Elie Isenberg-Grzeda

Nonalcoholic Thiamine-Related Encephalopathy (Wernicke-Korsakoff Syndrome) Among Inpatients With Cancer: A Series of 18 Cases

BACKGROUND Wernicke-Korsakoff Syndrome (WKS) is a neuropsychiatric syndrome caused by thiamine deficiency. Cancer predisposes to thiamine deficiency through various mechanisms. Although many case reports exist on nonalcoholic WKS in cancer, larger qualitative studies are lacking. METHOD Retrospective study of patients admitted to a cancer hospital and diagnosed with WKS during routine care on a psychiatric consultation service. Only patients with at least 1 additional supporting feature (magnetic resonance imaging findings, low serum thiamine concentrations, or response to treatment) were included. Data pertaining to demographics, risk factors, phenomenology, and outcomes were abstracted from medical records by chart review. RESULTS In all, 18 patients were included. All patients developed WKS during cancer treatment. Hematologic malignancy, gastrointestinal tract tumors, low oral intake, and weight loss were common risk factors. All patients presented with cognitive dysfunction, most commonly impaired alertness, attention, and short-term memory. All were diagnosed by operational criteria proposed by Caine et al., 1997 (where 2 of the following are required: nutritional deficiency, ocular signs, cerebellar signs, and either altered mental status or mild memory impairment). Few exhibited Wernickes classic triad. Diagnostic and treatment delay were common. Only 3 patients recovered fully. CONCLUSION Nonalcoholic WKS can occur during cancer treatment and manifests clinically as delirium. Diagnosis should be made using operational criteria, not Wernickes triad. Most patients were not underweight and had normal serum concentration of vitamin B12 and folate. A variety of mechanisms might predispose to thiamine deficiency and WKS in cancer. Given the high frequency of residual morbidity, studies should focus on decreasing diagnostic and treatment delay.

Wernicke-Korsakoff syndrome in patients with cancer: a systematic review

Wernicke-Korsakoff syndrome in patients with cancer is understudied. Much of what is known-that significant under-recognition and delays in treatment exist-comes from studies of alcohol misuse disorders or non-alcohol-related Wernicke-Korsakoff syndrome in patients. We investigated the frequency and associated features of cancer-related Wernicke-Korsakoff syndrome in the published literature. We included 90 articles reporting on 129 patients. Only 38 (30%) of 128 patients with data available exhibited the entire triad of classic features of Wernicke-Korsakoff syndrome: confusion, ataxia, and ophthalmoplegia or nystagmus. Diagnosis during life was missed altogether in 22 (17%) of 128 patients. The operational diagnostic criteria (at least two of the following: nutritional deficiency, ocular signs, cerebellar signs, and either altered mental status or mild memory impairment), which are considered more reliable than the classical triad, were used in only nine (7%) cases, yet 120 (94%) met the operational criteria for diagnosis at the time of presentation when applied retroactively. Complete recovery was reported in only 47 (36%) cases. Given that oncologists or haematologists accounted for only 17 (19%) first authors among the articles included, it is important that oncologists are aware of the risk factors for cancer-related Wernicke-Korsakoff syndrome, and that they are vigilant about diagnosing and treating the disease especially in the absence of alcohol misuse disorders.

High rate of thiamine deficiency among inpatients with cancer referred for psychiatric consultation: results of a single site prevalence study

Thiamine deficiency (TD) is increasingly recognized in medically ill patients. The prevalence of TD among cancer patients is unknown. This study aims to characterize the prevalence of TD among inpatients with cancer.

A review of cognitive screening tools in cancer.

Purpose of review Cancer-related cognitive impairment (CRCI) is highly prevalent, and assessment of cognition is crucial in providing optimal cancer care. Neuropsychological assessment (NPA) can be lengthy and expensive. Cognitive screening tools are plenty but validity has not been thoroughly studied for use in cancer patients. Recent findings Our search of the recent literature revealed that the Montreal Cognitive Assessment, Mini–Mental State Examination, and Clock Draw Test were the most frequently studied objective screening tools. The Functional Assessment of Cancer Therapy-Cognitive Function and the Cognitive Symptom Checklist-Work 21 were the most commonly studied subjective measures of perceived cognitive impairment. Evidence supports using the Montreal Cognitive Assessment or the Clock Draw Test over the Mini–Mental State Examination to screen for cognitive impairment within specific patient populations. In addition, adding a subjective measure of cognitive impairment (e.g., Functional Assessment of Cancer Therapy-Cognitive Function) may increase diagnostic sensitivity. Summary These suggest that cognitive screening tools may have a role in screening for CRCI, particularly when full NPA is not feasible. Researchers must continue to conduct high-quality studies to build an evidence to guide best practices in screening for CRCI.

Sexual health issues in cancer.

DOI:10.1097/SPC.0000000000000194 Although emotional and physical symptom screening in cancer is now a standard of care [1], systematic response to distress screening and evidence-based psychosocial interventions are often not fully integrated into care (Matthew, pp. 38–43). Sexual health and relationship needs in cancer are now widely recognized to be important (Matthew, pp. 38–43; Bober et al., pp. 44–54), but they lag even further behind; sexual health is not routinely assessed or addressed in cancer care (Matthew, pp. 38–43). Owing to these gaps in knowledge and practice, we included a section on sexual health in cancer in this quarter’s issue of Current Opinion in Supportive and Palliative Care. Our section includes several articles focusing on a variety of different topics but unified by the common thread of sexual health issues in cancer. The main goal in this section is to summarize the psychosexual issues experienced by men and women with cancer and the current evidence to help clinicians better assess and manage these difficulties. Given that knowledge, clinical assessment, level one interventions, access to specialized service, and research in sexual health issues in cancer need to be improved and expanded, it is hoped that this issue will help clinicians in their daily care of their patients with cancer. Four studies explore areas relevant to all people with cancer; relationship and fertility issues, sex and sexuality in the elderly, the palliative setting and lesbian, gay, bisexual, and transgender (LGBT), and a review of online interventions (Wittman, pp. 75–80; Benedict et al., pp. 87–94; Griebling, pp. 95–101; Wooten et al., pp. 81–86). Two studies explore women’s sexual health in cancer (Male et al., pp. 66–74; Bober et al., pp. 44–54). In turn, two studies explore men’s sexual health in cancer; Matthews (pp. 38–43) writes a comprehensive overview of the principles of sexual health treatments in men and Wassersug (pp. 55–65) uses clinical examples to illuminate men’s experience on androgen deprivation therapy after prostate cancer. All of us will have met at least one young adult cancer survivor who did not fully understand or receive fertility preservation counseling at the time of treatment, leading to immense distress and regret, and significant impact on the rest of their life. Supporting couples’ intimacy during cancer

Editorial, supportive care and psychological issues around cancer.

Since its beginnings in the mid 1970s [1], the field of psychosocial oncology has been devoted to the psychological, behavioral, social, and spiritual aspects of cancer care. Assessment of psychosocial domains is now routinely integrated into clinical care in all cancer centers and required to achie