Chemobrain: Revisión de estudios que evalúan el deterioro cognitivo de supervivientes de cáncer tratados con quimioterapia

Planteamiento del problema: Algunos pacientes oncológicos han expresado problemas de atención, concentración y memoria durante y después de los tratamientos con quimioterapia, a los que se ha llamado chemobrain. Como consecuencia de estas manifestaciones, en las últimas décadas los estudios dedicados a indagar este posible efecto adverso se han incrementado. Desarrollo del tema: Este trabajo pretende revisar y analizar los estudios científicos más recientes que investigan la naturaleza y alcance del daño cognitivo asociado a los tratamientos quimioterapéuticos. Los artículos analizados se han extraído de diferentes fuentes bibliográficas, principalmente de la base de datos PubMed. Como resultado de la búsqueda se aprecia que, en los últimos años, se han incremento los estudios de diseño longitudinal; este posible efecto adverso se sigue estudiando sobre todo en muestras de mujeres con cáncer de mama, las investigaciones en otros tipos de cánceres son insuficientes; así mismo, destaca la inclusión de nuevas herramientas de evaluación, como la resonancia magnética y el electroencefalograma, junto con nuevos experimentos realizados con animales, in vivo e in vitro, finalmente se constata la inclusión de algunos estudios sobre fármacos y estrategias eficaces para su afrontamiento. La elaboración de guías para el estudio sistemático y las recomendaciones para su abordaje aún quedan pendientes. Conclusiones: no existen datos concluyentes sobre el chemobrain, los estudios longitudinales deberán incentivarse, así como la valoración del impacto cognitivo de determinados esquemas quimioterapéuticos en diferentes cánceres. Los trabajos sobre el afrontamiento, psicológico y/o farmacoThe problem: Some cancer patients have expressed attention, concentration and memory problems, during and after their treatment with chemotherapy, also called chemobrain. Following these complains, in recent decades, studies about this adverse effect had increased. Development of the topic: this work aims to review and analyze the latest scientific studies investigating the nature and severity of cognitive impairment associated with chemotherapy treatments. Works discussed are drowned from different bibliographical sources, mainly from the PubMed database. Results show that, in recent years, longitudinal studies have increased, chemobrain is being studied above all in samples from women with breast cancer, research in other types of cancer is insufficient. Also, the works include new assessment tools, such as MRI and EEG. Advances are done with animal experiments, in vivo and in vitro. Finally, we found studies on drugs and effective strategies for coping of cognitive impairment. The development of guidelines for its systematic study and recommendations for its approach are still pending. Conclusion: There is not conclusive data on the chemobrain, longitudinal studies should be encouraged, as well as assessing the cognitive impact of certain chemotherapeutic agents in different cancers. The works on cognitive impairment´s coping, psychological and drug, should continue

Variables asociadas al deterioro cognitivo en pacientes de cáncer de colon

Objetivo: Identificar las variables predictoras de menor rendimiento cognitivo en pacientes de cáncer de colon tratados con cirugía que esperan recibir quimioterapia. Método: En una muestra de 89 pacientes de cáncer de colon se valoró la relación entre su rendimiento en tres dominios cognitivos (función ejecutiva, memoria verbal y habilidad psicomotora) y las siguientes variables: edad, sexo, años de escolaridad, estadio, pronóstico médico, comorbilidad, hemoglobina, ansiedad, depresión, astenia, calidad de vida, problemas físicos y psicosociales. Resultados: En la muestra predominan los varones (61,8%), mayores de 65 años (media 66,9), sin antecedentes neuropsicológicos (89,9%). Los datos correlacionales ponen de manifiesto relaciones selectivas entre alguna prueba de rendimiento cognitivo y ciertas variables evaluadas. Se destaca la existencia de correlaciones negativas de la edad, los problemas respiratorios y la percepción social de la calidad de vida con el rendimiento cognitivo en pruebas de memoria verbal, función ejecutiva y habilidad psicomotora (p < 0,05). Así mismo, los pacientes en estadio III del cáncer de colon rinden peor que aquellos con la enfermedad en estadio II y quienes tienen menos de cinco años de estudios difieren de los de más estudios en los tres dominios cognitivos (p < 0,05) Conclusiones: el perfil detectado de los enfermos de cáncer de colon de alto riesgo de déficit cognitivo es: paciente mayor, con enfermedad en estadio III, de escasa formación escolar, que tiene problemas respiratorios y una buena percepción de su calidad de vida social.Objective: Identify predictors of lower cognitive performance in colon cancer patients treated with surgery before undergoing chemotherapy. Methods: In a sample of 89 colon cancer patients, we evaluated the relation between their cognitive performance in three cognitive domains (executive function, verbal memory and psychomotor skill) and the following variables: Age, sex, years of study, stage, medical prognosis, comorbidity, haemoglobin, anxiety, depression, fatigue, quality of life, physical and psychosocial problems. Results: They are a predominantly male sample (61.8%), over 65 years (mean 66.9) without neuropsychological illness history (89.9%). But, data show correlational relationships between some cognitive performance test and certain variables assessed. There are remarkable negative correlations with age, respiratory problems and social perception of the quality of life, with lower cognitive performance on tests of verbal memory, executive function and psychomotor ability (p <0.05). Also, patients with stage III colon cancer performed worse than those with stage II disease and those with less than five years of study differ from most studies in the three cognitive domains (p < 0.05). Conclusions: The profile of patients with colon cancer at high risk of cognitive deficit is: Old age, with stage III disease, little formal education, breathing problems and a good perception of their quality of social lif

