples of breast cancer survivors and to explore clinical cut points. Data from three samples of breast cancer survivors were used for this secondary analysis. Convergent validity was determined by evaluating correlation strength among the derived PROMIS Cog and measures of depression, anxiety, stress, fatigue, sleep, loneliness, the FACT-Cog . Clinical cut-points for the PROMIS Cog were determined by plotting the receiver operating characteristic curves. 3 samples of breast cancer survivors (N = 471, N = 132, N = 90) were included. Absolute values of correlations demonstrating convergent validity ranged from 0.21 to 0.82, p's < 0.001, and were comparable to correlations with the full FACT-Cog 18 item perceived cognitive impairments(PCI) scale. ROC curve plots indicated a clinical cut off < 34 for the combined sample. The 8-item PROMIS Cog demonstrated good convergent validity and internal reliability in breast cancer survivors, comparable to the 18-item FACT-Cog PCI. The PROMIS Cog 8a is a brief self-report measure that can be easily incorporated into cancer-related cognitive impairment research designs or used in clinical settings.

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.

The effect of a reduced dose of enzalutamide on fatigue and cognition.

5051 Background: Enzalutamide (ENZA) is a highly effective treatment for patients (pts) with metastatic prostate cancer, but central nervous system (CNS)-associated side effects occur frequently and may hamper the quality of life. These side effects are addressed with dose reductions, while they potentially can be prevented by starting at a reduced dose, since androgen receptor saturation is already observed at dose levels above 60 mg once daily (OD) and ENZA plasma concentrations &gt; 5 mg/L. We hypothesized that a lower starting dose of ENZA can reduce the risk of CNS side effects in frail pts while preserving efficacy. In this study (NCT03927391) the effect of a reduced dose of ENZA on fatigue and cognitive side effects is determined. Methods: This randomized multi-center trial compared the ENZA standard dose of 160 mg OD to the reduced dose of 120 mg OD in frail prostate cancer pts. At baseline, and 6, 12, and 24 weeks after start of ENZA, fatigue and cognitive side effects were measured by the Functional Assessment of Chronic Illness Therapy–Fatigue (FACIT-F) and Functional Assessment of Cancer Therapy-Cognition (FACT-Cog) questionnaires. A change in scores of 3.0 for the FACIT-F and 7.0 for the FACT-Cog was considered clinically relevant. Linear mixed effects models were used to study within and between-group differences in fatigue and cognitive side effects over time. Furthermore, ENZA plasma concentrations were measured after 6, 12, and 24 weeks of treatment and PSA response (&gt;50% PSA decline) was compared between the two dosing regimens. Results: A total of 51 pts were included (25 reduced dose, 26 standard dose). Completion rates for the questionnaires were high throughout the study (&gt;90%). Pts treated at the reduced dose showed no significant changes in FACIT-F and FACT-Cog scores over time. Pts treated at the standard dose showed increasingly worse FACIT-F and FACT-Cog scores. This resulted in clinically relevant and statistically significant better FACIT-F and FACT-Cog scores for pts treated at the reduced dose compared to pts treated at the standard dose after 24 weeks (table). All pts had therapeutic ENZA concentrations (&gt;5 mg/L) throughout the study. PSA response did not differ between both groups (87% for 120mg OD vs 80% for 160mg OD, p=0.796). Conclusions: By starting with a reduced dose of ENZA of 120mg OD CNS side effects can be prevented, which might beneficially affect the quality of life of frail prostate cancer pts, without any indication of interference with efficacy endpoints. Clinical trial information: NCT03927391 . [Table: see text]

Epigenetic aging in older breast cancer survivors and noncancer controls: preliminary findings from the Thinking and Living with Cancer Study.

Cancer and its treatments may accelerate aging in survivors; however, research has not examined epigenetic markers of aging in longer term breast cancer survivors. This study examined whether older breast cancer survivors showed greater epigenetic aging than noncancer controls and whether epigenetic aging related to functional outcomes. Nonmetastatic breast cancer survivors (n=89) enrolled prior to systemictherapy and frequency-matched controls (n=101) ages 62 to 84years provided two blood samples to derive epigenetic aging measures (Horvath, Extrinsic Epigenetic Age [EEA], PhenoAge, GrimAge, Dunedin Pace of Aging) and completed cognitive (Functional Assessment of Cancer Therapy-Cognitive Function) and physical (Medical Outcomes Study Short Form-12) function assessments at approximately 24 to 36 and 60 months after enrollment. Mixed-effects models tested survivor-control differences in epigenetic aging, adjusting for age and comorbidities; models for functional outcomes also adjusted for racial group, site, and cognitive reserve. Survivors were 1.04 to 2.22years biologically older than controls on Horvath, EEA, GrimAge, and DunedinPACE measures (p=.001-.04) at approximately 24 to 36months after enrollment. Survivors exposed to chemotherapy were 1.97 to 2.71years older (p=.001-.04), and among this group, an older EEA related to worse self-reported cognition (p=.047) relative to controls. An older epigenetic age related to worse physical function in all women (p<.001-.01). Survivors and controls showed similar epigenetic aging over time, but Black survivors showed accelerated aging over time relative to non-Hispanic White survivors. Older breast cancer survivors, particularly those exposed to chemotherapy, showed greater epigenetic aging than controls that may relate to worse outcomes. If replicated, measurement of biological aging could complement geriatric assessments to guide cancer care for older women.

