Impairment In Breast Cancer Patients Research Articles

The prevalence of mild cognitive impairment in breast cancer patients receiving chemotherapy according to the criteria of the National Institute on Aging-Alzheimer's Association (NIA-AA).

Breast cancer patients receiving chemotherapy can develop cognitive impairment. There is no gold standard for defining cognitive impairment. We applied the National Institute on Aging-Alzheimer's Association (NIA-AA) criteria for mild cognitive impairment (MCI) to determine its prevalence in breast cancer patients receiving adjuvant chemotherapy and examine differences between patients with and without MCI. We used pre-existing cognitive data on 5 neuropsychological test outcomes (verbal memory, processing speed, executive functioning, and verbal fluency) gathered from 240 breast cancer patients who received adjuvant conventional (n = 154) or high-dose chemotherapy (n = 86). Assessments occurred 6 or 12months post-chemotherapy and results were compared with data from 66 women without cancer. MCI was defined by the following: (i) presence of concern regarding a change in cognition, (ii) impairment in one or more cognitive tests (1.5 standard deviation below a normative mean), (iii) preservation of independence in functional abilities, and (iv) the absence of dementia. Twenty percent (n = 49) of breast cancer patients who received chemotherapy (conventional therapy n = 29 (12%), high-dose therapy = 20 (8.3%)) met the criteria for MCI, compared with 7.6% (n = 5) of controls. Prevalence was significantly different between patients and controls (P = 0.020, and corrected for IQ P < 0.001). Patients with MCI had significant lower education levels (P < 0.002) and premorbid IQ (P = 0.001) compared with patients without MCI. Twenty percent of breast cancer patients treated with chemotherapy met NIA-AA criteria for MCI, compared with 7.6% of the controls. These criteria, which include formal test performance as well as a person's symptoms and functional status, can be useful in clinical practice and scientific research.

Physical Functional Impairment in Breast Cancer Patients: A Cross-Sectional Expert Survey.

Anti-cancer treatment imparts a variety of physical impairments that cause limitations in physical functioning among women with breast cancer. The aim of the study was to explore the opinions of healthcare professionals (HCPs) working with breast cancer patients on various aspects of physical functional impairments in breast cancer patients and survivors (BCP&S). The study was a cross-sectional survey. Taking into consideration the literature definition of 'physical function', its determinants, and literature published on relevant clinical factors in breast cancer, a survey questionnaire containing 29 questions was constructed. Thirty-seven HCPs, including physiotherapists, occupational therapists, and medical cancer experts, participated in the study. The participant's responses were obtained using a 5-point 'Agreement' Likert scale. Data analysis included a frequency table and the reliability test (Cronbach's alpha). The reliability of the questionnaire used in the survey was found to be acceptable (Cronbach's alpha = 0.891). The majority of the participants were of the opinion that various parameters and determinants of 'physical function' get adversely affected in BCP&S, leading to limitations in the performance of activities of daily living (e.g., dressing and bathing), particularly in elderly and frail women. Participants agreed that such impairments in physical functioning affect social and role functioning and the overall quality of life (QoL) of women with breast cancer negatively. This study found that various parameters and determinants of physical functioning are adversely affected in BCP&S, and physical functional impairments are prevalent in women with breast cancer, affecting their QoL negatively. Implications for breast cancer patients: This study points out the need for long-term surveillance of BCP&S for physical functional limitations and a proactive treatment approach to prevent such limitations.

Effect of Taichi on cognitive function in Breast cancer patients undergoing radiotherapy: A randomized controlled trial

ObjectiveTo evaluate the short-term effect of Tai Chi on cognitive function in breast cancer patients undergoing radiotherapy compared to the control group receiving moderate intensity walking. DesignParallel, single blinded, randomized controlled trial. SettingMangaluru, Karnataka, India. Participants44 female post-surgery Breast cancer patients undergoing radiotherapy. InterventionsBased on the inclusion criteria patients were randomly assigned into two groups of 22 each. Group A received the Taichi intervention and Group B received the moderate-intensity walking for 30 min,5 times per week for 3 weeks. Outcome measureFunctional Assessment of Cancer Therapy Cognitive scale version 3 (FACT-Cog 3) RandomisationEach random number was concealed separately within a small opaque envelope (SNOSE) and the subjects were equally allocated into two groups with an allocation of 1:1. Statistical analysisIndependent sample t-test for between the group comparison and paired t-test for within the group comparison. ResultsThere were no statistically significant results found between the groups (p-value > 0.05). ConclusionThe present randomized controlled trial showed that Tai Chi did not improve the cancer-related cognitive Impairment in Breast cancer patients compared to moderate intensity walking. Clinical Trial Registration number: CTRI/2021/08/036012.

