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; eleven were retained for meta-analysis. There was agreement that cognitive impairments are evident for a subset of patients prior to HCT. Meta-analytic findings of 404 patients revealed no significant changes in cognitive functioning pre- to post-HCT (P values > .05). Age, time since transplant, and total body irradiation were not associated with changes in cognitive functioning. Patients who received autologous transplants were more likely to demonstrate improvements in attention (P = .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

Long-Term Consequences of Methamphetamine Exposure in Young Adults Are Exacerbated in Glial Cell Line-Derived Neurotrophic Factor Heterozygous Mice

Methamphetamine abuse in young adults has long-term deleterious effects on brain function that are associated with damage to monoaminergic neurons. Administration of glial cell line-derived neurotrophic factor (GDNF) protects dopamine neurons from the toxic effects of methamphetamine in animal models. Therefore, we hypothesized that a partial GDNF gene deletion would increase the susceptibility of mice to methamphetamine neurotoxicity during young adulthood and possibly increase age-related deterioration of behavior and dopamine function. Two weeks after a methamphetamine binge (4 x 10 mg/kg, i.p., at 2 h intervals), GDNF +/- mice had a significantly greater reduction of tyrosine hydroxylase immunoreactivity in the medial striatum, a proportionally greater depletion of dopamine and 3,4-dihydroxyphenylacetic acid (DOPAC) levels in the striatum, and a greater increase in activated microglia in the substantia nigra than wild-type mice. At 12 months of age, methamphetamine-treated GDNF +/- mice exhibited less motor activity and lower levels oftyrosine hydroxylase-immunoreactivity, dopamine, DOPAC, and serotoninthanwild-typemice. Greater striatal dopaminetransporter activity in GDNF +/- mice may underlie their differential response to methamphetamine. These data suggest the possibility that methamphetamine use in young adults, when combined with lower levels of GDNF throughout life, may precipitate the appearance of parkinsonian-like behaviors during aging

Predicting Fear of Recurrence and Protective Health Behaviors Using Protection Motivation Theory

Prior research suggests that fear of cancer recurrence is very common among cancer survivors. This study examined the extent to which Protection Motivation Theory variables of threat appraisal and coping appraisal accounted for differences in fear of recurrence and performance of health behaviors in cancer patients who recently completed treatment. It was hypothesized that greater fear of recurrence would be related to a combination of high threat appraisal and low coping appraisal. Also, it was hypothesized that higher rates of health behaviors would be related to higher threat appraisals for cancer recurrence and higher coping appraisals for reducing risk of recurrence by improving diet or exercising. A sample of 155 early-stage breast cancer patients (mean age = 59 years) who completed surgery, chemotherapy, and/or radiotherapy between 6-24 months previously (mean = 12 months) completed measures of fear of recurrence, threat appraisal (perceived risk and severity of a potential cancer recurrence), fruit and vegetable intake in the past month, exercise for the past week, and coping appraisal (perceived response efficacy and self-efficacy to perform diet and exercise recommendations to reduce recurrence risk). Basic demographic and clinical information was also collected. The study findings supported the hypothesis that the combination of threat and coping appraisal beliefs explain which breast cancer survivors report higher fear of recurrence. However, the observed results did not support the hypothesized interaction between threat and coping appraisal for predicting either diet or exercise habits. Instead, coping appraisal alone predicted both fruit and vegetable consumption and exercise habits. Future research should focus on examining these relationships longitudinally and further assess coping appraisal and how it impacts fear of recurrence

Predicting Fear of Recurrence and Protective Health Behaviors Using Protection Motivation Theory

Prior research suggests that fear of cancer recurrence is very common among cancer survivors. This study examined the extent to which Protection Motivation Theory variables of threat appraisal and coping appraisal accounted for differences in fear of recurrence and performance of health behaviors in cancer patients who recently completed treatment. It was hypothesized that greater fear of recurrence would be related to a combination of high threat appraisal and low coping appraisal. Also, it was hypothesized that higher rates of health behaviors would be related to higher threat appraisals for cancer recurrence and higher coping appraisals for reducing risk of recurrence by improving diet or exercising. A sample of 155 early-stage breast cancer patients (mean age = 59 years) who completed surgery, chemotherapy, and/or radiotherapy between 6-24 months previously (mean = 12 months) completed measures of fear of recurrence, threat appraisal (perceived risk and severity of a potential cancer recurrence), fruit and vegetable intake in the past month, exercise for the past week, and coping appraisal (perceived response efficacy and self-efficacy to perform diet and exercise recommendations to reduce recurrence risk). Basic demographic and clinical information was also collected. The study findings supported the hypothesis that the combination of threat and coping appraisal beliefs explain which breast cancer survivors report higher fear of recurrence. However, the observed results did not support the hypothesized interaction between threat and coping appraisal for predicting either diet or exercise habits. Instead, coping appraisal alone predicted both fruit and vegetable consumption and exercise habits. Future research should focus on examining these relationships longitudinally and further assess coping appraisal and how it impacts fear of recurrence