Serum interleukin-15 levels in cancer patients with cachexia

Interleukin-15 (IL-15) has important anabolic effects on muscle protein metabolism through a decrease in the ATP-ubiquitin-dependent proteolytic pathway. The role of IL-15 in human cancer cachexia is unknown. The aim of this study was to assess the relationship between interleukin-15 (IL-15) in cancer patients with cachexia at diagnosis of malignancy and 8 weeks later. An observational study of 21 cancer patients (with and without cachexia) and 8 healthy subjects was conducted. Body composition was measured by leg-to-leg impedance. Serum IL-15 levels were assessed at baseline and after 4 and 8 weeks. Baseline IL-15 values were similar in cancer patients and in healthy subjects. Cancer patients with lower baseline levels of IL-15 (<2 pg/ml) had significantly higher fat mass (%) along the study. Eighteen patients completed the study: five patients showed an increase of 3.7 kg at the end of the study (5.4% of body weight) and showed a mean increase of IL-15 of 1.32 pg/ml (121%) at 4 weeks and 2.32 pg/ml (197%) at 8 weeks, as compared with mean decrease of -4.1 kg (-5.3%) and -0.09 pg/ml (-2.5%) and 0.6 pg/ml (40.8%) in the 13 patients who lost weight (P=0.001 and P=0.022, respectively). Changes of IL-15 at 4 and 8 weeks were directly associated with changes in body weight, body mass index (BMI), fat-free mass and muscle mass (P<0.05), and indirectly associated with percentage of weight loss (P<0.05). In summary, although the results indicate that IL-15 does not have a role in cancer cachexia pathogenesis, the association during evolution between serum IL-15 and changes in weight and muscle mass suggests a possible role of IL-15 as a marker of the body composition response in cancer patients who are losing weight at the time of diagnosisThis study was partially supported by a grant from the Fundación Mutua Madrileñ

Mieloma multiple Propuesta de un nuevo sistema de clasificacion

Centro de Informacion y Documentacion Cientifica (CINDOC). C/Joaquin Costa, 22. 28002 Madrid. SPAIN / CINDOC - Centro de Informaciòn y Documentaciòn CientìficaSIGLEESSpai

Mieloma múltiple: propuesta de un nuevo sistema de clasificación

Tesis doctoral inédita leída el 13-6-1988 en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Medicin

Actividad laboral en una cohorte de pacientes con carcinoma de pulmón Employment in a cohort of lung cancer patients

Introducción: La actividad laboral en el cáncer de pulmón es un aspecto psicosocial que ha recibido poca atención hasta el momento actual por distintos motivos, a pesar de considerarse una dimensión de la calidad de vida para todo paciente oncológico. Objetivos: Analizar la reinserción y adaptación al entorno laboral en una cohorte de pacientes con un carcinoma de pulmón para describir los factores que influyen en la vuelta al trabajo de estos enfermos. Pacientes y métodos: El estudio incluyó 35 pacientes consecutivos diagnosticados de un cáncer de pulmón y que estaban empleados en el momento del diagnóstico. El cuestionario incluyó aspectos epidemiológicos, clínicos y laborales (32 variables en total) que se relacionaron con la reincorporación al mundo laboral. También se incluyeron percepciones subjetivas de los enfermos respecto a este tema. Resultados: El 96,9% de los pacientes pasaron a inactivos tras comenzar el tratamiento de la enfermedad y un 85,7% lo seguían estando tras éste. La presencia de secuelas fue la variable con mayor influencia en la inactividad laboral. Conclusiones: Éste es el primer estudio exploratorio en nuestro país acerca de la reinserción laboral de los pacientes diagnosticados de un carcinoma de pulmón.Background: Cancer affects many dimensions determining quality of life, including work. However, the importance of work to cancer survivors has received little attention. Aim: Employment and work-related disability were investigated in a cohort of lung cancer patients to describe a possible discrimination and other work issues. Patients and Methods: The study included consecutively 35 lung cancer patients who were employed at diagnosis. The questionnaire included cancer-related symptoms and work-related factors. Clinical details were obtained from the medical record. Patients were interviewed face to face and 32 variables were recorded. Results: 96,9 per cent of patients were unable to work after diagnosis, but 85,7% returned to work at the end of treatment. Most of the problems reported in the study were linked to the sequelae of their disease and related treatments. Conclusions: This is the first exploratory study in Spain about labour reintegration in lung cancer patients. Further studies are necessary

