Mallory G. Cases

Cognitive Functioning in Men Receiving Androgen Deprivation Therapy for Prostate Cancer: A Systematic Review and Meta-Analysis

PurposePrior research examining the impact of androgen deprivation therapy (ADT) for prostate cancer on cognitive performance has found inconsistent relationships. The purpose of this study was to systematically review the existing literature and determine the effect of ADT on performance across seven cognitive domains using meta-analysis.MethodsA search of PubMed Medline, PsycINFO, Cochrane Library, and Web of Knowledge/Science databases yielded 157 unique abstracts reviewed by independent pairs of raters. Fourteen studies with a total of 417 patients treated with ADT were included in the meta-analysis. Objective neuropsychological tests were categorized into seven cognitive domains: attention/working memory, executive functioning, language, verbal memory, visual memory, visuomotor ability, and visuospatial ability.ResultsSeparate effect sizes were calculated for each cognitive domain using pairwise comparisons of patients who received ADT with (1) prostate cancer patient controls, (2) noncancer controls, or (3) ADT patients’ own pre-ADT baselines. Patients treated with ADT performed worse than controls or their own baseline on visuomotor tasks (g = −0.67, p = .008; n = 193). The magnitude of the deficits was larger in studies with a shorter time to follow-up (p = .04). No significant effect sizes were observed for the other six cognitive domains (p = .08–.98).ConclusionsProstate cancer patients who received ADT performed significantly worse on visuomotor tasks compared to noncancer control groups. These findings are consistent with the known effects of testosterone on cognitive functioning in healthy men. Knowledge of the cognitive effects of ADT may help patients and providers better understand the impact of ADT on quality of life.

Patient education in allogeneic hematopoietic cell transplant: What patients wish they had known about quality of life

Quality of life (QOL) is increasingly recognized as an important clinical outcome of hematopoietic cell transplantation (HCT), but patient education is often overlooked. The aim of the current qualitative study was to examine education regarding post-HCT QOL from the patient’s perspective. Allogeneic HCT recipients participated in one of four focus groups. Participants were asked to recall what they had been told about post-HCT QOL as they were preparing for transplant, how their QOL differed from what they expected and how to educate future patients about post-HCT QOL. Verbatim transcripts were coded for both a priori and emergent themes using content analysis. A total of 24 patients participated (54% female, mean age 51, range 23–73 years). Participants frequently expressed the desire for additional education regarding post-HCT QOL, particularly late complications. They noted that late complications were often unexpected, had a profound impact on their QOL and threatened their ongoing sense of recovery. They emphasized that the timing, content and format of education regarding QOL should be flexible to meet their diverse needs. Findings from the current study draw attention to the importance of patient education regarding post-HCT QOL as well as additional QOL research designed with patient education in mind.

A systematic review and meta-analysis of changes in cognitive functioning in adults undergoing hematopoietic cell transplantation

Evidence is mixed regarding the effects of hematopoietic cell transplantation (HCT) on changes in cognitive functioning among adults. Meta-analysis, which is designed to help reconcile conflicting findings, has not yet been conducted on studies of adults receiving HCT. To fill this gap, the current study provides a systematic review and meta-analysis of cognitive functioning in adults receiving HCT. A search of PubMed, PsycInfo, CINAHL, and Cochrane Library yielded 732 abstracts, which were independently evaluated by pairs of raters. Seventeen studies were systematically reviewed; 11 were retained for meta-analysis. There was agreement that cognitive impairments are evident for a subset of patients before HCT. Meta-analytical findings of 404 patients revealed no significant changes in cognitive functioning pre- to post HCT (P-values >0.05). Age, time since transplant and TBI were not associated with changes in cognitive functioning. Patients who received autologous transplants were more likely to demonstrate improvements in attention (P=0.004). The systematic review identified several limitations of existing literature, including small, clinically heterogeneous samples. Large, cooperative group studies are needed to address these design limitations. Nevertheless, results from the current meta-analysis suggest that cognitive functioning does not significantly change following HCT.

Caregivers' quality of life after blood and marrow transplantation: a qualitative study

