Heather J. Green

Altered cognitive function in men treated for prostate cancer with luteinizing hormone-releasing hormone analogues and cyproterone acetate: A randomized controlled trial

Objective  To report the first systematic investigation of the cognitive effects of luteinizing hormone‐releasing hormone (LHRH) analogues in male patients, as LHRH analogues have been associated with memory impairments in women using these drugs for gynaecological conditions.

Quality of life compared during pharmacological treatments and clinical monitoring for non-localized prostate cancer: a randomized controlled trial.

To investigate the effects of different management strategies for non‐localized prostate cancer on mens quality of life and cognitive functioning.

A Meta-Analysis of Cognitive Impairment and Decline Associated with Adjuvant Chemotherapy in Women with Breast Cancer

A meta-analysis was performed to quantify the magnitude and nature of the association between adjuvant chemotherapy and performance on a range of cognitive domains among breast cancer patients. A total of 27 studies (14 cross-sectional, 8 both cross-sectional and prospective, and 5 prospective) were included in the analyses, involving 1562 breast cancer patients who had undergone adjuvant chemotherapy and 2799 controls that included breast cancer patients who did not receive adjuvant chemotherapy. A total of 737 effect sizes (Cohen’s d) were calculated for cross-sectional and prospective longitudinal studies separately and classified into eight cognitive domains. The mean effect sizes varied across cross-sectional and prospective longitudinal studies (ranging from −1.12 to 0.62 and −0.29 to 1.12, respectively). Each cognitive domain produced small effect sizes for cross-sectional and prospective longitudinal studies (ranging from −0.25 to 0.41). Results from cross-sectional studies indicated a significant association between adjuvant chemotherapy and cognitive impairment that held across studies with varied methodological approaches. For prospective studies, results generally indicated that cognitive functioning improved over time after receiving adjuvant chemotherapy. Greater cognitive impairment was reported in cross-sectional studies comparing chemotherapy groups with healthy control groups. Results suggested that cognitive impairment is present among breast cancer patients irrespective of a history of chemotherapy. Prospective longitudinal research is warranted to examine the degree and persisting nature of cognitive impairment present both before and after chemotherapy, with comparisons made to participants’ cognitive function prior to diagnosis. Accurate understanding of the effects of chemotherapy is essential to enable informed decisions regarding treatment and to improve quality of life among breast cancer patients.

Effects of memory load and distraction on performance and event-related slow potentials in a visuospatial working memory task

Brain electrical activity related to working memory was recorded at 15 scalp electrodes during a visuospatial delayed response task. Participants (N = 18) touched the remembered position of a target on a computer screen after either a 1 or 8 sec delay. These memory trials were compared to sensory trials in which the target remained present throughout the delay and response periods. Distractor stimuli identical to the target were briefly presented during the delay on 30% of trials. Responses were less accurate in memory than sensory trials, especially after the long delay. During the delay slow potentials developed that were significantly more negative in memory than sensory trials. The difference between memory and sensory trials was greater at anterior than posterior electrodes. On trials with distractors, the slow potentials generated by memory trials showed further enhancement of negativity, whereas there were minimal effects on accuracy of performance. The results provide evidence that engagement of visuospatial working memory generates slow wave negativity with a timing and distribution consistent with frontal activation. Enhanced brain activity associated with working memory is required to maintain performance in the presence of distraction.

A feasibility study of group cognitive rehabilitation for cancer survivors: enhancing cognitive function and quality of life

This research aimed to address the gap in evidence‐based treatment available for cancer survivors who are experiencing cognitive dysfunction, through piloting a novel treatment intervention. The overall research question was whether a group cognitive rehabilitation intervention would be feasible for improving cognitive function and quality of life for people who have completed cancer treatment.

Stress and coping strategies among firefighters and recruits

This study compared psychological distress and coping strategies for three different permanent firefighter groups in South-East Queensland, Australia: recruits (n = 42), on-shift firefighters (n = 51), and firefighters who had recently attended one of 13 fatal incidents (n = 52). Older firefighters reported more general distress but no increase in posttraumatic stress symptoms. Coping strategies tended to be associated with higher distress and posttraumatic stress, but once this general tendency was taken into account, seeking instrumental support was associated with lower posttraumatic stress symptoms. Results support previous findings that cumulative exposure and events outside work contribute to distress in firefighters.

Side-effects of treatments for locally advanced prostate cancer.

