Colorectal cancer (CRC) is the third most common cancer worldwide. After curative intent treatmen... more Colorectal cancer (CRC) is the third most common cancer worldwide. After curative intent treatment, international guidelines recommend surveillance protocols which include annual CT chest, abdomen and pelvis (CAP) and serum carcinoembryonic antigen (CEA) monitoring which aim to improve overall survival by early detection of recurrence. Despite the widespread recommendations, robust evidence of an overall survival benefit is lacking. Our study aimed to quantify the utility of annual CT CAP as a surveillance modality in comparison to the rate of potentially harmful false-positive and incidental findings. High-risk stage II and stage III CRC patients were retrospectively identified from the Sydney Cancer Survivorship Centre database. Findings on surveillance CT were classified into confirmed recurrence or the potentially harmful findings of (a) false-positive or (b) clinically significant incidental finding. A total of 376 surveillance CT CAPs were performed in 174 survivors between 12 September 2013 and 30 June 2020. The recurrence rate during the study period was 23/174 (13.2%) with the majority of recurrences detected by abnormal CEA (14/23, 60.9%) versus surveillance CT (4/23, 17.4%), with the remainder identified on non-surveillance CT (5/23, 21.7%). Curative intent surgery was performed in 12/23 people with CRC recurrence. Surveillance CT was shown to result in high levels of false-positive (31/174, 17.8% of patients) or clinically significant incidental findings (30/174, 17.2% of patients). The risk of identifying these potentially harmful findings was ongoing with each year of surveillance CT. Surveillance CT was associated with low detection rates and high rates of potentially harmful findings bringing this surveillance modality under further scrutiny. An increased emphasis should be placed on educating survivors on the benefits of surveillance CT weighed against the risk of potentially harmful findings.
Endocrine therapy forms the backbone of systemic therapy for the majority of persons with early a... more Endocrine therapy forms the backbone of systemic therapy for the majority of persons with early and late-stage breast cancer. However, the side effects can negatively affect quality of life, and impact treatment adherence and overall oncological outcomes. Adverse effects on cognition are common, underreported and challenging to manage. We aim to describe the nature, incidence, risk factors and underlying mechanisms of endocrine therapy-induced cognitive dysfunction. We conducted a comprehensive literature review of the studies reporting on cognitive dysfunction associated with endocrine therapies for breast cancer. We also summarise prevention and treatment strategies, and ongoing research. Given that patients are taking endocrine therapies for longer durations than ever before, it is essential that these side effects are managed pro-actively within a multi-disciplinary team in order to promote adherence to endocrine therapy and improve patients’ quality of life.
Background Advances in diagnostic and therapeutic strategies in oncology have significantly incre... more Background Advances in diagnostic and therapeutic strategies in oncology have significantly increased the chance of survival of cancer patients, even those with metastatic disease. However, cancer-related cognitive impairment (CRCI) is frequently reported in patients treated for non-central nervous system cancers, particularly during and after chemotherapy. Design This review provides an update of the state of the art based on PubMed searches between 2012 and March 2019 on ‘cognition’, ‘cancer’, ‘antineoplastic agents’ or ‘chemotherapy’. It includes the most recent clinical, imaging and pre-clinical data and reports management strategies of CRCI. Results Evidence obtained primarily from studies on breast cancer patients highlight memory, processing speed, attention and executive functions as the most cognitive domains impaired post-chemotherapy. Recent investigations established that other cancer treatments, such as hormone therapies and targeted therapies, can also induce cognitive...
9500 Background: The role of adjuvant WBRT in MBMs is controversial. This trial compares WBRT wit... more 9500 Background: The role of adjuvant WBRT in MBMs is controversial. This trial compares WBRT with Obs after local treatment of 1-3 MBMs. Methods: The primary endpoint is distant intracranial failure (DIF) within 12 months of randomization. The a priori neurocognitive function (NCF) endpoint is Hopkins Verbal Learning Test-Revised (HVLT-R) delayed recall at 4 months. Secondary endpoints include local failure (LF), overall survival (OS) and global quality of life (QoL). Analyses were conducted on intention-to-treat basis with nominal two-sided significance level 5%. Drug therapy was allowed. Effective drugs became available during trial and their impact was analysed. Results: Of 586 eligible patients (pts), 215 consented from 31 sites in 3 countries (Australia, UK and Norway) between 2009 and 2017. Eight (0.04%) who withdrew or had no data collected were excluded. 107 randomized to Obs and 100 to WBRT. Mean age 62 years, 67% males, 61% with single MBM of mean size 2cm, 67% had extrac...
