BACKGROUND/OBJECTIVES: Cancer- or chemotherapy-related cognitive deficit is a common side effect occurring in patients with Hodgkin lymphoma. No previous study compared the influence of different types of treatment on the onset and development of chemotherapy cognitive impairment in longitudinal design. The aim of this study was to assess whether a more intensive form of chemotherapy causes greater cognitive impairment. METHODS: Forty-four patients at three different stages of the disease and with three different treatments (ABVD + 30 Gy, BEACOPPesc, or ABVD + 30 Gy plus BEACOPPesc) completed the neuropsychological battery and psychological measures of affective distress and quality of life. We compared their cognitive performance before, immediately after, and 6 months after the treatment. RESULTS: Whether or not we divided the total number of people with Hodgkin lymphoma into two groups (mild and moderate disease versus severe disease) or three groups (mild, moderate, and advanced disease), we found no statistically significant difference between the groups in cognitive performance or other psychological factors or experienced quality of life. CONCLUSIONS: Our results did not show that disease stage or treatment protocol had an effect on the depth of cognitive impairment in cancer or chemotherapy. We hypothesize that, in terms of brain health, intensive forms of chemotherapy (6 × BEA-COPPesc) do not pose a greater risk than milder forms (4 × ABVD + 30 Gy IF RT and 2 × BEACOPPesc + 4 × ABVD + 30 Gy IF RT) of cancer treatment for Hodgkin lymphoma. However, a limitation of our study is the small number of participants in the study, so it would be advisable to repeat the study on a larger sample of patients. Confirmation of our results could be beneficial in that neither patients nor physicians need to worry that intensive chemotherapy will worsen cognitive deficits.
- Publikační typ
- časopisecké články MeSH
Chemotherapy-related cognitive impairment (CRCI) is a well-documented side effect of cancer treatment in various types of tumors including Hodgkin's lymphoma (HL). However, a longitudinal study evaluating the cognitive performance of HL patients has been completely lacking. The aim of the study was to determine the presence of CRCI in HL patients before, promptly after, and 6 months after treatment. Thirty-six patients newly diagnosed with HL and 45 healthy controls (HC) completed the neuropsychological battery and psychological measures of affective distress and quality of life. The results indicate that HL patients have impaired performance compared to HC which cannot be explained by emotional factors. Cognitive impairments prior to treatment were found in 3 of 6 cognitive domains, i.e., verbal memory and learning, speed of processing/psychomotor speed, and abstraction/executive function. Promptly after the chemotherapy, deficits were found in the domains of memory and learning, verbal memory, speed of processing/psychomotor speed, and abstraction/executive function. Weaker cognitive performance persist even 6 months after the end of chemotherapy, specifically in domains of verbal memory and learning, and abstraction/executive function. Our results indicate the presence of cognitive impairment in HL patients already prior to treatment and increased damages caused by chemotherapy, while some of them may last for up to 6 months after the treatment.
- MeSH
- exekutivní funkce MeSH
- Hodgkinova nemoc * komplikace farmakoterapie MeSH
- kognitivní dysfunkce * chemicky indukované komplikace MeSH
- kvalita života MeSH
- lidé MeSH
- longitudinální studie MeSH
- neuropsychologické testy MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Východiska: Narušení kognitivních funkcí (poruchy paměti, pozornosti, koncentrace atd.) se vyskytuje po chemoterapii a dalších léčebných postupech u 17–75 % pacientů s různými nádorovými onemocněními a výrazně zhoršuje jejich kvalitu života. Kognitivní deficit spojený s chemoterapií (chemotherapy-related cognitive impairment – CRCI) postihuje pacienty všech věkových skupin. Narušení kognitivních funkcí v souvislosti s chemoterapií bývá obvykle spíše mírné, souvislost s rozvojem demence nebyla potvrzena. Chemoterapie v kombinaci s radioterapií vede k vyléčení 80–90 % pacientů s Hodgkinovým lymfomem. Cíl: Tento přehledový článek shrnuje nejčastěji popisované změny v kognitivních funkcích u pacientů s CRCI. Článek se dále zabývá popisem možných patofyziologických mechanizmů, které leží v pozadí uvedených změn a rizikových faktorů, které mohou zvyšovat pravděpodobnost vzniku poškození kognitivních funkcí po chemoterapii u nádorových onemocnění. Zvláštní zřetel přitom bereme na problematiku Hodgkinova lymfomu. Současně se věnujeme neuroprotektivním faktorům a možnostem léčebného ovlivnění narušení kognitivních funkcí po chemoterapii. Závěr: Ke změnám dochází především ve schopnosti učení a paměti, rychlosti reakcí, pozornosti a v exekutivních funkcích. Patofyziologické mechanizmy CRCI jsou komplexní a nejsou dosud plně objasněny. Studována je v této souvislosti role přímého neurotoxického působení léčby, anémie, navozený oxidační stres a zánětlivá reakce, genetické faktory a snížení konektivity mozku. CRCI je dále modifikován věkem nemocných a komorbiditami. Zkoumány jsou farmakologické i nefarmakologické možnosti léčby CRCI.
Background: Cognitive impairment (impairment of memory, attention, or concentration) is documented in 17–75% of patients with various malignancies treated with chemotherapeutic agents that worsen quality of life. CRCI affects patients of all ages. The impairment of cognitive function in connection with chemotherapy is usually mild, but an event. relationship with dementia remains to be confirmed. Chemotherapy in combination with radiotherapy in Hodgkin lymphoma can cure 80–90% of patients. Aim: This review summarizes the most frequently observed changes in cognitive function in patients suffering from CRCI. The article further describes the possible pathophysiological mechanisms behind these changes and the risk factors that can increase the likelihood of cognitive functional impairment after chemotherapy of malignant tumors. Special attention is given to how this relates to Hodgkin’s lymphoma. We also discuss the neuroprotective factors involved in chemotherapy-related cognitive impairment and its treatment options. Conclusion: Changes occur mainly in the ability to learn and remember, in the speed of reactions, and in attention and executive functions. Although CRCI pathophysiological mechanisms are complex and not yet fully understood, the involvement of neurotoxicity, such as that induced by treatment, anemia, higher levels of oxidative stress and inflammatory responses, genetic factors, and reduced brain connectivity is discussed. CRCI is further modified by comorbidities and patient age. Pharmacological and nonpharmacological treatment options for CRCI are outlined.
- MeSH
- adjuvantní chemoterapie škodlivé účinky MeSH
- anemie MeSH
- antidepresiva druhé generace MeSH
- cytokiny fyziologie MeSH
- cytostatické látky toxicita MeSH
- fluoxetin terapeutické užití MeSH
- Hodgkinova nemoc * farmakoterapie MeSH
- kognice MeSH
- kognitivní dysfunkce * etiologie patofyziologie terapie MeSH
- komorbidita MeSH
- lidé MeSH
- neuroprotekce MeSH
- oxidační stres fyziologie MeSH
- rizikové faktory MeSH
- věkové faktory MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- přehledy MeSH