A sizable literature has documented the challenges of providing care to a family member with cancer, although fewer studies have reported on caregivers of allogeneic hematopoietic cell transplantation (HCT) recipients. Existing studies of HCT caregivers suggest that they are at risk for distress. For example, prior to HCT, caregivers report significantly higher levels of anxiety, traumatic stress, and insomnia than population norms (1, 2). Several years after transplant, risk of depression among spouses of HCT recipients is 3.5 times greater than that of similar peers (3). Spouses of HCT recipients also report less social support, greater marital dissatisfaction, greater loneliness, and less spiritual well-being than their peers (3). In qualitative interviews of HCT recipients and spouses, spouses were more likely than patients to report negative life changes as the result of transplant (4). The goal of the current study was to qualitatively examine post-HCT quality of life from the caregiver’s perspective. As part of a larger qualitative study of patient education regarding quality of life after allogeneic HCT, patients and caregivers were recruited from a single institution to participate in separate focus groups. At this institution, caregivers are required to attend a class regarding how to care for an allogeneic HCT recipient. Caregiver support groups are available as well. Results of the patient focus groups have been reported previously (5). Caregivers were asked about their quality of life and their perceptions of the patient’s quality of life, with a focus on how the transplant team could better prepare future caregivers for life after transplant. As the study was exploratory in nature, there were no a priori hypotheses. Caregivers were nominated by eligible patient participants (5). To be eligible, caregivers had to be able to speak and read English and provide informed consent. Caregivers attended one of four caregiver-only focus groups held in November 2011 and March 2012. Groups ranged in size from three to six caregivers. Details of study methodology have been described previously (5). Focus group questions are listed in Table 1. A total of 16 caregivers participated in the focus groups. Participants had a median age of 55 (range 25-80). The majority was Caucasian (100%), non-Hispanic (88%), married (94%), had not completed college (62%), and reported a current annual household income of US

Associations between Obesity, Body Fat Distribution, Weight Loss and Weight Cycling on Serum Pesticide Concentrations

40,000 a year or more (79%). Representative quotes from caregivers are displayed in Table 2. Nearly all participants agreed that providing care to a HCT recipient entailed significant physical and emotional demands. Several participants noted that caregiving required permanent life changes and a lifelong commitment to the patient. Social isolation was commonly reported and perceived to be detrimental for both the patient and caregiver. Many described constant vigilance about disinfecting their surroundings to prevent infection, sometimes far longer than required by the transplant team. Some caregivers reported a loss of identity as they no longer engaged in the activities they used to find meaningful. Although some caregivers reported significant emotional support from family and friends, others felt overlooked as loved ones’ concerns were typically centered exclusively on the patient. Caregivers reported feeling unprepared for the severity and duration of emotional and physical changes in the patient. They also expressed difficulty determining how much they should push patients to engage in activities the caregivers perceived to be beneficial (e.g., exercising, resuming previous hobbies). Nearly all caregivers reported that their relationship with the patient was significantly changed due to the transplant process. Some felt that the transplant brought them closer together while others perceived significant strain in the relationship. Caregivers commonly voiced feelings of gratitude for the patient’s survival in addition to insomnia, helplessness, guilt, fatigue, and fear about cancer recurrence. They also described high levels of anxiety at each outpatient follow-up appointment, which were temporarily assuaged by hearing the patient’s blood counts. Although caregivers described significant negative emotions, few reported receiving psychosocial services. In general, caregivers were reluctant to discuss ways in which they took care of themselves. Many reported guilt about focusing on their own needs. Prayer, use of social support, and focusing on one day at a time were the most commonly reported coping strategies. Use of web-based sharing systems such as blogging, email, or other social networking sites to inform family and friends of the patient’s progress and receive support was also widely perceived to be helpful. Caregivers reported being well-informed regarding physical symptoms patients were likely to experience during the acute transplant period, symptom management, and other requirements for daily care of an HCT recipient (e.g., flushing lines, precautions against infection). Caregivers wanted more information regarding how to cope with emotional and cognitive changes in the patient. It was suggested a mentoring program be created, in which names and phone numbers of experienced caregivers were provided to caregivers new to HCT. In general, caregivers echoed many of the same themes as patients (5), including greater need for information regarding post-transplant morbidities such as graft-versus-host disease (GVHD). Caregivers also provided unique information about the patients’ experiences, most notably observed changes in personality, difficulty handling stress, and cognitive impairment. Caregivers participating in the current study frequently expressed significant unmet needs for information and support. We are aware of only one previous study of an intervention for caregivers of allogeneic HCT recipients, which found that caregivers perceived emotional expression to be helpful in dealing with stress (6). Caregivers may also benefit from greater information regarding long-term morbidities, tools to help manage their own and the patient’s emotional distress, and awareness of the importance of self-care and outside support (7). Studies among cancer patients suggest that this type of intervention can significantly reduce caregiver burden and improve quality of life (8). Although evidence-based caregiving interventions are currently lacking in HCT, caregivers should be directed towards resources available through cancer- and transplant-specific websites (e.g., National Marrow Donor Program, National Bone Marrow Transplant Link, Leukemia and Lymphoma Society).