Purpose Up to 70% of survivors report cognitive symptoms after chemotherapy. We compared two cogn... more Purpose Up to 70% of survivors report cognitive symptoms after chemotherapy. We compared two cognitive rehabilitation programs to a control group in cancer survivors. Methods Study population were adult cancer survivors with cognitive symptoms 6–60 months after adjuvant chemotherapy. Participants randomised to: Attention Process Training (APT), Compensatory Strategy Training (CST), or control group. Active interventions comprised 6–week, 2–h/week small group sessions. Assessments: pre- and post-intervention, 6- and 12-months later. Primary outcome was change in cognitive symptoms (FACT-COG-PCI subscale) between baseline and post-intervention. Secondary endpoints included objective neuropsychological performance, Functional Impact Assessment (FIA), patient-reported outcome measures, and associations. Analyses were on an intention-to-treat basis. Analysis of covariance mixed models were used for continuous outcomes. Results Sixty-five participants were randomised (APT n = 21; CST n = ...
Purpose Cancer-related cognitive impairment (CRCI) is a recognised adverse consequence of cancer ... more Purpose Cancer-related cognitive impairment (CRCI) is a recognised adverse consequence of cancer and its treatment. This study assessed the feasibility of collecting longitudinal data on cognition in patients with newly diagnosed, aggressive lymphoma undergoing standard therapy with curative intent via self-report, neuropsychological assessment, peripheral markers of inflammation, and neuroimaging. An exploration and description of patterns of cancer-related cognitive impairment over the course of treatment and recovery was also undertaken and will be reported separately. Methods Eligible participants completed repeated measures of cognition including self-report and neuropsychological assessment, and correlates of cognition including blood cell–based inflammatory markers, and neuroimaging at three pre-specified timepoints, time 1 (T1) — pre-treatment (treatment naïve), time 2 (T2) — mid-treatment, and time 3 (T3) — 6 to 8 weeks post-completion of treatment. Results 30/33 eligible p...
Background Our longitudinal study reported cognitive impairment in 43% of people following diagno... more Background Our longitudinal study reported cognitive impairment in 43% of people following diagnosis of localised colorectal cancer (CRC) versus 15% in healthy controls (p 0.5], Functional Deficit Score, blood results and neuroimaging. Results The study included 25 CRC survivors (60% men, median age 72) at mean 9 years after baseline (9 received adjuvant chemotherapy) and 25 controls (44% men, median age 68) at mean 6 years after baseline. There were no significant differences in cognitive scores or proportion with cognitive impairment (16 vs. 8%) between survivors and controls and no evidence of accelerated ageing in CRC survivors. Baseline cognitive performance predicted for subsequent cognitive function. There were no differences in functional tests or blood tests between groups. In 18 participants undergoing neuroimaging, 10 CRC survivors had higher myoinositol levels than 8 controls, and lower volume in the right amygdala and caudate and left hippocampal regions. Conclusions T...
PurposeChemotherapy-induced peripheral neuropathy (CIPN) commonly affects people treated for canc... more PurposeChemotherapy-induced peripheral neuropathy (CIPN) commonly affects people treated for cancer, with functional consequences of impaired balance and falls. Virtual reality technology (VR) may be able to assess balance, identifying patients at increased risk of falls. We aimed to assess the impact of neurotoxic chemotherapy on balance and falls risk using VR, and explore whether changes in balance threshold were associated with falls or validated CIPN measures. MethodsWe conducted a prospective, longitudinal cohort study at two Australian oncology centres. Eligible participants were commencing adjuvant chemotherapy containing a taxane for breast cancer, or oxaliplatin for colon cancer. Excluded: insufficient English to complete assessments, VR intolerance, or pre-existing balance disorder. VR balance threshold was recorded at baseline, intervals during chemotherapy, and 3- and 6-months after chemotherapy completion. Additional measures: 1) clinician-graded peripheral sensory neu...