Association of Circulating Levels of Inflammatory Cytokines and Chemotherapy-Associated Subjective Cognitive Impairment in a South African Cohort of Breast Cancer Patients

Background: The evidence links chemotherapy to cognitive impairment in breast cancer patients. This study assessed the link between subjective chemotherapy-related cognitive impairment and neuroinflammation in breast cancer patients. Methods: In a correlational study, 113 patients aged 21 to 60 years on chemotherapy regimens completed the Functional Assessment of Cancer Therapy-Cognition Test (FACT-Cog) as a measure of subjective cognitive functioning at three time points (baseline- T0, third cycle- T1, and sixth cycle- T2). The levels of inflammatory cytokines (interleukin-1 beta (IL-1β), interleukin-6 (IL-6), interleukin-8 (IL-8), and tumour necrosis factor-alpha (TNF-α)) were measured using an assay method and compared with the subjective cognitive impairment. Results: Midway through chemotherapy, higher levels of TNF-α were inversely linked with self-perceived cognitive performance, while higher levels of IL-1β were positively associated (p = 0.030). However, at the end of chemotherapy, only IL-8 (p = 0.50) was associated with higher self-perceived cognitive problems. Conclusions: The specific roles that various cytokines and their interactions may play in neuroinflammation or neuroprotection require further investigation.

Sexual dysfunctions in breast cancer patients: evidence in context.

In breast cancer patients, endocrine therapy may exert a negative impact on sexual functioning in both genders, with potentially relevant consequences concerning quality of life and treatment adherence. The availability of effective interventions to maintain and/or restore sexual health in breast cancer patients is a key issue to a research agenda. To summarize and critically discuss the most updated and qualitatively relevant literature on the therapeutic approach to sexual impairment in breast cancer patients, with a focus on patients treated with endocrine therapy. We searched PubMed from its inception to February 2022 for observational and intervention trials including participants with sexual dysfunctions. We were particularly interested in studies of breast cancer patients with sexual dysfunctions while undergoing endocrine therapy. We developed a search strategy with the aim of maximizing the number of articles considered for screening and potential inclusion. Forty-five studies were selected: 3 observational and 42 intervention studies. Thirty-five studies were exclusively focused on female breast cancer populations. We could not identify studies exclusively focused on or also including male breast cancer patients. Overall, in female patients, the available armamentarium encompasses vaginal lubricants, moisturizers, estrogens, dehydroepiandrosterone, CO2 laser, ospemifene, and counseling. None of these interventions has been demonstrated to completely solve sexual dysfunctions when singularly considered. More favorable outcomes have come from the combination of different therapies. In female breast cancer, future research is oriented toward the gain of evidence on combined therapies and long-term data on safety issues on the most promising interventions. The lack of evidence on sexual disturbances in male breast cancer patients remains a major concern.

Evaluating Cardiotoxicity in Breast Cancer Patients Treated with HER2 Inhibitors: Could a Combination of Radionuclide Ventriculography and Cardiac Biomarkers Predict the Cardiac Impact?

