Journal Article Annotations
2022, 2nd Quarter
Annotations by Carlos Fernandez Robles, MD, MBA and Marie Tobin, MD
July, 2022
The Finding:
Hippocampal sparing whole-brain radiotherapy (WBRT) was associated with statistically significant better outcomes in cognition (higher Montreal Cognitive Assessment (MOCA) scores), mobility (lower Eastern Cooperative Oncology Group (ECOG) scores), and quality of life (Quality-of-life Questionnaire (QLQ-30) when compared with traditional WBRT. The intervention also outperformed traditional WBRT in the Graded Prognosis Assessment and had a significantly less impact on hippocampal volume.
This well-designed randomized controlled trial used a patient selection strategy that was mindful of current functional status and thereby allowed for more relevant post-intervention comparison while minimizing potential confounding. Furthermore, the study employed a solid technical methodology to conduct the intervention and used well-established tools to conduct its impact analysis.
C-L psychiatrists often evaluate patients who have received WBRT or stereotactic radiotherapy. These treatments are used to treat brain metastases or control tumor growth and have been associated with cognitive dysfunction and compromised quality of life. Previous studies have shown that hippocampal tissue is sensitive to radiation damage and associated this damage with cognitive and quality of life decline in patients with brain neoplasms. This study confirms previous findings on the impact of WBRT on cognition and adds information on the impacts on physical function and quality of life. This, in turn, will help psychiatrists assess and support patients who are making difficult decisions for their cancer treatment.
The finding:
Fear of cancer recurrence (FCR)—defined as “fear, worry or concern related to the possibility that cancer will come back or progress”—is common in cancer patients and survivors. This study utilized a systematic review and meta-analysis to calculate the overall prevalence of FCR in patients and survivors. It included only studies that used the validated Fear of Cancer Recurrence Inventory: Short-Form (FCRI-SF). The study represents a collaborative effort across thirteen countries. The overall prevalence of FCR was 59% in active patients and survivors. FCR was more prevalent in females and younger participants. Participants with lung cancer and melanoma reported the highest levels of FCR while those with prostate cancer reported the lowest. No association was found between FCR and time since diagnosis indicating the persistence of FCR in survivors.
Strength and weaknesses:
The study utilized a large amount of data in the analyses; including 46 datasets and data from 11,226 respondents representing 13 different countries. Only studies reporting results from a validated measure of FCR were included in the analysis. This facilitated comparison among groups. The study also analyzed data for various cut-off points corresponding to different levels of severity of FCR. Another strength was the inclusion of patients with active cancer and survivors. A weakness of the study was the underrepresentation of older participants and participants from low and middle-income countries including South America and Africa. Furthermore, not all cancer types were included; for some cancer types, the number of participants was low.
Relevance:
This study identified the overall prevalence of FCR in patients with cancer and survivors. It identified important risk factors for FCR including younger age, female sex, and certain cancer types. The study provides useful suggestions for management including brief psychoeducation to normalize FCR, encouragement to seek professional support when FCR is severe or persisting, and repeating this education for patient regularly during treatment. The study also provides guidelines for future research focused on the identification of feasible and scalable interventions.
The finding:
This study performed a systematic review and meta-analysis to examine the association between disturbed sleep and sleep-wake activity and cancer prognostic factors (e.g., treatment response, time to progression) in a population of patients with cancer. The findings suggest that disturbances in sleep and sleep-wake immediately prior to and during cancer treatment are associated with reduced overall survival, poorer response to treatment, and shorter time to cancer progression. This is the first systematic review of the association between sleep and sleep-wake activity and cancer prognostic factors. The study focused on the period immediately prior to and during cancer treatment. This time period is important because sleep disturbances may be especially common due to biological (e.g. chemotherapy) and psychological factors.
Strength and weaknesses:
The review employed in the study is exhaustive and identified 4,879 studies leading to 105 papers for full-text review and 26 studies for analysis. Thirteen different cancer types were included and twenty-four studies included patients with advanced cancer. Studies utilizing self-report and objective sleep measures were included providing a nuanced picture of sleep disturbance.
However, the inclusion of studies using both types of measures is also a weakness, because it prevented comparison between studies. Another weakness is that 19 out of the 26 studies relied on answers to the single sleep item from the EORTC QLQ-C30 raising questions about sensitivity and reliability. Additionally, studies of sleep duration were not included.
Relevance:
Sleep disturbance is prevalent in medical illness and may be especially so in cancer: estimates of the prevalence of sleep disturbances in patients undergoing cancer treatment range from 30-75%. This systematic review focused on a critical time in the cancer treatment trajectory. Sleep disturbance caused increased symptom burden and adversely influences quality of life in patients undergoing cancer treatment. Furthermore, healthy sleep is associated with genome stability, immune efficacy, and sufficient melatonin secretion that play a role in mitigating carcinogenic processes. The apparent association of disturbance in sleep and sleep-wake activity with cancer prognostic factors is critical and highlights the importance of including management of sleep disturbance in overall cancer treatment. This study also provides evidence of the need for prospective longitudinal studies to further characterize the associations between sleep disturbance and cancer outcomes.