Bowel dysfunction is common after anterior resection for colorectal cancer (CRC). Pelvic floor re... more Bowel dysfunction is common after anterior resection for colorectal cancer (CRC). Pelvic floor rehabilitation (PFR) may improve functional outcomes after surgery. This review aimed to evaluate the efficacy of PFR for patients with bowel symptoms after anterior resection. MEDLINE, CINHAL, PUBMED, EMBASE, Scopus, PsycINFO, Web of Science, PEDRO and Cochrane Library were searched from inception to June 2019. A final search was performed on 11 July 2020. Randomised controlled trials (RCTs), cohort studies, case-control studies and case series of bowel dysfunction after CRC surgery and PFR were eligible for review. Outcome measures were bowel function changes measured by patient-reported outcomes and manometric measurement. Risk of bias assessments using Methodological Index for Non-Randomized Studies (MINORS) tool and Newcastle Ottawa Scale (NOS) were conducted. Eleven trials met eligibility criteria: four retrospective studies and seven prospective, non-randomised controlled studies. A total of 516 participants were included, of which 455 received PFR. Functional outcomes were measured by bowel functional outcome questionnaires, patient diary, anorectal manometry and three studies measured quality of life. Faecal incontinence was improved in seven studies, and bowel frequency also decreased in five studies. The mean MINORS score was 10 (8–13) out of 16 in non-comparative groups and 18 (16–22) out of 24 in comparative groups; the NOS was 4.2 (3–7) out of 9. The overall risk of bias was high in most studies. PFR appears to be beneficial for improving bowel function after anterior resection for CRC. However, the studies included had methodological limitations, so further investigation on the effectiveness of PFR is warranted.
1. Department of Medical Oncology, Liverpool Hospital, Sydney, New South Wales, Australia. 2. Uni... more 1. Department of Medical Oncology, Liverpool Hospital, Sydney, New South Wales, Australia. 2. University of Sydney, Sydney, New South Wales, Australia. 3. Centre for Medical Psychology & Evidence-based Decision-making, School of Psychology, University of Sydney, Sydney, New South Wales, Australia. 4. Concord Cancer Centre and Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
The purpose of this survey was to examine patient-doctor communication about the use of complemen... more The purpose of this survey was to examine patient-doctor communication about the use of complementary and alternative medicine (CAM) by adult patients with cancer and compare patients' satisfaction with the consultation between patients who had and those who had not discussed the use of CAM with their doctors. Oncologists from three hospitals screened patients for eligibility. Eligible patients were mailed a letter of invitation with a questionnaire (N = 1,323). Three hundred eighty-one questionnaires were returned. Sixty-five percent of cancer patients used at least one form of CAM. Use of CAM was not discussed with the oncologist by 55% of respondents using biologically based CAM and by 80% of those using non-biologically based CAM since the diagnosis of cancer. Patients who discussed the use of biologic CAM with their oncologists were more satisfied with the consultation than those who had not (p = .027), whereas there were no significant differences between patients who disc...
9021 Background: A subset of cancer patients has cognitive impairment and fatigue after chemother... more 9021 Background: A subset of cancer patients has cognitive impairment and fatigue after chemotherapy (CTh). We evaluated these symptoms and potential mechanisms in CRC patients and healthy controls (HC). Methods: Cognitive function was evaluated in CRC patients and HC at baseline (pre-CTh), 6 and 12 months. Group 1A (Stage II/III) received CTh and Gr 1B (Stage I/II) no CTh. Gr 2 had limited metastatic CRC. All subjects completed cognitive assessment and questionnaires for fatigue, QOL, anxiety/depression, and perceived cognitive function. Blood tests evaluated: 10 cytokines, clotting factors, sex hormones, CEA, CBC and apolipoprotein genotyping as potential causal factors. Primary endpoints: cognitive function and fatigue (Gr. 1A & 1B) at 12 months. Associations between results and demographic and disease-related factors were sought. Results: 359 CRC patients (173 Gr 1A, 116 Gr 1B, 70 Gr. 2) and 72 HC were assessed. Median age 58 (23-75 years); 58% male. Cognitive impairment: baseli...