Detailed methods of two home-based vegetable gardening intervention trials to improve diet, physical activity, and quality of life in two different populations of cancer survivors

OBJECTIVE Preliminary studies suggest pesticides may be linked to increased cancer risk. Since most pesticides are lipophilic and stored within adipose tissue, serum levels of organochlorines are affected not only by environmental exposures, but also by factors related to lipid turnover and storage. Our objective was to investigate whether serum organochlorines are influenced by weight loss, body fat distribution, and weight cycling. METHODS Ten overweight women were recruited upon entry into a weight loss program and surveyed regarding weight history, childbearing/lactation, and exposure to environmental contaminants. Anthropometric measures and phlebotomy were conducted at baseline and at four weeks (mean weight loss=5.1 kg). Serum was analyzed for 19 common polychlorinated pesticides and metabolites and 10 PCB congeners. RESULTS Organochlorine levels were not significantly affected by weight loss nor associated with body mass index (BMI). Strong positive correlations were noted between levels of DDE/DDT and age (DDE β=0.6986/p=0.0246/DDT β=0.6536/p=0.0404) and between DDE/DDT and waist-to-hip ratio (WHR) (DDE β=0.4356/p=0.0447/DDT β=0.8108/p=0.0044). Trends were noted for decreased levels of DDT in women who reported more episodes of weight cycling. CONCLUSION Serum organochlorine levels may be affected not only by age, but also factors related to lipid turnover (i.e., episodes of weight cycling and WHR), and warrants further study.

Fingernail and toenail clippings as a non-invasive measure of chronic cortisol levels in adult cancer survivors

BACKGROUND Cancer survivors suffer from long-term adverse effects that reduce health-related quality of life (QOL) and physical functioning, creating an urgent need to develop effective, durable, and disseminable interventions. Harvest for Health, a home-based vegetable gardening intervention, holds promise for these domains. METHODS This report describes the methods and recruitment experiences from two randomized controlled feasibility trials that employ a waitlist-controlled design. Delivered in partnership with Cooperative Extension Master Gardeners, this intervention provides one-on-one mentorship of cancer survivors in planning and maintaining three seasonal vegetable gardens over 12months. The primary aim is to determine intervention feasibility and acceptability; secondary aims are to explore effects on objective and subjective measures of diet, physical activity and function, and QOL and examine participant factors associated with potential effects. One trial is conducted exclusively among 82 female breast cancer survivors residing in the Birmingham, AL metropolitan area (BBCS); another broadly throughout Alabama among 46 older cancer survivors aged >60 (ASCS). RESULTS Response rates were 32.6% (BBCS) and 52.3% (ASCS). Both trials exceeded 80% of their accrual target. Leading reasons for ineligibility were removal of >10 lymph nodes (lymphedema risk factor), lack of physician approval, and unwillingness to be randomized to the waitlist. CONCLUSION To date, recruitment and implementation of Harvest for Health appears feasible. DISCUSSION Although both studies encountered recruitment challenges, lessons learned can inform future larger-scale studies. Vegetable gardening interventions are of interest to cancer survivors and may provide opportunities to gain life skills leading to improvements in overall health and QOL.

Head and Neck Cancer Adherence to Dietary Recommendations using Theory-Based Tools: Future Research Directions

PurposeCancer survivors are at greater risk of comorbidities and functional decline due to physiological and psychological stress which can be measured by salivary cortisol. If saliva is used, multiple samples must be collected to accurately quantify long-term stress; however, fingernail (FN) and toenail (TN) clippings offer an opportunity to measure retrospective cortisol levels in a non-invasive manner.MethodsThree sets of FN and TN clippings were collected at 12-month intervals in conjunction with saliva samples from cancer survivors (n = 109) participating in two clinical trials. FN and TN samples were stored at room temperature (RT); a subset underwent additional processing and freezing before analysis. Cortisol levels were determined via enzyme immunoassay, and correlation coefficients were generated to determine overall correspondence of the individual measures.ResultsMatched RT and frozen samples were highly correlated for TN (r = 0.950, p = 5.44 × 10−37) and FN (r = 0.784, p = 1.05 × 10−10). Correlations between RT FN and TN were statistically significant (r = 0.621, p = 3.61 × 10− 17), as were frozen FN and TN (r = 0.310, p = 0.0283). RT, but not frozen TN and FN correlated with salivary cortisol (r = 0.580, p = 1.65 × 10− 16 and r = 0.287, p = 0.00042 for TN and FN, respectively).ConclusionsFN and TN cortisol levels correlate with salivary cortisol in adult cancer survivors and may offer a less invasive and convenient means for measuring chronic cortisol levels.

Hospitalized Smokers’ Expectancies for Electronic Cigarettes versus Tobacco Cigarettes

Head and Neck Cancer Adherence to Dietary Recommendations using Theory-Based Tools: Future Research Directions The possibility of applying social cognitive theory (SCT) as a potential framework in improving head and neck cancer (HNCa) patient adherence to dietary interventions as reported by Rogers et al. is very interesting. The very high internal reliability of the SCT scales related to diet adherence was impressive.This is the first study to examine predictors or correlates of diet adherence in HNCa patients based on a behavioral change theory. Further, this study supports the need and legitimacy of the use of SCT in assessing dietary adherence to recommendations by HNCa patients.