Journal Article Annotations
2021, 3rd Quarter
Annotations by Elie Isenberg-Grzeda, MD, Carlos Fernandez Robles, MD
September, 2021
The finding:
Patients receiving Whole Brain Radiation Therapy (WBRT) and Stereotactic Radiosurgery (SRS) typically experience a short-term cognitive decline (1-4 months). The changes associated with SRS are transient, whereas, after WBRT, patients can experience deterioration over eight months that stabilizes or slightly improves long term. This metanalysis found changes in cognitive performance across multiple cognitive domains (learning and memory, executive function, processing speed, fine motor coordination, among others). Learning and memory were the most frequently affected doming. Patients treated with Hippocampal avoidance WBRT had a much lower rate of L&M decline in both the short- and mid-term compared with patients treated with conventional WBRT. Finally, this work also highlights the high prevalence (53-91%) of cognitive impairment in patients with brain metastases ; this impairment correlates with total lesion volume.
Strength and weaknesses:
First, it is essential to highlight that WBRT is indicated in patients with >3 brain metastases (BMs) and that SRS is indicated in patients with 1-3 BM. Therefore no “head-to-head” studies exist, and this is the first work comparing the cognitive sequelae of each treatment modality. The metanalysis design had strict exclusion criteria that prevented confounding factors resulting from poorly constructed and underpowered studies. The total sample size was large—over 1000 patients. Studying cognitive changes over time is challenging, and the included studies were vulnerable to external factors that could influence cognitive function and high dropout rates related to the high disease burden. Also, there is a wide margin of design heterogenicity among the included studies, which the authors suggest could have led to underestimating cognitive changes after radiotherapy.
Relevance:
For C-L psychiatrists involved in the care of patients with metastatic brain cancer, this meta-analysis offers a valuable comparison of the cognitive consequences of two frequently used treatment modalities, WBRT and SRS. The findings of this work informs practitioners’ evaluation of patients, treatment planning and help them support patients when making their decisions about care. Treatment of brain metastases in cancer patients is challenging, and achieving an optimal balance between antitumor and adverse side effects is necessary to maintain the highest quality of life possible.
The finding:
This meta-analysis demonstrated a high prevalence of ejaculation dysfunction (EjD) among bladder, colon, rectum, and testicular cancer survivors. EjD can be further divided into dry orgasm, erectile dysfunction, and premature ejaculation. Erectile dysfunction and dry orgasm have comparable prevalence across diseases; however, erectile dysfunction among patients with rectal cancer treated with surgery and radiotherapy yielded the highest prevalence rate (68.7%). Premature ejaculation was only described among testicular cancer survivors.
Strength and weaknesses:
This systematic review included 64 studies with a total of 10,057 participants. Subgrouping by disease and treatment type allows for translation of the results to clinical practice. Other strengths of the design are the control it exerts for bias, mean age, and publication year. The study’s limitations include the inability to categorize by different treatment techniques and control for other comorbid conditions (diabetes, hypertension, tobacco use), psychological factors (stress, depression) and concomitant medications/substance use. Finally, one other limitation noted by the authors is the heterogenicity of the terminology used for the different subtypes of ejaculation disorders, which could limit power of the analysis.
Relevance:
Sexual health plays a pivotal role in cancer treatment and survivorship quality of life, and it is often not discussed during routine care visits. C-L psychiatrists should be familiar with the prevalence and categorization of these disorders, given the impact on psychological well-being and the additive problems psychopharmacological interventions can have on these problems.
The finding:
The authors analysed pooled data from a database of cohort studies to ascertain the association between adult consumption of dairy and breast cancer. They found that there was likely no association between dairy consumption and ER-positive breast cancers, but a small inverse (i.e., protective) association between dairy consumption and ER-negative breast cancers. They noted that dietary calcium found a stronger association compared to calcium supplementation.
Strength and weaknesses:
The main strength of the study is that the authors pooled patient-level data from a large number of cohort studies. The main limitations were that dietary intake was by self-report and that the sample consisted mostly of white women, which may limit generalizability to racial minority patients.
Relevance:
There is unlikely to be an association between dairy consumption and the incidence of breast cancer. In psychosocial oncology, our patients routinely ask about lifestyle factors which may or may not be related to cancer occurrence. These risks can be a source of anxiety, stress, and even obsession in some patients. By understanding which factors pose a known and robust risk (e.g., smoking, sun exposure) and which factors are equivocal at best (e.g., dietary intake in adulthood), C-L psychiatrists can guide patients who are fixated on the questions such as “why” they got cancer or “what” they can do to prevent its recurrence.
There is a surprising dearth of literature on young carers of a relative with cancer, and this article is the first large synthesis of the studies published to date. The authors highlight the role of children in caring for adults with cancer, the consequences of this role on young carer’s lives, and the needs of children who find themselves in these roles. Given how commonplace cancer can be among patients of childbearing and child-rearing age, it will be no surprise to psychosocial oncologists that young carers are a common and important area of focus in clinical practice. This article will certainly resonate with psycho-oncology providers. It may allow for better recognition of young carers’ needs and distils many themes commonly seen in practice.