(1) Background: The aim of our study was to determine whether monitoring cardiac function through RNV and cardiac biomarkers could predict the cardiac impact of combined therapy with trastuzumab, pertuzumab and docetaxel, which are regularly used nowadays to treat HER2-positive breast cancer. (2) Methods: This prospective monocentric study included 22 patients, diagnosed with HER2-positive breast cancer, who had their LVEFs and cardiac biomarkers evaluated both at the beginning of their treatment and after 6 months. Among all of the enrolled patients, two blood specimens were collected to assess circulating cardiac biomarkers. RNV was performed in each patient after "in vivo" radiolabeling of the erythrocytes. The obtained results were then statistically correlated. (3) Results: The average LVEF decrease between the two time points was approximately 4%. Of the five biomarkers we considered in this paper, only NT-proBNP correlated with the LVEF values obtained both in the baseline study and after 6 months of follow-up (r = -0.615 for T0 and r = -0.751 for T1, respectively). ST2/IL-33R proved statistically significant at the T1 time point (r = -0.547). (4) Conclusions: A combination of LVEF, NT-proBNP and ST2/IL-33R assessment may be useful for early detection of cardiac impairment in breast cancer patients treated with trastuzumab, pertuzumab and docetaxel.

Effectiveness of Nonpharmacologic Interventions for Chemotherapy-Related Cognitive Impairment in Breast Cancer Patients: A Systematic Review and Network Meta-analysis.

Neurotoxicity is a major adverse effect of chemotherapy in breast cancer (BC) patients. A number of nonpharmacologic interventions are used to alleviate chemotherapy-related cognitive impairment (CRCI), but no studies have compared their effectiveness. The aim of this study was to identify and compare the effectiveness of different nonpharmacologic interventions for CRCI in BC patients. A systematic review and network meta-analysis was conducted following the Cochrane guidelines. All randomized controlled trials were searched in the Cochrane Library, PubMed, MEDLINE (via OVID), Web of Science, EMBASE, and CINAHL databases from inception to September 2021. Studies using nonpharmacologic interventions to manage CRCI symptoms were included. A network meta-analysis and a comparative effects ranking were completed by STATA v14.0. Twelve studies with 8 nonpharmacologic interventions were included. For subjective outcomes on CRCI, there was no significant difference between nonpharmacologic interventions. For objective outcomes, qigong and exercise were more effective than the psychotherapy. Qigong and exercise were also more effective than music therapy. The top 3 interventions were psychotherapy (83.4%), music therapy (60.8%), and electroacupuncture (52.5%) for subjective outcomes and qigong (87.7%), exercise (82.1%), and electroacupuncture (70.3%) for objective outcomes. In the subjective evaluation, it was difficult to judge which interventions are best, but psychotherapy had the greatest probability. For objective evaluation, qigong and exercise may be the best nonpharmacologic interventions. This study provides evidence for the effectiveness of nonpharmacologic interventions for CRCI in BC patients and facilitates support for future clinical trials and work.

The alterations in event-related potential responses to pain empathy in breast cancer survivors treated with chemotherapy.

BackgroundPrevious findings indicated that breast cancer patients often have dysfunction in empathy and other cognitive functions during or after chemotherapy. However, the manifestations and possible neuro-electrophysiological mechanisms of pain empathy impairment in breast cancer patients after chemotherapy were still unknown.ObjectiveThe current study aimed to investigate the potential correlations between pain empathy impairment and event-related potentials (ERP) in breast cancer patients undergoing chemotherapy.MethodsTwenty-two breast cancer patients were evaluated on a neuropsychological test and pain empathy paradigm before and after chemotherapy, containing the Chinese version of the Interpersonal Reactivity Index (IRI-C), while recording ERP data.ResultsThe empathic concern scores were lower and personal distress scores were higher on IRI-C task compared with those before chemotherapy (t = 3.039, p < 0.01; t = −2.324, p < 0.05, respectively). Meanwhile, the accuracy rates were lower than those before chemotherapy for both pain and laterality tasks on the pain empathy paradigm (F = 5.099, P = 0.035). However, the response time was no significant differences before and after chemotherapy (F = 0.543, P = 0.469). Further, the amplitude of the N1 component was significantly increased (F = 38.091, P < 0.001), and the amplitude of the P2 component was significantly decreased (F = 15.046, P = 0.001) in the subsequent ERP study. A linear mixed effect model was used to analyze the correlation, the average amplitude of N1 and P2 were positively correlated with the accuracy rates in laterality tasks (r = 1.765, r = 1.125, respectively, P < 0.05).ConclusionThe results indicated that pain empathy impairment was performed in chemotherapeutic breast cancer patients, which was possibly correlated to the changes of N1 and P2 components in ERP. These findings provide neuro-electrophysiological information about chemo-brain in breast cancer patients.