9099 Background: There is growing evidence that fatigue and cognitive dysfunction can affect canc... more 9099 Background: There is growing evidence that fatigue and cognitive dysfunction can affect cancer survivors. Here we evaluated these symptoms in patients with CRC in a longitudinal prospective study. Methods: Patients with localized CRC were evaluated for cognitive function and fatigue at baseline (mean 8 weeks post-surgery or before neoadjuvant therapy), 6 & 12 months. Group A (Stage III/high risk II) received chemotherapy (CT) and group B (Stage I/II) received no CT. Pts had neuropsychological (NP) assessment with traditional tests and CANTAB, a computerized NP battery. They completed concurrent questionnaires for fatigue & QOL (FACT-F), anxiety/depression (GHQ), and perception of cognitive function (FACT-COG). Blood tests evaluated cytokine levels, blood clotting factors, sex hormones and apolipoprotein genotyping as potential causal factors. Primary endpoints were cognitive function (traditional NP tests) and fatigue. Associations between test results, demographic and disease-...
Background: Previous studies have shown dissociation between self-reported cognitive impairment a... more Background: Previous studies have shown dissociation between self-reported cognitive impairment and formal testing of cognitive function in cancer survivors, but are limited by small samples and variable assessment methods. Here we evaluate perceived cognitive function (PCF) and formal neuropsychological performance (NP) in a large sample of patients with colorectal (CRC) and breast cancer (BC). Methods: Patients with CRC were evaluated at baseline (post-surgery, before chemotherapy CT), 6, 12 and 24 months. ...
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, Jan 2, 2015
Cognitive dysfunction is reported in people with cancer. Therefore, we evaluated longitudinal cha... more Cognitive dysfunction is reported in people with cancer. Therefore, we evaluated longitudinal changes in cognitive function and underlying mechanisms in people with colorectal cancer (CRC) and healthy controls (HCs). Participants completed cognitive assessments and questionnaires reporting cognitive symptoms, fatigue, quality of life, and anxiety/depression at baseline (before chemotherapy, if given) and 6, 12, and 24 months. Blood tests included cytokines, clotting factors, apolipoprotein E genotype, and sex hormones. Primary end point was overall cognitive function measured by the Global Deficit Score at 12 months. We recruited 289 patients with localized CRC (173 received chemotherapy; median age, 59 years; 63% male), 73 patients with limited metastatic/recurrent CRC, and 72 HCs. Cognitive impairment was more frequent in patients with localized CRC than HCs at baseline (43% v 15%, respectively; P < .001) and 12 months (46% v 13%, respectively; P < .001), with no significant...
Colorectal cancer (CRC) is the third most common cancer worldwide. After curative intent treatmen... more Colorectal cancer (CRC) is the third most common cancer worldwide. After curative intent treatment, international guidelines recommend surveillance protocols which include annual CT chest, abdomen and pelvis (CAP) and serum carcinoembryonic antigen (CEA) monitoring which aim to improve overall survival by early detection of recurrence. Despite the widespread recommendations, robust evidence of an overall survival benefit is lacking. Our study aimed to quantify the utility of annual CT CAP as a surveillance modality in comparison to the rate of potentially harmful false-positive and incidental findings. High-risk stage II and stage III CRC patients were retrospectively identified from the Sydney Cancer Survivorship Centre database. Findings on surveillance CT were classified into confirmed recurrence or the potentially harmful findings of (a) false-positive or (b) clinically significant incidental finding. A total of 376 surveillance CT CAPs were performed in 174 survivors between 12 September 2013 and 30 June 2020. The recurrence rate during the study period was 23/174 (13.2%) with the majority of recurrences detected by abnormal CEA (14/23, 60.9%) versus surveillance CT (4/23, 17.4%), with the remainder identified on non-surveillance CT (5/23, 21.7%). Curative intent surgery was performed in 12/23 people with CRC recurrence. Surveillance CT was shown to result in high levels of false-positive (31/174, 17.8% of patients) or clinically significant incidental findings (30/174, 17.2% of patients). The risk of identifying these potentially harmful findings was ongoing with each year of surveillance CT. Surveillance CT was associated with low detection rates and high rates of potentially harmful findings bringing this surveillance modality under further scrutiny. An increased emphasis should be placed on educating survivors on the benefits of surveillance CT weighed against the risk of potentially harmful findings.