Feasibility and Acceptability of a Virtual "Coping with Brain Fog" Intervention for Improving Cognitive Functioning in Young Adults with Cancer.

Purpose: Cancer-related cognitive deficits (CRCDs) are common among young adults (YAs) (ages: 18-39) with cancer and can be debilitating. We aimed to determine the feasibility and acceptability of a virtual Coping with Brain Fog intervention among YAs with cancer. Our secondary aims were to explore the intervention's effect on cognitive functioning and psychological distress. Methods: This prospective feasibility study involved eight weekly, 90-minute virtual group sessions. Sessions focused on psychoeducation on CRCD, memory skills, task management, and psychological well-being. The primary outcomes were feasibility and acceptability of the intervention evaluated through attendance (>60% not missing >2 consecutive sessions) and satisfaction (Client Satisfaction Questionnaire [CSQ] score >20). Secondary outcomes included the following: cognitive functioning (Functional Assessment of Cancer Therapy-Cognitive Function [FACT-Cog] Scale) and symptoms of distress (Patient-Reported Outcomes Measurement Information System [PROMIS] Short Form-Anxiety/Depression/Fatigue) and participants' experiences using semistructured interviews. Paired t-tests and summative content analysis were used for quantitative and qualitative data analyses. Results: Twelve participants (five male, mean age = 33 years) were enrolled. All but one participant met feasibility criteria of not missing >2 consecutive sessions (11/12 = 92%). The mean CSQ score was 28.1 (standard deviation 2.5). Significant improvement in cognitive function as measured by FACT-Cog Scale was observed postintervention (p < 0.05). Ten participants adopted strategies from the program to combat CRCD, and eight reported CRCD symptom improvement. Conclusion: A virtual Coping with Brain Fog intervention is feasible and acceptable for the symptoms of CRCD among YAs with cancer. The exploratory data indicate subjective improvement in cognitive function, and will inform the design and implementation of a future clinical trial. ClinicalTrials.gov Registration: NCT05115422.

Effects of cognitive rehabilitation interventions on non-central nervous system cancer survivors: A meta-analysis

IntroductionCancer treatments can have a detrimental impact on cancer survivors’ cognitive function. Cognitive rehabilitation is considered the first-line intervention to address cognitive difficulties of cancer survivors. Nevertheless, its efficacy remains unclear.ObjectivesThis meta-analysis aimed to understand the effects of cognitive rehabilitation in non-central system (non-CNS) cancer survivors, through the assessment of the overall efficacy on subjective cognitive outcomes.MethodsThis meta-analysis was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. An electronic search on the databases PubMed, Scopus, and Web of Science was conducted in May 2021, considering the past 15 years, by two independent authors. Studies were eligible if they included cancer survivors (excluding CNS cancers) who were exposed to cognitive rehabilitation interventions, in which the subjective cognitive effects were measured through self-report questionnaires. The quality of studies was assessed using the Cochrane Risk of Bias Tool for Randomized Trials. The effect size was the standardized mean difference in the cognitive assessment, between baseline and post-intervention. Statistical heterogeneity was assessed using I2 Statistic. Publication bias was evaluated with Egger’s test. P&lt;0.05 was considered statistically significant. The meta-analysis was performed using R software.ResultsAmong 14 studies, with 1115 cancer survivors, one study included a pediatric population, other young adult survivors, and the remaining adult population. The most used scale for measuring cognitive changes was the Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog) and, as recommended, the Perceived Cognitive Impairments (PCI) subscale was used as the primary measure of subjective cognitive function. Results indicated beneficial effects following cognitive rehabilitation, with an overall standard mean difference between pre- and post-treatment of 3.4447, with CI95% [1.5543; 5.3350], p-value&lt;0.0004. The subgroup analysis between the measures of cognitive outcomes showed that the heterogeneity is Group=Other 0.00% (I2) and for the Group=FACT-Cog PCI is 86% (I2). Analyzing the FACT-Cog PCI, the CI95% [-2.93; 6.43] includes 0, meaning that the overall effect in this subgroup is non-significant. The meta-analysis does not demonstrate publication bias (p-value of the Egger test=0.3220).ConclusionsImprovement of cognitive function in non-CNS survivors throughout cognitive rehabilitation appears to be effective. The findings of this meta-analysis can help inform clinical practice and assist practitioners in recommending and developing interventions of cognitive rehabilitation and deciding how to evaluate them. Further research is required to strengthen this evidence.Disclosure of InterestNone Declared

A scoping review of cognitive assessment tools and domains for chemotherapy-induced cognitive impairments in cancer survivors.