Association of chemotherapy and subjective cognitive impairment in breast cancer patients: Meta-analysis of longitudinal prospective cohort studies.

This meta-analysis with longitudinal prospective cohort studies aimed to (a) determine whether chemotherapy is associated with time-dependent subjective cognitive impairment outcomes in breast cancer patients, and (b) identify the time point with the highest impact of chemotherapy on subjective cognitive impairment. Data were gathered from PubMed, EMBASE, CINAHL, PsycInfo, and the Cochrane Library. The mean differences of the subjective cognitive impairment level between the chemotherapy-treated patients and controls (patients not treated by chemotherapy and healthy subjects) were calculated using effect sizes (Hedges' g) by clinical time periods. The five clinical time periods were (a) baseline, (b) during chemotherapy, (c) within 1 month postchemotherapy, (d) within 1 year postchemotherapy, and (e) 1 year or longer postchemotherapy. Longitudinal data from nine data sets from 13 studies were pooled and analyzed. At baseline, chemotherapy-treated patients showed slightly better subjective cognitive impairment compared to patients not treated by chemotherapy and did not differ from healthy controls. Yet, the chemotherapy-treated patients had significantly worse subjective cognitive impairment compared to both type of controls after initiating chemotherapy. The effect sizes for the group differences were larger for the group comparison with healthy controls than the nonchemotherapy control (-0.50 vs. -0.19). The largest effects were found within 1 month postchemotherapy (-0.85), suggesting the acute impact of chemotherapy. Chemotherapy is associated with subjective cognitive impairment. The impact of chemotherapy appears to be an acute rather than a chronic side effect. Clinicians must consider including the assessment and management of subjective cognitive impairment in their routine practice.

Quantifying Risk of Ipsilateral Arm Lymphedema Causing Functional Impairment in Breast Cancer Patients: Results From a Prospective, Multi-Centre International Study of Treatment Toxicity

Breast cancer related lymphedema (BCRL) of the ipsilateral arm remains a highly morbid long-term side effect of breast cancer treatment, one which can lead to functional impairment. We sought to independently examine clinical and treatment related risk factors for the development of lymphedema-associated functional impairment.The REQUITE Consortium is a multi-center cohort study of patients with breast cancer treated at 26 hospitals in 8 countries from 2014-2017 who were prospectively evaluated for treatment toxicity. All patients received lumpectomy and adjuvant radiotherapy (RT) with or without chemotherapy at the discretion of their treating physician, and were enrolled prior to beginning RT. Arm circumference measurements and patient reported outcome (PRO) toxicity assessments were obtained before RT and annually after RT for a minimum of two years. Lymphedema-associated functional impairment was determined by PRO lymphedema that constrains activity and self-care. Grade 2+ BCRL was defined as ≥10% discrepancy in ipsilateral arm circumference compared to the contralateral arm. Cumulative incidence curves were stratified by the extent of axillary surgery and RT. Multivariable Cox models adjusted for axillary surgery, radiation, body mass index, and chemotherapy.The cohort included 1921 patients followed for a median of 27 months: 1345 received sentinel node biopsy (SLNBx) alone, 90 received SLNBx and regional lymph node RT (RLNR), 136 received axillary node dissection (ALND) alone, 200 received ALND+RLNR, and 150 received no axillary treatment. Invasive breast cancer was present in 1678 (87%) patients, while 591 (30.7%) received chemotherapy. Among the whole cohort, four times as many patients reported functional impairment than Grade 2+ BCRL (4.6% vs 1.1%). On multivariable analysis, taxane-based chemotherapy resulted in a significantly higher risk of functional impairment (hazard ratio [HR] 1.90, P = 0.01), as did ALND (HR 11.92, P = 0.02) and higher BMI (HR 1.06, P < 0.001). Although RLNR and SLNBx did not confer significantly higher risk on multivariable analysis when evaluated individually, the SLNBx+RLNR treatment group demonstrated a trend towards significantly higher risk of functional impairment compared to no axillary treatment (HR 8.21, P = 0.05). The risk of functional impairment was highest in those receiving ALND+RLNR (HR 15.52, P = 0.008) and ALND alone (HR 14.58, P = 0.01), with a 3-year cumulative incidence rate of 21% in both groups.Patients treated with taxane-based chemotherapy and those receiving more extensive axillary surgery are at significantly higher risk of developing ipsilateral arm lymphedema causing functional impairment. Additional variation in this toxicity may be due to genetic predisposition, which is under investigation in REQUITE. Lymphedema-associated functional impairment occurred substantially more often than Grade 2+ BCRL, highlighting the importance of capturing PROs.

