Vers une prise en charge des troubles cognitifs des patients atteints de cancer

International audienc

The patients' view on their cognitive impairments, demand for support and willingness to attend 'memory workshop': a survey in two French Cancer Centers

info:eu-repo/semantics/nonPublishe

Impact des traitements en cancérologie sur les fonctions cognitives: Le point de vue des patients, leur attente et leur souhait de participer à des ateliers de rééducation cognitive

Introduction. Cancer and chemotherapy can have adverse effects on cognitive functions and quality of life of patients. We wanted to know the patients' view on these disorders, but also their expectations in terms of assessment and support. Methods and results. A survey was conducted in day care hospital among 551 patients from three cancer centers. Most of the patients were between 40 and 74 years and suffered from breast cancer. Eighty-four percent were treated with chemotherapy. Forty-one percent of patients report memory problems, 26% were affected by specific concentration disorders, and 19% of the attention. On the whole, 52% of patients report at least one of the previous cognitive impairment. Among these patients, 80% evoked that the support of these problems was essential and 70% were willing to participate in "workshops" to deal with these disorders. Conclusion. The cognitive impairment occurrence is a real problem for patients receiving chemotherapy and becomes a priority in the global management of their disease. Studies assessing a specific support of theses symptoms should be encouraged to help patients. © John Libbey Eurotext.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

How to assess and manage cognitive impairment induced by treatments of non-central nervous system cancer

CERVOXY COLLInternational audienceA number of neurotoxicity associated with oncological treatments has been reported in non-central nervous system cancers.An expert group presents the state of the art and a guide to help the choice of appropriated tools to assess patient cognition in studies on oncology and neurobehavior in animal models. In addition, current cognitive rehabilitation programs currently under evaluation are also discussed.Cognitive assessments in oncology depend on the research question, study design, cognitive domains, patients’ characteristics, psychometric properties of the tests, and whether the tests are supervised or not by a neuropsychologist. Batteries of electronic tests can be proposed, but several of them are characterized by weak psychometric developments. In order to improve the comprehension on the impact of cancer treatments on cognition, new animal models are in development, and would in the future include non-human primate models.By bringing together the skills and practices of oncologists, neurologists, neuropsychologists, neuroscientists, we propose a series of specific tools and tests that accompany the cognitive management of non-CNS cancer patients

How to assess and manage cognitive impairment induced by treatments of non-central nervous system cancer

CERVOXY COLLInternational audienceA number of neurotoxicity associated with oncological treatments has been reported in non-central nervous system cancers.An expert group presents the state of the art and a guide to help the choice of appropriated tools to assess patient cognition in studies on oncology and neurobehavior in animal models. In addition, current cognitive rehabilitation programs currently under evaluation are also discussed.Cognitive assessments in oncology depend on the research question, study design, cognitive domains, patients’ characteristics, psychometric properties of the tests, and whether the tests are supervised or not by a neuropsychologist. Batteries of electronic tests can be proposed, but several of them are characterized by weak psychometric developments. In order to improve the comprehension on the impact of cancer treatments on cognition, new animal models are in development, and would in the future include non-human primate models.By bringing together the skills and practices of oncologists, neurologists, neuropsychologists, neuroscientists, we propose a series of specific tools and tests that accompany the cognitive management of non-CNS cancer patients

Baseline cognitive functions among elderly patients with localised breast cancer

International audiencePURPOSE: Cognitive deficits (CD) are reported among cancer patients receiving chemotherapy, but may also be observed before treatment. Though elderly patients are expected to be more prone to present age-related CD, poor information is available regarding the impact of cancer and chemotherapy on this population. This study assessed baseline cognitive functions (before adjuvant treatment) in elderly early stage breast cancer (EBC) patients. METHODS: Women >65years-old with newly diagnosed EBC were included in this prospective study. Episodic memory, working memory, executive functions and information processing speed were assessed by neuropsychological tests. Questionnaires were used to assess subjective CD, anxiety, depression, fatigue, quality of life and geriatric profile. Objective CD were defined using International Cognition and Cancer Task Force criteria. A group of elderly women without cancer coupled with published data related to healthy women were used for comparison (respectively to subjective and objective CD). RESULTS: Among the 123 elderly EBC patients (70±4years) included, 41% presented objective CD, which is greater than expected in healthy population norms (binomial test P<.0001). Verbal episodic memory was mainly impaired (21% of patients). No correlation was observed between objective CD and cancer stage or geriatric assessment. Subjective CD only correlated with verbal episodic memory (P=.01). CONCLUSIONS: This is the first large series assessing baseline cognitive functions in elderly EBC patients. More than 40% presented objective CD before any adjuvant therapy, which is higher than what is reported among younger patients. Our results reinforce the hypothesis that age is a risk factor for CD in EBC patients