Cancer survivors suffer from specific symptoms known as chemotherapy-induced cognitive impairments (CICIs). CICIs are difficult to capture with existing assessments such as the brief screening test for dementia. Although recommended neuropsychological tests (NPTs) exist, international consensus and shared cognitive domains of assessment tools are unknown. The aim of this scoping review was as follows: (1) to identify studies that assess CICIs in cancer survivors; (2) to identify shared cognitive assessment tools and domains by mapping the domains reported in studies using the International Classification of Functioning, Disability and Health (ICF) framework. The study followed the recommendations made by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. We searched the following three databases through October 2021: PubMed, CINAHL, and Web of Science. Prospective longitudinal or cross-sectional studies were selected to determine CICI-specific assessment tools for adult cancer survivors. Sixty-four prospective studies (36 longitudinal studies and 28 cross-sectional studies) were included after checking for eligibility. The NPTs were divided into seven main cognitive domains. The specific mental functions were often used in the order of memory, attention, higher-level cognitive functions, and psychomotor functions. Perceptual functions were used less frequently. In some ICF domains, shared NPTs were not clearly identified. In some different domains, the same NPTs were used, such as the trail making test and the verbal fluency test. When the association between the publishing year and the amount of NPT use was examined, it was found that the amount of tool use tended to decline over the publication years. The Functional Assessment of Cancer Therapy-Cognitive function (FACT-Cog) was a shared consensus tool among the patient-reported outcomes (PROs). Chemotherapy-induced cognitive impairments are currently gaining interest. Shared ICF domains such as memory and attention were identified for NPTs. There was a gap between the publicly recommended tools and the tools actually used in the studies. For PROs, a clearly shared tool, FACT-Cog, was identified. Mapping the domains reported in studies using the ICF can help in the process of reviewing consensus on which NPTs may be used to target cognitive domains. https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000053710, identifier UMIN000047104.

Cognitive functioning in women with breast cancer: psychometric properties of the Arabic version of the Functional Assessment of Cancer Therapy-Cognitive Function Tool

BackgroundThe Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog) evaluates perceived cognitive functioning and their impact on quality of life. This study was designed to evaluate the factors associated with cognitive functioning in a sample of women with breast cancer (BC) in Lebanon. We also sought to explore the psychometric properties of the FACT-Cog Arabic version.MethodsA cross-sectional study was carried out between March and August 2020 among women with BC. Socio-demographic and clinical characteristics were collected. In addition, patients were asked to complete the FACT-Cog Arabic version as well as the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire 30, the Patient Health Questionnaire (PHQ-9), and the Generalized Anxiety Disorder (GAD-7). The internal consistency of the FACT-Cog tool was evaluated using Cronbach’s alpha. Content, convergent, and known group validity of the FACT-Cog Arabic version were also evaluated. All statistical analyses were performed using SPSS version 23.0.ResultsA sample of 134 women with BC was collected. Internal consistencies of the FACT-cog total scale and its subscales were high (Cronbach’s α between 0.83 and 0.95). The convergent validity of the FACT-Cog Arabic version was supported by the positive correlation with the EORTC-cognitive functioning subscale. Moreover, negative correlations were found between FACT-Cog scale and fatigue, pain, anxiety, as well as depression. Known-group validity was supported by the statistically significant mean differences of the FACT-Cog total scale between patients in early (I &II) and late (III & IV) BC stages. Unmarried BC patients as well as those having higher depressive symptoms and a lower quality of life were found to be at higher risk of cognitive impairment.ConclusionThe FACT-Cog Lebanese Arabic version is a valid and reliable tool for assessing perceived cognitive functioning in BC women. Higher level of depression and impaired quality of life were associated with a decline in cognitive functioning.

Social Support, social ties, and cognitive function of women with breast cancer: findings from the Women’s Health Initiative (WHI) Life and Longevity After Cancer (LILAC) Study

PurposeThis study examined associations between self-reported cognitive functioning and social support as well as social ties among women with breast cancer.MethodsThe study included 3351 women from the Women’s Health Initiative Life and Longevity After Cancer cohort who were diagnosed with breast cancer stages I–III. Social support was assessed using a modified Medical Outcomes Study (MOS) Social Support Survey, and marital status was obtained from the baseline questionnaire. We also assessed social ties (e.g., number of friends, relatives, living children) and cognitive function (Functional Assessment of Cancer Therapy-Cognitive Function [FACT-COG]) on the year-1-follow up questionnaire. Multivariable quantile regression was used to estimate the changes in median cognitive scores. Kruskal–Wallis tests were used to assess the association of cognitive function with social ties.ResultsThe majority of participants were non-Hispanic White (93.3%), presently married (49%), with at least a 4-year college degree (53.2%), and had been diagnosed with localized breast cancer (79%). A 10-point higher social support score correlated to a 0.32 higher (better) median cognitive score (p < 0.001). Women who were presently married tended to have better cognition than women who were divorced/separated or widowed (p = 0.01). Significant associations were also present for having close relatives (p < 0.001) or friends (p < 0.001), with cognitive scores being higher in those with at least one close relative or friend compared to none.ConclusionWomen reporting higher social support and greater numbers of friends or relatives have higher cognitive functioning. Compared to divorced or separated women, married women were likely to have higher cognitive functioning. These findings suggest that social support assessments have the potential to help identify women at higher risk of cognitive decline.