Endocrine therapy forms the backbone of systemic therapy for the majority of persons with early a... more Endocrine therapy forms the backbone of systemic therapy for the majority of persons with early and late-stage breast cancer. However, the side effects can negatively affect quality of life, and impact treatment adherence and overall oncological outcomes. Adverse effects on cognition are common, underreported and challenging to manage. We aim to describe the nature, incidence, risk factors and underlying mechanisms of endocrine therapy-induced cognitive dysfunction. We conducted a comprehensive literature review of the studies reporting on cognitive dysfunction associated with endocrine therapies for breast cancer. We also summarise prevention and treatment strategies, and ongoing research. Given that patients are taking endocrine therapies for longer durations than ever before, it is essential that these side effects are managed pro-actively within a multi-disciplinary team in order to promote adherence to endocrine therapy and improve patients’ quality of life.
Background Advances in diagnostic and therapeutic strategies in oncology have significantly incre... more Background Advances in diagnostic and therapeutic strategies in oncology have significantly increased the chance of survival of cancer patients, even those with metastatic disease. However, cancer-related cognitive impairment (CRCI) is frequently reported in patients treated for non-central nervous system cancers, particularly during and after chemotherapy. Design This review provides an update of the state of the art based on PubMed searches between 2012 and March 2019 on ‘cognition’, ‘cancer’, ‘antineoplastic agents’ or ‘chemotherapy’. It includes the most recent clinical, imaging and pre-clinical data and reports management strategies of CRCI. Results Evidence obtained primarily from studies on breast cancer patients highlight memory, processing speed, attention and executive functions as the most cognitive domains impaired post-chemotherapy. Recent investigations established that other cancer treatments, such as hormone therapies and targeted therapies, can also induce cognitive...
9500 Background: The role of adjuvant WBRT in MBMs is controversial. This trial compares WBRT wit... more 9500 Background: The role of adjuvant WBRT in MBMs is controversial. This trial compares WBRT with Obs after local treatment of 1-3 MBMs. Methods: The primary endpoint is distant intracranial failure (DIF) within 12 months of randomization. The a priori neurocognitive function (NCF) endpoint is Hopkins Verbal Learning Test-Revised (HVLT-R) delayed recall at 4 months. Secondary endpoints include local failure (LF), overall survival (OS) and global quality of life (QoL). Analyses were conducted on intention-to-treat basis with nominal two-sided significance level 5%. Drug therapy was allowed. Effective drugs became available during trial and their impact was analysed. Results: Of 586 eligible patients (pts), 215 consented from 31 sites in 3 countries (Australia, UK and Norway) between 2009 and 2017. Eight (0.04%) who withdrew or had no data collected were excluded. 107 randomized to Obs and 100 to WBRT. Mean age 62 years, 67% males, 61% with single MBM of mean size 2cm, 67% had extrac...
Purpose Up to 70% of survivors report cognitive symptoms after chemotherapy. We compared two cogn... more Purpose Up to 70% of survivors report cognitive symptoms after chemotherapy. We compared two cognitive rehabilitation programs to a control group in cancer survivors. Methods Study population were adult cancer survivors with cognitive symptoms 6–60 months after adjuvant chemotherapy. Participants randomised to: Attention Process Training (APT), Compensatory Strategy Training (CST), or control group. Active interventions comprised 6–week, 2–h/week small group sessions. Assessments: pre- and post-intervention, 6- and 12-months later. Primary outcome was change in cognitive symptoms (FACT-COG-PCI subscale) between baseline and post-intervention. Secondary endpoints included objective neuropsychological performance, Functional Impact Assessment (FIA), patient-reported outcome measures, and associations. Analyses were on an intention-to-treat basis. Analysis of covariance mixed models were used for continuous outcomes. Results Sixty-five participants were randomised (APT n = 21; CST n = ...
Purpose Cancer-related cognitive impairment (CRCI) is a recognised adverse consequence of cancer ... more Purpose Cancer-related cognitive impairment (CRCI) is a recognised adverse consequence of cancer and its treatment. This study assessed the feasibility of collecting longitudinal data on cognition in patients with newly diagnosed, aggressive lymphoma undergoing standard therapy with curative intent via self-report, neuropsychological assessment, peripheral markers of inflammation, and neuroimaging. An exploration and description of patterns of cancer-related cognitive impairment over the course of treatment and recovery was also undertaken and will be reported separately. Methods Eligible participants completed repeated measures of cognition including self-report and neuropsychological assessment, and correlates of cognition including blood cell–based inflammatory markers, and neuroimaging at three pre-specified timepoints, time 1 (T1) — pre-treatment (treatment naïve), time 2 (T2) — mid-treatment, and time 3 (T3) — 6 to 8 weeks post-completion of treatment. Results 30/33 eligible p...