Multimodal Web-Based Intervention for Cancer-Related Cognitive Impairment in Breast Cancer Patients: Cog-Stim Feasibility Study Protocol.

Simple SummaryCognitive difficulties and their impact on patients’ quality of life are frequently reported by patients treated for breast cancer, who ask for support to improve these difficulties. Cognitive stimulation and physical activity resulted as beneficial for cognitive difficulties, but they are challenging to generalize in hospitals. To overcome this limitation, home-based computerized interventions have been proposed. In this study, the feasibility of a combined intervention of web-based cognitive stimulation and physical activity among breast cancer patients undergoing radiotherapy will be investigated. The overall goal is to develop interventions for cognitive difficulties adapted to supportive care units.Cancer-related cognitive impairment (CRCI) is a frequent side-effect of cancer treatment, with important consequences on patients’ quality of life. Cognitive stimulation and physical activity are the most efficient in improving cognitive impairment, but they are challenging to generalize in hospitals’ routine and to patients’ needs and schedules. Moreover, the added value of a combination of these interventions needs to be more investigated. The Cog-Stim study is an interventional study investigating the feasibility of a web-based multimodal intervention (combining cognitive stimulation and physical activity for the improvement of cognitive complaints among breast-cancer patients currently treated with radiotherapy (n = 20). Patients will take part in a 12-week program, proposing two sessions per week of web-based cognitive stimulation (20 min/session with HappyNeuron®) and two sessions per week of web-based physical activity (30 min/session with Mooven® platform). Cognitive complaints (FACT-Cog) and objective cognitive functioning (CNS Vital Signs®), anxiety, depression (HADS), sleep disorders (ISI) and fatigue (FACIT-Fatigue) will be assessed before and after the intervention. The primary endpoint is the adherence rate to the intervention program. Patients’ satisfaction, reasons for non-attrition and non-adherence to the program will also be assessed. The overall goal of this study is to collect information to develop web-based interventions for cognitive difficulties in supportive care units.

125P Cognitive impairment in breast cancer patients up to 18 months after cancer treatments: The French multicentric longitudinal CANTO-Cog cohort substudy

125P Cognitive impairment in breast cancer patients up to 18 months after cancer treatments: The French multicentric longitudinal CANTO-Cog cohort substudy

Chemotherapy-related subjective cognitive impairment in breast cancer patients in semi-rural South Africa

BackgroundBreast cancer is the most commonly diagnosed cancer amongst women worldwide. Whilst current evidence indicates the therapeutic benefits from the use of chemotherapy, self-perceived cognitive difficulties emerged as a frequent occurrence during and after chemotherapy treatment in breast cancer patients.AimThe current study sought to investigate self-perceived cognitive impairment in a group of breast cancer patients in semi-rural South Africa.SettingThe patients were recruited from an outpatient oncology clinic at a semi-rural, tertiary academic hospital in Gauteng, South Africa.MethodsIn a randomised, quantitative, time-based series study, 30 female patients aged 21–60 years (mean age = 50 years) diagnosed with stages II and III breast cancer on CMF (cyclophosphamide, methotrexate, fluorouracil) (n = 10) and FAC (fluorouracil, adriamycin, cyclophosphamide) (n = 20) chemotherapy regimens, completed the self-reported Functional Assessment of Cancer Therapy-Cognition (Fact-Cog) test as a measure of subjective cognitive functioning at three points during the course of treatment (T0, T1, T2).ResultsThe results of the paired sample t-tests showed the scores on the Fact-Cog test confirmed significant cognitive decline for both treatment groups from baseline (T0) to completion (T2) of chemotherapy; CMF group, t (9) = 2.91, p = 0.017 and the FAC group t (19) = 4.66, p < 0.001.ConclusionThis study confirms that self-reported subjective cognitive impairment is common in breast cancer patients who received chemotherapy in a sample of South African patients. The results have implications for the overall care of cancer patients.ContributionThe context-based knowledge engendered by the current study is expected to augment the continuum of care for breast cancer patients.