We appreciate the interest in and comments about our recent article. We made it clear in our report that all patients were followed for ≥ 1 year from the last HIFU treatment. Patients therefore had at least three opportunities to fail biochemically. The issue of biopsy after treatment is important; there is currently no consensus on reporting standards. Previous studies on radiotherapy and cryotherapy used biopsies after treatment as an endpoint, but biopsies have largely been discontinued in favour of biochemical outcomes. Whilst the biological significance and prognostic value of these biopsies are unknown, we feel that they can give important insights in refining the conduct of novel ablation therapies such as HIFU. There are numerous changes that tend to be reported when histology is reviewed after HIFU. We summarized these changes into a binary outcome, i.e. the presence or absence of prostate cancer. Until further work is done on the significance or otherwise of other findings, we feel that this simple classification has the most utility. The sampling ratio (number of cores taken per unit volume of tissue) probably exceeds the sampling ratio at diagnosis, given the small volume of the gland after HIFU.

Dignity Therapy and Life Review for Palliative Care Patients: A Randomized Controlled Trial

CONTEXT Dignity therapy (DT) is a psychotherapeutic intervention with increasing evidence of acceptability and utility in palliative care settings. OBJECTIVES The aim of this study was to evaluate the legacy creation component of DT by comparing this intervention with life review (LR) and waitlist control (WC) groups. METHODS Seventy adults with advanced terminal disease were randomly allocated to DT, LR, or WC followed by DT, of which 56 completed the study protocol. LR followed an identical protocol to DT except that no legacy document was created in LR. Primary outcome measures were the Brief Generativity and Ego-Integrity Questionnaire, Patient Dignity Inventory, Functional Assessment of Cancer Therapy-General, version 4, and treatment evaluation questionnaires. RESULTS Unlike LR and WC groups, DT recipients demonstrated significantly increased generativity and ego-integrity scores at study completion. There were no significant changes for dignity-related distress or physical, social, emotional, and functional well-being among the three groups. There were also no significant changes in primary outcomes after the provision of DT after the waiting period in the WC group. High acceptability and satisfaction with interventions were noted for recipients of both DT and LR and family/carers of DT participants. CONCLUSION This study provides initial evidence that the specific process of legacy creation is able to positively affect sense of generativity, meaning, and acceptance near end of life. High acceptability and satisfaction rates for both DT and LR and positive impacts on families/carers of DT participants provide additional support for clinical utility of these interventions. Further evaluation of specific mechanisms of change post-intervention is required given DTs uncertain efficacy on other primary outcomes.

Psychological intervention for improving cognitive function in cancer survivors: a literature review and randomized controlled trial

Although the impact of cancer and associated treatments on cognitive functioning is becoming an increasingly recognized problem, there are few published studies that have investigated psychological interventions to address this issue. A waitlist randomized controlled trial methodology was used to assess the efficacy of a group cognitive rehabilitation intervention (“ReCog”) that successfully targeted cancer-related cognitive decline in previously published pilot research. Participants were 29 cancer survivors who were randomly allocated to either the intervention group or a waitlist group who received the intervention at a later date, and 16 demographically matched community volunteers with no history of cancer (trial registration ACTRN12615000009516, available at http://www.ANZCTR.org.au/ACTRN12615000009516.aspx). The study was the first to include an adapted version of the Traumatic Brain Injury Self-Efficacy Scale to assess cognitive self-efficacy (CSE) in people who have experienced cancer. Results revealed participating in the intervention was associated with significantly faster performance on one objective cognitive task that measures processing speed and visual scanning. Significantly larger improvements for the intervention group were also found on measures of perceived cognitive impairments and CSE. There was some evidence to support the roles of CSE and illness perceptions as potential mechanisms of change for the intervention. Overall, the study provided additional evidence of feasibility and efficacy of group psychological intervention for targeting cancer-related cognitive decline.

Exploring the influence of housing design and occupant environmental attitudes on energy and water usage

Sustainable housing is intended to achieve a lower impact on the environment; however, to what extent occupants and their behaviour are a determinant in realising this goal is unclear. In this article occupant attitudes towards the environment are used as an indicator of behaviour while resource usage is used as an indicator for the environment. A study of occupants of sustainable and conventional housing is used to examine this question. The results show that the former use 75% less energy compared with those of conventional houses of the same age, in the same climate zone. More positive attitudes to environmental conservation correlated with lower energy use, but were not found to be a statistically significant predictor of energy use when analysed with other predictor variables. Hence, we argue that sustainable housing characteristics and associated technologies have a much higher weighting relative to occupant attitudinal factors. The data also suggest that the sustainable design of a detached house is associated with approximately double the reduction in energy consumption, compared with the influence of pro-environmental attitudes. Hence, sustainable attributes in the design of housing is a significant indicator in determining the resource usage of housing in this study. The implications of these results have an important part to play in the debate on influence of behavioural factors compared with technological factors in the drive to higher energy efficiency