Background Our longitudinal study reported cognitive impairment in 43% of people following diagno... more Background Our longitudinal study reported cognitive impairment in 43% of people following diagnosis of localised colorectal cancer (CRC) versus 15% in healthy controls (p 0.5], Functional Deficit Score, blood results and neuroimaging. Results The study included 25 CRC survivors (60% men, median age 72) at mean 9 years after baseline (9 received adjuvant chemotherapy) and 25 controls (44% men, median age 68) at mean 6 years after baseline. There were no significant differences in cognitive scores or proportion with cognitive impairment (16 vs. 8%) between survivors and controls and no evidence of accelerated ageing in CRC survivors. Baseline cognitive performance predicted for subsequent cognitive function. There were no differences in functional tests or blood tests between groups. In 18 participants undergoing neuroimaging, 10 CRC survivors had higher myoinositol levels than 8 controls, and lower volume in the right amygdala and caudate and left hippocampal regions. Conclusions T...
PurposeChemotherapy-induced peripheral neuropathy (CIPN) commonly affects people treated for canc... more PurposeChemotherapy-induced peripheral neuropathy (CIPN) commonly affects people treated for cancer, with functional consequences of impaired balance and falls. Virtual reality technology (VR) may be able to assess balance, identifying patients at increased risk of falls. We aimed to assess the impact of neurotoxic chemotherapy on balance and falls risk using VR, and explore whether changes in balance threshold were associated with falls or validated CIPN measures. MethodsWe conducted a prospective, longitudinal cohort study at two Australian oncology centres. Eligible participants were commencing adjuvant chemotherapy containing a taxane for breast cancer, or oxaliplatin for colon cancer. Excluded: insufficient English to complete assessments, VR intolerance, or pre-existing balance disorder. VR balance threshold was recorded at baseline, intervals during chemotherapy, and 3- and 6-months after chemotherapy completion. Additional measures: 1) clinician-graded peripheral sensory neu...
Bowel dysfunction is common after anterior resection for colorectal cancer (CRC). Pelvic floor re... more Bowel dysfunction is common after anterior resection for colorectal cancer (CRC). Pelvic floor rehabilitation (PFR) may improve functional outcomes after surgery. This review aimed to evaluate the efficacy of PFR for patients with bowel symptoms after anterior resection. MEDLINE, CINHAL, PUBMED, EMBASE, Scopus, PsycINFO, Web of Science, PEDRO and Cochrane Library were searched from inception to June 2019. A final search was performed on 11 July 2020. Randomised controlled trials (RCTs), cohort studies, case-control studies and case series of bowel dysfunction after CRC surgery and PFR were eligible for review. Outcome measures were bowel function changes measured by patient-reported outcomes and manometric measurement. Risk of bias assessments using Methodological Index for Non-Randomized Studies (MINORS) tool and Newcastle Ottawa Scale (NOS) were conducted. Eleven trials met eligibility criteria: four retrospective studies and seven prospective, non-randomised controlled studies. A total of 516 participants were included, of which 455 received PFR. Functional outcomes were measured by bowel functional outcome questionnaires, patient diary, anorectal manometry and three studies measured quality of life. Faecal incontinence was improved in seven studies, and bowel frequency also decreased in five studies. The mean MINORS score was 10 (8–13) out of 16 in non-comparative groups and 18 (16–22) out of 24 in comparative groups; the NOS was 4.2 (3–7) out of 9. The overall risk of bias was high in most studies. PFR appears to be beneficial for improving bowel function after anterior resection for CRC. However, the studies included had methodological limitations, so further investigation on the effectiveness of PFR is warranted.
1. Department of Medical Oncology, Liverpool Hospital, Sydney, New South Wales, Australia. 2. Uni... more 1. Department of Medical Oncology, Liverpool Hospital, Sydney, New South Wales, Australia. 2. University of Sydney, Sydney, New South Wales, Australia. 3. Centre for Medical Psychology & Evidence-based Decision-making, School of Psychology, University of Sydney, Sydney, New South Wales, Australia. 4. Concord Cancer Centre and Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
The purpose of this survey was to examine patient-doctor communication about the use of complemen... more The purpose of this survey was to examine patient-doctor communication about the use of complementary and alternative medicine (CAM) by adult patients with cancer and compare patients' satisfaction with the consultation between patients who had and those who had not discussed the use of CAM with their doctors. Oncologists from three hospitals screened patients for eligibility. Eligible patients were mailed a letter of invitation with a questionnaire (N = 1,323). Three hundred eighty-one questionnaires were returned. Sixty-five percent of cancer patients used at least one form of CAM. Use of CAM was not discussed with the oncologist by 55% of respondents using biologically based CAM and by 80% of those using non-biologically based CAM since the diagnosis of cancer. Patients who discussed the use of biologic CAM with their oncologists were more satisfied with the consultation than those who had not (p = .027), whereas there were no significant differences between patients who disc...