Increased resting-state cerebellar-cortical connectivity in breast cancer survivors with cognitive complaints after chemotherapy

Cognitive complaints after chemotherapy are common in breast cancer patients, but the neural bases for these complaints remain unclear. This pilot study explored resting-state functional connectivity (FC) as a marker of subtle cognitive changes in breast cancer patients who experience cognitive complaints. Chemotherapy-treated (n = 20, at least 6 months off therapy) and untreated (n = 17, disease-control) female breast cancer patients with cognitive complaints and healthy controls (n = 20) were recruited. The FC of the right dorsolateral prefrontal cortex was calculated, and any correlations between this FC and neuropsychological assessments were determined. Chemotherapy-treated patients with cognitive complaints displayed increased FC between the right dorsolateral prefrontal cortex and both the contralateral cerebellar lobule VII and the cerebellar vermis XI, compared to the disease-control and healthy-control groups, despite unimpaired neuropsychological performance. The increased FC was negatively correlated with executive function and attention in breast cancer survivors with cognitive complaints. Our pilot study findings provide evidence that cerebellar-cortical FC changes may be a pathophysiological basis for chemotherapy-related cognitive complaints. In addition, the FC changes have the potential to reflect minor or compensated cognitive function impairment in breast cancer patients.

Effects of brief acceptance and commitment therapy (ACT) on subjective cognitive impairment in breast cancer patients undergoing chemotherapy

Purpose This study examined the efficacy of a brief acceptance and commitment therapy (ACT) on subjective cognitive impairment in breast cancer patients undergoing chemotherapy. Methods Data collection was carried out in 3-time points: baseline (T1), screening (T2), and post-treatment (T3). Respondents who had significant subjective cognitive impairment were randomly divided into two groups: intervention (n = 30) and waitlist (n = 30). Respondents in the intervention group received 4 sessions of 1 hour of ACT therapy. Findings Respondents in the intervention group showed significant improvement in subjective cognitive impairment, depression, anxiety, and psychological inflexibility after the ACT intervention (p < 0.05). After controlling the covariates, group differences in all variables were significant except for fatigue and psychological inflexibility has the highest effect size (d = 4.69). Conclusion ACT could be considered as an effective intervention to ameliorate subjective cognitive impairment, anxiety, depression, and psychological inflexibility in breast cancer patients undergoing chemotherapy. Implications for Psychosocial Providers This study highlights the importance of screening for subjective cognitive impairment in breast cancer patients undergoing chemotherapy and heightens their opportunity to receive proper management as earlier as possible.

Catechol-O-Methyltransferase Gene Polymorphisms and the Risk of Chemotherapy-Induced Prospective Memory Impairment in Breast Cancer Patients with Varying Tumor Hormonal Receptor Expression.