Biological basis of cognitive function impairment induced by antineoplastic treatment

A menudo los pacientes que reciben tratamiento con quimioterapia y/o radioterapia presentan problemas de memoria y de atención. Se desconocen los mecanismos exactos por los que esto se produce, aunque se han propuesto diversas explicaciones. Tanto la quimioterapia como la radioterapia poseen una acción tóxica directa en el SNC, especialmente sobre las células progenitoras neurales y las de la glía, que son las responsables de mantener la neurogénesis del hipocampo y la integridad de la sustancia blanca. A ello cabe añadir el daño que pueden inducir los tratamientos en la vascularización cerebral, la alteración de la respuesta inmune mediada por citoquinas, y los cambios hormonales ya sean secundarios a la quimioterapia o a la propia hormonoterapia. La intensidad de estos efectos estaría modulada por diversos factores genéticos que influyen sobre la capacidad de reparación neuronal, la farmacodinamia y la actividad de los neurotransmisoresOften patients treated with chemotherapy and/or radiotherapy suffer memory and attention problems. The exact mechanisms of action are unknown, although several explanations have been proposed. Both chemotherapy and radiotherapy have a direct toxic effect in the CNS, especially neural progenitor cells and the glia, which are responsible for maintaining neurogenesis in the hippocampus and white matter integrity. Besides the treatments can induce vascular damage in the brain, altering the immune response mediated by cytokines, and hormonal changes secondary to either chemotherapy or hormone therapy itself. The intensity of these effects would be modulated by several genetic factors that influence the ability of neuronal repair, pharmacodynamics and activity of neurotransmitter

ERCC1 and topoisomerase I expression in small cell lung cancer: Prognostic and predictive implications

Small cell lung cancer is the most aggressive lung cancer subtype. The standard treatment approach is based on cisplatin regimens. Although response rates to treatment are approximately 60-80%, the median survival is still very poor. Excision repair cross complementation group 1 (ERCC1) is an enzyme that removes cisplatin-induced DNA adducts and has been related with prognosis and cisplatin response. Topotecan is the standard treatment as second-line therapy and it is an inhibitor of topoisomerase I (TOP I). We selected 76 patients with small cell lung (SCLC) to analyze the ERCC1 and TOP I mRNA expression. ERCC1 was studied both by quantitative PCR and immunohistochemistry. A significant association was found between the inmunohistochemistry expression of ERCC1 and the lack of platinum response (p=0.001). Moreover, low levels of TOP I RNA were shown to be linked to cisplatin response (p=0.002). In the survival analysis, a significant correlation between a better PFS with a low TOP I RNA expression as well as a negative ERCC1 inmunostaining were found, in both cases with a significant p-value (p=0.02 and 0.009, respectively). In summary, our results suggest the use of ERCC1 immunohistochemistry and TOP I mRNA analysis to predict cisplatin response and prognosis in SCLC patient

Cancer survivors referred to a long-term survivorship outpatient service within academic medical oncology: descriptive study

Purpose Long-term cancer survivors (LTCS) are a vulnerable and continued growing population. To date, only few studies have been conducted in the Spanish population; none of them with a comprehensive analysis of the most common problems identified for cancer survivors in order to improve their care and quality of life. Methods We conducted an observational descriptive study in 347 patients recruited between January 2015 and December 2016 from our newly created medical office for the specific care and follow-up of LTCS. Variables that describe the medical history were completed by the oncologist and measures on common problems previously reported for LTCS, related to cancer diagnosis and treatment, function, lifestyle, and emotional concerns, were collected from the patient. Results The mean age of our patients was 65.1 years at the time of the study and a median time without any antitumor treatment of 5.7 years. At the time of cancer diagnosis, 298 patients (85.9%) had at least one related chronic disease and 184 patients (53%) were retired. In addition, in 17.9% of those who continued working, income had been reduced. The incidence of health problems showed an increase during follow-up, even after 5 years, and required evaluation in an emergency department in 157 cases (45.3%). Regardless of age or sex, 239 patients (68.9%) had a significant decrease in sexual activity and 120 (34.6%) were diagnosed with clinical depression. Conclusions LTCS are patients with significantly high socioeconomic, labor, sexual, health, and psychological problems, 5 years after completion of cancer treatment, especially in older survivors. Implications for Cancer Survivor Common concerns of LTCS were identified and are consistent across many countries. It is important to realize that even 5 or so years following treatment, both medical and non-medical problems can exist and may need attention by an expert