Fear of Cancer Recurrence in Breast Cancer Survivors Before and After Follow-up Mammograms

The purpose of this study was to assess fear of cancer recurrence (FCR) in breast cancer survivors returning for regularly scheduled follow-up mammograms. FCR was hypothesized to increase prior to the mammogram, decrease from immediately pre- to immediately post-mammogram, and then increase following the mammogram. Based on the cognitive-behavioral model (CBM) of health anxiety, greater perceived risk of recurrence, worse perceived consequences of a recurrence, lower coping self-efficacy, and more engagement in reassurance-seeking behaviors were hypothesized to be associated with greater FCR in each time segment. Finally, exploratory analyses evaluated the various trajectories in FCR over time using growth mixture modeling and the CBM to predict class membership. The sample comprised 161 women who completed treatment for stage 0-IIIA breast cancer between 6 and 36 months previously. Participants completed the following measures at least 31 days prior to the scheduled mammogram: perceived risk and perceived consequences of breast cancer recurrence, treatment efficacy beliefs, coping self-efficacy, and reassurance seeking behaviors. Participants reported FCR at one month, one week, and immediately prior to the mammogram as well as one month, one week, and immediately after the mammogram using visual analogue scales (VAS) to rate anxiety and worry about cancer recurrence, the Cancer Worry Scale (CWS), and the Fear of Cancer Recurrence Inventory (FCRI). State anxiety and reassurance post-mammogram were also assessed. FCR significantly changed over time with increases in CWS scores prior to the mammogram, a significant decline on the VAS observed immediately following receipt of results, and a significant increase on the VAS, and decrease in reassurance during the month following the mammogram. The CBM did not significantly predict change in FCR over time, but certain variables did predict fluctuations including coping-self efficacy and perceived risk in the expected directions. Finally, growth mixture models revealed two classes, high-FCR and low-FCR, which were predicted by the CBM. These study findings support the use of the CBM in predicting which cancer survivors experience greater FCR and indicates that CBM-driven interventions may prove beneficial for reducing distressing FCR

Cancer Outcomes in Hispanics/Latinos in the United States: An Integrative Review and Conceptual Model of Determinants of Health

Cancer is the leading cause of death among Hispanics. Compared to non-Hispanic Whites, Hispanics are more likely to be diagnosed with advanced stages of disease and experience poor quality of life following a cancer diagnosis. Cancer outcomes are influenced by a confluence of social, cultural, behavioral and biological factors. Yet, much of the behavioral and psychosocial research in oncology has focused on non-Hispanic Whites, thus limiting our understanding of the potential web of factors that can influence cancer-related outcomes among Hispanics. Furthermore, features of Hispanic ethnicity and culture may influence and interact with, social, psychosocial, health care, disease-specific, and medical factors known to influence cancer-related outcomes, yet very few studies have integrated Hispanic cultural processes when addressing cancer-related outcomes for this ethnic group. Guided by the extant literature in oncology, Hispanic culture and health, and previously established models of determinants of minority health, we present a conceptual model that highlights the interplay of social, cultural, psychosocial, disease-specific, health care, and medical factors as determinants of cancer outcomes (morbidity, mortality, quality of life) and review key evidence of how features of Hispanic culture may influence cancer outcomes and contribute to the disparate outcomes observed in Hispanic cancer samples relative to non-Hispanic Whites. Finally, we conclude with a discussion of future research opportunities and existing challenges to researching oncology outcomes among Hispanics

Factors Associated with Breast Cancer Worry 3 Years After Completion of Adjuvant Treatment

Objective: Although many survivors continue to worry about cancer years after completing treatment, little is known about factors associated with cancer worry. This study examined associations between breast cancer worry and demographic and clinical variables, as well as fatigue, symptom burden, and risk perception in a sample of breast cancer survivors 3 years post-adjuvant treatment. We hypothesized that after controlling for demographic and treatment factors, a significant proportion of variance in cancer worry would be explained by greater fatigue severity, more symptom burden, and greater perceived risk of recurrence. Methods: Stage 0-II breast cancer patients (N = 202) completed measures of risk perception, cancer worry (modified Lerman\u27s Cancer Worry Scale), symptom burden (Memorial Symptom Assessment Scale), and fatigue severity (Fatigue Symptom Inventory) 3 years after completing adjuvant treatment. Multiple regression analyses were used to determine the proportion of variance in cancer worry accounted for by fatigue, symptom burden, and risk perception after controlling for demographic and clinical variables. Results: Age, fatigue, symptom burden, and risk perception each explained a significant proportion of variance in cancer worry (p \u3c 0.05). Fatigue, symptom burden, and risk perception together accounted for 27% of the variance in cancer worry after controlling for demographic and clinical factors (p \u3c 0.01). Conclusions: The hypothesis was supported that fatigue, symptom burden, and risk perception are associated with cancer worry among breast cancer survivors. It is possible that lingering fatigue and other symptoms may remind breast cancer survivors of their disease. Copyright © 2012 John Wiley & Sons, Ltd