BackgroundExisting research evidence indicates that breast cancer patients have different degrees of cognitive dysfunction after chemotherapy, and polymorphisms in 3 genes (catechol-O-methyltransferase, COMT; apolipoprotein E, APOE; and brain-derived neurotrophic factor, BDNF) have been associated with cognitive impairment. However, the role of these 3 gene polymorphisms in modulating cognitive impairment in breast cancer survivors with varying hormonal receptor expression is not clear at present.To explore the effects of genetic polymorphisms in BDNF, APOE, and COMT on the regulation of prospective memory impairments induced by chemotherapy in breast cancer patients with various expression levels of estrogen receptor (ER) and progesterone receptor (PR).Material/MethodsA total of 232 patients with breast cancer (113 with ER−/PR− and 119 with ER+/PR+) were evaluated before and after chemotherapy for cognitive function, including prospective memory. Following previously published sequencing procedures, we assessed 6 single-nucleotide polymorphisms (SNPs), including BDNF (rs6265), APOE (rs429358, rs7412), and COMT (rs165599, rs4680, rs737865).ResultsThe patients showed poorer prospective memory scores after chemotherapy than before chemotherapy. Furthermore, the ER−/PR− group showed poorer event-based prospective memory (EBPM) scores than the ER+/PR+ group (z=−7.831, p<0.01) after chemotherapy. The patients with the COMT rs737865G/G genotype, compared with those with the A/A and A/G genotypes, showed a linear EBPM performance (β=1.499, 95% confidence interval (CI)=1.017~2.211) and were less likely to have memory impairment. In contrast, APOE and BDNF polymorphisms did not influence cognitive performance.ConclusionsThe patterns of hormonal receptor expression may be related to prospective memory impairments induced by chemotherapy in breast cancer patients. Furthermore, the COMT polymorphism (rs737865) was linearly related to the extent of deficits in EBPM and may represent a potential genetic marker of risk for cognitive deficits triggered by chemotherapy in patients with breast cancer.

The Developmental Trajectory of Cancer-Related Cognitive Impairment in Breast Cancer Patients: A Systematic Review of Longitudinal Neuroimaging Studies.

This systematic review explored the neurobiological mechanisms underlying the clinical time course of cancer-related cognitive impairment (CRCI) in breast cancer patients through the review of longitudinal neuroimaging studies. Before chemotherapy, results reported no evidence for neuropsychological, structural (gray matter) and brain perfusion changes. However, functional brain alterations were evident and revealed a frontoparietal hyperactivation during working memory tasks. Fatigue and number of days since surgery were the two suggested confounding factors. Acutely after chemotherapy, this review found no evidence for neuropsychological changes while suggesting a pattern of frontal structural, perfusion and functional brain abnormalities. These findings seemed to be dependent on age, menopausal status at baseline, and fMRI task performed. Years after chemotherapy, results revealed evidence of partial neuropsychological, structural, and functional brain recovery. Regarding brain abnormality, this review suggested that it may begin quite early in the disease course, be more prominent shortly after chemotherapy and partially recover over time. Several hypotheses underlying these changes were discussed. The present review also provided important information for developing a time-specific treatment and prevention strategies and for the consideration of functional neuroimaging as a relevant tool for CRCI diagnosis, clinical monitoring, and intervention studies. The findings also suggested the need to implement studies with longitudinal designs, including a pre-treatment assessment, since cross-sectional studies were not able to detect this pattern of recovery over time, supporting only the theory of brain abnormalities, in breast cancer survivors.

Electroacupuncture trigeminal nerve stimulation plus body acupuncture for chemotherapy-induced cognitive impairment in breast cancer patients: An assessor-participant blinded, randomized controlled trial

Chemotherapy causes various side effects, including cognitive impairment, known as ‘chemobrain’. In this study, we determined whether a novel acupuncture mode called electroacupuncture trigeminal nerve stimulation plus body acupuncture (EA/TNS + BA) could produce better outcomes than minimum acupuncture stimulation (MAS) as controls in treating chemobrain and other symptoms in breast cancer patients. In this assessor- and participant-blinded, randomized controlled trial, 93 breast cancer patients under or post chemotherapy were randomly assigned to EA/TNS + BA (n = 46) and MAS (n = 47) for 2 sessions per week over 8 weeks. The Montreal Cognitive Assessment (MoCA) served as the primary outcome. Digit span test was the secondary outcomes for attentional function and working memory. The quality of life and multiple functional assessments were also evaluated. EA/TNS + BA treated group had much better performance than MAS-treated group on reverse digit span test at Week 2 and Week 8, with medium effect sizes of 0.53 and 0.48, respectively, although no significant differences were observed in MoCA score and prevalence of chemobrain between the two groups. EA/TNS + BA also markedly reduced incidences of diarrhoea, poor appetite, headache, anxiety, and irritation, and improved social/family and emotional wellbeing compared to MAS. These results suggest that EA/TNS + BA may have particular benefits in reducing chemotherapy-induced working memory impairment and the incidence of certain digestive, neurological, and distress-related symptoms. It could serve as an effective intervention for breast cancer patients under and post chemotherapy (trial registration: https://www.clinicaltrials.gov: NCT02457039).