9021 Background: A subset of cancer patients has cognitive impairment and fatigue after chemother... more 9021 Background: A subset of cancer patients has cognitive impairment and fatigue after chemotherapy (CTh). We evaluated these symptoms and potential mechanisms in CRC patients and healthy controls (HC). Methods: Cognitive function was evaluated in CRC patients and HC at baseline (pre-CTh), 6 and 12 months. Group 1A (Stage II/III) received CTh and Gr 1B (Stage I/II) no CTh. Gr 2 had limited metastatic CRC. All subjects completed cognitive assessment and questionnaires for fatigue, QOL, anxiety/depression, and perceived cognitive function. Blood tests evaluated: 10 cytokines, clotting factors, sex hormones, CEA, CBC and apolipoprotein genotyping as potential causal factors. Primary endpoints: cognitive function and fatigue (Gr. 1A & 1B) at 12 months. Associations between results and demographic and disease-related factors were sought. Results: 359 CRC patients (173 Gr 1A, 116 Gr 1B, 70 Gr. 2) and 72 HC were assessed. Median age 58 (23-75 years); 58% male. Cognitive impairment: baseli...
9099 Background: There is growing evidence that fatigue and cognitive dysfunction can affect canc... more 9099 Background: There is growing evidence that fatigue and cognitive dysfunction can affect cancer survivors. Here we evaluated these symptoms in patients with CRC in a longitudinal prospective study. Methods: Patients with localized CRC were evaluated for cognitive function and fatigue at baseline (mean 8 weeks post-surgery or before neoadjuvant therapy), 6 & 12 months. Group A (Stage III/high risk II) received chemotherapy (CT) and group B (Stage I/II) received no CT. Pts had neuropsychological (NP) assessment with traditional tests and CANTAB, a computerized NP battery. They completed concurrent questionnaires for fatigue & QOL (FACT-F), anxiety/depression (GHQ), and perception of cognitive function (FACT-COG). Blood tests evaluated cytokine levels, blood clotting factors, sex hormones and apolipoprotein genotyping as potential causal factors. Primary endpoints were cognitive function (traditional NP tests) and fatigue. Associations between test results, demographic and disease-...
Background: Previous studies have shown dissociation between self-reported cognitive impairment a... more Background: Previous studies have shown dissociation between self-reported cognitive impairment and formal testing of cognitive function in cancer survivors, but are limited by small samples and variable assessment methods. Here we evaluate perceived cognitive function (PCF) and formal neuropsychological performance (NP) in a large sample of patients with colorectal (CRC) and breast cancer (BC). Methods: Patients with CRC were evaluated at baseline (post-surgery, before chemotherapy CT), 6, 12 and 24 months. ...
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, Jan 2, 2015
Cognitive dysfunction is reported in people with cancer. Therefore, we evaluated longitudinal cha... more Cognitive dysfunction is reported in people with cancer. Therefore, we evaluated longitudinal changes in cognitive function and underlying mechanisms in people with colorectal cancer (CRC) and healthy controls (HCs). Participants completed cognitive assessments and questionnaires reporting cognitive symptoms, fatigue, quality of life, and anxiety/depression at baseline (before chemotherapy, if given) and 6, 12, and 24 months. Blood tests included cytokines, clotting factors, apolipoprotein E genotype, and sex hormones. Primary end point was overall cognitive function measured by the Global Deficit Score at 12 months. We recruited 289 patients with localized CRC (173 received chemotherapy; median age, 59 years; 63% male), 73 patients with limited metastatic/recurrent CRC, and 72 HCs. Cognitive impairment was more frequent in patients with localized CRC than HCs at baseline (43% v 15%, respectively; P < .001) and 12 months (46% v 13%, respectively; P < .001), with no significant...
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