How to assess and manage cognitive impairment induced by treatments of non-central nervous system cancer

CERVOXY COLLInternational audienceA number of neurotoxicity associated with oncological treatments has been reported in non-central nervous system cancers.An expert group presents the state of the art and a guide to help the choice of appropriated tools to assess patient cognition in studies on oncology and neurobehavior in animal models. In addition, current cognitive rehabilitation programs currently under evaluation are also discussed.Cognitive assessments in oncology depend on the research question, study design, cognitive domains, patients’ characteristics, psychometric properties of the tests, and whether the tests are supervised or not by a neuropsychologist. Batteries of electronic tests can be proposed, but several of them are characterized by weak psychometric developments. In order to improve the comprehension on the impact of cancer treatments on cognition, new animal models are in development, and would in the future include non-human primate models.By bringing together the skills and practices of oncologists, neurologists, neuropsychologists, neuroscientists, we propose a series of specific tools and tests that accompany the cognitive management of non-CNS cancer patients

J Natl Cancer Inst

BACKGROUND: Using the large nationwide CANTO cohort, we assessed cognitive functioning change after cancer treatments in a subgroup of breast cancer patients. METHODS: We included patients with newly diagnosed invasive stage I-III breast cancer enrolled in the CANTO sub-study focused on cognitive evaluation and healthy control women matched for age and education. Episodic and working memory, executive functions, processing speed, attention, self-report cognitive difficulties (SRCD), fatigue, anxiety/depression were assessed with neuropsychological tests and self-report questionnaires, before treatment (baseline), about 1 (year-1) and 2 years (year-2) after diagnosis. We used linear mixed models to study changes in cognition and tested the effect of adjuvant chemotherapy. RESULTS: We studied 276 localized breast cancer patients (62% chemotherapy (CT+)) compared to 135 healthy controls. After adjustment, patients had lower baseline working memory, processing speed and attention scores than healthy controls (p ≤ 0.001), and the difference remained significant over follow-up for working memory and processing speed. Executive function scores were similar between groups at baseline but decreased at year-1 among patients compared to healthy controls (p for change = 0.006). This decrease in CT+ patients was significant when compared to healthy controls scores (p for change < 0.001). After adjustment, SRCD were similar between breast cancer patients and healthy controls at baseline but increased in patients after treatment at year-1 (p for change = 0.002). CONCLUSIONS: Cognitive difficulties are an important concern in breast cancer patients, starting at diagnosis. Cancer treatments induce executive function decline and SRCD, which decrease over follow-up.Etude des toxicités chroniques des traitements anticancéreux chez les patientes porteuses cance

Treatment and outcomes of older versus younger women with HER2-positive metastatic breast cancer in the real-world national ESME database

International audienceBACKGROUND: Treatment and outcomes of patients with HER2-positive (HER2+) metastatic breast cancer (MBC) have dramatically improved over the past 20 years. This work evaluated treatment patterns and outcomes according to age. METHODS: Women who initiated a treatment for HER2+ MBC between 2008 and 2016 in one of the 18 French comprehensive centers part of the ESME program were included. Objectives were the description of first-line treatment patterns, overall survival (OS), first-line progression-free survival (PFS), and prognostic factors among patients aged 70 years or more (70+), or less than 70 (<70). RESULTS: Of 4045 women diagnosed with an HER2+ MBC, 814 (20%) were 70+. Standard first-line treatment (chemotherapy combined with an anti-HER2 therapy) was prescribed in 65% of 70+ versus 89% of <70 patients (p < 0.01). Median OS was 49.2 (95% CI, 47.1-52.4), 35.3 (95% CI, 31.5-37.0) and 54.2 months (95% CI, 50.8-55.7) in the whole population, in patients 70+ and <70, respectively. Corresponding median PFS1 were 12.8 (95% CI, 12.3-13.3), 11.1 (95% CI, 10.0-12.3) and 13.2 months (95% CI, 12.7-13.9), respectively. In 70+ women, initiation of non-standard first-line treatment had an independent detrimental time-varying effect on both OS and PFS (HR on OS at 1 year: chemotherapy without anti-HER2 2.79 [95% CI: 2.05-3.79]; endocrine therapy and/or anti-HER2 1.96 [95% CI: 1.43-2.69]). CONCLUSIONS: In this large retrospective real-life database, older women with HER2+ MBC received standard first-line treatment less frequently than younger ones. This was independently associated with a worse outcome, but confounding factors and usual selection biases cannot be ruled out