A mindfulness-based intervention for breast cancer patients with cognitive impairment after chemotherapy: study protocol of a three-group randomized controlled trial

BackgroundMindfulness has been applied to improve cancer care by enhancing psychological well-being. However, little is known about its impact on cognitive impairment experienced by cancer patients after chemotherapy. Mindfulness may be relevant in tackling cognitive impairment by decreasing emotional distress and fatigue, by decreasing inflammation, and by strengthening functional brain connectivity. The aim of the present study protocol is to evaluate the efficacy and mechanisms of a mindfulness-based intervention to reduce cognitive impairment in breast cancer patients after chemotherapy.Methods/designThe present study is a three-arm, parallel-group, randomized controlled trial with assessments at baseline, 1 to 3 weeks after the intervention and at 3 months’ follow-up. One hundred and twenty breast cancer patients who ended treatment a minimum of 6 months and a maximum of 5 years before, and who have cognitive complaints, will be enrolled. They will be randomized into one of the following three study arms: (1) a mindfulness-based intervention group (n = 40), (2) an active control condition based on physical training (n = 40), or (3) a treatment as usual (TAU) control group (n = 40). Both the mindfulness-based intervention and the active control condition consist of four group sessions (3 h for the mindfulness condition and 2 h for the physical training) spread over 8 weeks. The primary outcomes will be cognitive symptoms as measured by the Cognitive Failure Questionnaire and changes in functional brain connectivity in the attention network. Secondary outcomes will be (1) levels of emotional distress, fatigue, mindfulness, quality of life; (2) neurocognitive tests; (3) structural and functional brain changes using MR imaging and (4) measures of inflammation.DiscussionThe study will examine the impact of a mindfulness-based intervention on cognitive impairment in breast cancer patients. If the findings of this study confirm the effectiveness of a mindfulness-based program to reduce cognitive impairment, it will be possible to improve quality of life for ex-cancer patients. We will inform health care providers about the potential use of a mindfulness-based intervention as a non-pharmaceutical, low-threshold mental health intervention to improve cognitive impairment after cancer.Trial registrationClinicalTrials.gov, ID: NCT03736460. Retrospectively registered on 8 November 2018.

Cognitive impairments in breast cancer survivors treated with chemotherapy: a study based on event-related potentials.

Chemotherapy-related cognitive impairments in breast cancer patients were usually reported through cognitive questionnaires or scales which may be subjective and insensitive. This study is to assess the effect of chemotherapy on cognitive function in breast cancer patients stratified by age using objective electrophysiological measure, the P300 component of event-related potentials (ERPs) with a large sample size. Totally, 529 primary breast cancer patients, including 178 cases at initial diagnosis stage and before chemotherapy (Group1), 167 cases during chemotherapy (Group2), and 184 cases post chemotherapy and during follow-up period (Group3), were examined with ERPs (P300 component) to assess the effect of chemotherapy on their cognitive function. There were significant differences of P300 latency in Group2 (364.74 ± 15.73ms) and Group3 (364.02 ± 17.12ms, mean follow-up period of 2.42years) compared with Group1 (355.13 ± 19.47ms, P < 0.001), respectively. With further age stratification: in patients of < 50years, P300 latency was significantly prolonged in Group2 and Group3 compared with Group1 (P < 0.001), respectively; in patients of 50-59years, P300 latency was significantly prolonged in Group2 compared with Group1 (P < 0.05), but without difference in Group1 and Group3 (P>0.05); In patients of ≥ 60years, there were no differences of P300 latency among three the groups (P>0.05). It is first suggested by our objective detection data that the side effect of chemotherapy on cognitive functions in breast cancer patients may decrease with age. Electrophysiological cognitive impairments mainly occur in younger breast cancer patients undergoing chemotherapy and would last for years after chemotherapy, which highlights the importance of early intervention for those patients, especially in younger patients.